Ebru Demiralay, Şemsi Altaner, Hüseyin Yüce Bircan, Banu Bilezikçi

Tiroidin Hyalinize Trabeküler Tümörü-Olgu Sunumu: Sitolojik, Morfolojik ve İmmünohistokimyasal Özellikleri

Hyalinize trabeküler adenom tiroidin az görülen benign bir neoplazmdır. Sitolojik yaymalarda ve parafin kesitlerde papiller ve meduller tiroid karsinomu ile karışabilir. Klinik olarak ötiroid olan 60 yaşında kadın hastada radyoaktif iyot ile sağ lobda soliter soğuk nodül tespit edildi. Tiroid ince iğne aspirasyon biyopsisi (TİİAB) sitolojik olarak hiposellüler olup hücresel olarak papiller karsinom özellikleri gösteren hücreler içermekteydi. "Papiller karsinom şüphesi" şeklinde rapor edildi. Hastaya sağ subtotal tiroidektomi uygulanarak intraoperatif inceleme istendi. Makroskopik olarak iyi sınırlı, 2 cm. çapta, çevresinde ince fibröz kapsülü bulunan kirli beyaz renkli nodül yapısı izlendi. Frozen kesitlerde hyalinize stromada solid adalar ve trabeküller patern gösteren nükleer psödoinklüzyonlar içeren hücreler ve mikrokalsifikasyonlar görülmesi üzerine papiller karsinom ile uyumlu olabileceği düşünüldü. Parafin kesitlerde tümör ince fibröz kapsül ve hyalinize stromaya sahip trabeküler yapılar oluşturmuş papiller karsinomun hücresel özelliklerine benzer hücrelerden oluşmaktaydı. İmmunohistokimyasal incelemede tümör hücreleri tiroglobulin pozitifti. HBME, CK19 ve kalsitonin negatifti. Olgu "Hyalinize trabeküler adenom" olarak rapor edildi. Nadir görülen bu tümörün sitolojik, morfolojik ve immunohistokimyasal özelliklerine dikkat çekmek amacıyla sunulmuştur

Anahtar Kelimeler:

tiroid, hyalinize trabeküler adenom, sitoloji, immunohistokimya

The Hyalinizing Trabecular Tumor of the Thyroid Gland-Case Report: Morphologic, Cytological and Immunohistochemical Features

Hyalinizing trabecular adenoma of the thyroid gland is a rare benign neoplasm. This can be confused with papillary carcinoma and thyroid medullary carcinoma in cytology from the permanent sections analysed. The female patient was clinically diagnosed as having euthyroid and radioactive iodine as a result of the scan performed which revealed a solitary "cold" nodule in right lobe. The hypocellulary TIIAB consisted of cells that were features of papillar carcinoma. A final diagnosis of the TIIAB was reported as a suspicious papillary carcinomas of the thyroid. A total thyroidectomy was performed and requested to be frozen. In the frozen section analysed, It was thought to be compatible with papillary carcinoma due to having solid and trabecular patterns in the hyalinizing stroma, nucleer pseodoinclusions and microcalsifications. Histologically, prominent nesting, trabecular growth patterns and a hyaline stroma were found. In the permanent sections analysed, the tumor exhibited clear margins of thin, fibrous capsule cells that were features of papillar carcinoma. Tumor cells were diffusely positive for thyroglobulin, but negative for staining with antibodies to HBME-1, CK19 and calcitonin. The case was reported as"hyalinizing trabecular adenoma". This rare tumor is presented to draw attention to the features of cytology, morphologic and immunohistochemical.

Keywords:

thyroid, hyalinizing trabecular adenoma, cytological, immunohistochemistry,

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Carney JA, Ryan J, Goellner JR. Hyalinizing trabecular adenoma of the thyroid gland. Am J Surg Pathol 1987;11:583-91
Evenson A, Mowschenson P, Wang H, et al. Hyalinizing trabecular adenoma-an uncommon thyroid tumor frequently misdiagnosed as papillary or medullary thyroid carcinoma. The Am J Surg 2007;193:707-12
Casey MB, Sebo TJ, Carney JA. Hyalinizing trabecular adenoma of the thyroid gland. Am J Clin Pahol 2004;122:506-10
Bishop JA, Ali SZ. Hyalinizing Trabecular adenoma of the thyroid gland. Diagnostic Cytopathology 2010;39:306-10
McCluggage WG, Sloan JM. Hyalinizing trabecular carcinoma of the thyroid gland. Histopathology 1996;28:357-62
Galgano MT, Mills SE, Stelow EB. Hyalinizing trabecular adenoma of the thyroid revisited: A histologic and immunohistochemical study of thyroid architecture and sclerosis. Am J Surg Pathol 2006; 30:1269-73 prominent trabecular
Papotti M, Riella P, Montemurro F, Pietribiasi F, Bussolati G. Immunophenotypic heterogeity of hyalinizing trabecular tumors of the thyroid. Histopathology 1997;31:525-33
Ohtsuki Y, Kimura M, Murao S, et al. Immunohistochemical and electron microscopy studies of a case of hyalinizing mass associated with it. Med Mol Morphol 2009;42:189-94
Salvatore G, Chiappetta G, Nikiforov YE, et al. Molecular profile of hyalinizing trabecular tumours of the thyroid: High prevalence of RET/PTC rearrangements and absence of B-raf and N-ras poit mutations. Eur J Cancer 2005;41:816-21