Abstract
Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid, accounting for approximately 85% of all cancers at this site. PTC usually presents clinically as a thyroid nodule, often discovered incidentally on routine examination; less commonly, patients present with metastatic disease in the neck lymph nodes. PTC spreads via lymphatics to the regional lymph nodes and, less frequently, to the lungs. PTC is much more common in women and has a well-documented association with prior radiation exposure to the neck. It generally carries a good prognosis; death secondary to PTC is rare.
A malignant thyroid FNA diagnosis accounts for about 5% of all thyroid FNAs, the majority of them PTCs. When a definite diagnosis of PTC is made by FNA, 94–96% prove to be PTC on histologic follow-up. Conventional PTCs are notable histologically for numerous papillae lined by cuboidal to low columnar neoplastic follicular cells with characteristic nuclear features. PTC has many histological variants, however, and these have a spectrum of corresponding cytomorphologic characteristics. At the molecular level, the most important event is activation of the MAPK pathway, resulting from RET/PTC gene rearrangements and activating mutations of RAS and BRAF. The standard treatment is lobectomy or near-total thyroidectomy, sometimes followed by radioactive iodine.
Keywords
This is a preview of subscription content, log in via an institution.
References
LiVolsi VA, Albores-Saavedra J, Asa SL. Papillary carcinoma. In: Lellis D, Lloyd R, Heitz PU, Eng C, editors. WHO classification of tumours. Pathology and genetics of tumours of endocrine organs. Lyon: IARC Press; 2004. p. 57–66.
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.
Jung CK, Little MP, Lubin JH, et al. The increase in thyroid cancer incidence during the last four decades is accompanied by a high frequency of BRAF mutations and a sharp increase in RAS mutations. J Clin Endocrinol Metab. 2014;99:E276–85.
Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma. A paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2:1023–9.
Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56:333–9.
Suzuki A, Hirokawa M, Higuchi M, et al. Cytological characteristics of papillary thyroid carcinoma on LBC specimens, compared with conventional specimens. Diagn Cytopathol. 2015;43:108–13.
Lee JS, Choi HS, Park IA, Ryu HS. Liquid-based fine needle aspiration biopsy of papillary thyroid carcinoma: logistic regression analysis with conventional and new cytomorphologic features. Acta Cytol. 2013;57:233–40.
Lee SH, Jung CK, Bae JS, Jung SL, Choi YJ, Kang CS. Liquid-based cytology improves preoperative diagnostic accuracy of the tall cell variant of papillary thyroid carcinoma. Diagn Cytopathol. 2014;42:11–7.
Szporn AH, Yuan S, Wu M, Burstein DE. Cellular swirls in fine needle aspirates of papillary thyroid carcinoma: a new diagnostic criterion. Mod Pathol. 2006;19:1470–3.
Lee YS, Kim Y, Jeon S, Bae JS, Jung SL, Jung CK. Cytologic, clinicopathologic, and molecular features of papillary thyroid carcinoma with prominent hobnail features: 10 case reports and systematic literature review. Int J Clin Exp Pathol. 2015;8:7988–97.
Asioli S, Maletta F, Pagni F, et al. Cytomorphologic and molecular features of hobnail variant of papillary thyroid carcinoma: case series and literature review. Diagn Cytopathol. 2014;42:78–84.
Rupp M, Ehya H. Nuclear grooves in the aspiration cytology of papillary carcinoma of the thyroid. Acta Cytol. 1989;33:21–6.
Papotti M, Manazza AD, Chiarle R, Bussolati G. Confocal microscope analysis and tridimensional reconstruction of papillary thyroid carcinoma nuclei. Virchows Arch. 2004;444:350–5.
Ellison E, Lapuerta P, Martin SE. Psammoma bodies in fine-needle aspirates of the thyroid: predictive value for papillary carcinoma. Cancer. 1998;84:169–75.
Strickland KC, Howitt BE, Marqusee E, et al. The impact of non-invasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid. 2015;25:987–92.
Faquin WC, Wong LQ, Afrogheh AH, et al. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in the Bethesda system for reporting thyroid cytopathology. Cancer Cytopathol. 2016;124:181–7.
Yang GC, Fried K, Yakoushina TV, Schreiner AM. Encapsulated follicular variant of papillary thyroid carcinoma: fine-needle aspiration with ultrasound and histologic correlation of 41 cases. Acta Cytol. 2013;57:26–32.
Gallagher J, Oertel YC, Oertel JE. Follicular variant of papillary carcinoma of the thyroid: fine-needle aspirates with histologic correlation. Diagn Cytopathol. 1997;16:207–13.
Mesonero CE, Jugle JE, Wilbur DC, et al. Fine-needle aspiration of the macrofollicular and microfollicular subtypes of the follicular variant of papillary carcinoma of the thyroid. Cancer Cytopathol. 1998;84:235–44.
Baloch ZW, Gupta PK, Yu GH, et al. Follicular variant of papillary carcinoma: cytologic and histologic correlation. Am J Clin Pathol. 1999;111:216–22.
Cancer Genome Atlas Network. Integrated genomic characterization of papillary thyroid carcinoma. Cell. 2014;159:676–90.
Maletta F, Massa F, Torregrossa L, et al. Cytological features of “non-invasive follicular thyroid neoplasm with papillary-like nuclear features” and their correlation with tumor histology. Hum Pathol. 2016;54:134–42.
Strickland K, Vivero M, Jo VY, et al. Pre-operative cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a prospective analysis. Thyroid. 2016;26:1466–1471. [Epub ahead of print].
Howitt BE, Chang S, Eszlinger M, et al. Fine-needle aspiration diagnoses of noninvasive follicular variant of papillary thyroid carcinoma. Am J Clin Pathol. 2015;144:850–7.
Policarpio-Nicolas ML, Sirohi D. Macrofollicular variant of papillary carcinoma, a potential diagnostic pitfall: A report of two cases including a review of literature. Cytojournal. 2013;10:16.
Chung D, Ghossein RA, Lin O. Macrofollicular variant of papillary carcinoma – a potential thyroid FNA pitfall. Diagn Cytopathol. 2007;35:560–4.
Goellner JR, Johnson DA. Cytology of cystic papillary carcinoma of the thyroid. Acta Cytol. 1982;26:797–808.
Yang GC, Stern CM, Messina AV. Cystic papillary thyroid carcinoma in fine needle aspiration may represent a subset of the encapsulated variant in WHO classification. Diagn Cytopathol. 2010;38:721–6.
Moreira AL, Waisman J, Cangiarella JF. Aspiration cytology of the oncocytic variant of papillary adenocarcinoma of the thyroid gland. Acta Cytol. 2004;48:137–41.
Doria MI Jr, Attal H, Wang HH, Jensen JA, DeMay RM. Fine needle aspiration cytology of the oxyphil variant of papillary carcinoma of the thyroid. A report of three cases. Acta Cytol. 1996;40:1007–11.
Baloch ZW, LiVolsi VA. Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med. 2000;124:1192–5.
Guan H, Vandenbussche CJ, Erozan YS, et al. Can the tall cell variant of papillary thyroid carcinoma be distinguished from the conventional type in fine needle aspirates? A cytomorphologic study with assessment of diagnostic accuracy. Acta Cytol. 2013;57:534–42.
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;27:143–8.
Jayaram G. Cytology of columnar-cell variant of papillary thyroid carcinoma. Diagn Cytopathol. 2000;22:227–9.
Giorgadze TA, Scognamiglio T, Yang GC. Fine-needle aspiration cytology of the solid variant of papillary thyroid carcinoma: a study of 13 cases with clinical, histologic, and ultrasound correlations. Cancer Cytopathol. 2015;123:71–81.
Takagi N, Hirokawa M, Nobuoka Y, Higuchi M, Kuma S, Miyauchi A. Diffuse sclerosing variant of papillary thyroid carcinoma: a study of fine needle aspiration cytology in 20 patients. Cytopathology. 2014;25:199–204.
Hirokawa M, Maekawa M, Kuma S, Miyauchi A. Cribriform-morular variant of papillary thyroid carcinoma – cytological and immunocytochemical findings of 18 cases. Diagn Cytopathol. 2010;38:890–6.
Boonyaarunnate T, Olson MT, Bishop JA, Yang GC, Ali SZ. Cribriform morular variant of papillary thyroid carcinoma: clinical and cytomorphological features on fine-needle aspiration. Acta Cytol. 2013;57:127–33.
Casey MB, Sebo TJ, Carney JA. Hyalinizing trabecular adenoma of the thyroid gland: cytologic features in 29 cases. Am J Surg Pathol. 2004;28:859–67.
Carney JA, Hirokawa M, Lloyd RV, Papotti M, Sebo TJ. Hyalinizing trabecular tumors of the thyroid gland are almost all benign. Am J Surg Pathol. 2008;32:1877–89.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Pusztaszeri, M.P., Auger, M., Stelow, E.B., Yang, G.C.H., Sanchez, M.A., LiVolsi, V.A. (2018). Papillary Thyroid Carcinoma, Variants, and Related Tumors. In: Ali, S., Cibas, E. (eds) The Bethesda System for Reporting Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-60570-8_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-60570-8_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-60569-2
Online ISBN: 978-3-319-60570-8
eBook Packages: MedicineMedicine (R0)