Diffuse sclerosing variant of papillary thyroid carcinoma: ultrasonographic and clinicopathological features in children/adolescents and adults

Clin Radiol. 2022 May;77(5):e356-e362. doi: 10.1016/j.crad.2022.01.051. Epub 2022 Feb 20.


Aim: To analyse the clinicopathological features and ultrasound findings of the diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) and compare differences between children/adolescents (CAs) and adults.

Materials and methods: Medical records and ultrasound images of 97 consecutive DSV-PTC patients were reviewed and comparison was made between CAs and adults.

Results: The average age was 31.2 ± 12.4 years old and 16.5% patients were CAs. Unilateral lobe was involved in 40.2% patients and 69.1% combined with Hashimoto's thyroiditis. Up to 95.9% patients had lymph node metastasis (LNM). CAs had more contralateral central LNM (CCLNM) and contralateral lateral LNM (CLLNM) than adults (p=0.047, p=0.025). Lung metastasis was also more common in CAs (p=0.002). Involved lobes mostly appeared as diffuse heterogeneous echogenicity on ultrasonography with isoechogenicity as the most common predominant echo (48.4%). Diffuse microcalcifications were observed frequently with grade 2-3 accounting for 52.3%. Lesions involving the whole gland lobe (diffuse type) occurred in 63.9%. Blood flow was poor in 71.6% (with grade 0-1). Microcalcifications of both lobes and metastatic lymph nodes and lesions involving (diffuse type) were more common in CAs (p=0.038, 0.002; 0.011). Of 39 patients with unilateral lobe involvement, ultrasonic sensitivity for CCLNM and CLLNM was only 50% and 66.7% respectively.

Conclusion: DSV-PTC has characteristic ultrasonographic findings. DSV-PTC of CAs may be more aggressive than that of adults. Ultrasonic sensitivity for LNM of contralateral compartments was not satisfactory and diagnostic methods with good efficacy are required.

MeSH terms

  • Adolescent
  • Adult
  • Calcinosis*
  • Carcinoma, Papillary* / diagnostic imaging
  • Child
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Thyroid Cancer, Papillary / diagnostic imaging
  • Thyroid Cancer, Papillary / pathology
  • Thyroid Neoplasms* / pathology
  • Young Adult