Occult carcinoma confirmed to be a diffuse sclerosing variant of papillary thyroid carcinoma with unusual immunohistochemical features: A pitfall of clinicopathological diagnosis |
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| Institution: | 1. Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8556, Japan;2. Depertment of Surgical Pathology, Sunagawa City Medical Center, Sunagawa, Hokkaido 073-0196, Japan;1. Department of Otolaryngology, Toho University Omori Medical Center, 6-11-1, Omorinishi, Otaku 143-8541, Tokyo, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Yokohama City University School of Medicine, Kanagawa, Japan;1. Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan;2. Department of Pathology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan |
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| Abstract: | Immunocytochemistry in a 78-year-old man diagnosed as having systemic metastatic cancer of unknown primary origin revealed atypical cells positive for napsin A and TTF-1, suggesting adenocarcinoma of the lung. However, there was no evidence of a primary lesion in the lung on positron emission tomography/computed tomography or at autopsy. Meanwhile, both the left and right thyroid lobes were firm and grayish white with marked fibrosis. Histology identified a diffuse sclerosing variant of papillary thyroid carcinoma that was positive for TTF-1 and napsin A but negative for PAX8. This disease entity is often misdiagnosed clinically as chronic thyroiditis. This is the first report of napsin A-positive and PAX8-negative thyroid carcinoma and highlights the pitfalls of clinicopathological diagnosis. |
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