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Author: search.filters.author.Stojkoska, ElenaSubject: search.filters.subject.papillary carcinoma

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    Multifocal Hurthle cell (oxyphilic) variant of papillary thyroid carcinoma associated with Hashimoto`s thyroiditis: A case report
    (Macedonian Association of Pathology, 2016-09)
    Qerimi, Adelina
    ;
    ;
    Ognenoska-Jankovska, Biljana
    ;
    Stojkoska, Elena
    ;
    Objective: Oxyphilic (Hurthle cell) variant of papillary thyroid carcinoma (OVPTC) is a rare subtype accounting for 1-11% of all cases of papillary thyroid carcinomas (PTCs). The clinicopathological features and biological behavior of OVPTC have not yet been thoroughly characterized. We present a case of multifocal OVPTC with concurrent Hashimoto`s thyroiditis. Material and Methods: A 51-year-old female patient with multinodular goiter underwent a fine-needle aspiration biopsy which was reported as negative, followed by a subtotal thyroidectomy procedure. Results: The surgically obtained material consisted of two oval fragments designated as right and left thyroid lobe with the largest diameter of 5 cm and 4.5 cm, respectively. Grossly, on the cut section of the left lobe two well-circumscribed, white to grey-tanned foci with the largest diameter of 1.3 cm and 0.6 cm, respectively, were found. Microscopically, in a background of Hashimoto`s thyroiditis, the two foci revealed a neoplasm with predominantly insular growth pattern and focally follicular or papillary structures composed of large polygonal cells with abundant eosinophilic granular cytoplasm and optically clear nuclei with the characteristic intranuclear pseudoinclusions and nuclear grooves. Psammoma bodies and areas of calcification were also present. Mitoses were rare and no vascular or capsular invasion was encountered. Immunohistochemically, tumor cells showed diffuse positivity for low-molecular-weight cytokeratin and cytokeratin 19 and focal positivity for thyroid transcription factor-1. Conclusions: This case confirms that although OVPTC remains controversial, it usually displays the morphological and immunohistochemical features of the classical type of PTC, which can aid in avoiding the diagnostic pitfalls in distinguishing this subtype of PTC from other benign or malignant Hurthle cell lesions.
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    Warthin-like papillary carcinoma of the thyroid: A case report
    (Macedonian Association of Pathology, 2016-09)
    Stojkoska, Elena
    ;
    ;
    Qerimi, Adelina
    ;
    Ognenoska-Jankovska, Biljana
    ;
    Objective: Warthin-like variant of papillary carcinoma (WLPCT) is an uncommon variant, first described in 1995, with a clinical presentation and prognosis similar to the classic papillary thyroid carcinoma (PTC). We report a case of WLPCT focusing on the histopathological and immunohistochemical features. Material and Methods: A 60-year old female, with no remarkable past medical history, underwent surgical treatment of an enlarged multinodal goiter with previous negative fine-needle aspiration biopsy findings. A left total and right subtotal thyroidectomy was performed. The patient is alive and well 4 months after the surgery. Results: On gross examination, the right lobe of the thyroid gland measured 4.5x1.5x1 cm, and the left lobe with adjoined isthmic lobe measured 5x3.5x2 cm. In the right lobe an oval, firm, grey, 0.8 cm large nodule was found, while in the left lobe another well-circumscribed, pale-brown, 2.5 cm large nodule was present. The left lobe nodule was diagnosed as an atypical follicular adenoma with no capsular or vascular invasion. Histology of the right lobe nodule showed an encapsulated tumor composed of papillary structures lined by oncocytic cells and rich lymphoid stroma, with germinal centers in the papillary stalks, typical for WLPCT. Immunohistochemically, tumor cells of WLPCT showed positive expression for cytokeratin 19, thyroid transcription factor-1 and thyroglobulin. Conclusions: Warthin-like variant is one of the rarest variants of PTC (less than 100 reported cases in the literature) with as favorable prognosis as the classic PTC. Morphology and immunohistochemistry are of decisive significance in differentiating these neoplasms from benign lymphoepithelial lesions, Hurthle cell carcinoma and tall cell variant of PTC.
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    Follicular variant of papillary thyroid carcinoma arising in struma ovarii: A case report
    (Macedonian Association of Pathology, 2016-09)
    Stojkoska, Elena
    ;
    Qerimi, Adelina
    ;
    Ognenoska-Jankovska, Biljana
    ;
    ;
    Objective: Struma ovarii is a rare form of ovarian mature teratoma and is the most common type of monodermal teratoma (3% of all ovarian teratomas). 5-10% of such tumors are malignant with papillary carcinoma as the most common type (70%) while 26% of them are a follicular variant of papillary thyroid carcinoma (FVOPTC). We report a case of FVOPTC arising in struma ovarii focusing on the clinical, histopathological and immunohistochemical features. Material and Methods: A 29-year old nulliparous female underwent laparoscopic surgery of a 7 cm a large right ovarian cyst, diagnosed by ultrasound. Clinically and biochemically she was euthyroid with normal serum TSH level, and without previous significant medical or gynecological history. Results: Grossly, a laparoscopically obtained material consisted of 8x3 cm fragment of cyst wall measuring 0.2 to 0.6 cm in thickness with a focus of 5 mm large grayish-white tumor. Histology of the cyst wall showed thyroid tissue characteristic of cystic struma ovarii while the tumor showed typical nuclear features of papillary thyroid carcinoma with follicle formation and minimal presence of papillary structures typical for FVOPTC arising in thyroid tissue. Immunohistochemical staining showed positive expression for thyroglobulin, TTF-1, and cytokeratin-19 in the tumor cells. Conclusions: FVOPTC arising in struma ovarii is difficult to assess because it is a rare tumor with about 60 published cases and lacking standard criteria for diagnosis. Thus, the morphological criteria for the diagnosis of this tumor are based on classical criteria for primary thyroid carcinoma. Prognostically, FVOPTCs measuring less than 2 cm arising in struma ovarii are considered as low-risk lesions with a low rate of recurrence and metastasis.