Title: Case report on Non Invasive Follicular thyroid neoplasm with papillary like Nuclear Feature (NIFTP), A Diagnostic Dilemma

Authors: Dr Akshita Mehta, Dr Neha Mohindroo, Dr Shobh Mohindroo

 DOI: https://dx.doi.org/10.18535/jmscr/v9i2.46

Abstract

Non-invasive Follicular thyroid neoplasm with papillary like nuclear features (NIFTP) is a newer addition in WHO 2017 blue book of endocrine neoplasm and has an indolent behavior. We present a case of a 30 years old female who presented with neck swelling slightly left to the midline. On USG a solitary nodule was identified in left lobe of thyroid with TIRADS5. On FNA a cytological diagnosis of papillary neoplasm was given and she underwent left lobectomy post which she was given histopathological diagnosis of NIFTP. It is a difficult entity to diagnose on FNA / biopsy until the entire nodule is submitted along with the capsule so overdiagnosis and over treatment is a risk.

References

  1. Lloyd RV, Osamura RY, Klöppel G, Rosai J(editors) WHO Classification of Tumours of Endocrine Organs, 4th edn. Lyon, France: IARC, 2017.
  2. Nikiforov YE, Seethala RR, Tallini Get al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma. A paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol 2016; 2: 1023–9.
  3. Kakudo, K., Bychkov, A., Bai, Y., Li, Y., Liu, Z. and Jung, C.K. (2018), The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives. Pathol Int, 68: 641-664.
  4. Rivera M., Ricarte-Filho J., Knauf J., et al. Molecular genotyping of papillary thyroid carcinoma follicular variant according to its histological subtypes (encapsulated Vs infiltrative) reveals distinct BRAF and RAS mutation patterns. Modern Pathology.2010: 23 (9): 1191-1200.
  5. Pusztaszeri M, Bongiovanni M. The impact of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the diagnosis of thyroid nodules. Gland Surg. 2019 Aug;8 (Suppl 2):S86-S97. doi: 10.21037/gs.2018.12.01. PMID: 31475095; PMCID: PMC6694025.
  6. Canini V, Leni D, Pincelli AI, et al. Clinical-pathological issues in thyroid pathology: study on the routine application of NIFTP diagnostic criteria. Sci Rep. 2019;9(1):13179.
  7. Brandler TC Zhou F, Liu CZ, et al. Can noninvasive follicular thyroid neoplasm with papillary-like nuclear features be distinguished from classic papillary thyroid carcinoma and follicular adenomas by fine-needle aspiration? Cancer Cytopathol 2017;125:378-88.
  8. Strickland KC, Vivero M, Jo VY, et al. Preoperative cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a prospective analysis. Thyroid 2016;26: 1466-71.
  9. Chereau N, Greilsamer T, Mirallié E, et al. NIFT-P: Are they indolent tumors? Results of a multi-institutional study. Surgery 2019;165:12-6.

Corresponding Author

Dr Neha Mohindroo

SR KNH Shimla, India