Cytokeratin 19 and Galectin 3 Immunohistochemistry in the Differential Diagnosis of Solitary Thyroid Nodules

Ramesh Babu, C (2017) Cytokeratin 19 and Galectin 3 Immunohistochemistry in the Differential Diagnosis of Solitary Thyroid Nodules. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Thyroid nodules presents as a challenge in the diagnosis, evaluation and management. The prevalence of the nodule depends upon the factors like age, sex, diet, iodine deficiency. Estimates for 2012 revealed Thyroid neoplasm as the fifth most expected malignancy in American women1. Thyroid lesions clinically present as nodule. These nodules are solitary or multiple comprises of both Non Neoplastic and Neoplastic lesions. A discrete swelling in an otherwise impalpable gland is termed as Solitary thyroid nodule. Solitary nodule occurs in 4-7% of adult population. It presents in 5% of population at an average age of 60 years. It is more common in females (6.4%) as compared to males (1.5%). Most of the thyroid nodules clinically diagnosed as solitary were hyperplastic nodules in multinodular goiter, 5 to 20% found to be true malignant lesions. The prevalence of malignancy in solitary cold nodule is more common, ranges from 10% to 44.7%. The most common thyroid problems faced by the surgeon and the pathologist is the evaluation of the patient with an apparently single thyroid lesions. AIM OF THE STUDY: Thyroid nodules present as a challenge in evaluation, diagnosis and management.The incidence of solitary thyroid nodule is common among the 4-7% of adult population. Solitary nodule are more common in females. The malignancy incidence is more common in males. The ultimate aim in evaluation of the solitary nodule is to differentiate benign hyperplasia from the true malignancy. The present study aims to evaluate the immunohistochemical expression of CK19 and Galectin 3 in solitary thyroid lesions to assess their potential in diagnosis and classification of thyroid lesions. METHODS: Among the 171 solitary thyroid nodule specimens, 50 cases has been selected for the study during the period from June 2014 to May 2016. Corresponding histopathological slides were prepared from formalin fixed paraffin embedded tissue of resected thyroid specimens. They were subjected to H&E staining and immunohistochemical markers of CK19 and Galectin3. RESULTS: The incidence of solitary thyroid nodule was 13.29%. Of which the commonest age group between 20-49 years with female preponderance. The Benign neoplasm constitute about 18.72% and malignant neoplasm about 81.28%. The commonest malignant neoplasm was papillary carcinoma with an incidence of 84.5%. CK 19 expression was found in all the conventional Papillary carcinoma and in Follicular variants of Papillary carcinoma, 2of 2 Medullary carcinoma, and 1 case of anaplastic carcinoma. Only 2 of 8 Follicular adenoma, 2 of 3 Hurthle cell adenoma were positive for CK19 expression.CK19 was negative in warthin variant of papillary carcinoma. CK19 was 89% sensitive, 90% specific for papillary carcinoma with diagnostic accuracy of 90% Galectin 3 expression was found in 86.5% of papillary carcinoma which is statistically significant P value of <0.001. It was found to be negative in all the benign lesions of thyroid. CONCLUSION: The present study findings suggests that the immunohistochemical localization of CK19 and Galectin-3 is a useful adjunct to the histopathological diagnosis of a solitary thyroid lesions. CK19 expression favors the diagnosis of papillary carcinoma and all its variant. Galectin 3 is also a fairly reliable marker in differentiating follicular adenoma from follicular carcinoma. The combined immunostaining for CK19 and Galectin3 may be useful in the differential diagnosis of thyroid neoplasm.

Item Type: Thesis (Masters)
Additional Information: Reg.NO.201413007
Uncontrolled Keywords: Solitary thyroid nodule, CK19, Galectin3, Papillary carcinoma, Thyroid.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 18 Jul 2020 16:08
Last Modified: 18 Jul 2020 16:08

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