[163] Sclerosing Papillary Hyperplasia without Myoepithelium: A Variant of Papillary Thyroid Carcinoma?

Roberto G Gamez, Sonia Narendra, Carol Reynolds, Daniel W Visscher. Mayo Clinic, Rochester, MN

Background: To this date 12 cases of the breast tumor resembling the tall cell variant of papillary thyroid carcinoma (BTRPTC) have been reported, two reports raised the possibility of malignant potential due to metastatic disease. A recent review of our experience with solid and cystic papillary carcinoma showed a wide variety of histologic features, some overlaping with BTROTC (presence of nuclear grooves, clearing and inclusions). We report the clinical characteristics and follow up of six cases with overlapping clinical and histological features between BTRPTC and solid and cystic papillary carcinoma.
Design: All of the 6 cases had been seen as part of our consultation service. The available H&E slides were reviewd. The clinical and histologic characteristics and follow up were analyzed and recorded.
Results: The mean age of diagnosis was 57 years (range 38-79), the mean follow up time was 32.5 months (range 5 – 117), 83% lacked a myoepithelial layer, 100% (2 of 2) had negative sentinel nodes and no metastatic disease has been reported in any case. Our previous review of the solid and cystic variants of papillary carcinoma showed that besides the common papillary architecture, around 30% shared at least one or more of the same histologic characteristics of the BTRPTC. The cells were columnar or cuboidal in 40% and 25% of the cases, 25% had nuclear clearing or inclusions, 7% had nuclear grooves and all lakced a myoepithelial layer. All of our 6 new cases have columnar cells, nuclear clearing or inclusions, nuclear grooves, lack myoepithelial cells and show a papillary architecture with a surrounding sclerotic stroma.

Table 1 Clinical characteristics.
CaseDx YearAgeERMyoepithelialAxillary LNFollow up (months)AWD
1200338NP(-)ND117+
2201047(-)Focally (+)ND16+
3201179(-)(-)ND13+
4201152(-)(-)(-)5+
5201263Focally (+)(-)(-)6+
6200963NP(-)ND38+
All were wide local excisions, Dx: Diagnosis, NP not performed, ND not determined, AWD alive without disease


Conclusions: The histological and clinical features of our cases overlap those of BTROTC and show resemble the solid and cystic variants of papillary carcinoma. This raises the possibility that these cases and BTRPTC might be a variant of papillary carcinoma. In our experience none of the tumors showed malignant (metastatic) potential as reported in a previously published case report and have an excellent prognosis. Until more cases and clinical follow up is available for clarification of its malignant potential, we propose the name sclerosing papillary hyperplasia without myoepithelium.
Category: Breast

Wednesday, March 6, 2013 9:30 AM

Poster Session V # 13, Wednesday Morning

 

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