Thyreoglossal Duct Cyst with Evidence of Solid Cell Nests and Atypical Thyroid Follicles
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Thyreoglossal Duct Cyst with Evidence of Solid Cell Nests and Atypical Thyroid Follicles Marco Manzoni 1 & Francesca Bono 1 & Andrew Smith 1 & Giovanni Cavenaghi 2 & Werner Garavello 2 & Fabio Pagni 1
Published online: 13 April 2016 # Springer Science+Business Media New York 2016
Dear Editor, We have appreciated the exhaustive paper of Wei et al. [1], which provides outstanding knowledge regarding the epidemiological and clinico-pathological spectrum of thyreoglossal duct cyst (TGDC) associated diseases. We would like to contribute to such large series with the exceptional report of TGDC associated solid cell nests (SCNs). Since being first described, thyroideal solid cell nests (SCNs) are considered to be benign squamoid aggregates that derive from the ultimobranchial body [2]. Further studies have clearly defined the histochemical features of these benign structures [3] and, more recently, the immunohistochemical and genetic features have been defined [4–7]. Here, we report a very rare case of SCNs found near the hyoid bone in close association with follicular thyroid remnants. Only one other report, by Michal et al., was found in the current literature that described the presence of SCNs in a branchial cyst of an elderly man [8]. In our case, a 3-year-old child clinically developed a subhyoideal midline neck swelling with multiple episodes of infection. After surgical removal of the thyreoglossal cyst by Sistrunk operation, the histological specimen was composed of atypical TTF-1 positive follicular structures (Thyroid Transcription Factor-1, clone 8G7G3/1, Dako) closely associated with p40 positive solid nests of squamoid appearance (Tumor Protein p63, anti-p40 polyclonal, Abcam). Histologically, the thyroid remnants were composed of atypical follicular structures that showed a mild grade of nuclear
* Fabio Pagni [email protected] 1
Department of Medicine and Surgery, Pathology Section, University of Milano-Bicocca, Milan, Italy
2
Department of Otolaryngology, San Gerardo Hospital, Monza, Italy
overlapping, occasional nuclear clearing, and an irregular nuclear membrane profile. Grooves and occasional pseudoinclusions were present in a few cells, suggesting the differential diagnosis with papillary thyroid carcinoma. However, nuclear features were incomplete for this diagnosis and the immunohistochemistry revealed negativity for HBME-1 (Hector Battifora Mesothelial Antigen-1, clone ab2383, AbCam) and for BRAF V600E (serine/threonineprotein kinase B-raf, clone VE1, Ventana), thus supporting the benign nature of the lesion. Moreover, the squamoid areas were composed of spindled main cells, which showed an oval nucleus and absence of cystic areas: in accordance with the Asioli classification [9], the features described are indicative of a floret-like, type-1 SCN [3, 4]. The proliferative index, evaluated by ki-67 (clone MIB-1, Dako) immunohistochemical antigen expression, revealed only a few positive cells in the follicular counterpart. No C-cells were identified on hematoxylin and eosin stained sections a
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