Endocrine Pathology Online

Pathology of Papillary Carcinoma originating in Hashimoto's Thyroiditis

Dr Sampurna Roy MD                                                     



Hashimoto's thyroiditis is an inflammatory disease of the thyroid gland with

autoimmune etiology.

Patients afflicted with Hashimoto's have a higher risk of thyroid malignancies such

as papillary thyroid carcinoma.

The presence of coexistent Hashimoto's thyroiditis does not affect the diagnostic

evaluation or management of papillary thyroid cancers.

The survival of patients who have papillary thyroid cancers may be superior in

coexistent Hashimoto's thyroiditis.

Neoplastic transformation is a multistep process that results in a continuous spectrum

from the normal (physiological) state to a fully established neoplasm.

The gold standard for diagnosis of papillary thyroid carcinoma is conventional

histology, the essential element being the characteristic nuclear features, regardless

of whether papillary structures are present or not.

However, other criteria are being used  increasingly in the diagnosis of neoplasms,

including immunohistochemical staining and molecular profile.

The RET/PTC gene rearrangement is highly specific for papillary thyroid carcinoma

and is associated with the characteristic nuclear features seen in papillary

thyroid carcinoma.

There is an overlap in the morphological features, immunohistochemical staining

pattern, and most importantly, molecular profile between papillary thyroid carcinoma

and Hashimoto's thyroiditis.

Although considered a 'benign' condition, Hashimoto's thyroiditis almost always

harbours a genetic rearrangement that is strongly associated with and is highly

 specific for papillary thyroid carcinoma.

Lymphocytic infiltration with germinal centre formation leading to follicular

epithelial damage as evidenced by Hurthle cell metaplasia support the diagnosis

of Hashimoto's thyroiditis. 


Further reading

Concomitant papillary thyroid carcinoma and Hashimoto's thyroiditis.

Total thyroidectomy for the treatment of Hashimoto's thyroiditis coexisting with papillary thyroid carcinoma.

Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis.

The many faces and mimics of papillary thyroid carcinoma.

Differentiated thyroid carcinoma in previously manifested autoimmune thyroid disease

Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: impact on presentation, management, and outcome.

Expression of the RET/PTC fusion gene as a marker for papillary carcinoma in Hashimoto's thyroiditis. 

Clear nuclear changes in Hashimoto's thyroiditis. A clinicopathologic study of 12 cases.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)









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