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CYTOPATHOLOGY INTERESTING CASE #4
65 year old man with 2.3 cm right lower thyroid nodule.
Submitted & Prepared by – Jalal Jalaly, MBBS & Zubair Baloch, MD
US-FNA (Onsite smears and ThinPrep)Please click on thumbnails for full view slides
Surgical Pathology Follow-up
DiagnosisPapillary Thyroid Carcinoma (PTC), Tall Cell Variant
Key facts
• Epidemiology
• Key cytomorphological features
• Molecular findings
• References
PTC-Tall Cell Variant
Epidemiology:– 1.3–12% of all papillary thyroid carcinomas
– Commonly present at an older age (54.3 years)
– Aggressive variant of PTC with higher extrathyroidalextension and shortened survival compared to classical PTC
– The wide range of prevalence (1.3-12%) reflects lack of agreement on percentage of tall cells required for diagnosis (as per 4th edition of WHO the diagnosis of PTC-Tall cell variant
requires 30% of tall cells)
PTC-Tall Cell Variant
Key cytomorphological features:
– Architecture:
– Papillary groups or cellular fragments
– Cytoplasm:
– Elongated/ tall cell with height at least twice or thrice their width
– Oncocytic cytoplasm with distinct cell borders
– Nuclear Features:
– Elongated nuclei with crowding and overlapping
– Prominent central nucleoli
– Nuclear grooves and intranuclear inclusion including multiple inclusions (AKA Soap bubble appearance)
PTC-Tall Cell Variant
• Molecular findings:
– BRAF mutation is more common in PTC-TCV compared to classical PTC
– Loss of heterozygosity for chromosome 1, p53 gene, and RET/PTC3 rearrangement
PTC – Tall Cell Variant
• References:• Solomon A, Gupta PK, LiVolsi VA, Baloch ZW. Distinguishing tall cell
variant of papillary thyroid carcinoma from usual variant of papillary thyroid carcinoma in cytologic specimens. Diagn Cytopathol. 2002 Sep;27(3):143-8.
• Ghossein R, Livolsi VA. Papillary thyroid carcinoma tall cell variant. Thyroid. 2008 Nov 1;18(11):1179-81.
• Baloch ZW, LiVolsi VA. Special types of thyroid carcinoma. Histopathology. 2018 Jan 1;72(1):40-52.