A Practical Diagnostic Approach to Solid/Trabecular Nodules in the Thyroid
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A Practical Diagnostic Approach to Solid/Trabecular Nodules in the Thyroid Marco Volante & Mauro Papotti
Published online: 12 April 2008 # Humana Press Inc. 2008
Abstract Nodules having a non-follicular–non-papillary structure may be frequently encountered in the thyroid, the solid/trabecular arrangement being the most common feature. When solid/trabecular pattern is predominant within a thyroid nodule, the wide range of differential diagnoses represents one of the major diagnostic problems in the routine thyroid practice, including – among others – relatively frequent entities such as trabecular adenoma or solid variant of papillary carcinoma and rare tumors such as hyalinizing trabecular tumor or paraganglioma. Morphology alone may not be sufficient to proper-type solid/ trabecular tumors in the thyroid and, therefore, a panel of immunohistochemical markers is recommended, including thyroglobulin/calcitonin as the first step, followed by specific markers according to the morphological and clinical setting. A schematic algorithm is presented, which takes into consideration the diagnostic hallmarks of the most relevant entities that enter in the differential diagnosis in solid/trabecular nodules within the thyroid. Keywords thyroid . tumors . trabecular . solid . growth pattern
Introduction Follicular and papillary growth patterns represent the most common architectural features within thyroid nodules in M. Volante (*) : M. Papotti Department of Clinical and Biological Sciences at San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043 Turin, Orbassano, Italy e-mail: [email protected]
both benign and malignant settings. Alternative to these, nodules having a non-follicular–non-papillary structure may be encountered, the solid/trabecular (ST) arrangement being the most common feature. In general, irrespective of the biological nature of the lesion under analysis, trabecular growth is represented by sheets of cells regularly arranged in one or few rows or more irregularly anastomosing, separated by usually scarce connective tissue and a thin vascular network. The solid growth is an extreme of the trabecular architecture, being represented by a more nodular arrangement with a wider thickness of cellular islands and a more irregular and dispersed vascular network. However, the border between compact trabecular growth and solid pattern is poorly defined, and since this latter form is usually mixed with and represents an architectural arrangement parallel to the trabecular one, they will be considered together. ST growth is most commonly associated to growth patterns of conventional follicular or papillary tumors although, in some instances, it may be prominent if not exclusive of a nodule within the thyroid. A wide range of differential diagnoses exists, which represents one of the major diagnostic problems in the routine thyroid practice. As an example of the potential misdiagnosis that might occur in the presence of trabecular nodules within the thyroid gland, we briefly report the clinical history o
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