Chablé-Montero F, Shah BSA, Montante-Montes de Oca D, Ángeles-Ángeles A, Henson DE, Albores-Saavedra J

Language: English
References: 28
Page: 961-965
PDF size: 252.51 Kb.

ABSTRACT

We report the case of a 26-year-old woman with a 19 cm malignant hepatic neoplasm with morphological features that closely resembled a follicular thyroid carcinoma. Despite this, it was interpreted as a cholangiocarcinoma due to the absence of a primary thyroid tumor and the lack of thyroglobulin and TTF-1 immunoreactivity by the hepatic tumor. The left hepatic lobectomy specimen showed an encapsulated and multinodular gray-white mass with cystic and hemorrhagic areas. Microscopically, it displayed predominant macro and microfolicullar patterns with focal solid, trabecular and insular areas. The small and distended follicles contained a colloid-like secretion and were lined by low cuboidal cells with scant cytoplasm, round or oval hyperchromatic nuclei with fine chromatin. The solid areas, trabecular and insular structures were similar to those of follicular or papillary thyroid carcinomas. In addition, some of the neoplastic cells had clear nuclei with occasional grooves. The tumor was positive for cytokeratin (CK) 7, CK 19 and CD138, and negative for TTF-1, thyroglobulin, Hepar-1, Glypican-3, alpha-fetoprotein and neuroendocrine markers. A thyroid neoplasm was excluded clinically and by ultrasound and computed tomography. Although, the residual hepatic parenchyma was initially not cirrhotic, the patient eventually developed cryptogenic cirrhosis. The patient received adjuvant chemotherapy and died of metastatic disease 18 months after surgery. The thyroid-like pattern broadens the morphologic spectrum of cholangiocarcinoma.

REFERENCES

1. Shaib Y, El-Serag HB. The epidemiology of cholangiocarcinoma. Sem Liver Dis 2004; 24: 115-24.

2. Goodman ZD. Neoplasms of the liver. Mod Pathol 2007; 20(Suppl. 1): S49-S60.

3. Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Atlas of tumor pathology. 3rd. series. Fascicle27. Washington: Armed Forces Institute of Pathology; 2000.

4. Nakanuma Y, Sato Y, Harada K, Sasaki M, Xu J, Ikeda H. Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World J Hepatol 2010; 2: 419-27.

5. Albores-Saavedra J, Hoang MP, Murakata LA, Sinkre P, Yaziji H. Atypical bile duct adenoma, clear cell type: a previously undescribed tumor of the liver. Am J Surg Pathol 2001; 25: 956-60.

6. Sato K, Murai H, Ueda Y, Katsuda S. Intrahepatic sarcomatoid cholangiocarcinoma of round cell variant: a case report and immunohistochemical studies. Virchows Arch 2006; 449: 585-90.

7. Adachi S, Morimoto O, Kobayashi T. Lymphoepitheliomalike cholangiocarcinoma not associated with EBV. Pathol Int 2008; 58: 69-74.

8. Huang Y, Tsung JS, Lin CW, Cheng TY. Intrahepatic cholangiocarcinoma with lymphoepithelioma-like carcinoma component. Ann Clin Lab Sci 2004; 34: 476.

9. Fornelli A, Bondi A, Jovine E, Eusebi V. Intrahepatic cholangiocarcinoma resembling a thyroid follicular neoplasm. Virchows Arch 2010; 456: 339-42.

10. Albores-Saavedra J, Wu J. The many faces and mimics of papillary thyroid carcinoma. Endoc Pathol 2006; 17: 1-18.

11. Rosai J, Carcangiu ML, De Lellis R. Tumors of the thyroid gland, Atlas of Tumor Pathology. 3rd. series. Fascicle 5. Armed Forces Institute of Pathology; 1992.

12. Albores-Saavedra J, Gould E, Vardaman C, Vuitch F. The macrofollicular variant of variant of papillary thyroid carcinoma. A study of 17 cases. Hum Pathol 1991; 22: 1195-205.

13. Albores-Saavedra J, Housini I, Vuitch F, et al. Macrofollicular variant of papillary thyroid carcinoma with minor insular component. Cancer 1997; 80: 1110-16.

14. Kondo T, Katoh R, Omata K, et al. Incidentally detected liver metastasis of well-differentiated follicular carcinoma of the thyroid, mimicking ectopic thyroid. Pathol Int 2000; 50: 509-13.

15. Kouso H, Ikegami T, Ezaki T, et al. Liver metastasis from thyroid carcinoma 32 years after resection of the primary tumor: report of a case. Surg Today 2005; 35: 480-2.

16. Kraft O. Hepatic metastasis of differentiated thyroid carcinoma. Nucl Med Rev Cent East Eur 2005; 8: 44-6.

17. Ghanem N, Bley T, Altehoefer C, et al. Ectopic thyroid gland in the porta hepatis and lingua. Thyroid 2003; 13: 503-7.

18. Strohschneider T, Timm D, Worbes C. Ectopic thyroid gland tissue in the liver. Chirurg 1993; 64: 751-3.

19. Chan ES, Yeh MM. The use of immunohistochemistry in liver tumors. Clin Liver Dis 2010; 14: 687-703.

20. Frankel WL. Update on pancreatic endocrine tumors. Arch Pathol Lab Med 2006; 130: 963-6.

21. Capelli P, Martignoni G, Pedica F, et al. Endocrine neoplasms of the pancreas: pathologic and genetic features. Arch Pathol Lab Med 2009; 133: 350-64.

22. Eusebi V, Damiani S, Ellis IO, et al. Breast tumor resembling the tall cell variant of papillary thyroid carcinoma. Am J Surg Pathol 2003; 27: 1114-18.

23. Tosi AL, Ragazzi M, Asioli S, et al. Breast tumor resembling the tall cell variant of papillary thyroid carcinoma: report of 4 cases with evidence of malignant potential. Int J Surg Pathol 2007; 5: 14-19.

24. Amin MB, Gupta R, Ondrej H, et al. Primary thyroid-like follicular carcinoma of the kidney: report of 6 cases of a histologically distinctive adult renal epithelial neoplasm. Am J Surg Pathol 2009; 33: 393-400.

25. Jung SJ, Chung JI, Park SH, Ayala AG, Ro JY. Thyroid follicular carcinoma-like tumor of the kidney: a case report with morphologic, immunohistochemical and genetic analysis. Am J Surg Pathol 2006; 30: 411-15.

26. Sterlacci W, Verdofer I, Gabriel M, Mikuz G. Thyroid follicular carcinoma-like renal tumor: a case report with morphologic, immunophenotypic, cytogenetic and scintigraphic studies. Virchows Arch 2008; 452: 91-5.

27. Angeles-Angeles A, Chablé-Montero F, Martínez-Benítez B, Albores-Saavedra J. Unusual metastases of papillary thyroid carcinoma: report of 2 cases. Ann Diagn Pathol 2007; 13: 189-96.

28. Lara-Torres CO, Ortiz-Hidalgo C. Well-differentiated (Marschalko-type) plasmacytoma resembling thyroid follicular structures. J Hematop 2008; 1: 127-9.