Prevalence and Histologic Features of Multifocal Fibrosing Thyroiditis in the Routine Pathology Practice

Multifocal fibrosing thyroiditis (MFT) is a poorly understood condition characterized by multiple fibrotic scar-like lesions with paucicellular core and peripheral follicular cell atypia. Described by Dr. Rosai in 1990 in consultation cases, MFT has received limited attention due to its perceived rarity. To define its prevalence and clinicopathologic features in the routine practice, consecutive thyroid resections were analyzed from the archives of two medical institutions in Italy and Portugal. Among 1,736 resections 27 MFT were identified (1.56%), corresponding to a detection rate of 1.34% MTF cases per year in the study cohort. No significant difference between Italian and Portuguese cases were observed. Twenty-three of 27 (85.2%) patients were female. Age range was 34-69 years (median: 52). Autoimmune thyroiditis affected 7/27 patients (25.9%), with clinical hypothyroidism in four (14.8%). Clinical hyperthyroidism was present in 4/27 patients (14.8%), including 2 cases of hyperfunctioning adenoma, 1 case of toxic multinodular goiter, and 1 case of Graves' disease. In 2/27 cases (7.4%) thyroid resection was performed due to fibrotic MFT foci mimicking PTC. Malignant thyroid nodules - papillary thyroid carcinoma (PTC) in all cases - or other benign nodules caused thyroid resection in 10/27 (37.0%) and in 12/27 (44.4%) cases, respectively; Hashimoto thyroiditis (2 cases) and Graves disease (1 case) caused thyroid resection in the remaining cases. Meticulous histologic examination disclosed additional alterations in 25/27 cases (92.6%), often overlapping with each other and with PTC: incidental millimetric PTC in 7/27 cases (25.9%), follicular nodular disease in 17/27 cases (62.9%), chronic lymphocytic thyroiditis/Hashimoto thyroiditis in 14/27 (51.8%). No genetic alteration was identified in any of the 15/27 cases tested. In the routine practice MFT is an uncommon disorder affecting diseased thyroids that simulates PTC. Its cause remains elusive.