Utility of immunohistochemical markers in differentiating benign from malignant follicular-derived thyroid nodules

Abstract

Background: Thyroid nodules are common among adults though only a small percentage is malignant, which can histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management.

Methods: We investigated immunoexpression in 98 surgically removed benign thyroid nodules including 52 hyperplastic nodules (HN) and 46 follicular/Hurthle cell adenomas (FA), and 54 malignant tumors including 22 follicular carcinoma (FC), 20 classic papillary carcinoma (PTC), and 12 follicular variant papillary carcinoma (FVPC).

Results: The staining results showed that malignant tumors express galectin-3, HBME-1, CK19 and Ret oncoprotein significantly more than benign nodules. The sensitivity of these markers for the distinction between benign and malignant lesions ranged from 83.3% to 87%. The sensitivity of two-marker panels was not significantly different. Immunoexpression was usually diffuse and strong in malignant tumors, and focal and weak in the benign lesions.

Conclusion: Our findings indicate that these immunomarkers are significantly more expressed in malignant tumors compared to benign lesions and may be of additional diagnostic value when combined with routine histology.

Figure 1

Immunohistochemical stain of hyperplastic colloid nodule shows the cells are negative for galectin-3 (100×).

Figure 2

Immunohistochemical stain of hyperplastic colloid nodule shows the cells are negative for Ret oncoprotein (100×).

Figure 3

Immunohistochemical stain of hyperplastic colloid nodule shows the cells are negative, for HBME-1 (100×).

Figure 4

Immunohistochemical stain of hyperplastic colloid nodule shows the cells are negative for CK19 (100×).

Figure 5

Immunohistochemical stain of follicular adenoma shows the tumor cells focally reactive for galectin-3 (100×).

Figure 6

Immunohistochemical stain of follicular adenoma shows the tumor cells focally reactive for Ret oncoprotein (100×).

Figure 7

Immunohistochemical stain of follicular adenoma shows the tumor cells focally reactive for HBME-1 (100×).

Figure 8

Immunohistochemical stain of follicular adenoma shows the tumor cells focally reactive CK19 (400×).

Figure 9

Immunohistochemical stain reveals that tumor cells in follicular carcinoma are strongly and diffusely positive for galectin-3 (400×).

Figure 10

Immunohistochemical stain reveals that tumor cells in follicular carcinoma are strongly and diffusely positive for Ret oncoprotein (400×).

Figure 11

Immunohistochemical stain reveals that tumor cells in follicular carcinoma are strongly and diffusely positive for HBME-1 (400×).

Figure 12

Immunohistochemical stain reveals that tumor cells in follicular carcinoma are strongly and diffusely positive for CK19 (400×).

Figure 13

Immunohistochemical stain reveals that the tumor cells of classic papillary thyroid carcinoma are strongly and diffusely positive for galectin-3 (100×).

Figure 14

Immunohistochemical stain reveals that the tumor cells of classic papillary thyroid carcinoma are strongly and diffusely positive for Ret oncoprotein (100×).

Figure 15

Immunohistochemical stain reveals that the tumor cells of classic papillary thyroid carcinoma are strongly and diffusely positive for HBME-1 (100×).

Figure 16

Immunohistochemical stain reveals that the tumor cells of classic papillary thyroid carcinoma are strongly and diffusely positive for CK19 (100×).

Figure 17

Immunohistochemical stain shows that the tumor cells of follicular variant of papillary carcinoma are strongly and diffusely positive for galectin-3 (100×).

Figure 18

Immunohistochemical stain shows that the tumor cells of follicular variant of papillary carcinoma are strongly and diffusely positive for Ret oncoprotein (100×).

Figure 19

Immunohistochemical stain shows that the tumor cells of follicular variant of papillary carcinoma are strongly and diffusely positive for HBME-1 (400×).

Figure 20

Immunohistochemical stain shows that the tumor cells of follicular variant of papillary carcinoma are strongly and diffusely positive for CK19 (400×).