Psammomatous calcifications in thyroid oncocytic (Hürthle cell) follicular tumors

ElsevierVolume 62, February 2023, 152061Annals of Diagnostic PathologyAuthor links open overlay panelAbstract

Concentric calcifications, also known as psammoma bodies, are a relatively frequent finding in certain types of tumors, particularly papillary thyroid carcinoma (PTC). In the thyroid, they have been assigned a significant role in the diagnosis of PTC and in distinguishing between these tumors and other types of thyroid neoplasms. Concentric calcifications have also less commonly been noted in other processes in the thyroid, such as in tumors characterized by cells containing abundant oxyphilic cytoplasm (i.e., Hürthle cells). We have studied 12 patients with oncocytic thyroid follicular tumors that contained scattered psammomatous calcifications that led to difficulties in diagnosis. The patients were 9 women and 3 men, aged 34 to 63 years. 10 cases corresponded to benign, non-invasive oncocytic tumors and 2 cases were minimally invasive follicular carcinomas of oncocytic (so called Hürthle cell) type. The psammomatous calcifications were randomly scattered throughout the lesions and were present as a focal, incidental finding in 8 cases and were diffuse in 4 cases. They were composed of concentrically laminated deposits of dense basophilic material closely resembling psammoma bodies, often associated with more homogeneous deposits of lightly eosinophilic material without concentric lamination that were interpreted as precipitated thyroglobulin. Seven patients with clinical follow-up, including one with minimally invasive carcinoma, were alive and well between 5 and 12 years after diagnosis. Concentric laminated calcifications may be encountered in oncocytic (Hürthle cell) follicular tumors and should not be interpreted as indicative of PTC in the context of oncocytic neoplasms of the thyroid.

Introduction

Psammomatous calcifications represent a degenerative phenomenon that can be observed in a variety of neoplastic processes throughout the human body, including tumors of the ovaries, pleura, meninges, kidney, and thyroid. When present in the thyroid, the tumors have been closely associated with papillary thyroid carcinoma (PTC) [1]. In fact, the presence of psammoma bodies has often been regarded as a criterion for making a diagnosis of PTC even in the absence of viable tumor on histologic sections or at metastatic sites, such as lymph nodes where isolated psammoma bodies may be the only finding in neck lymph node dissections [2], [3], [4]. A few authors have documented psammoma bodies in the thyroid in conditions other than PTC; in particular, the occurrence of such structures in oncocytic (Hürthle cell) neoplasms has been variously mentioned in major texts [1], [3], [5].

We have studied 12 patients with oncocytic (Hürthle cell) tumors of the thyroid that were remarkable for the presence of psammomatous concentric calcifications. The clinicopathologic features of our patients and a review of the literature are presented.

Section snippetsMaterials and methods

Twelve cases with the features here described were identified from the surgical pathology files of our institution between the years 1990–2020. From 5 to 13 histologic glass slides stained with hematoxylin and eosin (H&E) were available for review in each case. Clinical information was abstracted from the patient's medical records or obtained from the referring physician, and included gender, age, clinical presentation, location and size of the lesion, and clinical follow-up. The study was

Clinical features

The main clinical features in our patients are presented in Table I. The patients were 9 women and 3 men, aged 34 to 63 years (mean: 48 years). 10 cases corresponded to benign, non-invasive oncocytic tumors and 2 cases were minimally invasive follicular carcinomas of oncocytic (Hürthle cell) type. The tumors measured from 2.0 to 4.7 cm in maximum diameter. 6 were located in the right lobe, 5 in the left lobe, and 1 in the isthmus. All patients were treated by lobectomy, except for cases 11 and

Discussion

Round calcific concretions exhibiting concentric lamination designated as “psammoma bodies” are a frequent feature of PTC and are found in up to 50 % of cases in these tumors [6], [7]. Some authors make a distinction between “true” psammoma bodies and psammoma body-like structures located within the lumina of follicles. It has been stated that true psammoma bodies must be located within the interstitium or within lymphatics to qualify for this designation [1]. Amorphous deposits of densely

Funding

No outside sources of funding were received for this work.

Declaration of competing interest

David Suster receives royalty payments for text book authorship from Elsevier. Natali Ronen has no disclosures to report.

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