The oncocytic variant of papillary carcinoma of the thyroid: A clinicopathologic study of 15 cases

Abstract

The oncocytic variant of papillary carcinoma of the thyroid represents an unusual neoplasm whose clinicopathological features and biological behavior have not been thoroughly characterized. We studied 15 cases of thyroid tumors predominantly composed of oncocytic (oxyphilic) cells that were characterized by showing the classical nuclear features of papillary carcinoma of the thyroid. Thirteen patients were women, and two were men; their ages ranged from 34 to 86 years. The tumors measured from 1 to 4 cm in diameter and were well circumscribed and confined to the thyroid gland in all cases except for one, in whom there was extrathyroidal local extension. Histologically, all tumors showed, at least focally, the formation of papillary structures; in 13 cases the papillary features were found to predominate or were admixed in equal proportion with a follicular pattern of growth, and in two the follicular growth pattern predominated and only abortive, small papillary structures could be found on extensive search. In all cases, the classical optically clear nuclei of papillary carcinoma were present throughout the lesions. Nuclear grooves and intranuclear cytoplasmic inclusions were also a prominent and constant component of these lesions. In 13 cases, the tumors showed the features of Hashimoto's or lymphocytic thyroiditis in the surrounding, uninvolved thyroid parenchyma. Follow-up of 1.2 to 13 years (median, 4.5 years) showed the development of cervical lymph node metastases 9 months after surgery in one case; the remainder of patients were alive and free of disease. Oncocytic papillary carcinoma seems to represent a distinctive morphological variant of carcinoma of the thyroid that in our experience does not appear to behave more aggressively than conventional papillary carcinoma. The frequent association of these tumors with autoimmune thyroiditis raises the possibility that the oncocytic changes may be pathogenetically related with the latter process. These tumors should be distinguished from benign and malignant Hurthle cell tumors and other oncocytic thyroid neoplasms that may follow a different biological behavior.