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Han, Lee, Choi, Kwon, Chon, and Lee: A Case of Hyalinizing Trabecular Tumor of the Thyroid Gland Misdiagnosed as Medullary Carcinoma at Cytologic Examination
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2008; 23(5): 327-331.

Published online: 31 October 2008

DOI: https://doi.org/10.3803/jkes.2008.23.5.327

A Case of Hyalinizing Trabecular Tumor of the Thyroid Gland Misdiagnosed as Medullary Carcinoma at Cytologic Examination

Jae Joon Han1, Yun Jung Lee1, Moon Chan Choi1, Mikwang Kwon1, 2, Suk Chon1, 2, Juhie Lee3

1Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Korea.

2Research Institute of Endocrinology, Kyung Hee University School of Medicine, Korea.

3Department of Pathology, Kyung Hee University School of Medicine, Korea.

Received 11 August 2008       Accepted 29 August 2008

Copyright © 2008 Korean Endocrine Society

Abstract

A hyalinizing trabecular tumor (HTT) is a rare benign thyroid tumor that can present as a solitary thyroid nodule, a prominent nodule in a multinodular goiter, or as an incidental finding within a thyroidectomy specimen. The clinical importance of this entity is that it is frequently misdiagnosed as papillary carcinoma or medullary carcinoma on fine-needle aspiration cytology or histopathologic examination. The cytology of HTT is characterized by hypercellularity, nuclear grooves, nuclear pseudoinclusions, and powdery chromatin of the tumor cells, which is frequently seen in papillary carcinomas. The histologic findings of the tumor show polygonal and spindle cells arranged in a trabecular growth pattern with the presence of a variable hyalinized stroma. Calcitonin and other neuroendocrine markers can be used to differentiate HTT from medullary carcinoma. MIB-1, galectin-3, or other cytokeratin markers help to exclude papillary carcinoma. We report a patient with a thyroid tumor misdiagnosed as a medullary carcinoma on fine-needle aspiration and finally diagnosed as HTT after total thyroidectomy and immunohistochemical examination.

Keywords: fine needle aspiration, hyalinizing trabecular tumor, thyroid nodules

Figures and Tables

Fig. 1
0.8 × 0.7 cm and 1.6 × 0.7 cm sized isoechoic nodules were noted at right and left thyroid.
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Fig. 2
Specimen form fine needle aspiration show atypical spindle cells having elongate nuclei and pseudoinclusions.
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Fig. 3
After total thyroidectomy, cut surface of surgical specimen shows three rather well defined nodules, measuring 1.7 × 1.3 cm, 1 × 0.8 cm and 1.0 × 1.0 cm in size, respectively.
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Fig. 4
H&E stain, ×400; Proliferation of spindle and ovoid cells with granular ampophilic cytoplasm and medium sized nucleus, separated by vascular stroma, hyalinized collagen and amyloid, arranged in follicular and trabecular pattern.
jkes-23-327-g004
Fig. 5
Immunohistochemical stain with calcitonin, thyroglubuilin were both positive. But, chromogranin and synaptophysin were both negative.
jkes-23-327-g005
Fig. 6
Immunohistochemical stain with MIB-1 (Ki-67) was positive along with the cell membrane.
jkes-23-327-g006
Fig. 7
Galectin stain was positive.
jkes-23-327-g007

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