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Case Study of a Woman in Her 70s with a Thyroid Nodule
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Case Study of a Woman in Her 70s with a Thyroid Nodule
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1Case Study of a Woman in Her 70s with a Thyroid Nodule
Clinical History
A female in her 70s presented with acute on chronic hypoxic respiratory failure. Upon workup,
she was found to have a TIRADS 5 thyroid isthmus lesion. The clinical team wanted to rule out
malignancy prior to tracheostomy placement. The patient underwent an ultrasound-guided fine
needle aspiration at an outside institution.
Cytology (Per Outside Report)
This nodule was placed into the Bethesda Category III: Atypia of Undetermined Significance.
The sample was described as hypocellular with poor preservation artifact and demonstrate few
groups of highly atypical cells with nuclear enlargement, crowding, elongation, and multiple
nuclear pseudoinclusions as well as abundant cytoplasms.
ThyroSeq® was performed and showed a PAX8-GLIS3 fusion.
Final Diagnosis
HYALINIZING TRABECULAR TUMOR
Discussion
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Hyalinizing trabecular tumor (HTT) is a follicular cell-derived neoplasm composed of large
trabeculae of elongated/polygonal cells with hyaline cytoplasm admixed with intra-trabecular
hyaline material (1). HTTs represent <1% of all thyroid neoplasms. HTTs have a female
predominance with a mean age of 50 years (2). In a case series of 119 HTTs, only 1 developed
metastasis (2).
HTTs can be difficult to diagnose by morphology alone and because some of the features may
resemble thyroid tumors, including papillary thyroid carcinoma (PTC), follicular adenoma (FA),
medullary thyroid carcinoma (MTC) and paragangliomas (2,3). Because of the overlapping
features of nuclear grooves, intranuclear cytoplasmic inclusions and vesicular chromatin, HTTs
must be separated from PTC. However, intratrabecular hyalinization is extremely rare in PTC. In
addition, PTCs often show invasive growth, have a papillary or follicular architecture and have
psammoma bodies. Follicular adenomas show intertrabecular, perivascular stromal hyalinization,
but lack the perpendicular arrangement of nuclei, grooves and pseudoinclusions more common
in HTT. MTCs can have a multitude of growth patterns but will have amyloid rather than
hyalinization and can be confirmed with calcitonin, chromogranin and CEA staining.
Paragangliomas overlap with HTTs, but can be separated using chromogranin, synaptophysin
and S100 immunohistochemical staining.
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