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The significance of papillary architecture in the follow-up biopsies of patients with progestin-treated atypical endometrial hyperplasia
Wangpan J. Shi, Oluwole Fadare
J Pathol Transl Med. 2026;60(1):58-68.   Published online January 8, 2026
DOI: https://doi.org/10.4132/jptm.2025.09.12
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AbstractAbstract PDF
Background
Follow-up biopsies in patients with progestin-treated atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (AH/EIN) may show papillary structures, the significance of which is unclear. Methods: The authors reviewed 253 serial specimens of 84 consecutive patients diagnosed with AH/EIN, inclusive of each patient's pre-progestin treatment sample and all post-treatment specimens. We assessed the predictive relationship between papillary architecture in a post-treatment biopsy and two study outcomes: AH/EIN or carcinoma in at least one sample subsequent to the one in which papillae were identified, and/or the last specimen received for that patient. Results: Papillae were identified in only 51.5% of pre-treatment samples but were present in at least one subsequent post-treatment sample for all patients. Post-treatment samples that exhibited papillae and no glandular crowding were associated with AH/EIN in at least one subsequent specimen in 39.7% (29/73) of cases, compared to 24.0% (6/25) in samples with neither papillae nor glandular crowding (p = .227) and 64.0% (16/25) in samples with concurrent gland crowding and papillae (p = .048). Univariate logistic regression analyses showed that the presence of papillae was not associated with study outcomes (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.49 to 1.99; p = .985), as compared with gland crowding (OR, 1.54; 95% CI, 1.04 to 2.27; p = .031), or concurrent papillae and gland crowding (OR, 2.36; 95% CI, 1.01 to 5.52; p = .048). Conclusions: In post-treatment samples of progestin-treated AH/EIN, the presence of papillary architecture was not demonstrably associated with study outcomes independent of gland crowding, although the concurrent presence of both features may be significantly predictive.
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Low Ki-67 labeling index is a clinically useful predictive factor for recurrence-free survival in patients with papillary thyroid carcinoma
Takashi Masui, Katsunari Yane, Ichiro Ota, Kennichi Kakudo, Tomoko Wakasa, Satoru Koike, Hirotaka Kinugawa, Ryuji Yasumatsu, Tadashi Kitahara
J Pathol Transl Med. 2025;59(2):115-124.   Published online February 18, 2025
DOI: https://doi.org/10.4132/jptm.2024.11.08
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  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
We report a new risk stratification of invasive stage papillary thyroid carcinomas (PTCs) by combining invasive status, using extrathyroid invasion (Ex) status, and tumor growth speed using the Ki-67 labeling index (LI). Methods: We examined tumor recurrence in 167 patients with PTC who were surgically treated at the Kindai University Nara Hospital between 2010 and 2022. The patients were classified according to the degree of invasion [negative (Ex0) or positive (Ex1, Ex2, and Ex3)] and tumor growth speed expressed with Ki-67 LI, as low (<5%) or high (>5%). This study confirmed previous findings that the disease-free survival (DFS) rate in PTCs significantly differed between patients with a high and low Ki-67 index. Results: When combining Ex status (negative or positive) and Ki-67 proliferation status (low or high), the DFS rate of invasion in the negative, low Ki-67 LI group was only 1.1%, while that of invasion in the positive, high Ki-67 LI was 44.1%. This study reports for the first time that recurrence risks can be stratified accurately when combining carcinoma’s essential two features of extrathyroid invasion status and tumor growth speed. Conclusions: We believe the evidence for low tumor recurrence risk may contribute to use of more conservative treatment options for invasive-stage PTCs and help alleviate patient anxiety about tumor recurrence and death.

Citations

Citations to this article as recorded by  
  • Research Progress on the Correlation between Three Biomarkers, Ki-67, CAIX and VEGF and Clear Cell Renal Cell Carcinoma
    锦容 马
    Advances in Clinical Medicine.2025; 15(09): 326.     CrossRef
  • Immunophenotypic Panel for Comprehensive Characterization of Aggressive Thyroid Carcinomas
    Mihail Ceausu, Mihai Alin Publik, Dana Terzea, Carmen Adina Cristea, Dumitru Ioachim, Dana Manda, Sorina Schipor
    Cells.2025; 14(19): 1554.     CrossRef
  • High Ki-67 labeling index correlates with aggressive clinicopathological features in papillary thyroid carcinoma: a retrospective study
    Defi Nurlia Erdian, Maria Francisca Ham, Dina Khoirunnisa, Agnes Stephanie Harahap
    Thyroid Research.2025;[Epub]     CrossRef
Review
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Cytologic hallmarks and differential diagnosis of papillary thyroid carcinoma subtypes
Agnes Stephanie Harahap, Chan Kwon Jung
J Pathol Transl Med. 2024;58(6):265-282.   Published online November 7, 2024
DOI: https://doi.org/10.4132/jptm.2024.10.11
  • 15,751 View
  • 625 Download
  • 11 Web of Science
  • 10 Crossref
AbstractAbstract PDF
Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, characterized by a range of subtypes that differ in their cytologic features, clinical behavior, and prognosis. Accurate cytologic evaluation of PTC using fine-needle aspiration is essential but can be challenging due to the morphologic diversity among subtypes. This review focuses on the distinct cytologic characteristics of various PTC subtypes, including the classic type, follicular variant, tall cell, columnar cell, hobnail, diffuse sclerosing, Warthin-like, solid/trabecular, and oncocytic PTCs. Each subtype demonstrates unique nuclear features, architectural patterns, and background elements essential for diagnosis and differentiation from other thyroid lesions. Recognizing these distinct cytologic patterns is essential for identifying aggressive subtypes like tall cell, hobnail, and columnar cell PTCs, which have a higher risk of recurrence, metastasis, and poorer clinical outcomes. Additionally, rare subtypes such as diffuse sclerosing and Warthin-like PTCs present unique cytologic profiles that must be carefully interpreted to avoid diagnostic errors. The review also highlights the cytologic indicators of lymph node metastasis and high-grade features, such as differentiated high-grade thyroid carcinoma. The integration of molecular testing can further refine subtype diagnosis by identifying specific genetic mutations. A thorough understanding of these subtype-specific cytologic features and molecular profiles is vital for accurate diagnosis, risk stratification, and personalized management of PTC patients. Future improvements in diagnostic techniques and standardization are needed to enhance cytologic evaluation and clinical decision-making in thyroid cancer.

Citations

Citations to this article as recorded by  
  • Oncocytic Thyroid Tumours With Pathogenic FLCN Mutations Mimic Oncocytic Papillary Thyroid Carcinoma on Fine‐Needle Aspiration
    Adeel M. Ashraf, Faisal Hassan, Adrian A. Dawkins, Julie C. Dueber, Derek B. Allison, Thèrése J. Bocklage
    Cytopathology.2026; 37(1): 108.     CrossRef
  • Using a new type of visible light-based emission fluorescence microscope to identify the benign and malignant nature of thyroid tissue during the surgical process: Analysis of diagnostic results
    Yu Miao, Liu Xiaowei, Li Muyang, Gao Jian, Chen Lu
    Photodiagnosis and Photodynamic Therapy.2026; 57: 105324.     CrossRef
  • Clinical Behavior of Aggressive Variants of Papillary Thyroid Carcinoma: A Retrospective Case–Control Study
    Jovan Ilic, Nikola Slijepcevic, Katarina Tausanovic, Bozidar Odalovic, Goran Zoric, Marija Milinkovic, Branislav Rovcanin, Milan Jovanovic, Matija Buzejic, Duska Vucen, Boban Stepanovic, Sara Ivanis, Milan Parezanovic, Milan Marinkovic, Vladan Zivaljevic
    Cancers.2026; 18(2): 345.     CrossRef
  • Nuclear pseudoinclusion is associated with BRAFV600E mutation: Analysis of nuclear features in papillary thyroid carcinoma
    Agnes Stephanie Harahap, Dina Khoirunnisa, Salinah, Maria Francisca Ham
    Annals of Diagnostic Pathology.2025; 75: 152434.     CrossRef
  • 2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
    Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shin Je Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyo
    International Journal of Thyroidology.2025; 18(1): 30.     CrossRef
  • Structure-based molecular screening and dynamic simulation of phytocompounds targeting VEGFR-2: a novel therapeutic approach for papillary thyroid carcinoma
    Shuai Wang, Lingqian Zhang, Wenjun Zhang, Xiong Zeng, Jie Mei, Weidong Xiao, Lijie Yang
    Frontiers in Pharmacology.2025;[Epub]     CrossRef
  • 2025 Korean Thyroid Association Clinical Management Guideline on Active Surveillance for Low-Risk Papillary Thyroid Carcinoma
    Eun Kyung Lee, Min Joo Kim, Seung Heon Kang, Bon Seok Koo, Kyungsik Kim, Mijin Kim, Bo Hyun Kim, Ji-hoon Kim, Shinje Moon, Kyorim Back, Young Shin Song, Jong-hyuk Ahn, Hwa Young Ahn, Ho-Ryun Won, Won Sang Yoo, Min Kyoung Lee, Jeongmin Lee, Ji Ye Lee, Kyon
    Endocrinology and Metabolism.2025; 40(3): 307.     CrossRef
  • A Case of Warthin-Like Variant of Papillary Thyroid Cancer
    Amy Chow, Israa Laklouk
    Cureus.2025;[Epub]     CrossRef
  • Propensity score-matched analysis of the ‘2+2’ parathyroid strategy in total thyroidectomy with central neck dissection
    Hao Gong, Simei Yao, Tianyuchen Jiang, Yi Yang, Yuhan Jiang, Zhujuan Wu, Anping Su
    Frontiers in Endocrinology.2025;[Epub]     CrossRef
  • Cytological Findings in Pediatric Thoracic Tumors: A Review of Diagnostic Insights and Pitfalls
    Parikshaa Gupta, Pranab Dey
    Acta Cytologica.2025; : 1.     CrossRef
Original Articles
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TERT mutations and aggressive histopathologic characteristics of radioiodine-refractory papillary thyroid cancer
Ju Yeon Pyo, Yoon Jin Cha, SoonWon Hong
J Pathol Transl Med. 2024;58(6):310-320.   Published online September 12, 2024
DOI: https://doi.org/10.4132/jptm.2024.07.29
  • 5,090 View
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  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
Radioiodine (RI) ablation following thyroid-stimulating hormone suppression is an effective treatment for papillary thyroid cancer (PTC), typically leading to favorable outcomes. However, RI-refractory tumors exhibit aggressive behavior and poor prognoses. Recent studies highlight the role of genetic abnormalities in PTC signaling pathways, including the activation of telomerase reverse transcriptase (TERT), and the correlation of mutations with adverse outcomes.
Methods
This study analyzed mutations in BRAF V600E and the TERT-promoter genes, comparing clinicopathological features between RI-refractory and RI-responsive PTCs. Among 82 RI-refractory patients, formalin-fixed, paraffin-embedded tissues from initial surgeries were available for 26. Another 89 without distant metastasis over 5 years formed a matched RI-responsive control group.
Results
Histopathologically, RI-refractory PTCs showed increased frequencies of small tumor clusters without fibrovascular cores, hobnail features, and a high height-to-width ratio of tumor cells. These tumors were more likely to exhibit necrosis, mitosis, lymph node metastasis, extrathyroidal extension, and involvement of resection margins. TERT-promoter mutations were statistically significantly associated with these aggressive clinicopathologic features. Immunohistochemically, decreased expression of sodium iodide symporter and thyroglobulin stimulating hormone receptor proteins was common in RI-refractory PTCs, along with lower levels of oncogenic proteins such as vascular endothelial cell growth factor, vascular endothelial cell growth factor receptor 2, and nuclear factor kappa-light-chain-enhancer of activated B cells. Total loss of PTEN expression was occasionally observed. In contrast, all cases tested positive for cytoplasmic β-catenin.
Conclusions
RI-refractory PTCs are linked to TERT mutations and exhibit specific aggressive histopathologic features, particularly in tumor centers.

Citations

Citations to this article as recorded by  
  • Characterizing thyroid carcinomas in the elderly: Histological subtypes and TERT promoter mutation analysis based on the latest WHO classification
    Myoung Ju Koh, Songmi Noh, Jin Kyong Kim, Gi Jeong Kim
    Annals of Diagnostic Pathology.2026; 80: 152578.     CrossRef
  • Insulin resistance and metabolic dysfunction in thyroid nodules and differentiated thyroid cancer
    Stefano Iuliano, Maria Mirabelli, Stefania Giuliano, Antonio Brunetti
    Current Opinion in Oncology.2026; 38(1): 1.     CrossRef
  • Differentiated high-grade thyroid carcinoma (DHGTC): clinicopathological analysis of a new entity in a chilean center
    Marlín Solórzano, Ignacio Fuentes, José Miguel González, Nicole Lustig, Lorena Mosso, Joel Falcón, Catalina Ruiz, Joaquín Viñambres, Rodolfo Cabello, Hernán González, Pablo H Montero, Francisco Cruz, Rodrigo Jaimovich, Juan Carlos Quintana, Antonieta Sola
    Endocrine.2026;[Epub]     CrossRef
  • Characteristics and outcome of pediatric and adult differentiated thyroid cancer with distant metastases
    Ali S. Alzahrani, Lulu Alobaid, Eman Albasri, Afnan Hadadi, Abdulrhman Hakami, Fayha Abothenain, Deema Alturki, Najla Ewain, Ali Howaidi, Hindi Alhindi, Ghada Alskait, Yasser Aljufan, Shatha Alghaihb, Azzam Alkhalifah, Leenah AlAyoubi, Amani Abualnaja
    Frontiers in Endocrinology.2026;[Epub]     CrossRef
  • The ability of anexelekto (AXL) expression and TERT promoter mutation to predict radioiodine-refractory differentiated thyroid carcinoma
    Hasrayati Agustina, Tutik Nur Ayni, Yohana Azhar, Erwin Affandi Soeriadi, Bethy Suryawathy Hernowo
    Diagnostic Pathology.2025;[Epub]     CrossRef
  • Clinicopathologic characteristics of papillary thyroid carcinoma, tall cell subtype and subtype with tall cell features, an institutional experience
    Xueting Jin, Shunsuke Koga, Xiao Zhou, Niaz Z. Khan, Zubair W. Baloch
    Human Pathology.2025; 161: 105867.     CrossRef
  • Calcifying nested stromal-epithelial tumor of the liver: Report of two cases revealing novel WT1 mutation and distinct epigenetic features
    Andrea Strakova-Peterikova, Franco Fedeli, Boris Rychly, Jiri Soukup, Michael Michal, Petr Martinek, Marian Grendar, Elaheh Mosaieby, Nikola Ptakova, Maryna Slisarenko, Michal Michal, Kvetoslava Michalova
    Virchows Archiv.2025;[Epub]     CrossRef
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Diagnostic challenges in the assessment of thyroid neoplasms using nuclear features and vascular and capsular invasion: a multi-center interobserver agreement study
Agnes Stephanie Harahap, Mutiah Mutmainnah, Maria Francisca Ham, Dina Khoirunnisa, Abdillah Hasbi Assadyk, Husni Cangara, Aswiyanti Asri, Diah Prabawati Retnani, Fairuz Quzwain, Hasrayati Agustina, Hermawan Istiadi, Indri Windarti, Krisna Murti, Muhammad Takbir, Ni Made Mahastuti, Nila Kurniasari, Nungki Anggorowati, Pamela Abineno, Yulita Pundewi Setyorini, Kennichi Kakudo
J Pathol Transl Med. 2024;58(6):299-309.   Published online September 12, 2024
DOI: https://doi.org/10.4132/jptm.2024.07.25
Correction in: J Pathol Transl Med 2025;59(3):201
  • 5,436 View
  • 412 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
The diagnosis of thyroid neoplasms necessitates the identification of distinct histological features. Various education/hospital centers located in cities across Indonesia likely result in discordances among pathologists when diagnosing thyroid neoplasms.
Methods
This study examined the concordance among Indonesian pathologists in assessing nuclear features and capsular and vascular invasion of thyroid tumors. Fifteen pathologists from different centers independently assessed the same 14 digital slides of thyroid tumor specimens. All the specimens were thyroid neoplasms with known BRAFV600E and RAS mutational status, from a single center. We evaluated the pre- and post-training agreement using the Fleiss kappa. The significance of the training was evaluated using a paired T-test.
Results
Baseline agreement on nuclear features was slight to fair based on a 3-point scoring system (k = 0.14 to 0.28) and poor to fair based on an eight-point system (k = –0.02 to 0.24). Agreements on vascular (κ = 0.35) and capsular invasion (κ = 0.27) were fair, whereas the estimated molecular type showed substantial agreement (κ = 0.74). Following the training, agreement using the eight-point system significantly improved (p = 0.001).
Conclusions
The level of concordance among Indonesian pathologists in diagnosing thyroid neoplasm was relatively poor. Consensus in pathology assessment requires ongoing collaboration and education to refine diagnostic criteria.

Citations

Citations to this article as recorded by  
  • Nuclear pseudoinclusion is associated with BRAFV600E mutation: Analysis of nuclear features in papillary thyroid carcinoma
    Agnes Stephanie Harahap, Dina Khoirunnisa, Salinah, Maria Francisca Ham
    Annals of Diagnostic Pathology.2025; 75: 152434.     CrossRef
Review
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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: its updated diagnostic criteria, preoperative cytologic diagnoses and impact on the risk of malignancy
Hee Young Na, So Yeon Park
J Pathol Transl Med. 2022;56(6):319-325.   Published online November 9, 2022
DOI: https://doi.org/10.4132/jptm.2022.09.29
  • 9,762 View
  • 315 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Due to the extremely indolent behavior, a subset of noninvasive encapsulated follicular variant papillary thyroid carcinomas has been classified as “noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)” since 2016 and is no longer considered carcinoma. Since the introduction of this new terminology, changes and refinements have been made in diagnostic criteria. Initially, the incidence of NIFTP was estimated substantial. However, the reported incidence of NIFTP varies greatly among studies and regions, with higher incidence in North American and European countries than in Asian countries. Thus, the changes in the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) differ inevitably among regions. Because more conservative surgery is recommended for NIFTPs, distinguishing NIFTPs from papillary thyroid carcinomas in preoperative fine-needle aspiration cytology became one of the major concerns. This review will provide comprehensive overview of updates on diagnostic criteria, actual incidence and preoperative cytologic diagnoses of NIFTP, and its impact on the ROM in TBSRTC.

Citations

Citations to this article as recorded by  
  • Diagnosis of invasive encapsulated follicular variant papillary thyroid carcinoma by protein-based machine learning
    Truong Phan-Xuan Nguyen, Minh-Khang Le, Sittiruk Roytrakul, Shanop Shuangshoti, Nakarin Kitkumthorn, Somboon Keelawat
    Journal of Pathology and Translational Medicine.2025; 59(1): 39.     CrossRef
  • Papillae, psammoma bodies, and/or many nuclear pseudoinclusions are helpful criteria but should not be required for a definitive cytologic diagnosis of papillary thyroid carcinoma: An institutional experience of 207 cases with surgical follow up
    Tarik M. Elsheikh, Matthew Thomas, Jennifer Brainard, Jessica Di Marco, Erica Manosky, Bridgette Springer, Dawn Underwood, Deborah J. Chute
    Cancer Cytopathology.2024; 132(6): 348.     CrossRef
  • ThyroSeq overview on indeterminate thyroid nodules: An institutional experience
    Sam Sirotnikov, Christopher C. Griffith, Daniel Lubin, Chao Zhang, Nabil F. Saba, Dehong Li, Amanda Kornfield, Amy Chen, Qiuying Shi
    Diagnostic Cytopathology.2024; 52(7): 353.     CrossRef
  • Oncocytic Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Case Report
    Kaveripakam Ajay Joseph, Sana Ahuja, Sufian Zaheer
    Indian Journal of Surgical Oncology.2024; 15(S4): 606.     CrossRef
  • Cytologic hallmarks and differential diagnosis of papillary thyroid carcinoma subtypes
    Agnes Stephanie Harahap, Chan Kwon Jung
    Journal of Pathology and Translational Medicine.2024; 58(6): 265.     CrossRef
  • Preoperative evaluation of thyroid nodules – Diagnosis and management strategies
    Tapoi Dana Antonia, Lambrescu Ioana Maria, Gheorghisan-Galateanu Ancuta-Augustina
    Pathology - Research and Practice.2023; 246: 154516.     CrossRef
  • Reevaluating diagnostic categories and associated malignancy risks in thyroid core needle biopsy
    Chan Kwon Jung
    Journal of Pathology and Translational Medicine.2023; 57(4): 208.     CrossRef
  • Strategies for Treatment of Thyroid Cancer
    Deepika Yadav, Pramod Kumar Sharma, Rishabha Malviya, Prem Shankar Mishra
    Current Drug Targets.2023; 24(5): 406.     CrossRef
  • Identification of NIFTP-Specific mRNA Markers for Reliable Molecular Diagnosis of Thyroid Tumors
    So-Yeon Lee, Jong-Lyul Park, Kwangsoon Kim, Ja Seong Bae, Jae-Yoon Kim, Seon-Young Kim, Chan Kwon Jung
    Endocrine Pathology.2023; 34(3): 311.     CrossRef
Case Study
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Papillary and medullary thyroid carcinomas coexisting in the same lobe, first suspected based on fine-needle aspiration cytology: a case report
Hyun Hee Koh, Young Lyun Oh
J Pathol Transl Med. 2022;56(5):301-308.   Published online September 13, 2022
DOI: https://doi.org/10.4132/jptm.2022.08.03
  • 6,422 View
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AbstractAbstract PDF
Because different types of thyroid malignancies have distinct embryological origins, coexisting tumors are rarely observed. We describe a coexisting papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) first suspected by fine-needle aspiration cytology (FNAC). A 57-year-old female presented with an irregular mass in the right thyroid lobe. The cytopathologic findings of fine-needle aspiration showed two components: a papillary-like arrangement consisting of cells with pale enlarged nuclei indicative of PTC and loose clusters comprised of oval cells with granular chromatin indicative of MTC. The diagnosis of a coexisting PTC and MTC was initially confirmed by calcitonin immunocytochemistry and later after total thyroidectomy. Although some surgical case reports of PTC and MTC coexisting in either the same or different lobes have been documented, a case suspected by FNAC before the surgery has rarely been reported. Because appropriate treatment and prognosis of PTC and MTC are different, cytopathologists should be aware of this rare entity.

Citations

Citations to this article as recorded by  
  • Evaluation of Diagnostic Accuracy of Medullary Thyroid Carcinoma Using Fine‐Needle Aspiration Cytology—Based on a Single Tertiary Centre Experience
    Si‐Yi Chen, Dong‐Mei Gu
    Cytopathology.2026;[Epub]     CrossRef
  • Synchronous papillary and medullary thyroid carcinoma with distinct genetic mutations: A case report
    Huanyu Jiang, Lijuan Zhou, Gang Zou, Haidong Zhang, Zhenkun Yu
    Oral Oncology.2025; 161: 107191.     CrossRef
  • Coexisting papillary and medullary thyroid carcinomas in a 60 year old male: a case report
    Allahdad Khan, Anam Malik, Abdul Ahad Riaz, Muhammad Hussnain Sadiq, Muhammad Shahzaib Arshad, Alka Rani, Ibrahim Nagmeldin Hassan
    Annals of Medicine & Surgery.2025; 87(10): 6740.     CrossRef
  • Dedifferentiated Leiomyosarcoma of the Uterine Corpus with Heterologous Component: Clinicopathological Analysis of Five Consecutive Cases from a Single Institution and Comprehensive Literature Review
    Suyeon Kim, Hyunsik Bae, Hyun-Soo Kim
    Diagnostics.2024; 14(2): 160.     CrossRef
  • Coexisting Medullary and Papillary Thyroid Carcinomas: A Case of Dual Neoplasia With a High Risk of Misdiagnosis
    Santiago Sierra Castillo, Maria A Henao Rincón, David Aristizabal Colorado, David Alexander Vernaza Trujillo, Alin Abreu Lomba
    Cureus.2024;[Epub]     CrossRef
Original Articles
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Correlation between myoferlin expression and lymph node metastasis in papillary thyroid carcinoma
Ji Min Na, Dong Chul Kim, Dae Hyun Song, Hyo Jung An, Hyun Min Koh, Jeong-Hee Lee, Jong Sil Lee, Jung Wook Yang, Min Hye Kim
J Pathol Transl Med. 2022;56(4):199-204.   Published online May 11, 2022
DOI: https://doi.org/10.4132/jptm.2022.03.19
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AbstractAbstract PDF
Background
Myoferlin is a multifunctional protein expressed in various normal and cancer cells, with novel oncogenic roles being newly discovered. Recently, correlations have been found between myoferlin expression and unfavorable prognosis in various carcinomas. This study investigated the prognostic role of myoferlin expression in papillary thyroid carcinoma (PTC), specifically that associated with nodal metastasis.
Methods
We collected clinicopathological data and PTC tissues from 116 patients who had been admitted to Gyeongsang National University Hospital in 2010. Immunohistochemical analysis was performed on surgical specimen-derived tissue microarray blocks. Myoferlin expression was graded, and the relationship between expression level and pathological features of tumors based on the American Joint Committee on Cancer staging system was evaluated.
Results
Of the 116 patient samples, 100 cases exhibited positive myoferlin expression. Higher grade of myoferlin expression was correlated with lower T category group (p = .010). Presence of lymph node metastasis was determined to be significantly correlated with low-grade myoferlin expression (p = .019), with no significant difference between pN1a and pN1b tumors.
Conclusions
Our study revealed an adverse correlation between myoferlin expression and pathological features of PTC, evidence of the potential prognostic role of myoferlin in PTC lymph node metastasis.
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A multicenter study of interobserver variability in pathologic diagnosis of papillary breast lesions on core needle biopsy with WHO classification
Hye Ju Kang, Sun Young Kwon, Ahrong Kim, Woo Gyeong Kim, Eun Kyung Kim, Ae Ree Kim, Chungyeul Kim, Soo Kee Min, So Young Park, Sun Hee Sung, Hye Kyoung Yoon, Ahwon Lee, Ji Shin Lee, Hyang Im Lee, Ho Chang Lee, Sung Chul Lim, Sun Young Jun, Min Jung Jung, Chang Won Jung, Soo Youn Cho, Eun Yoon Cho, Hye Jeong Choi, So Yeon Park, Jee Yeon Kim, In Ae Park, Youngmee Kwon
J Pathol Transl Med. 2021;55(6):380-387.   Published online October 6, 2021
DOI: https://doi.org/10.4132/jptm.2021.07.29
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  • 4 Web of Science
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AbstractAbstract PDFSupplementary Material
Background
Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification.
Methods
Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier).
Results
On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems.
Conclusions
Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

Citations

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  • Beyond the benign: A rare case report of myxoid pleomorphic liposarcoma
    Arslan Ahmad, Muhammad Ammar, Muhammad Hasnain Saleem Choudary, Muhammad Nouman Sadiq, Rana Uzair Ahmad, Nouman Aziz
    Radiology Case Reports.2025; 20(5): 2500.     CrossRef
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    Shijing Wang, Qingfu Zhang, Xiaoyun Mao
    Frontiers in Oncology.2024;[Epub]     CrossRef
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    Matthew G. Hanna, Niels H. Olson, Mark Zarella, Rajesh C. Dash, Markus D. Herrmann, Larissa V. Furtado, Michelle N. Stram, Patricia M. Raciti, Lewis Hassell, Alex Mays, Liron Pantanowitz, Joseph S. Sirintrapun, Savitri Krishnamurthy, Anil Parwani, Giovann
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    Liang Xu, Qixin Mao, Qiuming Liu, Yufeng Gao, Lihua Luo, Chungen Guo, Wei Qu, Ningning Yan, Yali Cao
    Oncology Letters.2023;[Epub]     CrossRef
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    Aparna Harbhajanka, Hannah L. Gilmore, Benjamin C. Calhoun
    Modern Pathology.2022; 35(11): 1500.     CrossRef
Article image
Proto-oncogene Pokemon in thyroid cancer: a potential promoter of tumorigenesis in papillary thyroid carcinoma
Kyungseek Chang, Sung-Im Do, Kyungeun Kim, Seoung Wan Chae, In-gu Do, Hyun Joo Lee, Dong Hoon Kim, Jin Hee Sohn
J Pathol Transl Med. 2021;55(5):317-323.   Published online August 9, 2021
DOI: https://doi.org/10.4132/jptm.2021.06.28
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AbstractAbstract PDFSupplementary Material
Background
Pokemon is an oncogenic transcription regulator that plays a critical role in cellular differentiation. Although it has been found to be overexpressed in several types of cancer involving different organs, its role in thyroid gland has yet to be reported. The objective of this study was to evaluate the expression of Pokemon in papillary thyroid carcinoma (PTC) based on clinicopathological parameters.
Methods
Tissue microarray samples derived from patients with PTC or benign thyroid disease were used to evaluate Pokemon expression based on immunohistochemical analysis. Correlations of its expression with various clinicopathological parameters were then analyzed.
Results
Pokemon expression was observed in 22.0% of thyroid follicular cells from the normal group, 44.0% from the group with benign thyroid diseases, and 92.1% from the group with PTC (p < .001). The intensity of Pokemon expression was markedly higher in the PTC group. Pokemon expression level and PTC tumor size showed an inverse correlation. T1a tumors showed strong expression levels of Pokemon. However, larger tumors showed weak expression (p = .006).
Conclusions
Pokemon expression is associated with tumorigenesis of PTC, with expression showing an inverse correlation with PTC tumor size. This might be related to the negative regulation of aerobic glycolysis by Pokemon.

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Article image
Highly prevalent BRAF V600E and low-frequency TERT promoter mutations underlie papillary thyroid carcinoma in Koreans
Sue Youn Kim, Taeeun Kim, Kwangsoon Kim, Ja Seong Bae, Jeong Soo Kim, Chan Kwon Jung
J Pathol Transl Med. 2020;54(4):310-317.   Published online June 15, 2020
DOI: https://doi.org/10.4132/jptm.2020.05.12
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AbstractAbstract PDF
Background
The presence of telomerase reverse transcriptase (TERT) promoter mutations have been associated with a poor prognosis in patients with papillary thyroid carcinomas (PTC). The frequency of TERT promoter mutations varies widely depending on the population and the nature of the study.
Methods
Data were prospectively collected in 724 consecutive patients who underwent thyroidectomy for PTC from 2018 to 2019. Molecular testing for BRAF V600E and TERT promoter mutations was performed in all cases.
Results
TERT promoter alterations in two hotspots (C228T and C250T) and C216T were found in 16 (2.2%) and 4 (0.6%) of all PTCs, respectively. The hotspot mutations were significantly associated with older age at diagnosis, larger tumor size, extrathyroidal extension, higher pathologic T category, lateral lymph node metastasis, and higher American Thyroid Association recurrence risk. The patients with C216T variant were younger and had a lower American Thyroid Association recurrence risk than those with hotspot mutations. Concurrent BRAF V600E was found in 19 of 20 cases with TERT promoter mutations. Of 518 microcarcinomas measuring ≤1.0 cm in size, hotspot mutations and C216T variants were detected in five (1.0%) and three (0.6%) cases, respectively.
Conclusions
Our study indicates a low frequency of TERT promoter mutations in Korean patients with PTC and supports previous findings that TERT promoter mutations are more common in older patients with unfavorable clinicopathologic features and BRAF V600E. TERT promoter mutations in patients with microcarcinoma are uncommon and may have a limited role in risk stratification. The C216T variant seems to have no clinicopathologic effect on PTC.

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Article image
A Multi-institutional Study of Prevalence and Clinicopathologic Features of Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) in Korea
Ja Yeong Seo, Ji Hyun Park, Ju Yeon Pyo, Yoon Jin Cha, Chan Kwon Jung, Dong Eun Song, Jeong Ja Kwak, So Yeon Park, Hee Young Na, Jang-Hee Kim, Jae Yeon Seok, Hee Sung Kim, Soon Won Hong
J Pathol Transl Med. 2019;53(6):378-385.   Published online October 21, 2019
DOI: https://doi.org/10.4132/jptm.2019.09.18
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AbstractAbstract PDF
Background
In the present multi-institutional study, the prevalence and clinicopathologic characteristics of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were evaluated among Korean patients who underwent thyroidectomy for papillary thyroid carcinoma (PTC).
Methods
Data from 18,819 patients with PTC from eight university hospitals between January 2012 and February 2018 were retrospectively evaluated. Pathology reports of all PTCs and slides of potential NIFTP cases were reviewed. The strict criterion of no papillae was applied for the diagnosis of NIFTP. Due to assumptions regarding misclassification of NIFTP as non-PTC tumors, the lower boundary of NIFTP prevalence among PTCs was estimated. Mutational analysis for BRAF and three RAS isoforms was performed in 27 randomly selected NIFTP cases.
Results
The prevalence of NIFTP was 1.3% (238/18,819) of all PTCs when the same histologic criteria were applied for NIFTP regardless of the tumor size but decreased to 0.8% (152/18,819) when tumors ≥1 cm in size were included. The mean follow-up was 37.7 months and no patient with NIFTP had evidence of lymph node metastasis, distant metastasis, or disease recurrence during the follow-up period. A difference in prevalence of NIFTP before and after NIFTP introduction was not observed. BRAFV600E mutation was not found in NIFTP. The mutation rate for the three RAS genes was 55.6% (15/27).
Conclusions
The low prevalence and indolent clinical outcome of NIFTP in Korea was confirmed using the largest number of cases to date. The introduction of NIFTP may have a small overall impact in Korean practice.

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Prognostic Role of Metastatic Lymph Node Ratio in Papillary Thyroid Carcinoma
Jung-Soo Pyo, Jin Hee Sohn, Kyungseek Chang
J Pathol Transl Med. 2018;52(5):331-338.   Published online August 30, 2018
DOI: https://doi.org/10.4132/jptm.2018.08.07
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AbstractAbstract PDF
Background
The aim of this study is to elucidate the clinicopathological significances, including the prognostic role, of metastatic lymph node ratio (mLNR) and tumor deposit diameter in papillary thyroid carcinoma (PTC) through a retrospective review and meta-analysis.
Methods
We categorized the cases into high (≥ 0.44) and low mLNR (< 0.44) and investigated the correlations with clinicopathological parameters in 64 PTCs with neck level VI lymph node (LN) metastasis. In addition, meta-analysis of seven eligible studies was used to investigate the correlation between mLNR and survival.
Results
Among 64 PTCs with neck level VI LN metastasis, high mLNR was found in 34 PTCs (53.1%). High mLNR was significantly correlated with macrometastasis (tumor deposit diameter ≥ 0.2 cm), extracapsular spread, and number of metastatic LNs. Based on linear regression test, mLNR was significantly increased by the largest LN size but not the largest metastatic LN (mLN) size. High mLNR was not correlated with nuclear factor κB or cyclin D1 immunohistochemical expression, Ki-67 labeling index, or other pathological parameters of primary tumor. Based on meta-analysis, high mLNR significantly correlated with worse disease-free survival at the 5-year and 10-year follow-up (hazard ratio [HR], 4.866; 95% confidence interval [CI], 3.527 to 6.714 and HR, 5.769; 95% CI, 2.951 to 11.275, respectively).
Conclusions
Our data showed that high mLNR significantly correlated with worse survival, macrometastasis, and extracapsular spread of mLNs. Further cumulative studies for more detailed criteria of mLNR are needed before application in daily practice.

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Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features and Its Impact on the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience
Milim Kim, Joung Eun Kim, Hyun Jeong Kim, Yul Ri Chung, Yoonjin Kwak, So Yeon Park
J Pathol Transl Med. 2018;52(3):171-178.   Published online April 3, 2018
DOI: https://doi.org/10.4132/jptm.2018.04.03
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AbstractAbstract PDF
Background
This study was performed to analyze cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and its impact on the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).
Methods
Five thousand five hundred and forty-nine cases of thyroid fine-needle aspiration cytology (FNAC) diagnosed between 2012 and 2014 were included in this study. Diagnostic categories based on TBSRTC were compared with final surgical diagnoses, and the ROM in each category was calculated both when NIFTP was included in malignant lesions and when excluded from malignant lesions.
Results
Of the 5,549 thyroid FNAC cases, 1,891 cases underwent surgical resection. In final diagnosis, 1,700 cases were revealed as papillary thyroid carcinoma (PTC), and 25 cases were reclassified as NIFTP. The cytologic diagnoses of NIFTP were non-diagnostic in one, benign in five, atypia of undetermined significance (AUS) in 14, follicular neoplasm in two, and suspicious for malignancy in three cases. Collectively, NIFTP/encapsulated follicular variant of PTC (EFVPTC) were more frequently classified as benign, AUS, or follicular neoplasm and less frequently categorized as malignant compared to conventional PTCs. Exclusion of NIFTP from malignant diagnoses resulted in a slight decrease in malignancy rates in non-diagnostic, benign, AUS, follicular neoplasm, and suspicious for malignancy categories without any statistical significance.
Conclusions
The decrease in the ROM was not significant when NIFTP was excluded from malignant lesions. In thyroid FNACs, NIFTP/EFVPTCs were mostly classified into indeterminate categories. Therefore, it might be feasible to separate NIFTP/EFVPTC from conventional PTC on FNAC to guide clinicians to conservative management for patients with NIFTP/EFVPTC.

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  • Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis
    Elina Haaga, David Kalfert, Marie Ludvíková, Ivana Kholová
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    Soon-Hyun Ahn
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Preoperative Cytologic Diagnosis of Warthin-like Variant of Papillary Thyroid Carcinoma
Jisup Kim, Beom Jin Lim, Soon Won Hong, Ju Yeon Pyo
J Pathol Transl Med. 2018;52(2):105-109.   Published online February 12, 2018
DOI: https://doi.org/10.4132/jptm.2017.12.26
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AbstractAbstract PDF
Background
Warthin-like variant of papillary thyroid carcinoma (WLV-PTC) is a relatively rare variant of papillary thyroid carcinoma with favorable prognosis. However, preoperative diagnosis using fine-needle aspiration (FNA) specimens is challenging especially with lymphocytic thyroiditis characterized by Hürthle cells and lymphocytic background. To determine a helpful cytological differential point, we compared WLV-PTC FNA findings with conventional papillary thyroid carcinoma with lymphocytic thyroiditis (PTC-LT) and conventional papillary thyroid carcinoma without lymphocytic thyroiditis (PTC) regarding infiltrating inflammatory cells and their distribution. Preoperative diagnosis or potential for WLV-PTC will be helpful for surgeons to decide the scope of operation.
Methods
Of the 8,179 patients treated for papillary thyroid carcinoma between January 2007 and December 2012, 16 patients (0.2%) were pathologically confirmed as WLV-PTC and four cases were available for cytologic review. For comparison, we randomly selected six PTC-LT cases and five PTC cases during the same period. The number of intratumoral and background lymphocytes, histiocytes, neutrophils, and the presence of giant cells were evaluated and compared using conventional smear and ThinPrep preparations.
Results
WLV-PTC showed extensive lymphocytic smear with incorporation of thyroid follicular tumor cell clusters and frequent histiocytes. WLV-PTC was associated with higher intratumoral and background lymphocytes and histiocytes compared with PTC-LT or PTC. The difference was more distinct in liquid-based cytology.
Conclusions
The lymphocytic smear pattern and the number of inflammatory cells of WLV-PTC are different from those of PTC-LT or PTC and will be helpful for the differential diagnosis of WLV-PTC in preoperative FNA.

Citations

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  • An Algorithmic Approach to Defining Variants of Papillary Thyroid Carcinoma: Accuracy of Fine Needle Aspiration Cytology
    Neha Nigam, Neha Kumari, Rishabh Sahai, Nandita Chaudhary, Sabaretnam Mayilvaganan, Pallavi Prasad, Prabhakar Mishra
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    Abdel Mouhaymen Missaoui, Fatma Hamza, Wafa Belabed, Manel Mellouli, Mohamed Maaloul, Slim Charfi, Issam Jardak, Tahya Sellami-Boudawara, Nabila Rekik, Mohamed Abid
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The Significance of TROP2 Expression in Predicting BRAF Mutations in Papillary Thyroid Carcinoma
Joon Seog Kong, Hyeon Jin Kim, Min-Jung Kim, Areumnuri Kim, Dalnim Lee, Kanghee Han, Sunhoo Park, Jae Soo Koh, Jae Kyung Myung
J Pathol Transl Med. 2018;52(1):14-20.   Published online December 11, 2017
DOI: https://doi.org/10.4132/jptm.2017.10.17
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  • 14 Crossref
AbstractAbstract PDF
Background
Trophoblast antigen 2 (TROP2) is a human trophoblast cell-surface glycoprotein that is overexpressed in several types of epithelial cancers, and is suggested to be associated with an unfavorable prognosis. BRAF mutations are the most common genetic alteration in papillary thyroid carcinoma (PTC). We evaluated the correlation between TROP2 expression and BRAF mutation in PTC.
Methods
First, we carried out pyrosequencing for BRAF mutations and immunohistochemistry for TROP2 expression with a tissue microarray consisting of 52 PTC cases. Membranous staining in at least 5% of tumor cells was designated as positive staining and we analyzed the relationship between TROP2 expression and diverse clinicopathological factors, including BRAF mutation. Second, we tested TROP2 mRNA expression in three thyroid cancer cell lines with BRAF mutations (BCPAP, SNU790, and 8505C) and a normal thyroid cell line. Additionally, we checked TROP2 protein levels in a normal thyroid cell line after introduction of the BRAF V600E mutation.
Results
In this study, 21 of 26 cases with BRAF mutation showed TROP2 immunoreactivity, whereas all 26 cases without BRAF mutation showed no immunoreactivity for TROP2 with a statistically significant difference (p<.001). Upregulation of TROP2 mRNA was observed in all three thyroid cancer cell lines, but not in the normal thyroid cell line. Interestingly, however, the TROP2 expression was increased in the normal thyroid cell line after introduction of the BRAF V600E mutation.
Conclusions
Based on these results, we concluded that TROP2 expression is significantly associated with BRAF mutation and that TROP2 immunohistochemistry could be used for predicting BRAF mutations or diagnosing papillary thyroid carcinoma.

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    Xinlu Yin, Wenzhi Jia, Le Xu, Wenjie Zheng, Yiqing Gao, Linglin Tang, You Zhang, Qianyun Wu, Dongsheng Xu, Shuxian An, Weijun Wei, Jianjun Liu, Qinyi Zhou, Jialin Feng, Jun Chen
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    David Kalfert, Marie Ludvikova, Martin Pesta, Tommi Hakala, Lucie Dostalova, Hana Grundmannova, Jindra Windrichova, Katerina Houfkova, Tereza Knizkova, Jaroslav Ludvik, Jiri Polivka, Ivana Kholova
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Programmed Death-Ligand 1 Expression and Its Correlation with Lymph Node Metastasis in Papillary Thyroid Carcinoma
Hyo Jung An, Gyung Hyuck Ko, Jeong-Hee Lee, Jong Sil Lee, Dong Chul Kim, Jung Wook Yang, Min Hye Kim, Jin Pyeong Kim, Eun Jung Jung, Dae Hyun Song
J Pathol Transl Med. 2018;52(1):9-13.   Published online October 3, 2017
DOI: https://doi.org/10.4132/jptm.2017.07.26
  • 10,892 View
  • 283 Download
  • 20 Web of Science
  • 18 Crossref
AbstractAbstract PDF
Background
The immunotherapeutic role of programmed death-ligand 1 (PD-L1) in life expectancy in many cancers has been highlighted. However, data regarding PD-L1 expression in papillary thyroid carcinoma (PTC) are limited. In this study, we describe the PD-L1 and programmed cell death protein 1 (PD-1) expressions in PTC and analyze their correlation with lymph node (LN) metastasis.
Methods
Clinicopathological data were obtained from 116 patients with PTC who were treated in Gyeongsang National University Hospital, Jinju, Korea in 2009. Tissue microarray blocks were made using representative paraffin blocks of classical PTCs excluding follicular variants. Two pathologists graded the proportion and intensity of PD-L1 and PD-1 expression in both tumor and inflammatory cells. According to their proportions, positive PTC cells were scored as negative (0%), grade 1 (1%–50%), and grade 2 (51%–100%). Similarly, positive inflammatory cells were graded as negative (0%), grade 1 (1%–10%), and grade 2 (11%–20%). The intensity of each protein expression was simplified as positive or negative.
Results
A statistically significant correlation exists between the proportions of PD-1 and PD-L1 expression both in papillary carcinoma (p=.001) and peritumoral lymphoid cells in the thyroid (p<.001). In addition, the proportion of PD-L1 expression in PTC cells was closely related to metastatic LNs (p=.036).
Conclusions
PD-L1 is a valuable predictive marker for LN metastasis in PTC. Immunomodulating therapies that inhibit PD-L1 might be an option for patients with LN metastasis.

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Prognostic Significance of a Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast: Comparative Analysis with Micropapillary Carcinoma
Hyun-Jung Kim, Kyeongmee Park, Jung Yeon Kim, Guhyun Kang, Geumhee Gwak, Inseok Park
J Pathol Transl Med. 2017;51(4):403-409.   Published online June 9, 2017
DOI: https://doi.org/10.4132/jptm.2017.03.18
  • 9,547 View
  • 201 Download
  • 17 Web of Science
  • 18 Crossref
AbstractAbstract PDF
Background
Mucinous carcinoma of the breast is an indolent tumors with a favorable prognosis; however, micropapillary features tend to lead to aggressive behavior. Thus, mucinous carcinoma and micropapillary carcinoma exhibit contrasting biologic behaviors. Here, we review invasive mucinous carcinoma with a focus on micropapillary features and correlations with clinicopathological factors.
Methods
A total of 64 patients with invasive breast cancer with mucinous or micropapillary features were enrolled in the study. Of 36 pure mucinous carcinomas, 17 (47.2%) had micropapillary features and were termed mucinous carcinoma with micropapillary features (MUMPC), and 19 (52.8%) had no micropapillary features and were termed mucinous carcinoma without micropapillary features. MUMPC were compared with 15 invasive micropapillary carcinomas (IMPC) and 13 invasive ductal and micropapillary carcinomas (IDMPC).
Results
The clinicopathological factors of pure mucinous carcinoma and MUMPC were not significantly different. In contrast to IMPC and IDMPC, MUMPC had a low nuclear grade, lower mitotic rate, higher expression of hormone receptors, negative human epidermal growth factor receptor 2 (HER2) status, lower Ki-67 proliferating index, and less frequent lymph node metastasis (p < .05). According to univariate analyses, progesterone receptor, HER2, T-stage, and lymph node metastasis were significant risk factors for overall survival; however, only T-stage remained significant in a multivariate analysis (p < .05).
Conclusions
In contrast to IMPC and IDMPC, the micropapillary pattern in mucinous carcinoma does not contribute to aggressive behavior. However, further analysis of a larger series of patients is required to clarify the prognostic significance of micropapillary patterns in mucinous carcinoma of the breast.

Citations

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Do Helper T Cell Subtypes in Lymphocytic Thyroiditis Play a Role in the Antitumor Effect?
Seok Woo Yang, Seong-Ho Kang, Kyung Rae Kim, In Hong Choi, Hang Seok Chang, Young Lyun Oh, Soon Won Hong
J Pathol Transl Med. 2016;50(5):377-384.   Published online September 15, 2016
DOI: https://doi.org/10.4132/jptm.2016.07.25
  • 10,204 View
  • 108 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Papillary thyroid carcinoma (PTC) is frequently accompanied by lymphocytic thyroiditis (LT). Some reports claim that Hashimoto’s thyroiditis (the clinical form of LT) enhances the likelihood of PTC; however, others suggest that LT has antitumor activity. This study was aimed to find out the relationship between the patterns of helper T cell (Th) cytokines in thyroid tissue of PTC with or without LT and the clinicopathological manifestation of PTC.
Methods
Fresh surgical samples of PTC with (13 cases) or without (10 cases) LT were used. The prognostic parameters (tumor size, extra-thyroidal extension of PTC, and lymph node metastasis) were analyzed. The mRNA levels of two subtypes of Th cytokines, Th1 (tumor necrosis factor α [TNF-α], interferon γ [IFN-γ ], and interleukin [IL] 2) and Th2 (IL-4 and IL-10), were analyzed. Because most PTC cases were microcarcinomas and recent cases without clinical follow-up, negative or faint p27 immunoreactivity was used as a surrogate marker for lymph node metastasis.
Results
PTC with LT cases showed significantly higher expression of TNF-α (p = .043), IFN-γ (p < .010), IL-4 (p = .015) than those without LT cases. Although the data were not statistically significant, all analyzed cytokines (except for IL-4) were highly expressed in the cases with higher expression of p27 surrogate marker.
Conclusions
These results indicate that mixed Th1 (TNF-α, IFN-γ , and IL-2) and Th2 (IL-10) immunity might play a role in the antitumor effect in terms of lymph node metastasis.

Citations

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    Shengpeng Yao, Hong Zhang
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Difference of the Nuclear Green Light Intensity between Papillary Carcinoma Cells Showing Clear Nuclei and Non-neoplastic Follicular Epithelia in Papillary Thyroid Carcinoma
Hyekyung Lee, Tae Hwa Baek, Meeja Park, Seung Yun Lee, Hyun Jin Son, Dong Wook Kang, Joo Heon Kim, Soo Young Kim
J Pathol Transl Med. 2016;50(5):355-360.   Published online August 22, 2016
DOI: https://doi.org/10.4132/jptm.2016.05.19
  • 8,479 View
  • 90 Download
AbstractAbstract PDF
Background
There is subjective disagreement regarding nuclear clearing in papillary thyroid carcinoma. In this study, using digital instruments, we were able to quantify many ambiguous pathologic features and use numeric data to express our findings.
Methods
We examined 30 papillary thyroid carcinomas. For each case, we selected representative cancer cells showing clear nuclei and surrounding non-neoplastic follicular epithelial cells and evaluated objective values of green light intensity (GLI) for quantitative analysis of nuclear clearing in papillary thyroid carcinoma.
Results
From 16,274 GLI values from 600 cancer cell nuclei and 13,752 GLI values from 596 non-neoplastic follicular epithelial nuclei, we found a high correlation of 94.9% between GLI and clear nuclei. GLI between the cancer group showing clear nuclei and non-neoplastic follicular epithelia was statistically significant. The overall average level of GLI in the cancer group was over two times higher than the non-neoplastic group despite a wide range of GLI. On a polygonal line graph, there was a fluctuating unique difference between both the cancer and non-neoplastic groups in each patient, which was comparable to the microscopic findings.
Conclusions
Nuclear GLI could be a useful factor for discriminating between carcinoma cells showing clear nuclei and non-neoplastic follicular epithelia in papillary thyroid carcinoma.
Case Study
A Rare Case of Recurrent Metastatic Solid Pseudopapillary Neoplasm of the Pancreas
Hye Seung Lee, Han Kyeom Kim, Bong Kyung Shin, Jin Hyuk Choi, Yoo Jin Choi, Ha Yeon Kim
J Pathol Transl Med. 2017;51(1):87-91.   Published online August 6, 2016
DOI: https://doi.org/10.4132/jptm.2016.06.16
  • 12,734 View
  • 234 Download
  • 18 Web of Science
  • 13 Crossref
AbstractAbstract PDF
A 61-year-old woman visited our hospital for bilateral multiple lung nodules and a mass in her thorax. She had a long history of multiple metastatic recurrences of solid pseudopapillary neoplasm (SPN); 24 years previously, the patient had undergone pylorus-preserving pancreaticoduodenectomy for a 9.9 × 8.6 cm mass in the pancreatic head. The tumor was diagnosed as an SPN. Nine years later, metastatic nodules were found on computed tomography in the patient’s liver and peritoneum and were excised. She subsequently underwent an additional eight metastatectomy procedures in diverse organs. For the presented event, the lung nodules were removed. The prevalence of malignant SPN in the general population is 5%–15%. However, multiple metastatic recurrence of malignant SPN is rare; the lung is a particularly rare site of metastasis, found in only three cases in the literature. Here, we describe this exceptional case and provide a literature review.

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Original Articles
Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis
Jung-Soo Pyo, Jin Hee Sohn, Guhyun Kang
J Pathol Transl Med. 2016;50(4):278-286.   Published online June 6, 2016
DOI: https://doi.org/10.4132/jptm.2016.03.29
  • 12,230 View
  • 111 Download
  • 23 Web of Science
  • 26 Crossref
AbstractAbstract PDF
Background
The clinicopathological characteristics and conclusive treatment modality for multifocal papillary thyroid microcarcinoma (mPTMC) have not been fully established.
Methods
A retrospective study, systematic review, and meta-analysis were conducted to elucidate the clinicopathological significance of mPTMC. We investigated the multiplicity of 383 classical papillary thyroid microcarcinomas (PTMCs) and the clinicopathological significance of incidental mPTMCs. Correlation between tumor recurrence and multifocality in PTMCs was evaluated through a systematic review and meta-analysis.
Results
Tumor multifocality was identified in 103 of 383 PTMCs (26.9%). On linear regression analysis, primary tumor diameter was significantly correlated with tumor number (R2=0.014, p=.021) and supplemental tumor diameter (R2=0.117, p=.023). Of 103 mPTMCs, 61 (59.2%) were non-incidental, with tumor detected on preoperative ultrasonography, and 42 (40.8%) were diagnosed (incidental mPTMCs) on pathological examination. Lymph node metastasis and higher tumor stage were significantly correlated with tumor multifocality. However, there was no difference in nodal metastasis or tumor stage between incidental and non-incidental mPTMCs. On meta-analysis, tumor multifocality was significantly correlated with tumor recurrence in PTMCs (odds ratio, 2.002; 95% confidence interval, 1.475 to 2.719, p<.001).
Conclusions
Our results show that tumor multifocality in PTMC, regardless of manner of detection, is significantly correlated with aggressive tumor behavior.

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  • 10.1016/j.bjorlp.2018.01.005

    CrossRef Listing of Deleted DOIs.2000;[Epub]     CrossRef
Parafibromin Staining Characteristics in Urothelial Carcinomas and Relationship with Prognostic Parameters
Serap Karaarslan, Banu Yaman, Hakan Ozturk, Banu Sarsik Kumbaraci
J Pathol Transl Med. 2015;49(5):389-395.   Published online September 15, 2015
DOI: https://doi.org/10.4132/jptm.2015.08.10
  • 9,087 View
  • 47 Download
  • 7 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Background
Parafibromin is a recently defined tumor suppressor gene. The aim of our study was to determine the relationships of parafibromin expression in urothelial carcinomas (UCs) with prognostic parameters and to evaluate the use of parafibromin as a potential marker of UC. Methods: Parafibromin expression was assessed in 49 UC specimens using immunohistochemistry. The correlations between parafibromin expression and clinical and pathologic parameters were investigated. Results: Of the patients, 42 (85.7%) were male, and the mean age was 69.6 ± 8.2 years (range, 54 to 88 years). Morphologically, the UCs were divided into two groups: papillary (n = 27) and non-papillary (n = 22). There were seven low-grade (14.3%) and 42 high-grade (85.7%) tumors. Parafibromin was negative in 13 tumors (26.5%), partially positive in 19 tumors (38.8%), and positive in 17 tumors (34.7%). Parafibromin expression was more negative in UCs from upper urinary locations (n=17) and with muscularis propria invasion (n=28), which was statistically significant (p = .009 and p = .007, respectively). There was no statistically significant relationship between parafibromin expression and gender, age, tumor grade, survival, or disease-free survival. Conclusions: We found that UC cases with parafibromin positivity had less of a tendency to show muscularis propria invasion and were more commonly located in the lower urinary system. These results need to be confirmed with studies based on larger case series.

Citations

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  • The roles of the tumor suppressor parafibromin in cancer
    Hua-chuan Zheng, Hang Xue, Cong-yu Zhang
    Frontiers in Cell and Developmental Biology.2022;[Epub]     CrossRef
  • Prognostic role of parafibromin staining and CDC73 mutation in patients with parathyroid carcinoma: A systematic review and meta‐analysis based on individual patient data
    Ruizhe Zhu, Zixing Wang, Ya Hu
    Clinical Endocrinology.2020; 92(4): 295.     CrossRef
  • Thein vitroandin vivoeffects of nuclear and cytosolic parafibromin expression on the aggressive phenotypes of colorectal cancer cells: a search of potential gene therapy target
    Hua-chuan Zheng, Jia-jie Liu, Jing Li, Ji-cheng Wu, Lei Yang, Gui-feng Zhao, Xin Zhao, Hua-mao Jiang, Ke-qiang Huang, Zhi-jie Li
    Oncotarget.2017; 8(14): 23603.     CrossRef
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    Hua-Chuan Zheng, Bao-Cheng Gong, Shuang Zhao
    Oncotarget.2017; 8(56): 95270.     CrossRef
  • Significance of Parafibromin Expression in Laryngeal Squamous Cell Carcinomas
    Inju Cho, Mija Lee, Sharon Lim, Ran Hong
    Journal of Pathology and Translational Medicine.2016; 50(4): 264.     CrossRef
Case Study
Article image
Fallopian Metaplastic Papillary Tumour: An Atypical Transdifferentiation of the Tubal Epithelium?
Miguel Fdo. Salazar, Isaías Estrada Moscoso, Lorena Troncoso Vázquez, Nubia Leticia López García, Paola Andrea Escalante Abril
J Pathol Transl Med. 2015;49(2):148-155.   Published online March 12, 2015
DOI: https://doi.org/10.4132/jptm.2014.10.15
  • 10,453 View
  • 60 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
A metaplastic papillary tumor of the Fallopian tube is an extremely uncommon condition, with odd and confusing features that make it difficult to categorize as benign or borderline. Here, we summarize all the published cases to date and document the case of a 41-year-old woman diagnosed with this alteration after her last childbirth and ensuing tubal ligation. One of the tubes was bulky and filled with a caramel-like substance encircling a blurry spot. Light microscopy detailed a slender stalk covered by eosinophilic, columnar plump cells, showing atypical nuclei and focal budding. Mitotic figures were absent. The immunohistochemistry panel was positive for pan-cytokeratin, epithelial membrane antigen, cyclin D1, and hormone receptors. Additionally, a proliferation index of less than 5% was rated using Ki-67. The true nature of this tumor (reactive vs neoplastic) is uncertain. Nonetheless, its association with pregnancy suggests an adaptive change, likely similar to the atypical transdifferentiation proposed for Arias-Stella reaction.

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  • Ungewöhnliche Proliferation des Eileiters
    Angelina Vlaški, Vanessa Neukunft, Andrea Maria Gassel, Frederick Klauschen, Doris Mayr
    Die Pathologie.2025; 46(1): 56.     CrossRef
  • Fallopian tube papilloma
    Shashank Mishra, Prerna Guleria
    Indian Journal of Pathology and Microbiology.2021; 64(3): 608.     CrossRef
  • Metaplastic papillary tumour of the fallopian tube, a rare entity, analysed by next‐generation sequencing
    Sandra Sunitsch, Julia Reisinger, Luca Abete, Karl Kashofer, Peter Regitnig
    Histopathology.2020; 76(6): 923.     CrossRef
Brief Case Reports
The Limitations of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Pancreatic Serous Cystadenoma: A Brief Case Report
Heae Surng Park, Sun Och Yoon, Beom Jin Lim, Joo Hee Kim, Soon Won Hong
Korean J Pathol. 2014;48(5):405-408.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.405
  • 8,493 View
  • 63 Download
PDF
Pulmonary Hodgkin Lymphoma in a Patient with Crohn’s Disease
Jae-Young Park, Juhie Lee
Korean J Pathol. 2014;48(5):387-389.   Published online October 27, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.387
  • 7,938 View
  • 35 Download
  • 2 Crossref
PDF

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  • The Complex Relationship between Mechanisms Underlying Inflammatory Bowel Disease, Its Treatment, and the Risk of Lymphomas: A Comprehensive Review
    Katarzyna Stasik, Rafał Filip
    International Journal of Molecular Sciences.2024; 25(8): 4241.     CrossRef
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    A. Dohan, S.A. Faraoun, M. Barral, Y. Guerrache, M. Boudiaf, X. Dray, C. Hoeffel, M. Allez, O. Farges, L. Beaugerie, T. Aparicio, P. Marteau, E.K. Fishman, O. Lucidarme, C. Eveno, M. Pocard, R. Dautry, P. Soyer
    Diagnostic and Interventional Imaging.2015; 96(9): 871.     CrossRef
Case Studies
Recurrent Thyroid Papillary Carcinoma in Children Under Ten Years Old: Report of Two Cases and Literature Review
Byeong-Joo Noh, Ji-Youn Sung, Youn-Wha Kim, Yong-Koo Park
Korean J Pathol. 2014;48(4):297-301.   Published online August 26, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.4.297
  • 9,074 View
  • 50 Download
  • 1 Crossref
AbstractAbstract PDF

Papillary thyroid carcinoma (PTC) in children under ten years old is very rare. To date, 18 cases of PTC in children under ten years old (including our two cases) have been reported in Korea. Here, we describe two cases of recurrent PTC with follicular variant and conventional type in an 8-year-old boy and a 7-year-old boy, respectively, and discuss clinicopathologic and molecular characteristics that differ in pediatric patients from adults.

Citations

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  • Extremely Well-Differentiated Papillary Thyroid Carcinoma Resembling Adenomatous Hyperplasia Can Metastasize to the Skull: A Case Report
    Ju Yeon Pyo, Jisup Kim, Sung-eun Choi, Eunah Shin, Seok-Woo Yang, Cheong Soo Park, Seok-Mo Kim, SoonWon Hong
    Yonsei Medical Journal.2017; 58(1): 255.     CrossRef
Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: A Case Study and Review of the Literature
Seyda Erdogan, Arbil Acikalin, Handan Zeren, Gulfılız Gonlusen, Suzan Zorludemir, Volkan Izol
Korean J Pathol. 2014;48(3):225-228.   Published online June 26, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.3.225
  • 10,413 View
  • 72 Download
  • 14 Crossref
AbstractAbstract PDF

Well-differentiated papillary mesothelioma is an uncommon tumor of the testes that usually presents as a hydrocele. Here, we present the case of one patient who did not have a history of asbestos exposure. The tumor was localized in the tunica vaginalis and was composed of three pedunculated masses macroscopically. Microscopically, branching papillary structures with focal coagulative necrosis were present. In addition to immunohistochemistry, simian virus 40 DNA was also tested by polymerase chain reaction. This report presents one case of this rare entity, its clinical and macroscopic features, and follow-up results.

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  • Factors predictive of progression in lesions categorised as well-differentiated papillary mesothelial tumour of the pleura, tunica vaginalis and peritoneum: a scoping review
    Sarita Prabhakaran, Harry James Gaffney, Yazad Irani, Ashleigh J. Hocking, David Roder, Sonja Klebe
    Cancer Treatment and Research Communications.2026; 47: 101137.     CrossRef
  • Testicular/paratesticular mesothelial tumours: Uncommon histopathologic entities in a very complex anatomical site
    Francesca Pagliuca, Stefano Lucà, Marco De Sio, Davide Arcaniolo, Gaetano Facchini, Marco De Martino, Francesco Esposito, Ferdinando DE Vita, Paolo Chieffi, Renato Franco
    Pathology - Research and Practice.2024; 253: 155069.     CrossRef
  • Well-differentiated Papillary Mesothelial Tumour of the Tunica Vaginalis Testis – A Rare Lesion, but one Pathologists Should Know About Two Patient Reports and a Review of the Literature
    Johannes Kläger, Felicitas Oberndorfer, Cristophe Brunel, Julian Veser, Eva Compérat
    International Journal of Surgical Pathology.2023; 31(6): 1126.     CrossRef
  • A diagnostic approach to paratesticular lesions with tubulopapillary architecture: a series of 16 serous borderline tumors/low-grade serous carcinoma and 14 well-differentiated papillary mesothelial tumors and mesothelioma
    Rabia Zafar, Lacey J. Schrader, John C. Cheville, J. Kenneth Schoolmeester, Anja C. Roden, Marie-Christine Aubry, Eunhee S. Yi, Aditya Raghunathan, Loren Herrera-Hernandez, R. Houston Thompson, Stephen A. Boorjian, Bradley C. Leibovich, Gary L. Keeney, Ra
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  • Mesothelioma subtypes of the tunica vaginalis: a rare case report and review of histological criteria
    Cutts Rebecca, Martin J Connor, Luxi Sun, Thomas Johnston, Rachel Gooch, John McLoughlin
    Journal of Surgical Case Reports.2019;[Epub]     CrossRef
  • Well‐differentiated papillary mesothelioma of tunica vaginalis testis of unknown malignant potential: Sonographic appearance
    K.W.S. Ko, K.S. Tse, K.W. Shek, M.N. Hau, S.H. Ting
    Journal of Clinical Ultrasound.2018; 46(5): 364.     CrossRef
  • Tunica Vaginalis Thickening, Hemorrhagic Infiltration and Inflammatory Changes in 8 Children with Primary Hydrocele; Reactive Mesothelial Hyperplasia? A Prospective Clinical Study
    Ioannis Patoulias, Evangelia Rachmani, Maria Kalogirou, Kyriakos Chatzopoulos, Dimitrios Patoulias
    Acta Medica (Hradec Kralove, Czech Republic).2018; 61(2): 41.     CrossRef
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    Sheetu Singh, Arpita Jindal
    Lung India.2018; 35(2): 171.     CrossRef
  • Two Case Reports of Benign Testicular Mesothelioma and Review of the Literature
    Cristobal Ramirez Sevilla, Carme Admella Salvador, Josep Feliu Canaleta, Juan Llopis Manzanera, Miguel Angel Barranco Sanz, Juan Antoni Romero Martin, Sergi Bernal Salguero, Francesco A. Mauri
    Case Reports in Oncological Medicine.2017;[Epub]     CrossRef
  • Well-differentiated Papillary Mesothelioma of the Tunica Vaginalis
    Wei Keith Tan, Mae-Yen Tan, Hui Meng Tan, Rajadurai Pathmanathan, Wei Phin Tan
    Urology.2016; 90: e7.     CrossRef
  • Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: Case Report and Systematic Review of Literature
    Wei Keith Tan, Mae-Yen Tan, Wei Shen Tan, Soon Ching Gan, Rajadurai Pathmanathan, Hui Meng Tan, Wei Phin Tan
    Clinical Genitourinary Cancer.2016; 14(4): e435.     CrossRef
  • The legacy of the F344 rat as a cancer bioassay model (a retrospective summary of three common F344 rat neoplasms)
    Robert R. Maronpot, Abraham Nyska, Jennifer E. Foreman, Yuval Ramot
    Critical Reviews in Toxicology.2016; 46(8): 641.     CrossRef
  • Malignant Mesothelioma of the Tunica Vaginalis: A Rare Neoplasm—Case Report and Literature Review
    Manuel Segura-González, Jorge Urias-Rocha, Jorge Castelán-Pedraza
    Clinical Genitourinary Cancer.2015; 13(6): e401.     CrossRef
  • In vivo Optical Coherence Tomography Imaging of the Mesothelium Using Developed Window Models
    Yeh-Chan Ahn, Yu-Gyeong Chae, Sang Seok Hwang, Bong-Kwon Chun, Maan Hong Jung, Sung Jin Nam, Hae-Young Lee, Jae Min Chung, Chulho Oak, Eun-Kee Park
    Journal of the Optical Society of Korea.2015; 19(1): 69.     CrossRef
Original Articles
Tumor Sprouting in Papillary Thyroid Carcinoma Is Correlated with Lymph Node Metastasis and Recurrence
Eunjung Lee, Wonkyung Jung, Jeong-Soo Woo, Jae Bok Lee, Bong Kyung Shin, Han Kyeom Kim, Aeree Kim, Baek-hui Kim
Korean J Pathol. 2014;48(2):117-125.   Published online April 28, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.2.117
  • 13,386 View
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AbstractAbstract PDF
Background

Identification of poor prognostic factors in papillary thyroid carcinoma (PTC) patients is important for the patients' care and follow-up. We can sometimes see small tumor clusters without desmoplasia and no evidence of lymphatic emboli around the main tumor mass of PTC. We termed this form of tumor clustering, 'tumor sprouting,' and determined whether these tumors correlate with lymphovascular invasion, lymph node metastasis, and recurrence.

Methods

We analyzed a total of 204 cases of papillary thyroid macrocarcinoma. Number, size and distance from the main tumor of the tumor sprouting were observed and analyzed with clinicopathologic characteristics.

Results

Tumor sprouting was observed in 101 patients. Presence of tumor sprouting was significantly associated with positive resection margin (p=.002), lymphovascular invasion (p=.001), lymph node metastasis (p<.001), and recurrence (p=.004). Univariate analysis of recurrence-free survival revealed that tumor multiplicity (p=.037), positive resection margin (p=.007), lymphovascular invasion (p=.004), lymph node metastasis (p<.001), and tumor sprouting (p=.004) were poor prognostic factors. In multivariate analysis, positive resection margin was an independent poor prognostic factor of recurrence.

Conclusions

In conclusion, tumor sprouting is significantly correlated with lymph node metastasis and recurrence. Evaluation of tumor sprouting in PTC patients could be helpful in predicting tumor recurrence or lymph node metastasis.

Citations

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  • The Initial Risk Stratification System for Differentiated Thyroid Cancer: Key Updates in the 2024 Korean Thyroid Association Guideline
    Shinje Moon, Young Shin Song, Kyong Yeun Jung, Eun Kyung Lee, Jeongmin Lee, Dong-Jun Lim, Chan Kwon Jung, Young Joo Park
    Endocrinology and Metabolism.2025; 40(3): 357.     CrossRef
  • Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 5. Evaluation of Recurrence Risk Postoperatively and Initial Risk Stratification in Different
    Eun Kyung Lee, Young Shin Song, Ho-Cheol Kang, Sun Wook Kim, Dong Gyu Na, Shin Je Moon, Dong-Jun Lim, Kyong Yeun Jung, Yun Jae Chung, Chan Kwon Jung, Young Joo Park
    International Journal of Thyroidology.2024; 17(1): 68.     CrossRef
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    Ho-Ryun Won, Bon Seok Koo
    International Journal of Thyroidology.2023; 16(2): 157.     CrossRef
  • Peripheral Versus Intraparenchymal Papillary Thyroid Microcarcinoma: Different Morphologies and PD-L1 Expression
    Bozidar Kovacevic, Dragana Vucevic, Snezana Cerovic, Catarina Eloy
    Head and Neck Pathology.2022; 16(1): 200.     CrossRef
  • Lymphovascular invasion and risk of recurrence in papillary thyroid carcinoma
    Katy Wagner, Earl Abraham, Bryan Tran, David Roshan, James Wykes, Peter Campbell, Ardalan Ebrahimi
    ANZ Journal of Surgery.2020; 90(9): 1727.     CrossRef
  • The Predictors of Multicentricity in Well-Differentiated Thyroid Cancer
    Mohamed Hegazi, Waleed El Nahas, Mohamed Elmetwally, Amr Hassan, Waleed Gado , Islam Abdou, Ahmed Senbel, Mohamed Samir Abou-Sheishaa
    Journal of Analytical Oncology.2018; 7(4): 65.     CrossRef
  • Prognostic impact of vascular invasion in differentiated thyroid carcinoma: a systematic review and meta-analysis
    Huy Gia Vuong, Tetsuo Kondo, Uyen N P Duong, Thong Quang Pham, Naoki Oishi, Kunio Mochizuki, Tadao Nakazawa, Lewis Hassell, Ryohei Katoh
    European Journal of Endocrinology.2017; 177(2): 207.     CrossRef
  • Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis
    Jung-Soo Pyo, Jin Hee Sohn, Guhyun Kang
    Journal of Pathology and Translational Medicine.2016; 50(4): 278.     CrossRef
P2X7 Receptor Expression in Coexistence of Papillary Thyroid Carcinoma with Hashimoto's Thyroiditis
Ji Hyun Kwon, Eun Sook Nam, Hyung Sik Shin, Seong Jin Cho, Hye Rim Park, Mi Jung Kwon
Korean J Pathol. 2014;48(1):30-35.   Published online February 25, 2014
DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.1.30
  • 11,315 View
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  • 21 Crossref
AbstractAbstract PDF
Background

This study was aimed at investigating the relation of P2X7 receptor (P2X7R) expression with the clinicopathological features of papillary thyroid carcinoma (PTC) coexisting with Hashimoto's thyroiditis (HT).

Methods

We examined 170 patients (84, PTC with HT; 86, PTC without HT). P2X7R expression was examined by immunohistochemical methods. The staining intensity and patterns were evaluated and scored using a semi-quantitative method.

Results

The PTC with HT group was more likely to contain women and had less extrathyroid extension, lymph node (LN) metastasis, lymphovascular invasion, and recurrence than the PTC without HT group. Patients positive for P2X7R had significantly higher frequencies of lymphovascular invasion, extrathyroid extension, LN metastasis, and absence of HT. As shown by multivariate analysis, the expression of P2X7R was significantly higher if HT was absent and extrathyroid extension was present. In the PTC with HT group, the expression of P2X7R was significantly higher in patients with tumor multifocality, lymphovascular invasion, and extrathyroid extension. In the PTC without HT group, the expression of P2X7R was significantly higher in women and those having tumor multifocality.

Conclusions

Coexistence of PTC with HT is associated with good prognostic factors, and P2X7R expression in PTC was correlated with poor prognostic factors and the absence of HT.

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    Yiqing Tang, Cuicui Qiao, Qianqian Li, Xiaodi Zhu, Ronglan Zhao, Xiaoxiang Peng
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    Abdel Mouhaymen Missaoui, Fatma Hamza, Wafa Belabed, Manel Mellouli, Mohamed Maaloul, Slim Charfi, Issam Jardak, Tahya Sellami-Boudawara, Nabila Rekik, Mohamed Abid
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    Manping Guo, Qingna Li, Xingfang Liu, Yiming Wang, Qiaoning Yang, Rui Li, Yang Zhao, Chenfei Li, Song Sheng, Hangkun Ma, Zhenghong Li, Rui Gao
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    Qizhi Tang, Weiyu Pan, Liangyue Peng, Francis Moore
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  • Hashimoto’s Thyroiditis Minimizes Lymph Node Metastasis in BRAF Mutant Papillary Thyroid Carcinomas
    Peter P. Issa, Mahmoud Omar, Yusef Buti, Chad P. Issa, Bert Chabot, Christopher J. Carnabatu, Ruhul Munshi, Mohammad Hussein, Mohamed Aboueisha, Mohamed Shama, Ralph L. Corsetti, Eman Toraih, Emad Kandil
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    Servet KOCAÖZ, Gülay TURAN
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    Azadeh A. Carr, Tina W.F. Yen, Diana I. Ortiz, Bryan C. Hunt, Gilbert Fareau, Becky L. Massey, Bruce H. Campbell, Kara L. Doffek, Douglas B. Evans, Tracy S. Wang
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    F Di Virgilio, E Adinolfi
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    Paola de Andrade Mello, Robson Coutinho-Silva, Luiz Eduardo Baggio Savio
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Cytological Findings of the Micropapillary Variant of Urothelial Carcinoma: A Comparison with Typical High-Grade Urothelial Carcinoma
Kyu-Ho Kim, Chang-Hwan Choi, Jee-Young Han, Lucia Kim, Suk-Jin Choi, In-Suh Park, Joon-Mee Kim, Young-Chae Chu
Korean J Pathol. 2013;47(4):365-371.   Published online August 26, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.4.365
  • 8,524 View
  • 53 Download
  • 4 Crossref
AbstractAbstract PDF
Background

Micropapillary variant of urothelial carcinoma (MPUC) showed distinct pathologic features and aggressive behavior. The cytologic findings of MPUC are still indistinct. In this study, we evaluated the cytological findings of MPUC compared with those of high-grade urothelial carcinoma (HGUC).

Methods

The voided urine cytology of 8 cases of MPUC and 8 cases of HGUC was reviewed. Following cytological parameters were evaluated: cellularity, background, number of small, tight papillary clusters, small acinar structure, scattered single cells, cytoplasmic features, nuclear-to-cytoplasmic ratio, nuclear pleomorphism, nuclear membrane irregularity, hyperchromasia, chromatin pattern and nucleoli.

Results

Compared to that of HGUC, cytology of MPUC showed large numbers of small, tight papillary clusters, small acinar structure, few numbers of single cells, and hyperchromatic nuclei. Other parameters were similar between the two groups; both groups showed similar cellularity, dense or vacuolated cytoplasm, moderate to severe nuclear pleomorphism, irregular nuclear membrane, coarse granular chromatin, and small and prominent nucleoli.

Conclusions

The urine cytology of MPUCs showed smaller and tighter papillary cell clusters, more small acinar structures, fewer numbers of scattered single cells, and more hyperchromatic nuclei than that of HGUC. These features can help to distinguish MPUC and HGUC and offer an early cytological diagnosis of MPUC.

Citations

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  • Cytologic features of micropapillary variant urothelial carcinoma in urinary tract cytology: Case series and review of literature
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Case Studies
A Case of Multifocal Papillary Thyroid Carcinoma Consisting of One Encapsulated Follicular Variant with BRAF K601E Mutation and Three Conventional Types with BRAF V600E Mutation
Wook Youn Kim, Young Sin Ko, Tae Sook Hwang, Hye Seung Han, So Dug Lim, Wan Seop Kim, Seo Young Oh
Korean J Pathol. 2013;47(3):293-298.   Published online June 25, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.3.293
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AbstractAbstract PDF

Multifocal papillary thyroid carcinoma (mPTC) comprises about 20-30% of PTC. In mPTC, individual tumor foci can be identical or frequently composed of different histological types including follicular, solid, tall-cell or conventional patterns. We report a case of mPTC consisting of one encapsulated follicular variant of papillary thyroid carcinoma (FVPTC) and three conventional PTCs in a 44-year-old woman. This case genetically demonstrates unique features including the simultaneous presence of the BRAF V600E (T1799A) mutation and the BRAF K601E (A1801G) mutation in conventional PTC and FVPTC, respectively.

Citations

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    Antonio Matrone, Fabrizia Citro, Carla Gambale, Alessandro Prete, Elisa Minaldi, Raffaele Ciampi, Teresa Ramone, Gabriele Materazzi, Liborio Torregrossa, Rossella Elisei
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  • BRAF gene: From human cancers to developmental syndromes
    Muhammad Ramzan Manwar Hussain, Mukhtiar Baig, Hussein Sheik Ali Mohamoud, Zaheer Ulhaq, Daniel C. Hoessli, Ghaidaa Siraj Khogeer, Ranem Radwan Al-Sayed, Jumana Yousuf Al-Aama
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  • Clinicopathological Features of Rare BRAF Mutations in Korean Thyroid Cancer Patients
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  • Recurrent Thyroid Papillary Carcinoma in Children Under Ten Years Old: Report of Two Cases and Literature Review
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  • Anaplastic Transformation of Papillary Thyroid Carcinoma in a Young Man: A Case Study with Immunohistochemical andBRAFAnalysis
    Ji Hye Park, Hyeong Ju Kwon, Cheong Soo Park, SoonWon Hong
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Papillary Carcinoma of the Thyroid Gland with Nodular Fasciitis-like Stroma
Ki Yong Na, Hyun-Soo Kim, Ji-Youn Sung, Won Seo Park, Youn Wha Kim
Korean J Pathol. 2013;47(2):167-171.   Published online April 24, 2013
DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.2.167
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AbstractAbstract PDF

Papillary thyroid carcinoma with nodular fasciitis-like stroma (PTC-NFS) is a rare variant of PTC. The term 'PTC with fibromatosis-like stroma' has been used as a synonym to describe this variant. It is characterized by extensive proliferation of fibroblasts and myofibroblasts in the tumor stroma, which occurs in up to 80% of the tumors. We herein describe a case of PTC-NFS which developed in a 49-year-old woman with the demonstration of findings of ultrasonography, fine needle aspiration cytology and histological examination of the lesion. To characterize the stromal components, we investigated the expression of several immunohistochemical markers which have been shown to be expressed differently in nodular fasciitis (NF) and fibromatosis (FM). The immunostaining results demonstrated nuclear and cytoplasmic accumulation of β-catenin, cytoplasmic transforming growth factor-β expression and nuclear Smad expression in the stromal cells, suggesting that the stromal cells in this case have similar molecular profiles to those of FM rather than NF.

Citations

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  • Papillary thyroid carcinoma with nodular fasciitis-like stroma: An intriguing encounter
    Pranjal Kalita, Biswajit Dey, Vandana Raphael, Gauranga Handique, Sungjemla Longkumer, Nikhil Choudhary
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    Haining Huang, Lei Li, Xiaolong Liu, Lihua Zhao, Zhihong Cui, Renya Zhang, Shuai Chen
    Human Pathology.2023; 136: 84.     CrossRef
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    Abdallah Roukain, Stefano La Rosa, Massimo Bongiovanni, Marie Nicod Lalonde, Valérie Cristina, Michael Montemurro, Stephane Cochet, Alexandra Luquain, Peter A. Kopp, Gerasimos P. Sykiotis
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    Caterina Rebecchini, Antoine Nobile, Simonetta Piana, Rossella Sarro, Bettina Bisig, Sykiotis P Gerasimos, Chiara Saglietti, Maurice Matter, Laura Marino, Massimo Bongiovanni
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    Sahar Aly Daoud, Reham Shehab El Nemr Esmail, Amal Ahmed Hareedy, Abdullah Khalil
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    Paula S. Ginter, Theresa Scognamiglio
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Original Articles
The Definition of Minimal Extrathyroid Extension in Thyroid Pathology by Analyzing Sizable Intra- and Extrathyroid Blood Vessels
Hyae Min Jeon, Beom Jin Lim, Hang-Seok Chang, SoonWon Hong
Korean J Pathol. 2012;46(6):548-553.   Published online December 26, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.6.548
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AbstractAbstract PDF
Background

To define the exact boundary of the intrathyroid and extrathyroid aspects of a gland when determining the extent of cancer invasion, we plan to clarify the definition of sizable vascular structures, which is one of the helpful histologic clues in determining a minimal extrathyroid extension. We hypothesized that arterial wall thicknesses in extrathyroid soft tissue would be significantly different from the arteries in the thyroid parenchyma.

Methods

Twenty cases of papillary carcinoma were selected. The numbers and wall thicknesses of the arteries and arterioles in intrathyroid and extrathyroid tissue were evaluated. The absence of nerve tissue in the thyroid gland was confirmed using the S-100 protein immunohistochemical stain.

Results

The comparison of the mean thicknesses of the total arteries between the extrathyroid and intrathyroid tissues in the retrospective study (26.88 µm vs. 15.07 µm, respectively) and the prospective study (35.24 µm vs. 16.52 µm, respectively) revealed significant differences (p=0.000). The greatest thickness of the intrathyroid arteries was 67.93 µm.

Conclusions

According to our results, the study showed that the extrathyroidal arteries were significantly thicker than the intrathyroidal arteries. We suggest that the sizable blood vessels of extrathyroidal arteries should be greater than 67.93 µm in thickness.

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Clear Cell Papillary Renal Cell Carcinoma: A Report of 15 Cases Including Three Cases of Concurrent Other-Type Renal Cell Carcinomas
Jeong Hwan Park, Cheol Lee, Ja Hee Suh, Kyung Chul Moon
Korean J Pathol. 2012;46(6):541-547.   Published online December 26, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.6.541
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AbstractAbstract PDF
Background

Clear cell papillary renal cell carcinoma (CCPRCC) is a recently established subtype of renal epithelial tumor. The aim of this study was to identify the diagnostic criteria of CCPRCC with an emphasis on immunohistochemical studies, and to report three cases with concurrent other-type renal cell carcinoma (RCC).

Methods

A total of 515 RCC patients that consecutively underwent surgical resection at Seoul National University Hospital from 1 January 2010 to 31 December 2011 were screened. Each case was reviewed based on the histologic features and was evaluated immunohistochemically.

Results

A total of 15 CCPRCCs were identified, which composed 2.9% of the total RCCs. The mean age was 52 years, and the average tumor size was 1.65 cm. All 15 cases showed low nuclear grade, no lymph node metastasis and no distant metastasis. The CCPRCCs showed variable architectural patterns including cystic, trabecular, papillary, and acinar. All of the cases showed moderate to intense immunoreactivity for cytokeratin 7 (CK7). CD10 was negative or showed focal weak positivity. Three cases had concurrent other-type RCC, including a clear cell RCC and an acquired cystic disease-associated RCC.

Conclusions

The strong CK7 and negative or focal weak CD10 expression will be useful for the diagnosis of CCPRCC.

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Case Reports
Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology Diagnosis of Solid Pseudopapillary Neoplasm: Three Case Reports with Review of Literature
Joon Seon Song, Chong Woo Yoo, Youngmee Kwon, Eun Kyung Hong
Korean J Pathol. 2012;46(4):399-406.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.399
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AbstractAbstract PDF

Solid pseudopapillary neoplasm of the pancreas (SPN) is relatively rare and it occurs almost exclusively in women. We recently experienced three cases of SPN diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). These three cases were two male and one female patient whose age was 29, 37, and 44 years old. Radiological diagnosis was pancreatic endocrine tumor (PEN) showing solid with a heterogenous echogenicity. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores. In conclusion, a single diagnosis of SPN based on clinical and radiological findings would be risky because there is a possibility of it being misdiagnosed as PEN or other malignancies. An EUS-FNA is therefore essential for establishing the diagnosis. In addition, the pathologists should recognize the characteristic cytologic findings with immunoprofiles of SPN to prevent misdiagnosis of SPN.

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Multifocal Renal Cell Carcinoma of Different Histological Subtypes in Autosomal Dominant Polycystic Kidney Disease
Ki Yong Na, Hyun-Soo Kim, Yong-Koo Park, Sung-Goo Chang, Youn Wha Kim
Korean J Pathol. 2012;46(4):382-386.   Published online August 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.4.382
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  • 13 Crossref
AbstractAbstract PDF

Renal cell carcinoma (RCC) in autosomal dominant polycystic kidney (ADPKD) is rare. To date, 54 cases of RCC in ADPKD have been reported. Among these, only 2 cases have different histologic types of RCC. Here we describe a 45-year-old man who received radical nephrectomy for multifocal RCC with synchronous papillary and clear cell histology in ADPKD and chronic renal failure under regular hemodialysis. The case reported herein is another example of the rare pathological finding of RCC arising in a patient with ADPKD.

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  • Autosomal Dominant Polycystic Kidney Disease-Related Multifocal Renal Cell Carcinoma: A Narrative Iconographic Review
    Consolato M. Sergi, Luis Guerra, Josef Hager
    International Journal of Molecular Sciences.2025; 26(9): 3965.     CrossRef
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    Poorva Vias, Shikha Goyal, Renu Madan, Nandita Kakkar, Ridhi Sood, Kannan Periasamy, Rajender Kumar
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    Petronella Orosz, Zita Kollák, Ákos Pethő, András Fogarasi, György Reusz, Kinga Hadzsiev, Tamás Szabó
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    Yuji Hakozaki, Kiyotaka Uchiyama, Akane Yanai, Daisuke Yamada, Yuka Kamijo, Yoshitaka Ishibashi
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    Mahmoud Abbas, Melanie Pätzel, Angelika Thurn, Olaf Brinkmann, Olaf Bettendorf
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    Hyuk Huh, Hyung Ah Jo, YongJin Yi, Seung Hyup Kim, Kyung Chul Moon, Curie Ahn, Hayne Cho Park
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    Chase C. Hansen, Michael Derrick, Irfan Warriach, James Thomas Cammack, James Thomas Cammack, Werner de Riese
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    Metka Volavšek, Margareta Strojan-Fležar, Gregor Mikuz
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Papillary Carcinoma of Thyroid Metastatic to Adenocarcinoma In Situ of Lung: Report of an Unusual Case
Kyoung Min Kim, Yo Na Kim, Hyun Hee Chu, Heung Yong Jin, Min Ho Kim, Myoung Ja Chung
Korean J Pathol. 2012;46(3):282-286.   Published online June 22, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.3.282
  • 9,477 View
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AbstractAbstract PDF

The tumor-to-tumor metastasis is a rare event. The lung tumors are the most common donor tumors in tumor-to-tumor metastasis, but are exceedingly rare as a recipient. Here, we report a case of papillary thyroid carcinoma (PTC) metastasizing to adenocarcinoma in situ (AIS, formerly bronchioloalveolar carcinoma) of the lung in a 44-year-old woman who underwent total thyroidectomy for PTC 8 years ago. To the best of our knowledge, the present case is the first case reporting on PTC metastasized to AIS. A review of the relevant literature is presented.

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    Yasushi Cho, Mitsuhito Kaji, Shunsuke Nomura, Yusuke Motohashi, Masaaki Sato, Motoya Takeuchi
    The Journal of the Japanese Association for Chest Surgery.2021; 35(5): 576.     CrossRef
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    Myoung Jae Kang, Ae Ri An, Myoung Ja Chung, Kyoung Min Kim
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  • Metastatic Renal Cell Neoplasm Within a Papillary Thyroid Carcinoma as Incidental Finding in an Asymptomatic Patient: a Case Report
    Maria-Rosa Bella-Cueto, Mireia Pascua-Solé, Albert Cano-Palomares, M. Àngels Cabezuelo-Hernandez, Maria-Rosa Escoda-Giralt, Santiago Barcons-Vilaplana, Paula Serret-Miralles, Carmen Caral-Vanaclocha, Xavier Guirao-Garriga, Joan Prats-Lopez, Meritxell Meda
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  • A Rare Case of Tumor-to-Tumor Metastasis of Thyroid Papillary Carcinoma within a Pulmonary Adenocarcinoma
    Taebum Lee, Yoon Jin Cha, Sangjeong Ahn, Joungho Han, Young Mog Shim
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  • Tumour-to-tumour metastasis from papillary thyroid carcinoma withBRAFmutation to lung adenocarcinoma withEGFRmutation: the utility of mutation-specific antibodies
    Yuki Katsuya, Akihiko Yoshida, Shun-ichi Watanabe, Koji Tsuta
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Original Articles
Detection of BRAFV600E Mutations in Papillary Thyroid Carcinomas by Peptide Nucleic Acid Clamp Real-Time PCR: A Comparison with Direct Sequencing
Dongjun Jeong, Yujun Jeong, Sungche Lee, Hyeran Lee, Wanju Lee, Hyungjoo Kim, Doosan Park, Soyoung Park, Wenxia Mu, Hyun-Deuk Cho, Mee-Hye Oh, Sung Soo Lee, Seung-Ha Yang, Chang-Jin Kim
Korean J Pathol. 2012;46(1):61-67.   Published online February 23, 2012
DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.1.61
  • 14,307 View
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  • 19 Crossref
AbstractAbstract PDF
Background

Papillary thyroid carcinoma (PTC) of the thyroid is the most common endocrine malignancy. High prevalence of an activating point mutation of BRAF gene, BRAFV600E, has been reported in PTC. We assessed the efficiency of peptide nucleic acid clamp real-time polymerase chain reaction (PNAcqPCR) for the detection of BRAFV600E mutation in PTC in comparison with direct sequencing (DS).

Methods

A total of 265 thyroid lesions including 200 PTCs, 5 follicular carcinomas, 60 benign lesions and 10 normal thyroid tissues were tested for BRAFV600E mutation by PNAcqPCR and DS.

Results

The sensitivity and accuracy of the PNAcqPCR method were both higher than those of DS for the detection of the BRAFV600E mutation. In clinical samples, 89% of PTCs harbored the BRAFV600E mutation, whereas 5 follicular carcinomas, 50 benign lesions and 10 normal thyroid tissues lacked the mutation. The mutation was associated with aggressive clinical behaviors as extrathyroid invasion (p=0.015), lymph node metastasis (p=0.002) and multiple tumor numbers (p=0.016) with statistical significance.

Conclusions

The PNAcqPCR method is efficiently applicable for the detection of the BRAFV600E mutation in PTCs in a clinical setting.

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  • Recurrent Thyroid Papillary Carcinoma in Children Under Ten Years Old: Report of Two Cases and Literature Review
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Fine Needle Aspiration Cytology of Solid and papillary Neoplasm of the Pancreas: Report of a Case.
Mee Yon Cho, Kwang Gil Lee, Kyi Beom Lee, Hyeun Joo Jeong, Woo Hee Jung
J Pathol Transl Med. 1990;1(1):85-92.
  • 1,875 View
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AbstractAbstract PDF
We present the cytologic features of a case of solid and papillary neoplasm of the pancreas. Cytologically, the tumor was composed of a monotonous population of polygonal cells containing ecentrically located round nuclei with one or two distinct small nucleoli and a finely stippled chromatin pattern. The tumor cells were similar to those of the islet cell tumor and showed isolated loosety aggregated and solid sheedts or large cell clumps. The large cell clumps revealed a branching papillary structure containing fibrovascular central core, which is characteristic histologic feature of solid and papillary neoplasm of the pancreas. The case was confirmed by tissue examination including histochemical immunohistochemical and electron microscopical studies. Utrastructurally, the tumor cells contanined a few membrane-bound electron dense granules.
Case Reports
Simultaneous Pancreatic Serous Microcystic Adenoma and Intraductal Papillary Mucinous Tumor of the Pancreas: A Case Report.
Hyoung Jong Kwak, Young Kon Kim, Baik Hwan Cho, Woo Sung Moon
Korean J Pathol. 2011;45:S29-S31.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S29
  • 3,587 View
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AbstractAbstract PDF
Serous cystadenomas of the pancreas account for approximately a third of pancreatic cystic neoplasms. Their coexistence with a second tumor is extremely rare. We now report a case of a serous microcystic adenoma combined with an intraductal papillary mucinous tumor of the pancreas in a 69-year-old man. Abdominal computed tomography scans demonstrated an incidental cystic mass in the body with cystic dilatation of the duct in the head of the pancreas. Central pancreatectomy with pancreatico-jejunostomy, and cyst excision of the pancreatic head were performed. Histologic examination demonstrated a serous microcystic cystadenoma in the body coexisting with an intraductal papillary mucinous adenoma in the head of the pancreas. This case study highlights the importance of careful intra-operative and pathologic examination for synchronous pancreatic tumors.
A Cutaneous Myoepithelial Carcinoma Arising in a Papillary Eccrine Adenoma.
Ji Han Jung, Soyoung Im, Seok Jin Kang, Gyong Moon Kim, Ki Taik Han, Jin Young Yoo, Chang Suk Kang
Korean J Pathol. 2011;45(6):644-649.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.644
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AbstractAbstract PDF
Cutaneous myoepithelial neoplasms and papillary eccrine adenomas (PEA) are rare conditions. Malignant tumors within a PEA are even rarer, with only one case reported to date. Herein, we present an extremely rare case of a cutaneous myoepithelial carcinoma arising in a PEA in a 70-year-old man presenting a solid mass in the left buttock. Histopathologically, most of the resected tumor revealed features consistent with the diagnosis of PEA. Some small nests and nodules were intermixed with the PEA and were present adjacent to the PEA. The tumor cells of nests and nodules showed ovoid to spindle shaped nuclei and slightly eosinophilic cytoplasm. Immunohistochemically, they were positive for both epithelial and myogenic markers, consistent with myoepithelioma. An inguinal lymph node with a metastatic lesion showed the same findings of myoepithelioma despite inconspicuous atypia. Our case showed malignant transformation of the myoepithelial cells at the outermost layers of the PEA.

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  • TRPS1::PLAG1 Fusion in a Primary Cutaneous Myoepithelial Carcinoma: A Case Report and Literature Review
    Timber Gillis, Jenika Howell, Fatemeh Jafarian
    Journal of Cutaneous Pathology.2026; 53(2): 169.     CrossRef
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Original Articles
CD56 and High Molecular Weight Cytokeratin as Diagnostic Markers of Papillary Thyroid Carcinoma.
Mi Kyung Shin, Jeong Won Kim, Young Su Ju
Korean J Pathol. 2011;45(5):477-484.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.5.477
  • 6,304 View
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  • 10 Crossref
AbstractAbstract PDF
BACKGROUND
The incidence of papillary thyroid carcinoma (PTC) has been increasing recently and a precise diagnosis is essential for optimal treatment. Ancillary immunohistochemical stains are important for diagnosing some difficult cases.
METHODS
The dignostic value of CD56, high molecular weight cytokeratin (HMCK), galectin-3 (GAL3), and cytokeratin 19 (CK19) were evaluated to distinguish PTC from other benign thyroid lesions (BTL). We studied 23 cases of papillary thyroid overt carcinomas, 57 papillary thyroid microcarcinomas, five follicular adenomas, five cases of Hashimoto's thyroiditis, and 12 nodular hyperplasias.
RESULTS
The statistical analysis showed significantly different expressions of CD56, HMCK, GAL3, and CK19 in PTC vs other BTL. The diagnostic specificity of HMCK and CD56 (90.9% and 72.7%, respectively) was higher than that of GAL3 and CK19 (50.0% and 36.4%, respectively). However, the sensitivity of HMCK and CD56 detection (92.5% and 95.0%, respectively) was lower than that of GAL3 and CK19 (98.8% and 100.0%, respectively). The combined use of CD56, HMCK, GAL3, and CK19 showed 87.5% sensitivity, 100.0% specificity, and 100.0% positive predictive value in differentiating PTC from other BTL.
CONCLUSIONS
Although the differential diagnosis of thyroid follicular lesions are based on histological and cytomorphological criteria, CD56 and HMCK might be useful markers for diagnosing PTC.

Citations

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  • Diagnostic role of immunohistochemical markers CK19 and CD56 in thyroid neoplasms
    Pallavi Priyadarshini, Manoj Kumar Patro, Prasanta Kumar Das
    MGM Journal of Medical Sciences.2023; 10(2): 176.     CrossRef
  • CD56 Expression in Papillary Thyroid Carcinoma Is Highly Dependent on the Histologic Subtype: A Potential Diagnostic Pitfall
    Uiju Cho, Yourha Kim, Sora Jeon, Chan Kwon Jung
    Applied Immunohistochemistry & Molecular Morphology.2022; 30(5): 389.     CrossRef
  • CD-56 IMMUNOREACTIVITY IN FOLLICULAR CELL DERIVED LESIONS OF THYROID
    Elvin Merin Cherian, Priya P. V, Sankar S
    Journal of Evolution of Medical and Dental Sciences.2018; 7(17): 2066.     CrossRef
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    Nehal S. Abouhashem, Suzan M. Talaat
    Pathology - Research and Practice.2017; 213(5): 509.     CrossRef
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    Maha E. Salama, Wael S. Ibrahim
    Egyptian Journal of Pathology.2016; 36(1): 39.     CrossRef
  • CD56, HBME-1 and cytokeratin 19 expressions in papillary thyroid carcinoma and nodular thyroid lesions
    Senay Erdogan-Durmus, Deniz Ozcan, Enver Yarikkaya, Ali Kurt, Aynur Arslan
    Journal of Research in Medical Sciences.2016;[Epub]     CrossRef
  • Defining the value of CD56, CK19, Galectin 3 and HBME-1 in diagnosis of follicular cell derived lesions of thyroid with systematic review of literature
    Duško Dunđerović, Jasmina Marković Lipkovski, Ivan Boričic, Ivan Soldatović, Vesna Božic, Dubravka Cvejić, Svetislav Tatić
    Diagnostic Pathology.2015;[Epub]     CrossRef
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    HananAlSaeid Alshenawy
    Journal of Microscopy and Ultrastructure.2014; 2(3): 127.     CrossRef
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    Hanan AlSaeid Alshenawy
    Pathology & Oncology Research.2014; 20(4): 819.     CrossRef
  • Potential diagnostic utility of CD56 and claudin-1 in papillary thyroid carcinoma and solitary follicular thyroid nodules
    Rasha M. Abd El Atti, Lobna S. Shash
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Cancer Subtypes of Breast Carcinoma with Micropapillary and Mucinous Component Based on Immunohistochemical Profile.
Sun Young Min, Eun Jung Jung, Hyesil Seol, In Ae Park
Korean J Pathol. 2011;45(2):125-131.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.2.125
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AbstractAbstract PDF
BACKGROUND
Micropapillary carcinoma (MPC) is known to have a worse prognosis than the other subtypes of breast cancer. Occasionally, MPC is observed in association with invasive ductal carcinoma not otherwise specified (IDC NOS), as well as mucinous carcinoma.
METHODS
We examined the immunohistochemical expression of an estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) in 127 cases of surgically resected MPC or IDC NOS with MPC. Further, we classified these cases based on their immunohistochemical profile.
RESULTS
Among the IDC NOS with MPC cases, 47 were luminal A (62.7%), 10 were luminal B (13.3%), and 9 were HER2 (12.0%). The MPC cases included 4 luminal A (50.0%), 2 luminal B (25.0%) and 1 HER2 (12.5%) subtypes. Of the mucinous carcinomas with MPC, 4 were grouped as luminal A (57.1%), 1 as luminal B (14.3%), and 2 as HER2 (28.6%) subtypes. However, among the mucinous carcinomas, 33 were categorized as luminal A (89.2%), 3 as luminal B (8.1%), and 1 as HER2 (2.7%) subtype, indicating a low incidence of HER2 subtype as compared to the other subtypes.
CONCLUSIONS
The luminal B and HER2 subtypes were prevalent in carcinomas with MPC. This result explains the poor prognosis of breast carcinomas with an MPC pattern.

Citations

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  • Investigation of Clinical Histopathologic Features and Metabolic Parameters of 18F-FDG PET/CT in Invasive Breast Carcinoma with a Micropapillary Component
    Elife Akgün, Göksel Alçın, Esra Canan Kelten Talu, Tevfik Fikret Çermik, Tuçe Söylemez Akkurt, Ebru Şen, Esra Arslan
    Molecular Imaging and Radionuclide Therapy.2023; 32(3): 221.     CrossRef
  • Micropapillary Breast Carcinoma: From Molecular Pathogenesis to Prognosis
    Georgios-Ioannis Verras, Levan Tchabashvili, Francesk Mulita, Ioanna Maria Grypari, Sofia Sourouni, Evangelia Panagodimou, Maria-Ioanna Argentou
    Breast Cancer: Targets and Therapy.2022; Volume 14: 41.     CrossRef
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    Katrina Collins, Andrew Ricci
    The Breast Journal.2018; 24(3): 339.     CrossRef
  • Prognostic Significance of a Micropapillary Pattern in Pure Mucinous Carcinoma of the Breast: Comparative Analysis with Micropapillary Carcinoma
    Hyun-Jung Kim, Kyeongmee Park, Jung Yeon Kim, Guhyun Kang, Geumhee Gwak, Inseok Park
    Journal of Pathology and Translational Medicine.2017; 51(4): 403.     CrossRef
Effect of Selective Cyclooxygenase 2 Inhibitor in TCDD Pre-exposed Thyroid Papillary Carcinoma Cell Line.
Hae Sung Kim, Kwang Sung Ahn, Jeong Hyeon Lee, Yang Seok Chae, Nam Hee Won, Jong Sang Choi, Chul Hwan Kim
Korean J Pathol. 2011;45(1):1-8.
DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.1.1
  • 4,288 View
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AbstractAbstract PDF
BACKGROUND
Cyclooxygenase 2 (COX-2) is related to carcinogenesis and progression of cancer. COX-2 has been detected in thyroid cancer. This suggests that COX-2 inhibitor may be useful to control the growth of thyroid cancer cells as well as the progression of thyroid cancer. Tetrachlorodibenzodioxin (TCDD), acting as an inflammatory cytokine, directly induces the expression of COX-2. We examine whether TCDD controls the effect of COX-2 inhibitor on thyroid cancer cells.
METHODS
The effects of TCDD and celecoxib on thyroid papillary carcinoma cell line (SNU790) were examined using cell proliferation and fluorescence-activated cell sorting analysis. Western blot analysis was performed to determine the expressed COX-2 levels and the cell cycle-related proteins. The matrix metalloproteinase-2 (MMP-2) expression and gelatinolytic activity were examined using real time-polymerase chain reaction and zymography.
RESULTS
TCDD directly induced the growth of SNU790 and the expression of cyclin D1, cyclin A, cyclin E, p21 and COX-2. Celecoxib suppressed the growth of SNU790 and the expression of cyclin D1 and cyclin E. Celecoxib reduced the MMP-2 expression and the gelatinolytic activity, but those effects were decreased in the SNU790 by either pre-treatment with TCDD or co-treatment with TCDD and celecoxib.
CONCLUSIONS
Celocoxib effect is directly reduced depending on the exposure to TCDD. TCDD exposure should be considered in the treatment with Celecoxib.

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  • Histone H3 phosphorylation, immediate-early gene expression, and the nucleosomal response: a historical perspective1This article is part of Special Issue entitled Asilomar Chromatin and has undergone the Journal’s usual peer review process.
    Shannon Healy, Protiti Khan, Shihua He, James R. Davie
    Biochemistry and Cell Biology.2012; 90(1): 39.     CrossRef
The Frequency of BRAF Mutation in Very Small Papillary Thyroid Carcinomas.
Taeeun Kim, Ji Hyun Roh, Hee Jung Park, Jee Eun Kwon, So Young Kang, Yoon La Choi, Young Lyun Oh
Korean J Pathol. 2010;44(3):308-314.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.3.308
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AbstractAbstract PDF
BACKGROUND
Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the thyroid and BRAF (V600E) is the most frequent genetic alteration in PTCs. The aim of this study was to investigate the frequency of BRAF mutation, especially in very small PTCs.
METHODS
We analyzed the presence of the BRAF mutation in PTCs in subgroups defined by tumor size (0.5 cm intervals).
RESULTS
Of 140 patients, 85 (60.7%) showed a BRAF mutation. The frequency of BRAF mutation in the subgroup was: 45/70 (64.3%) in tumors less than 0.5 cm in size, 18/28 (64.3%) in 0.6-1 cm tumors, 10/22 (45.5%) in 1.1-1.5 cm tumors, and 12/20 (60.0%) in 1.6-2 cm tumors. There was no statistically significant association between BRAF mutation and tumor size (p = 0.44). Similarly, BRAF mutation was not statistically related to age, sex, stage, perithyroidal extension or lymph node metastasis. On multivariate logistic regression analysis, tumor sizes larger than 0.5 cm were associated with lymph node metastasis (odds ratio, 3.79; 95% confidence interval, 1.81 to 7.91; p < 0.01).
CONCLUSIONS
The BRAF mutation is not related to tumor size even in very small PTCs. The similar frequency of BRAF mutation in very small PTCs suggests that the BRAF mutation is a very early event in the tumorigenesis of PTCs.

Citations

Citations to this article as recorded by  
  • BRAF mutation detection in indeterminate thyroid cytology specimens
    N. Paul Ohori, Rashi Singhal, Marina N. Nikiforova, Linwah Yip, Karen E. Schoedel, Christopher Coyne, Kelly L. McCoy, Shane O. LeBeau, Steven P. Hodak, Sally E. Carty, Yuri E. Nikiforov
    Cancer Cytopathology.2013; 121(4): 197.     CrossRef
  • BRAFV600E mutation does not serve as a prognostic factor in Korean patients with papillary thyroid carcinoma
    Dongbin Ahn, June Sik Park, Jin Ho Sohn, Jae Hyug Kim, Sun-Kyun Park, An Na Seo, Ji Young Park
    Auris Nasus Larynx.2012; 39(2): 198.     CrossRef
  • Mutational Patterns and Novel Mutations of the BRAF Gene in a Large Cohort of Korean Patients with Papillary Thyroid Carcinoma
    Chan-Kwon Jung, So-Young Im, Yeo-Ju Kang, Hyoungnam Lee, Eun-Sun Jung, Chang-Suk Kang, Ja-Seong Bae, Yeong-Jin Choi
    Thyroid.2012; 22(8): 791.     CrossRef
Microvessel and Lymphatic Vessel Density and VEGFR-3 Expression of Papillary Thyroid Carcinoma with Comparative Analysis of Clinicopathological Characteristics.
Harin Cheong, Hanna Kang, Hyung Kyung Kim, Ji Yoon Bae, Dong Eun Song, Min Sun Cho, Sun Hee Sung, Woon Sup Han, Heasoo Koo
Korean J Pathol. 2010;44(3):243-251.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.3.243
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AbstractAbstract PDF
BACKGROUND
This study was done to see if there were correlations between anatomic and molecular parameters such as microvessel density (MVD), lymphatic vessel density (LVD), and vascular endothelial growth factor receptor (VEGFR)-3 expression and various clinical parameters for papillary thyroid carcinomas of size > 1.0 cm (PTCs) and size < or = 1.0 cm (papillary thyroid microcarcinomas, PTMCs). PTMCs were divided into two subgroups (0-5 mm and 6-10 mm).
METHODS
We analyzed 197 thyroid carcinomas including 113 PTCs and 84 PTMCs. Tissue samples form 30 patients from each group matched for clinical characteristics were selected for immunostaining.
RESULTS
Although PTCs and PTMCs showed significant differences in clinical characteristics, they did not show significant difference in MVD, LVD, or VEGFR-3 expression. There was a significantly higher LVD in the PTMC subgroup with the larger tumors but no difference in clinical characteristics. LVD was higher in patients > 45 years old (more apparent in the PTC group) and LVD had suggestive correlations with multicentricity and extrathyroidal extension depending on analytic conditions.
CONCLUSIONS
Since LVD showed variable correlations with clinical variables for papillary carcinoma of the thyroid depending on analytic conditions, the individually planned treatments based on overall clinicopathological factors are advised.

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  • Freeze-dried bovine amniotic membrane as a cell delivery scaffold in a porcine model of radiation-induced chronic wounds
    Daemyung Oh, Daegu Son, Jinhee Kim, Sun-Young Kwon
    Archives of Plastic Surgery.2021; 48(4): 448.     CrossRef
  • Polydeoxyribonucleotide Improves Peripheral Tissue Oxygenation and Accelerates Angiogenesis in Diabetic Foot Ulcers
    Seoyoung Kim, Junhyung Kim, Jaehoon Choi, Woonhyeok Jeong, Sunyoung Kwon
    Archives of Plastic Surgery.2017; 44(06): 482.     CrossRef
Case Report
Intraductal Papillary Mucinous Tumor Simultaneously Involving the Liver and Pancreas: A Case Report.
Bong Hee Park, Jae Hee Suh, Hee Jeong Cha, Young Min Kim, Hye Jeong Choi
Korean J Pathol. 2010;44(1):83-86.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.83
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AbstractAbstract PDF
We describe here a 67-year-old man who was diagnosed with a rare case of intraductal papillary mucinous tumors that occurred simultaneously in the liver and pancreas. Abdominal computed tomography showed a tubular and cystic dilatation of the pancreatic duct in the pancreas tail, which suggested an intraductal papillary mucinous tumor (IPMT), and multiple intrahepatic duct stones. The patient underwent a distal pancreatectomy with splenectomy and a lateral segmentectomy of the liver. Microscopic examination showed an intraductal papillary mucinous neoplasms of borderline malignancy in the pancreas and a non-invasive intraductal papillary mucinous tumor with moderate dysplasia of the bile duct. Although several cases of intraductal papillary mucinous neoplasm of the liver (IPNL) without any pancreatic association have been described, the simultaneous presentation of both IPMT of the pancreas and IPNL is very rare. The patient has been doing well for 10 months postoperatively.

Citations

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  • Surgical resection for simultaneous intraductal papillary mucinous neoplasm of the bile duct and pancreatic duct: A case report
    Xiao-Rui Huang, Deng-Sheng Zhu, Ya-Hong Yu
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • Reoperation for heterochronic intraductal papillary mucinous neoplasm of the pancreas after bile duct neoplasm resection: A case report
    Gang Xiao, Tao Xia, Yi-Ping Mou, Yu-Cheng Zhou
    World Journal of Gastrointestinal Surgery.2023; 15(7): 1542.     CrossRef
  • Intraductal papillary neoplasm of the bile duct: The new frontier of biliary pathology
    Federico Mocchegiani, Paolo Vincenzi, Grazia Conte, Daniele Nicolini, Roberta Rossi, Andrea Benedetti Cacciaguerra, Marco Vivarelli
    World Journal of Gastroenterology.2023; 29(38): 5361.     CrossRef
  • Multicentric recurrence of intraductal papillary neoplasm of bile duct after spontaneous detachment of primary tumor: A case report
    Hiroki Fukuya, Akifumi Kuwano, Shigehiro Nagasawa, Yusuke Morita, Kosuke Tanaka, Masayoshi Yada, Akihide Masumoto, Kenta Motomura
    World Journal of Clinical Cases.2022; 10(3): 1000.     CrossRef
  • Co-occurrence of IPMN and malignant IPNB complicated by a pancreatobiliary fistula: A case report and review of the literature
    Xu Ren, Chun-Lan Zhu, Xu-Fu Qin, Hong Jiang, Tian Xia, Yong-Ping Qu
    World Journal of Clinical Cases.2019; 7(1): 102.     CrossRef
  • Synchronous pancreatic adenocarcinoma and intrahepatic cholangiocarcinoma arising in the context of intraductal papillary neoplasms
    Anmol Bansal, Swan N. Thung, Hongfa Zhu, Myron Schwartz, Sara Lewis
    Clinical Imaging.2016; 40(5): 897.     CrossRef
Original Article
Availability of Immunohistochemistry in the Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma.
Ji Yun Jeong, Jung Sik Jang, Yoon Kyung Sohn, Jin Hyang Jung, Yi Kyeong Chun, Ji Young Park
Korean J Pathol. 2010;44(1):48-55.
DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.48
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AbstractAbstract PDF
BACKGROUND
Making the diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) is often difficult, and there are no accurate immunohistochemical or molecular markers. The purpose of this study is to evaluate performing immunohistochemistry to make the diagnosis of FVPTC.
METHODS
A total of 249 thyroid lesions were studied. We made the tissue microarray, and we assessed the expression of HBME-1, galectin-3, CD56, and p63.
RESULTS
Galectin-3, HBME-1, and p63 were positive in 79.7%, 79.7%, and 15.9% of the FVPTC, respectively. These immunohistochemical features of FVPTC were between those of classic papillary thyroid carcinoma (CPTC) and those of non-PTC. The CD56 expression was positive in 75.4% of the FVPTC, which is much higher than that of the CPTC (28.3%), and even higher than that of the non-PTC lesions (60%). Comparing FVPTC with CPTC, the expression of galectin-3 was significantly higher and the expression of CD56 was significantly lower in the CPTCs. Comparing the FVPTC with follicular carcinoma (FC), the expression of all the markers was significantly higher in the FVPTC. Comparing PTC with FC, the expression of CD56 was lower and the expressions of the other markers were higher in the PTCs.
CONCLUSIONS
Galectin-3, HBME-1, and p63 can help make the diagnosis of FVPTC, and a cocktail of these markers can be even more useful. But CD56 is not thought to be useful to make the diagnosis of FVPTC.

Citations

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  • A Case of Multifocal Papillary Thyroid Carcinoma Consisting of One Encapsulated Follicular Variant withBRAFK601E Mutation and Three Conventional Types withBRAFV600E Mutation
    Wook Youn Kim, Young Sin Ko, Tae Sook Hwang, Hye Seung Han, So Dug Lim, Wan Seop Kim, Seo Young Oh
    Korean Journal of Pathology.2013; 47(3): 293.     CrossRef
Case Report
Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura: A Case Report.
Han Suk Ryu, Min Sun Jin, Hee Seung Choi, HeeJong Baek, Jae Soo Koh
Korean J Pathol. 2009;43(6):583-588.
DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.583
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AbstractAbstract PDF
Well-differentiated papillary mesothelioma (WDPM) is a rare subtype of malignant mesothelioma, which is considered to have low malignant potential. Because of its rare occurrence in the pleura, cytopathologists are not familiar with the cytologic features of WDPM, and to date only one report regarding the cytomorphology of aspiration biopsies of WDPM in pleura has been released. The authors present the findings of fine needle aspiration cytology of WDPM in the pleura in a 53-year-old woman. Aspiration smears showed papillary clusters composed of one to three layers of surface tumor cells and a central hyalinized stromal core. Tumor cells were round, ovoid, and spindle like with minimally atypical nuclei and small conspicuous nucleoli. Mitotic activity was virtually absent. Excisional biopsy histologic and immunohistochemical findings were wholly compatible with WDPM findings. Knowledge of the specific cytologic findings of WDPM is crucial for accurate diagnosis and appropriate treatment.

Citations

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  • Well-Differentiated Papillary Mesothelioma of the Peritoneum
    Jitendra G. Nasit, Gauravi Dhruva
    American Journal of Clinical Pathology.2014; 142(2): 233.     CrossRef

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