Skip to main content
SpringerLink
Log in

Papillary Thyroid Carcinoma and Variants

  • Chapter
  • First Online:
The Bethesda System for Reporting Thyroid Cytopathology

Abstract

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid, accounting for approximately 80% of all cancers at this site. It occurs in all age groups, including children, with a peak incidence in the third to fourth decades, and the M:F ratio is 1:3. Risk factors include external radiation to the neck during childhood, ionizing radiation, genetic factors, and nodular hyperplasia. PTC usually presents as a thyroid nodule, often discovered incidentally on routine examination; rarely, 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. It generally carries a good prognosis; death secondary to PTC is rare.

A malignant thyroid FNA diagnosis accounts for 4–8% of all thyroid FNAs, the majority of them PTCs. When a definite diagnosis of PTC is made by FNA, 96–100% prove to be PTC on histologic follow-up. Conventional PTCs are characterized histologically by numerous papillae lined by cuboidal to low columnar follicular cells with characteristic nuclear features (see below). Although traditionally considered the most common type of PTC, conventional PTC is diminishing in relative frequency as compared to PTC variants, especially in view of the increasing awareness and recognition of the follicular variant of PTC (FVPTC).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 29.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. LiVolsi VA, Albores-Saavedra J, Asa SL. Papillary carcinoma. In: Lellis D, Lloyd R, Heitz PU, Eng C, eds. WHO classification of tumours. Pathology and genetics of tumours of endocrine organs. Lyon: IARC Press; 2004:57-66.

    Google Scholar 

  2. Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-516.

    Article  PubMed  Google Scholar 

  3. Yang J, Schnadig V, Logrono R, Wasserman PG. Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations. Cancer. 2007;111(5):306-315.

    Article  PubMed  Google Scholar 

  4. Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid: a 12-year experience with 11, 000 biopsies. Clin Lab Med. 1993;13:699-709.

    CAS  PubMed  Google Scholar 

  5. Wang HH. Reporting thyroid fine-needle aspiration: literature review and a proposal. Diagn Cytopathol. 2006;34(1):67-76.

    Article  PubMed  Google Scholar 

  6. Renshaw AA. Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves. Am J Clin Pathol. 2001;116:477-482.

    Article  CAS  PubMed  Google Scholar 

  7. Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Endocr Pract. 2004;10(3):234-241.

    PubMed  Google Scholar 

  8. Miller TR, Bottles K, Holly EA, Friend NF, Abele JS. A step-wise logistic regression analysis of papillary carcinoma of the thyroid. Acta Cytol. 1986;30(3):285-293.

    CAS  PubMed  Google Scholar 

  9. Kini SR. Thyroid cytopathology: An atlas and text. Philadelphia: Lippincott Williams & Wilkins; 2008.

    Google Scholar 

  10. Lloyd RV, Erickson LA, Casey MB, et al. Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma. Am J Surg Pathol. 2004;28(10):1336-1340.

    Article  PubMed  Google Scholar 

  11. Renshaw AA. How closely do thyroid fine-needle aspirates need to be screened? Diagn Cytopathol. 2002;27(5):259-260.

    Article  PubMed  Google Scholar 

  12. Renshaw AA. Focal features of papillary carcinoma of the thyroid in fine-needle aspiration material are strongly associated with papillary carcinoma at resection. Am J Clin Pathol. 2002;118(2):208-210.

    Article  PubMed  Google Scholar 

  13. Hirokawa M, Carney JA, Goellner JR, et al. Observer variation of encapsulated follicular lesions of the thyroid gland. Am J Surg Pathol. 2002;26(11):1508-1514.

    Article  PubMed  Google Scholar 

  14. Baloch ZW, Livolsi VA. Follicular-patterned lesions of the thyroid: the bane of the pathologist. Am J Clin Pathol. 2002;117(1):143-150.

    Article  PubMed  Google Scholar 

  15. Renshaw AA, Gould EW. Why there is the tendency to “overdiagnose” the follicular variant of papillary thyroid carcinoma. Am J Clin Pathol. 2002;117(1):19-21.

    Article  PubMed  Google Scholar 

  16. Renshaw AA. “Histiocytoid” cells in fine-needle aspirations of papillary carcinoma of the thyroid: frequency and significance of an under-recognized cytologic pattern. Cancer. 2002;96(4):240-243.

    Article  PubMed  Google Scholar 

  17. Rupp M, Ehya H. Nuclear grooves in the aspiration cytology of papillary carcinoma of the thyroid. Acta Cytol. 1989;33(1):21-26.

    CAS  PubMed  Google Scholar 

  18. Papotti M, Manazza AD, Chiarle R, Bussolati G. Confocal microscope analysis and tridimensional reconstruction of papillary thyroid carcinoma nuclei. Virchows Arch. 2004;444(4):350-355.

    Article  PubMed  Google Scholar 

  19. Ellison E, Lapuerta P, Martin SE. Psammoma bodies in fine-needle aspirates of the thyroid: predictive value for papillary carcinoma. Cancer. 1998;84(3):169-175.

    Article  CAS  PubMed  Google Scholar 

  20. Rosai J, Zampi G, Carcangiu ML. Papillary carcinoma of the thyroid. A discussion of its several morphologic expressions, with particular emphasis on the follicular variant. Am J Surg Pathol. 1983;7(8):809-817.

    Article  CAS  PubMed  Google Scholar 

  21. Carcangiu ML, Zampi G, Pupi A, Castagnoli A, Rosai J. Papillary carcinoma of the thyroid. A clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer. 1985;55(4):805-828.

    Article  CAS  PubMed  Google Scholar 

  22. Baloch ZW, Gupta PK, Yu GH, Sack MJ, LiVolsi VA. Follicular variant of papillary carcinoma. Cytologic and histologic correlation. Am J Clin Pathol. 1999;111(2):216-222.

    CAS  PubMed  Google Scholar 

  23. Fulciniti F, Benincasa G, Vetrani A, Palombini L. Follicular variant of papillary carcinoma: cytologic findings on FNAB samples-experience with 16 cases. Diagn Cytopathol. 2001;25(2):86-93.

    Article  CAS  PubMed  Google Scholar 

  24. Goodell WM, Saboorian MH, Ashfaq R. Fine-needle aspiration diagnosis of the follicular variant of papillary carcinoma. Cancer. 1998;84(6):349-354.

    Article  CAS  PubMed  Google Scholar 

  25. Mesonero CE, Jugle JE, Wilbur DC, Nayar R. Fine-needle aspiration of the macrofollicular and microfollicular subtypes of the follicular variant of papillary carcinoma of the thyroid. Cancer. 1998;84(4):235-244.

    Article  CAS  PubMed  Google Scholar 

  26. Chung D, Ghossein RA, Lin O. Macrofollicular variant of papillary carcinoma: a potential thyroid FNA pitfall. Diagn Cytopathol. 2007;35(9):560-564.

    Article  PubMed  Google Scholar 

  27. Goellner JR, Johnson DA. Cytology of cystic papillary carcinoma of the thyroid. Acta Cytol. 1982;26(6):797-808.

    CAS  PubMed  Google Scholar 

  28. Faquin WC, Cibas ES, Renshaw AA. “Atypical” cells in fine-needle aspiration biopsy specimens of benign thyroid cysts. Cancer. 2005;105(2):71-79.

    Article  PubMed  Google Scholar 

  29. Moreira AL, Waisman J, Cangiarella JF. Aspiration cytology of the oncocytic variant of papillary adenocarcinoma of the thyroid gland. Acta Cytol. 2004;48(2):137-141.

    PubMed  Google Scholar 

  30. 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(5):1007-1011.

    PubMed  Google Scholar 

  31. Baloch ZW, LiVolsi VA. Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med. 2000;124(8):1192-1195.

    CAS  PubMed  Google Scholar 

  32. Ghossein RA, LiVolsi VA. Papillary carcinoma, tall cell variant. Thyroid. 2008;18(11):1179-1181.

    Article  CAS  PubMed  Google Scholar 

  33. 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(3):143-148.

    Article  PubMed  Google Scholar 

  34. Jayaram G. Cytology of columnar-cell variant of papillary thyroid carcinoma. Diagn Cytopathol. 2000;22(4):227-229.

    Article  CAS  PubMed  Google Scholar 

  35. Goellner JR, Carney JA. Cytologic features of fine needle aspirates of hyalinizing trabecular adenoma of the thyroid. Am J Clin Pathol. 1989;91:115-119.

    CAS  PubMed  Google Scholar 

  36. Casey MB, Sebo TJ, Carney JA. Hyalinizing trabecular adenoma of the thyroid gland: cytologic features in 29 cases. Am J Surg Pathol. 2004;28(7):859-867.

    Article  PubMed  Google Scholar 

  37. Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16(2):109-142.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, McGill University Health Center and McGill University, Montreal, QC, Canada

    Manon Auger M.D.

  2. Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA

    Edward B. Stelow M.D.

  3. Department of Pathology, Weill Medical College of Cornell University, New York, NY, USA

    Grace C. H. Yang M.D.

  4. Department of Pathology, Englewood Hospital and Medical Center, Englewood, NJ, USA

    Miguel A. Sanchez M.D.

  5. Department of Pathology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada

    Sylvia L. Asa M.D., Ph.D.

  6. University Health Network and Toronto Medical Laboratories, Toronto, ON, Canada

    Sylvia L. Asa M.D., Ph.D.

  7. Ontario Cancer Institute, Toronto, ON, Canada

    Sylvia L. Asa M.D., Ph.D.

  8. Departments of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA

    Virginia A. Livolsi M.D.

Authors
  1. Manon Auger M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward B. Stelow M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grace C. H. Yang M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miguel A. Sanchez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvia L. Asa M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Virginia A. Livolsi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. N. Wolfe Street, PATH 406 600, Baltimore, 21287, U.S.A.

    Syed Z. Ali

  2. Brigham & Women's Hospital, Harvard Medical School, Francis St. 75, Boston, 02115, U.S.A.

    Edmund S. Cibas

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Auger, M., Stelow, E.B., Yang, G.C.H., Sanchez, M.A., Asa, S.L., Livolsi, V.A. (2010). Papillary Thyroid Carcinoma and Variants. In: Ali, S., Cibas, E. (eds) The Bethesda System for Reporting Thyroid Cytopathology. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-87666-5_8

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-87666-5_8

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-87665-8

  • Online ISBN: 978-0-387-87666-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation