30 year old female, with a 3 cm tumor located in the left lobe , showing

infiltration into pharengeal wall and adjacent soft tissues

17 mitosis/ 50 hpf
Atypical mitosis
Macronucleol
 IHC
• Chromogranin A focal weak (+)
• Parathormone (+)
• GATA 3 (+)
• TTF1 (-) PTH

Ki67 PTH
 Parathyroid Carcinoma
• Rare
• usually secrete parathyroid •Local gross invasion into adjacent organs
hormone producing •Angioinvasion
hyperparathyroidism, which •Perineural invasion
is usually severe •IHC panel;
• Parathyroid carcinoma may Galectin 3, p53, Rb, p27, parafibromin
be suspected, but it usually
cannot be confirmed prior to
operation
 Tall Cell PTC
• Tall cell variant makes up 10% of the papillary cancers
• Usually large (>6 cm), extends extrathyroidally, and shows mitotic
activity and vascular invasion more often than classical papillary
cancer
• Tends to occur in elderly patients
PTC, Indicators of a Worse Disease Prognosis

• Histological subtype
• Extrathyroidal extension (ETE)
• High mitosis ( < 3 /10 HPF), necrosis
• Molecular features
Aggressive Subtypes of PTCs
(Real Carcinomas)

Tall cell variant Columnar cell variant Diffuse sclerosing variant

Solid variant Hobnail variant Diffuse follicular variant

How Much Tall ?
• Controversy about
the required height
of the tall cells
• Twice or thrice its
width ?
How Many Tall Cells ?
• According to various studies
threshold ranging from 30-75%
• WHO 2017: A tumor should
show at least 30% TCV
morphology to be defined as
“Tall Cell Variant”

Any foci of tall cells should be mentioned in

a pathology report regardless of the
percentage of the tall cells
Tall Cell PTC
• Tram-track follicles
• Abundant eosinophilic cytoplasm
with distinct cell borders
• Easily found typical nuclear
features of PTC

Thyroid, 2017
TCV-PTC
• How does the biological behavior differ ?
• Higher reccurrence (4,5 times greater) and
death rate (14 times greater) than classical PTC
• High expression of Muc1 and type IV collagenase may allow
for degradation of stroma and greater invasive properties
(with invasion of the trachea)
• Over-represented in RAI refractory thyroid CA
• Molecular features:
• More than 70% show a point mutation in BRAF proto-
oncogene
•PTC TCF and TCV have similar clinicopathological
features, more aggressive than classical PTC (increase in
tumor size, extensive ETE, positive margins more often)
• PTC TCF and TCV have higher rates of high grade
transformation (generous sampling needed to find out
such foci
• Lower the threshold for diagnosis of TCV to 30%