A large series of hyalinizing trabecular tumors: Cytomorphology and ancillary techniques on fine needle aspiration

Cancer Cytopathol. 2019 Jun;127(6):390-398. doi: 10.1002/cncy.22139. Epub 2019 May 28.

Abstract

Background: Hyalinizing trabecular tumors (HTTs) are rare, essentially benign, follicular cell-derived thyroid neoplasms characterized by a trabecular growth pattern and nuclear pseudoinclusions. Their cytological findings are misleading, because these tumors are often misinterpreted on fine needle aspirate cytology as malignant lesions, such as papillary thyroid cancer and/or medullary thyroid cancer, leading to unnecessary total thyroidectomy. The aim of this study was to analyze the cytomorphological features and application of ancillary techniques in a series of HTTs.

Methods: Of 26 histological cases of HTT collected from September 2001 to December 2018, 18 cases had concomitant cytopathology. Cytological cases were processed with liquid-based cytology (LBC). Immunocytochemistry for HBME-1 and galectine-3 as well as molecular testing for BRAFV600E mutation were performed on both LBC and histological specimens.

Results: The 18 lesions with fine needle aspirate cytology ranged in size from 5 to 45 mm. Cytological diagnoses included: 1 benign lesion favoring goiter (5.5%), 4 atypia of undetermined significance (22.2%), 6 follicular neoplasms (33.3%), 5 suspicious for malignancy favoring papillary thyroid cancer (28%), and 2 malignant (11%). Hence, 89% HTT had a negative concordant immunopanel, and they were 100% wild-type BRAFV600E .

Conclusion: The majority of our HTTs (83.3%) were diagnosed in the indeterminate Bethesda categories, suggesting that their cytomorphological features pose issues for reaching a conclusive cytological diagnosis. The ancillary test results in our series support the fact that HTT is a benign neoplasm.

Keywords: BRAF mutation; hyalinizing trabecular tumor; immunocytochemistry; molecular testing; personalized medicine; thyroid malignancy; thyroid nodule.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / analysis
  • Biopsy, Fine-Needle / statistics & numerical data
  • Carcinoma, Neuroendocrine / diagnosis*
  • Carcinoma, Neuroendocrine / genetics
  • Carcinoma, Neuroendocrine / pathology
  • Carcinoma, Neuroendocrine / surgery
  • Diagnosis, Differential
  • Diagnostic Errors / prevention & control
  • Diagnostic Errors / statistics & numerical data
  • Female
  • Galectin 3 / analysis
  • Humans
  • Hyalin / cytology
  • Immunohistochemistry
  • Liquid Biopsy / methods
  • Male
  • Middle Aged
  • Proto-Oncogene Proteins B-raf / genetics
  • Retrospective Studies
  • Thyroid Cancer, Papillary / diagnosis*
  • Thyroid Cancer, Papillary / genetics
  • Thyroid Cancer, Papillary / pathology
  • Thyroid Gland / cytology
  • Thyroid Gland / pathology*
  • Thyroid Gland / surgery
  • Thyroid Neoplasms / diagnosis*
  • Thyroid Neoplasms / genetics
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery
  • Thyroid Nodule / diagnosis*
  • Thyroid Nodule / genetics
  • Thyroid Nodule / pathology
  • Thyroid Nodule / surgery
  • Thyroidectomy / statistics & numerical data
  • Unnecessary Procedures / statistics & numerical data

Substances

  • Biomarkers, Tumor
  • Galectin 3
  • HBME-1 antigen
  • LGALS3 protein, human
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf

Supplementary concepts

  • Thyroid cancer, medullary