Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid Gland: Specimen Radiographic Features with Histopathological Correlation

Abstract

A 34-yr-old female presented with an incidentally detected thyroid mass. Physical examination showed a unilateral firm mass in the left neck. Ultrasound demonstrated a 2.3-cm ill-defined hypoechoic mass with internal microcalcifications at the lower pole of the left thyroid gland (Fig. 1) with cervical lymphadenopathy on the ipsilateral side. The lower pole of the right thyroid gland revealed punctate microcalcifications without discernible mass on ultrasound (Fig. 1). Fine-needle aspiration biopsy of the thyroid mass and lymph node revealed papillary carcinoma with lymph node metastasis. Subsequent total thyroidectomy with unilateral neck dissection was performed. After that, specimen radiography was done to evaluate the extent of calcifications using the Lorad/ Hologic Selenia FFDM system (Lorad/Hologic, Danbury, CT) dedicated to mammography. The specimen radiograph showed diffuse scattered microcalcifications involving nearly the entire thyroid and central lymph nodes (Fig. 1). Pathological diagnosis was diffuse sclerosing variant of papillary carcinoma (DSVPC) with lymph node metastases (Fig. 2). The pathological extent of lesions was well correlated with the specimen radiograph. The DSVPC of the thyroid gland is rare malignant neoplasm (1, 2). Histopathological features have been reported as diffuse involvement of the thyroid gland with dense fibrosis, extensive squamous metaplasia, patchy lymphoid infiltration with germinal centers, psammoma bodies, and areas of conventional papillary carcinoma (3). Sonographic features include diffuse scattered microcalcifications with underlying heterogenous echogenicity. These findings correlate to psammoma bodies, extensive fibrosis, and lymphocytic infiltration on histopathology (3). Until now, radiological features of DSVPC were reported solely on soft-tissue roentgenography of the neck, which revealed dense calcifications (1). On spec-