High‐grade medullary thyroid carcinoma with papillary‐like nuclear features: A report of five cases

Author:

Yamao Naoki1ORCID,Hirokawa Mitsuyoshi1ORCID,Suzuki Ayana1ORCID,Higuchi Miyoko1ORCID,Ishisaka Tomo2ORCID,Miyauchi Akira3ORCID,Akamizu Takashi4ORCID

Affiliation:

1. Department of Diagnostic Pathology and Cytology Kuma Hospital Kobe Japan

2. Department of Head and Neck Surgery Kuma Hospital Kobe Japan

3. Department of Surgery Kuma Hospital Kobe Japan

4. Department of Internal Medicine Kuma Hospital Kobe Japan

Abstract

AbstractBackgroundMedullary thyroid carcinoma (MTC) with papillary‐like nuclear features has not been previously described. Here, we aimed to describe the unique features of MTC and examine their prognostic value as markers of high‐grade MTC.MethodsOf the 110 MTC patients reviewed, a total of five (4.5%) who exhibited MTC with papillary‐like nuclear features based on observations from cytological preparations were included in this study. Papillary‐like nuclear features were defined as exhibiting all of the following characteristics: ground‐glass chromatin pattern, grooves, indented membrane, and lobulation.ResultsThe patients included four females and one male, with a median age of 70 years. Calcitonin‐doubling times for patients 1 and 3 were 0.8 and 0.34 years, respectively. Cytologically, patients 4 and 5 displayed a Ki‐67 labeling index of 5.1% and necrotic cells, respectively. All three histologically evaluated patients exhibited papillary‐like nuclear features and a Ki‐67 labeling index of >5.0%. Patients 1 and 3 had mitotic counts of ≥5 per 2 mm2. The MTC in all five patients was classified as high‐grade. Moreover, patient 1 harbored a RET mutation (M918T), while RET (R912W), BRAF (V600E), and CTNNB1 (S33F, T41I) mutations were present in patient 2.ConclusionOur work suggests that papillary‐like nuclear features in MTC may be associated with high‐grade tumors. These findings may be cytologically indicative of high‐grade tumors other than necrosis or mitosis.

Publisher

Wiley

Subject

General Medicine,Histology,Pathology and Forensic Medicine

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