Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2023; 11(24): 5797-5803
Published online Aug 26, 2023. doi: 10.12998/wjcc.v11.i24.5797
Papillary thyroid carcinoma with nodular fasciitis-like stroma - an unusual variant with distinctive histopathology: A case report
Jun Hu, Fei Wang, Wei Xue, Yong Jiang
Jun Hu, Fei Wang, Wei Xue, Yong Jiang, Department of Thyroid Surgery, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
Author contributions: Hu J, Wang F, Xue W and Jiang Y designed the research and performed the patient’s diagnosis and treatment; Hu J collected the patient’s clinical data and wrote the paper.
Informed consent statement: The study was performed after obtaining the patient’s informed consent. The patient was treated according to the relevant criteria of the disease.
Conflict-of-interest statement: There is no conflict of interest to report. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016)
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Jiang, MD, Chief Physician, Department of Thyroid Surgery, The First People’s Hospital of Changzhou, No. 185 Juqian Street, Changzhou 213003, Jiangsu Province, China. yjiang8888@hotmail.com
Received: May 24, 2023
Peer-review started: May 24, 2023
First decision: July 8, 2023
Revised: July 12, 2023
Accepted: August 3, 2023
Article in press: August 3, 2023
Published online: August 26, 2023
Processing time: 92 Days and 20 Hours
Abstract
BACKGROUND

Papillary thyroid carcinoma (PTC) is regarded as a fairly common endocrine malignancy, which can be divided into different multiple variants due to wide morphologic differences. The majority of PTC variants have been reported, but PTC with nodular fasciitis-like stroma (NFS) is a rare pathological variant and has been infrequently reported in the relevant literature. This condition involves abundant reactive stromal components rich in spindle cells, which may account for 60%-80% of the tumor along with a typical papillary carcinoma.

CASE SUMMARY

A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck, the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery. Thyroid function test results were normal. Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone. Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm × 4.0 cm with a hypoechoic complex nodule, decreased vascularity and speckles of microcalcification. The patient underwent left thyroidectomy with central compartment lymph node dissection. Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC. The patient was asymptomatic at the 3-mo follow-up.

CONCLUSION

PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.

Keywords: Papillary thyroid carcinoma; Nodular fasciitis-like stroma; Spindle cell; Metaplasia; Neck ultrasound; Differential diagnosis; Case report

Core Tip: Papillary thyroid carcinoma (PTC) with nodular fasciitis-like stroma (NFS) is a histological variant of PTC with a favorable prognosis. The diagnosis of PTC-NFS requires a combination of ultrasonography, fine-needle aspiration cytology, and histological examination. Total thyroidectomy combined with cervical lymph node dissection is the best treatment for PTC-NFS.