Diffuse sclerosing variant of papillary carcinoma of the thyroid. A histopathological study of four cases

We present four cases of an unusual diffuse sclerosing variant of papillary carcinoma of the thyroid occurring in Japanese women ranging in age from 17 to 42 years. Macroscopically, both lobes of the thyroid were involved, being diffusely enlarged and firm. Histologically, the tumor was characterized by squamous metaplasia of tumor cells, numerous psammoma bodies, extensive stromal fibrosis, severe lymphocytic infiltration with formation of lymph follicles, and thin bundles of smooth muscle cells in the fibrous stroma. The tumor islands were located mainly within the dilated lymphatic vessels and the metastatic tumor involved the bilateral cervical lymph nodes in all cases. It is assumed that papillary carcinoma of this type invades the thyroid lymphatics during the early stage and, without forming nodular lesions, disseminates to both lobes with extensive metastasis to the cervical lymph nodes. It should be noted that papillary carcinoma of this type often suggests chronic thyroiditis clinically because of the symmetrical enlargement of the thyroid and frequent positive anti-thyroid antibodies in the serum. Some workers have reported the prognosis to be unfavorable because of extensive lymphatic involvement, but the prognosis of this variant has not yet been defined.