Jayaraman MonishaRita, V Lakshmipriya, Harikrishnan Volga, Manian Sridevi
Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Pathology and Laboratory Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Cureus. 2024 May 28;16(5):e61267. doi: 10.7759/cureus.61267. eCollection 2024 May.
The hobnail variant of papillary thyroid carcinoma (HVPTC) represents a distinctive and relatively rare histological subtype of thyroid malignancies. This variant is characterized by its unique cellular morphology with a hobnail appearance, that is, cells with apically positioned nuclei. There are other characteristics like micropapillary pattern and loss of cohesiveness of cells, which are indicative of HVPTC. It can be difficult to distinguish this pattern from other thyroid neoplasms; thus, a thorough microscopical examination is required. Thyroglobulin, thyroid transcription factor-1 (TTF-1), and other thyroid markers are commonly expressed by the tumor cells. Clinically, HVPTC is similar to conventional papillary thyroid cancer (PTC) in many aspects like incidence and epidemiology, but the former is associated with a worse prognosis. According to some research, the hobnail variety might behave more aggressively than conventional PTC, which highlights how crucial it is to identify and comprehend this distinct subtype. While the genetic and molecular underpinnings of HVPTC are still being elucidated, some studies have reported associations with specific genetic alterations, including BRAF, TP53, and TERT mutations. Investigating these molecular signatures may contribute to a better understanding of the variant's pathogenesis and potentially guide targeted therapeutic approaches in the future. In order to customize treatment plans, histopathology is essential in correctly diagnosing it. In this article, we present a case of PTC which presented as a solitary nodule on ultrasonogram in a 40-year-old female.
甲状腺乳头状癌的鞋钉样变体（HVPTC）是一种独特且相对罕见的甲状腺恶性肿瘤组织学亚型。该变体的特征在于其独特的细胞形态，呈鞋钉样外观，即细胞核位于顶端的细胞。还有其他特征，如微乳头模式和细胞黏附性丧失，这些都是HVPTC的指征。将这种模式与其他甲状腺肿瘤区分开来可能很困难；因此，需要进行全面的显微镜检查。肿瘤细胞通常表达甲状腺球蛋白、甲状腺转录因子-1（TTF-1）和其他甲状腺标志物。临床上，HVPTC在发病率和流行病学等许多方面与传统甲状腺乳头状癌（PTC）相似，但前者的预后较差。根据一些研究，鞋钉样变体的行为可能比传统PTC更具侵袭性，这凸显了识别和理解这种独特亚型的重要性。虽然HVPTC的遗传和分子基础仍在阐明中，但一些研究报告了与特定基因改变的关联，包括BRAF、TP53和TERT突变。研究这些分子特征可能有助于更好地理解该变体的发病机制，并可能在未来指导靶向治疗方法。为了定制治疗方案，组织病理学对于正确诊断它至关重要。在本文中，我们介绍了一例40岁女性的PTC病例，该病例在超声检查中表现为孤立性结节。
