Home⇛Philippine Scientific Journal⇛vol. 57 no. 1 (2024)

Hyalinizing Trabecular Tumor of the Thyroid Gland

Sean Yukliev S. Austria | Monica Y. Tolentino | Edna May L. Go | Azenith May H. Rafanan | Glenn Nathaniel S. Valloso

Discipline: medical sciences (non-specific)

 

Abstract:

This is a case of a 43-year-old female with an 8-year history of a gradually enlarging anterior neck mass. Following bilateral subtotal lobectomy with isthmusectomy, gross examination of the thyroid gland showed nodular right and left lobes and an enlarged isthmus containing a 1.2 centimeter well circumscribed mass with solid cream-white cut surface. Microscopy revealed the mass to be well-demarcated, composed of neoplastic cells arranged in a trabecular and nested growth pattern. The cells are enlarged and elongated with eosinophilic cytoplasm and oval vesicular nuclei, with some exhibiting intranuclear inclusions and nuclear grooves. Also identified is a hyalinized stroma with a prominent vasculature. Special stains revealed a PAS-positive and Congo Red-negative stroma. Immunohistochemistry study revealed a distinct membranous staining pattern for Ki-67 (MIB-1). Positive staining with TTF-1 confirmed its thyroid follicular epithelial cell origin, while S100 staining yielded a negative result. These findings are consistent with a hyalinizing trabecular tumor.



References:

  1. Singh G, Gupta V, Sharma AK, Gupta N Evaluation of Thyroid Dysfunction Among Type Diabetic Punjabi Population 2011
  2. Dulek H, Vural F, Aka N, Zengin S. The prevalence of thyroid dysfunction and its relationship with perinatal outcomes in pregnant women in the third trimester. North ClinIstanb. 2019 Sep 2;6(3):267-272. doi: 10.14744/nci.2018.51422. PMID: 31650114; PMCID: PMC6790929.
  3. Dong AC , Stagnaro-Green A. Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and meta-analysis. Thyroid. 2019 Feb;29(2):278–89. http://dx.doi.org/10.1089/thy.2018.0475
  4. Altomare M, La Vignera S, Asero P, et al.: High prevalence of thyroid dysfunction in pregnant women. J Endocrinol Invest. 2013, 36:407-411. 10.3275/8658 
  5. Lazarus JH. Thyroid function in pregnancy. Br. Med. Bull. 97, 137–148 (2011).
  6. Vanderpump MP. The epidemiology of thyroid disease. Br. Med. Bull. 99, 39–51 (2011). 4
  7. Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a Comprehensive review. J. Clin. Endocrinol. Metab. 94(6), 1853–1878 (2009).
  8. Brent GA: Diagnosing thyroid dysfunction in pregnant women: is case finding enough?. J Clin Endocrinol Metab. 2007, 92:39-41. 10.1210/jc.2006-2461
  9. Carlos-Raboca J, Jimeno C, Kho S, Andag-Silva A, Jasul Jr. G, Nicodemus N, et al. View of the Philippine Thyroid Diseases Study (philtides 1): Prevalence of thyroid disorders among adults in the Philippines: Journal of the Asean Federation of Endocrine Societies [Internet]. 2012. Available from: https://aseanendocrinejournal.org/index.php/JAFES/article/view/9/400
  10. Miranda A, Sousa N. Maternal hormonal milieu influence on fetal brain development [Internet]. Brain and behavior. U.S. National Library of Medicine; 2018. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5822586/
  11. Brown RS. Minireview: Developmental regulation of thyrotropin receptor gene expression in the fetal and newborn thyroid [Internet]. Endocrinology. U.S. National Library of Medicine; 2004. Available from: https://pubmed.ncbi.nlm.nih.gov/15231704/
  12. Patel J, Landers K, Mortimer R H, Richard K. Thyroid hormones and fetal neurological development. Journal of Endocrinology 2011 209 1-8. doi.org/10.1530/JOE-10-0444.
  13. Negro R. Significance and management of low TSH in pregnancy. In: Lazarus J, Pirags V, Butz S, editors. The thyroid and reproduction. New York: Georg Thieme Verlag; 2009. pp. 84–95.
  14. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, Faix JD, Klein RZ. Maternal thyroid deficiency and pregnancy complications: implications for population screening. Journal of Medical Screening 2000 7 127–130. doi:10.1136/jms.7.3.127.
  15. Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstetrics and Gynecology 2006 108 1283–1292 doi:10.1097/01.AOG.0000244103.91597.c5.
  16. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd EW, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstetrics and Gynecology 2005 105 239–245 doi:10.1097/01.AOG.0000152345.99421.22.
  17. Pop VJ, Brouwers EP, Vader HL, Vulsma T, van Baar AL, de Vijlder JJ. Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study. Clinical Endocrinology 2003 59 282–288 doi:10.1046/j.1365 2265.2003.01822.x.
  18. Vaidya B, Hubalewska-Dydejczyk A, Laurberg P, Negro R, Vermiglio F, Poppe K. Treatment and screening of hypothyroidism in pregnancy: results of a European survey.
  19. Eur. J. Endocrinol. 166(1), 49–54 (2012).
  20. Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 92 Suppl 2007 S1–S47 doi:10.1210/jc.2007-0141.
  21. Practice bulletin no. 148: Thyroid disease in pregnancy [Internet]. Obstetrics and gynecology. U.S. National Library of Medicine; 2015. Available from: https://pubmed.ncbi.nlm.nih.gov/25798985/
  22. Renzo G, FIGO Working group on good clinical practice in maternal–fetal medicine (2015-2018). doi: 10.1002/ijgo.12745
  23. RANZCOG. Testing for hypothyroidism during pregnancy with serum. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 2015. Available from: https://sydneynorthhealthnetwork.org.au/wp-content/uploads/2016/03/1080-testing-for-hypothyroidism-during-pregnancy-with-serum.pdf
  24. Antenatal care for uncomplicated pregnancies [Internet]. National Center for Biotechnology Information. U.S. National Library of Medicine; 2016. Available from: https://pubmed.ncbi.nlm.nih.gov/31961630/
  25. Erik K. Alexander, Elizabeth N. Pearce, Gregory A. Brent, Rosalind S. Brown, Herbert Chen, Chrysoula Dosiou, William A. Grobman, Peter Laurberg, John H. Lazarus, Susan J. Mandel, Robin P. Peeters, and Scott Sullivan. 2017. Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017. 315-389. http://doi.org/10.1089/thy.2016.0457
  26. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014 Jun; 3(2):76-94. doi: 10.1159/000362597. Epub 2014 Jun 7. PMID: 25114871; PMCID: PMC4109520.
  27. Vila L, Velasco I, González S, Morales F, Sánchez E, Lailla JM, Martinez-Astorquiza T, Puig-Domingo M, Grupo de Trabajo de Trastornos por Deficiencia de Yodo y Disfunción Tiroidea de la Sociedad Española de Endocrinología y Nutrición 2012 Detection of thyroid dysfunction in pregnant women: universal screening is justified. Endocrinol Nutr 59:547–60.    Crossref, Medline, Google Scholar 2012 Indian Thyroid Society Guidelines for Management of Thyroid Dysfunction During Pregnancy. Clinical Practice Guidelines. Elsevier. New Delhi. Google Scholar
  28. Gharib H, Tuttle RM, Baskin J, Fish LH, Singer PA, McDermott MT. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. Thyroid 2005 15 24–28. doi:10.1089/thy.2005.15.24.
  29. Wang W, Teng W, Shan Z, Wang S, Li J, Lin Z, Zhou J, Mao J, Yu X, Li J, Chen Y, Xue H, Fan C, Wang H, Zhang H, Li C, Zhou W, Gao B, Shang T, Zhou J, Din B, Ma Y, Wu Y, Xu H, Lu W. The prevalence of thyroid disorder during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. European Journal of Endocrinology 2011 164 263-268. doi.org/10.1530/EJE-10-0660.
  30. Brent GA. Diagnosing thyroid dysfunction in pregnant women: is case finding enough? Journal of Clinical Endocrinology and Metabolism 2007 92 39–41. doi:10.1210/jc.2006-2461.
  31. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, Bilous R. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding. Journal of Clinical Endocrinology and Metabolism 2007 92 203–207. doi:10.1210/jc.2006-1748.
  32. Ajmani SN, Gupta J, Bansal CL, Ajmani AK. Role of thyroid dysfunction and thyroid autoimmunity in infertile women: study done in 450 bedded maternity hospital of Delhi, India. Int J Reprod Contracept Obstet Gynecol [Internet]. 2017 May 25 [cited 2026 Jan. 22];6(6):2597-600. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/2606
  33. Murty NV, B U, JM R, K S, K V, G V. High prevalence of subclinical hypothyroidism in pregnant women in South India. Int J Reprod Contracept Obstet Gynecol [Internet]. 2017 Feb. 6 [cited 2026 Jan. 22];4(2):453-6. Available from: https://www.ijrcog.org/index.php/ijrcog/article/view/1918
  34. Kinci MF, et al. Evaluation of the Thyroid Functions in Adolescent, Normal and Advanced Age Pregnancies. Medical Journal of Mugla Sitki Kocman University 2021;8(1):29-33. DOI:10.47572/muskutd.732704

Tools


Copyright © 2026  KITE Digital Educational Solutions |  Exclusively distributed by CE-Logic