Primary secretory carcinoma of thyroid with unusual features mimicking metastasis?

IF 2.3 3区医学 Q2 PATHOLOGY

Diagnostic Pathology Pub Date : 2025-07-30 DOI:10.1186/s13000-025-01693-4

Joseph Teague, Allison Ciolino, Mirabelle Sajisevi

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Abstract

Introduction: Secretory Carcinoma (SC) of the thyroid is a relatively new and often misdiagnosed cancer. Like SC of the breast and salivary gland, it is characteristically diffusely positive for S100 and Mammaglobin by immunohistochemical (IHC) staining.

Methods: Case report.

Results: A 63-year-old female presented with neck swelling and difficulty breathing. CT scan showed a large thyroid mass. Tracheal compression and deviation required stent placement and urgent radiation. Microscopic analysis showed neoplastic cells with frequent intracytoplasmic globules, including signet-ring cells. IHC stains were inconclusive to tumor type and metastasis from an occult primary was considered. However, PET-CT scan, mammography, and upper endoscopy were negative. Next-generation sequencing was performed revealing an ETV6-NTRK3 fusion favoring SC of the thyroid.

Conclusions: SC of the thyroid with unusual histomorphology and IHC staining may be overlooked and can mimic a metastasis. Given that a correct diagnosis critically affects prognosis and treatment, pitfalls can be avoided by utilizing molecular testing in complicated cases.

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原发性分泌性甲状腺癌伴异常特征模拟转移？

甲状腺分泌性癌（SC）是一种相对较新的且常被误诊的癌症。与乳腺和唾液腺SC一样，通过免疫组化（IHC）染色，S100和Mammaglobin呈弥漫性阳性。方法：病例报告。结果：女性，63岁，颈部肿胀，呼吸困难。CT扫描显示甲状腺大肿块。气管受压和偏曲需要支架置入和紧急放疗。显微镜分析显示肿瘤细胞中有胞浆内常见的小球体，包括印戒细胞。免疫组化染色对肿瘤类型不确定，并考虑转移自隐匿原发灶。然而，PET-CT扫描，乳房x光检查和上内镜检查均为阴性。下一代测序显示ETV6-NTRK3融合有利于甲状腺SC。结论：甲状腺SC具有不寻常的组织形态和免疫组化染色，可能被忽视，并可能模拟转移。鉴于正确的诊断对预后和治疗至关重要，在复杂病例中利用分子检测可以避免陷阱。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic Pathology 医学-病理学

CiteScore

4.60

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： Diagnostic Pathology is an open access, peer-reviewed, online journal that considers research in surgical and clinical pathology, immunology, and biology, with a special focus on cutting-edge approaches in diagnostic pathology and tissue-based therapy. The journal covers all aspects of surgical pathology, including classic diagnostic pathology, prognosis-related diagnosis (tumor stages, prognosis markers, such as MIB-percentage, hormone receptors, etc.), and therapy-related findings. The journal also focuses on the technological aspects of pathology, including molecular biology techniques, morphometry aspects (stereology, DNA analysis, syntactic structure analysis), communication aspects (telecommunication, virtual microscopy, virtual pathology institutions, etc.), and electronic education and quality assurance (for example interactive publication, on-line references with automated updating, etc.).