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Lymphatic endothelial cancerization in papillary thyroid carcinoma: Hidden evidence of lymphatic invasion
Author(s) -
Mai Kien T.,
Truong Luan D.,
Ball Christopher G.,
Olberg Bernhard,
Lai Chi K.,
Purgina Bibianna
Publication year - 2015
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/pin.12272
Subject(s) - lymphatic system , pathology , lymphatic endothelium , lymph , thyroid carcinoma , thyroid , lymph node , metastasis , carcinoma , lymphatic vessel , medicine , biology , cancer
We hypothesize that cystic structures in metastatic papillary thyroid carcinoma ( PTC ) develop along the framework of lymphatic channels. To investigate this phenomenon, different categories of PTC were immunostained for D 2‐40 and TTF1 . In this study, reactivity for D 2‐40 was considered as positive when there is membranous staining as often seen in lymphatic endothelial cells. Thirty cases of PTC with lymph node metastasis or with potential for lymphatic invasion and 20 cases metastatic PTC in lymph nodes were reviewed and found to show double/mosaic immunoreactivity for TTF1/D2 ‐40 in 40–100% of cases. PTC metastasis in lymph nodes with cysts and some branching lymphatic‐like channels lined by follicular cells with or without nuclear features of PTC were diffusely reactive to TTF1 , and focally to D 2‐40. For primary and metastatic PTC , focal membranous D 2‐40 reactivity was also demonstrated in cysts or cleft linings. For25 thyroid neoplasms with no known potential for lymphatic invasion, there was no such immunoreactivity. The mosaic or double immunoreactivity for TTF1/D2 ‐40 suggests lymphatic cancerization and possible endothelial mimicry of follicular cells. Mosaic/double immunoreactivity is helpful to detect the hidden pattern of lymphatic invasion masquerading as ‘benign‐appearing’ follicles and supports our hypothesis of malignant cells developing along the lymphatic framework.