|Sl No||Article Title||Page|
|1||Reporting Standardization in Pathology
|2||Role of Nerve Bundle Morphometry in Diagnosis of Hirschsprung Disease
Islam T, Banu SG,Dey BP,Rahman MM, Rahman P,Shabnam US, Shiraj-Um-Mahmuda S
|3||Detection of Epstein Barr Virus in Nasopharyngeal Carcinoma in Bangladeshi Patients: A Molecular and Pathological Study
Islam F, Kamal M, Habib S
|4||Identification of Atypical Epithelial Proliferation in Fallopian Tube in Association with Ovarian Serous Carcinoma
Sultana S, Akhter S, Rahman DA, Islam N, Mehjabin M, Khatun S, Yusuf F
|5||Cytological Patterns of Cervical Papanicolaou Smear at Tertiary Hospital– A Retrospective Study
Ansari M, Khan AH, Hossain S, Chowdhury MS, Khanom F
|6||Expression of P63 and AMACR in Benign and Malignant Lesions of Prostate
Haque S, Islam N, Kabir E, Shilpi HR, Begum S, Sharmin L, Jahan N
|7||Multilocular Cystic Nephroma: A Case Report in an Adult Patient
Islam F, Begum A, Kamal M
|8||Primary Adenoid Cystic Carcinoma of the Ovary: A Rare Case Report
Rahman MZ, Mahmud R, Siddiqui SR, Das NC
|9||Co-existent Caecal Adenocarcinoma and Tuberculosis: A Rare Case Report
Rahman DA, Rabby JE, Saadat MA
|10||Information for Contributors
Topic: ORAL Mucosal Lesions
Date: 10 June 2022 Time: 7:30 PM
Case No. 01: Clinical information: Male 47 years. White patches in buccal mucosa for 4 years not improving on conservative treatment.
Dx. Leukoplakia with dysplasia
Case No. 02: Clinical information: Female 36 years. White path on both lateral borders of tongue for 3 years. Burning sensation during eating.
Dx. Lichen planus
Case No. 03. Clinical information: Male 50 years. Small biopsy from a white patch in left buccal mucosa. The habit of betal nut leaf for long.
Dx. Oral submucosal fibrosis
Case No. 04 Clinical information: Male 30 Years. Diffuse whitish, diffuse, painless, spongy plaques on buccal mucosa.
Dx. White spongy nevus
Case No. 05 Clinical information: Female 45 years. Progressing blackish patches in oral mucosa, gum and tongue.
Dx. Oral mucosal melanosis (Addison’s disease )
|Sl No||Article Title||Page|
|1||Liquid Biopsy: Current Prospects and Challenges
Rahman DA, Sharif MM
|2||Histomorphological Pattern of Lung in a Sequential Series of 200 Autopsies Sample in Dhaka Medical College
Biswas U, Dewan RK, Ferdous JN, Jinnah SA, Akter K, Sultana T, Khan RR, Saha MK, Islam MA
|3||Histomorphological Types of Thyroiditis Coexisting with Multinodular Goitre
Papry A, Kamal M
|4||Association of E-Cadherin Expression in Radical Cystectomy Specimens of Infiltrating Urothelial Carcinoma with Histopathological Parameters
Rahman P, Khan KH, Rahman MM, Karim R, Islam AF, Shabnam S, Islam T, Mahmuda SS
|5||Demographic Incidence of Germ Cell Tumors and their Clinicopathological Spectrum: A 2 Years’ Observation
Nasreen S, Sadaf A, Jahan R, Ara SA
|6||Association between Immunohistochemical Expression of p53 Protein and Histopathological Prognostic Factors in Gastric Carcinoma
Karim R, Kabir AN, Rahman P,Hassan MI, Nowsher MN, Sultana S, Siddika F, Rahman MM
|7||Cystic Partially Differentiated Nephroblastoma – Rare Renal Neoplasm of Childhood
Islam T, Biswas A, Parveen S, Rahman MM
|8||Information for Contributors
|Sl No||Article Title||Page|
|1||The Necessity of Clinical History in Histopathology Reporting
|2||Evaluation of CD56 Expression in Epithelial Ovarian Carcinoma and its Correlation with Histopathological Grading and Staging
Zhumur M, Rahman A, Rahman MM, Jinnah MA, Jahra FT, Dewan MR, Jeba R
|3||Expression of Ki-67 along with ER, PR in Relation with Ductal Carcinoma of Breast
Jahan N, Islam N, Kabir E, Hassan MI, Ferdose J, Khanam K, Sultana S
|4||The Spectrum of Histopathological Lesions in Gallbladder
Ansari M, Khan AH, Hossain S, Chowdhury MS, Khanom F
|5||Histopathological Evaluation of Childhood Liver Disease: An Experience in a Tertiary Centre of Bangladesh
Parvez M, Arjuman F, Arshad–Ul –Azim M, Mahmud S, Ahmed SS
|6||Pattern of Invasion; a Reliable Prognostic Indicator for Oral Squamous Cell Carcinoma
Munmun UK, Baqi SA, Kabir AN, Begum F, Mehjabin M, Hassan MI
|7||Primary Lung Mucoepidermoid Carcinoma: A Case Report
Parvez M, Haque AA, Khair MM
|8||Biphenotypic Sinonasal Sarcoma in a Twenty Six Year Old Female- A Newly Described Entity
Afroz S, Jamtsho J, Rahman P, Dey BP, Rahman MM, Rahman MZ
|10||Information for Contributors
Official Organ of Bangladesh Academy of Pathology
Vol 4, No 2, July 2020
|Sl No||Article Title||Page no|
|1||Histopathological Findings in Fatal COVID-19 Infections
|2||Intratumoral and Peritumoral Angiogenic and Lymphangiogenic Microvessel Density in Invasive Breast Carcinoma and their Correlation with Lymph Node Metastasis
Mehjabin M,Asaduzzaman, Chakravarty S,Hassan MI, Munmun UK,Islam N,Talukder AS, Kamal M
|3||Immunohistochemical Analysis and Molecular Subtyping of Breast Cancer
Sharmin S, Ambiya AS, Hussain M, Rima FAPDF
|4||Diagnosis of Hirschsprung Disease by Frozen Section Biopsy Using Routine Hematoxylin-Eosin (HE) Stain: A Year’s Study
Banu SG, Islam T
|5||Histomorphology of Gastroesophageal Junction Lesions (GEJ) and their Malignant Potential in Gastroesophageal Reflux Disease (GERD): A Study of 145 Cases in a Tertiary Level Hospital in Bangladesh
Zabin SG, Dewan RK, Jinnah SA, Jeba R, Sultana T, Rahman LY, Khan ZB
|6||E-Cadherin Expression in Transitional Cell Carcinoma of the Urinary Bladder and its Correlation with Histopathological Grade and Tumour Stage
Quruni MO, Saha MK, Afrin SS, Hossain MS, Shaheen N, Dewan RK
|7||Extracellular Matrix Metalloproteinase Inducer (EMMPRIN/CD147) Expression and its Correlation with Progression of Oral Squamous Cell Carcinoma
Saha MK,Quruni MO, Afrin SS, Hossain MS,Mahmud F, Mahmud SA, Jinnah MA, Dewan MR
|8||The Many Faces of Focal Segmental Glomerulosclerosis: A Review
|9||Primary Malignant Melanoma of the Breast: A Case Report
Sadaf A, Hossain MI, Sultana N, Khan AS
|10||Information for Contributors
The scientific sub-committee of 5th National Convention of Bangladesh Academy of Pathology (BAP) which will be held virtually cordially invites abstracts for free paper session. The last date for submission of abstracts is 10th January 2022.
The abstract should be the computer composed and not exceeding 250 words. The title of the papershould in bold capital letters. The title should be followed by name(s) of the presenting authors. The text should briefly cover the introduction, objective, methodology, results and conclusions. The abstract should be mailed to Prof. Dr Nasimul Islam (firstname.lastname@example.org) and Prof. Dr.Md. Zillur Rahman, (email@example.com) Members Scientific Subcommittee.
The scientific sub-committee will send acceptance letter to the presenting author by 15th January 2022. The allotted time for each presentation is eight minutes. Question-answer session will be held at the end of the session.
Prof. Md. Golam Mostofa
Chairman, Scientific sub-committee.
5th National Convention, BAP, 2022.
Minutes of EC Meeting on 25/11/2021 in PDF Open
Scientific Webinar from BAP
Topic: Immuno-Interrogation to Define Diffuse Large B-Cell Lymphoma: Sharing Experience 2020.
0n 8th January 2021, Friday at 07:30 pm (Bangladesh standard time)
Panel of experts:
1. Prof Humaun Kamal Islam (USA)
2. Prof Ferdousy Begum
3. Lt Col Wasim Selimul Haque
Recorded video in youtube embedded here
Scientific Webinar on Prostate Cancer presented by Professor Golam Mostafa on 25-12-2020 [Video]
Meeting on MD Pathology curriculum on 20-12-2020 [Videos]
Part 1: Click here to open
Part 2: Click here to open
The Journal of Histopathology and Cytopathology (JHC) aims in our understanding of the pathophysiological and pathogenetic mechanisms of human disease by publishing original papers, review articles, case reports and short communications related to basic and translational fields in pathology. It serves as bridges between basic biomedical science and clinical medicine with particular emphasis on, but is not restricted to, tissue based studies only. It is published twice a year as the Journal Committee of the Bangladesh Academy of Pathology.
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Journals: van Riel D, Leijten LM, Kochs G, Osterhaus AD, Kuiken T: Decrease of Virus Receptors during Highly Pathogenic H5N1 Virus Infection in Humans and Other Mammals. Am J Pathol 2013, 183:1382-1389
Electronic Journals: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group: Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009, 6:e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097
Books: Frosch MP: Central Nervous System. Robbins Basic Pathology, 9th Edition. Edited by Kumar V, Abbas AK, Aster JC. Philadelphia, PA, Saunders, 2012, pp. 811-850
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Authors must disclose all financial and personal relationships that might bias their work; to prevent ambiguity, a conflict of interest statement must appear on the manuscript title page, detailing any conflicts (or the absence thereof) for each author.
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Concise articles make a greater impact than long ones and are less likely to be delayed by editing to a suitable length. Full articles should be no more than 4000 words from the beginning of the Introduction to the end of the Discussion. Review articles and special features may occasionally exceed this limit by arrangement with the Editor-in-Chief.
Abstract (not structured and no more than 300 words)
Following the title page(s), the next page should carry an unstructured prose abstract of 300 words or less. It should clearly convey the purposes of the study, and the main procedures, findings and conclusions. It should be understandable without reference to the rest of the paper, and contain no citation to references in the reference list. Only standard abbreviations as listed below are permitted.
Keywords (3 to 10)
Below the abstract, authors should provide and identify as such 3 to 10 keywords or short phrases to assist indexing the article and that may be published with the abstract. MESH headings are a useful guide for authors in considering keywords.
Research articles are divided into sections with the headings: Abstract, Introduction, Methods, Results and Discussion. Long articles may need subheadings (especially within the Results and Discussion) to clarify their content. The sections should not be numbered. Other types of articles, such as reviews and commentaries, still need a title and abstract and should adhere as closely as possible to these guidelines.
*Fatima K,1 Banu SG,2 Kamal M3
Epidermal nevus has various histological patterns. Epidermal nevus having features of epidermolytic hyperkeratosis is a rare condition. This lesion is clinically indistinguishable from other epidermal nevi but shows characteristic histological features. Diagnosis of this entity is important management. Epidermolytic hyperkeratosis is an autosomal dominant disease. Offspring of these patients may have generalized epidermolytic hyperkeratosis. Here we present a case of 12 years old boy with Epidermal nevus with epidermolytic hyperkeratosis, which is a rare entity.
[Journal of Histopathology and Cytopathology, 2020 Jan; 4 (1):65-69]
Keywords: Epidermal nevus, Epidermolytic hyperkeratosis, Generalized epidermolytic hyperkeratosis, Line of Blaschko.
Epidermal nevus comprises a heterogenous group of diseases. It is a congenital non-inflammatory cutaneous hamartoma. It may occur sporadically or as a part of several syndromes. The condition affects 1 in 1000 people in the world.1 Histologically, epidermal nevi are composed of keratinocytes, apocrine glands, eccrine glands, sebaceous glands or other components of pilosebaceous unit. Epidermal nevi are traditionally asymptomatic. Small number of cases of epidermal nevi show histologic features of epidermolysis hyperkeratosis. Epidermolytic hyperkeratosis has been observed in variety of benign and malignant skin condition or hereditary disorders. Epidermal nevus with epidermolysis hyperkeratosis has a significant clinical importance. This patient carries the risk of parenting a child of gerneralizedepidermolytichyperkeratosis.2 We report a case of epidermal nevus showing epidermolytic hyperkeratosis in a 12 year old boy for the rarity of the entity.
A 12 year old boy of a non-consanguineous parentage, presented with non-pruritic, dark coloured elevated skin eruptions since birth. The lesion was first observed over the dorsum of right foot. After that lesions gradually appeared in front of leg and thigh, lower abdomen and flexor aspect of both forearm. Lesions were not related with any seasonal variation. Patient had a normal birth history and developmental milestones. Right sided extremities were more involved than left side.Examination revealed numerous hyperpigmented warty papules distributed in both extremities and lower abdomen (Figure. 1 and 2). Hair, nails and oral mucosa were normal. Other system examination revealed no abnormality. No laboratory investigation was done.
Clinically it was diagnosised as Linear verrucous epidermal nevus. For histopathological examination 3 mm punch biopsy was taken from right foot. Histological examination revealed hyperkeratosis, acanthosis, papillomatosis, elongated rete ridges. The dermis revealed mild perivascular infiltration of chronic inflammatory cells.Some foci also revealed perinuclear vacuolization of the keratinocytes in spinous and granular layers, and increased number of keratohyalin granules in the stratum granulosum (Figure 3, 4 and 5). So, histologically it was diagnosed as epidermal nevus with epidermolytic hyperkeratosis.
Epidermal nevus is hamartoma of skin, occurs due to over growth of epidermis. It arises from embryonic ectoderm as a result of mosaic postzygotic mutations. Lesions are present at birth in about half of the patients or may develop early in childhood. Depending on the affected component of the epidermis epidermal nevus can be divided into two types: keratinocytic or non organoidand organoid type.3 Keratinocytic epidermal nevus is the most common type of epidermal nevus. It occurs due to overgrowth of keratinocytes. Different varients of keratinocytic epidermal nevus are seen, such as linear epidermal nevus, hard nevus of Unna, soft epidermal nevus and nevus verrucosus etc.1 On the other hand organoid type shows predominantly another component of skin.4 Epidermal nevus occurs as a result of activated genetic mutation in FGFR-3, HRAS or PIK3CA genes. FOXN1 is highly expressed in these lesions.1 Most common pattern of keratinocytic nevus is linear epidermal nevus. The lesions are verrucous, skin-coloured dirty gray or brown coloured papule, which coalesce to form serpiginious plaques. They follow the line of Blaschko. These lines are thought to be representative pathways of epidermal cell migration and proliferation during development of fetus.5
Linear epidermal nevus may be either localized or systematized. In localized type, only one linear lesion is present and lesion is confined to one side of the body. Common sites are head, trunk and extremities. In systematized type there are many parallel linear lesions are seen. They may be unilateral or bilateral.
Localized and more commonly systematized linear epidermal nevus may be associated with skeletal deformity and CNS deficiency.6 Rarely squamous cell carcinoma or basal cell carcinoma may arise in epidermal nevus.7
Epidermal nevus may occur as a part of epidermal nevus syndrome and may be associated with internal manifestation. These syndromes have characteristic cutaneous findings and at times relevantly specific internal findings.1 The six different types of epidermal nevus syndromes are nevus sebaceous, CHILD (congenital hemidysplasia with ichthyosiform erythroderma and limb defects) syndrome, nevus comedonicus, Becker’s nevus, Proteus syndrome, phacomatosispigmentokeratotica.
Histologically epidermis of epidermal nevus is hyperplastic. There is variable hyperkeratosis, papillomatosis and acanthosis with elongation of rete ridges. Upto 62% of biopsy specimens have these pattern and these are called non-epidermolytic epidermal nevus. About 16% of epidermal nevi show features of epidermolytic hyperkeratosis. Other histologic patterns are psoriatic type, acrokeratosisverruciformis like type and a Darier’s disease like type.1 Epidermolytic hyperkeratosis is more common in systematized type than localized type. This reaction pattern of skin was first described by Ackerman in 1970.7It occurs due to defective keratin genes (KRT-1 and KRT-2), which causes excessive and abnormal keratinization. The salient histologic features are- compact hyperkeratosis, perinuclear vacuolization of the cells in stratum malpighii, irregular cellular boundaries and increased numbers of large irregular keratohyaline granules. Epidermolytic hyperkeratosis is seen in other conditions, such as- bullous congenital icthyosiformerythroderma, icthyosisbullosa of Siemens, Vorner’spalmoplanterkeratoderma, melanocytic nevus, epidermolyticacanthoma, basal cell carcinoma and squamous cell carcinoma etc.
Main clinical differential diagnosis of epidermal nevus areepidermodysplasiaverruciformis, inflammatory linear verrucous epidermal nevus, linear psoriasis and lichenstriatus.Epidermodysplasiaverruciformis is a genetic disease characterized by HPV infection. This is usually associated with HPV 5 or 8, less commonly 3, 4, 5.1 Histologically this lesion is characterized by acanthosis, hyperkeratosis, large cells with blue-gray cytoplasm, often with dysplastic change and irregular granular layer with rare perinuclear halo. Inflammatory linear verrucous epidermal nevus (ILVEN) is a type of epidermal nevus. These lesions are also distributed in linear pattern, but they are erythematous and itchy. Histologically ILVEN is characterized by some specific features, which are absent in epidermal nevus. These are- areas of depressed orthokeratosis with underlyinghypergranulosis, alternating areas of slightly raised parakeratosis with underlying hypogranulosis.8 In linear psoriasis, the lesions may be pink to red papules or silvery scales. Typical histologic findings are regular elongation of rete ridges, thin suprapaillary plates, hypo or agranulosis, Munro microabcess and spongiform pustules of Kogoj, which are absent in epidermal nevus. In lichen striatus, the lesions are erythematous papules arranged in linear pattern following lines of Blaschko. But histologically it differs from epidermal nevus by presence of vacuolar alteration of basal layer and band like lymphocytic infiltrate.7 Treatment modalities of epidermal nevus are topical cream, cryotherapy, laser and dermabrasion. But management is difficult, because the lesions recur unless treatment extend into dermis.
Epidermal nevus with epidermolytic hyperkeratosis is a rare condition. As this is a mosaic genetic disorder of suprabasal keratin, it can be transmitted to offspring and produce generalized epidermolytic hyperkeratosis. So genetic counseling is essential for these patients.
Sadaf A, 1 Hossain MI,2 Sultana N,3 Nasreen S,4 Rahman Z5
Mature cystic teratoma is the commonest ovarian germ cell tumor. Though malignant transformation is uncommon, papillary thyroid carcinoma has rarely been described as associated with ovarian teratomas. We report a case of a 34-years old multiparous woman who presented with acute abdominal pain and an ovarian mass. After salphingo-oophorectomy, the patient was diagnosed as papillary thyroid carcinoma that arose within a mature cystic ovarian teratoma. To our knowledge, this is the first reported case of papillary thyroid carcinoma arising within a mature ovarian teratoma in this tertiary health care center in Chattogram. We recommend long term follow up to see any metastatic possibility.
[Journal of Histopathology and Cytopathology, 2020 Jan; 4 (1):60-64]
Keywords: Mature cystic teratoma, papillary thyroid carcinoma, struma ovarii.
Among the ovarian germ cell tumors Mature Cystic Teratoma (MCT) is the most common and comprises 10–20% of all ovarian tumors. However, malignant transformation of MCT is not common and the incidence is 1–3%.1 Squamous Cell Carcinoma (SCC) is the commonest type, found in 80% of cases.2 Papillary thyroid carcinoma (PTC) within teratoma is one of the rarest types with ranges varying from 0.1% and 0.2%, and usually diagnosed postoperatively.3 The synchronous development of malignant struma ovarii and primary thyroid carcinoma is extremely rare, though a handful of cases were reported.4 So, presence of thyroid tissue in teratoma, should proceed with further work up to confirm the diagnosis and to explore the possibility of a malignant lesion in the mass- either primary or metastasis.5 Here we present a case of a patient with a PTC arising within a ovarian MCT.
34-year-old multiparous woman who had abdominal pain, distention and irregular menstrual bleeding for approximately for 6 months, presented to the emergency service of Chittagong Medical College Hospital in May 2019 with the complaints of a sharp pain in lower abdomen, with accompanying vomitting. There was no previous medical or surgical history.
On abdominal examination, a tender mass adjacent to the left side of the umbilicus were detected. Manual examination of the vagina revealed tenderness and mass in left adnexal region. Paps smear was done with no abnormality detected. Haemogram and biochemical test results were normal except a hemoglobin level of 9.2 gm/dl. CA-125 was within normal limit and β-HCG was normal. Ultrasonography of the lower abdomen revealed a complex solid cystic mass measuring 82x62x55 mm, with mixed echotexture, compatible with dermoid cyst.
At laparotomy, a cystic mass of approximately 9x7cm size, with a white, smooth glistening surface, originating from the left ovary was observed. Opposite ovary was apparently normal and no adhesion or intra-abdominal deposit was observed. Left sided salphingo-oophorectomy was performed preserving the uterus and right ovary and sent to Department of Pathology, Chittagong Medical College, Chattogram for histopathological evaluation. On gross pathological examination, a cystic mass of 9 cm in diameter (fig-1) with 3cm fallopian tube were noted. On cross section, hair, sebum & fatty materials were come out and some thick greenish fluid was drained and some solid structure was observed on its wall (fig-2).
Microscopic examination revealed mature teratomatous component represented by skin with associated adnexal structures, muscles, fat, benign glands lined by mucin containing columnar epithelium (fig-3,4) and thyroid tissue, within the thyroid tissue foci papillary thyroid carcinoma (fig-5,6) was found. Lining cells had oval nuclei showing nuclear overlapping, grooving and intranuclear cytoplasmic inclusions. Follicles also contained amorphous eosinophilic thick colloid. The fallopian tube was unremarkable. Immunohistochemical (IHC) examination revealed positivity for TTF-1 (fig-8,9). With these findings, diagnosis of a “mature cystic teratoma with malignant transformation to papillary thyroid carcinoma” was made. Postoperatively plasma levels of T3, T4, TSH and thyroglobulin of the patient were normal. A normal parenchymal vasculature was identified by postoperative ultrasonography of the thyroid gland.
Mature cystic teratomas are also known as dermoid cysts, because they are mostly cystic, skin & skin appendages are the most common structures. Thyroid tissue is present in 10% of the all cases.6 Teratomas containing more than 50% of thyroid tissues are called struma ovarii, often presented as monodermal teratoma.7 Malignant transformation of MCT is rare; however, several types of malignancy can develop from any one of three germ-cell layers. Squamous cell carcinoma, derived from ectoderm is the commonest type; less common malignancies include soft tissue sarcomas, adenocarcinomas, malignant melanomas, basal cell carcinomas, carcinoid tumors, and thyroid carcinomas.2 Among thyroid carcinomas the most common histological type is the papillary carcinoma (44%), other types are follicular carcinoma (30%) and follicular variant of papillary carcinoma (26%).3
The malignant change of an initially benign cystic teratoma is detected in patients between 40 and 60 years of age, older than its benign counterpart. Although the cancer occurs at any age, most patients are postmenopausal.1 The tumor may present as pelvic discomfort, with a pelvic mass on abdominal imaging (USG, CT, MRI) or during laparotomy for any other reason. Preoperative definitive diagnosis of stroma ovarii or papillary thyroid carcinoma is not possible. The only possibility of preoperative diagnosis is by radioactive iodine scan (not done routinely).8 Various case reports have been published over the past few years regarding the histological diagnoses and treatment options. The diagnoses of thyroid carcinomas arising in teratomas should be made following the guidelines for diagnosing carcinomas in thyroid gland. Disease is treatable with good out come in most cases. Only 7% and 14% of patients with papillary carcinoma and typical follicular carcinoma, respectively died of disease. Due to rarity of disease no consensus on treatment has been made, however treatment options include oophorectomy, additional thyroidectomy, radioactive iodine and long term follow up with serum thyroglobulin measurement.9
In order to determine metastatic disease, in MCT cases undergoing malignant transformation, follow up of thyroglobulin (Tg) levels is recommended. The only source of circulating Tg is the thyroid tissue and ovarian teratomas containing thyroid tissue, which is a very rare condition. However, high Tg level in benign thyroid diseases hamper determination of it as a convenient tumour marker in MCT, who did not undergo thyroidectomy and who contain thyroid tissue with malignant transformation. On the other hand, the high levels of anti-thyroglobulin antibody (anti-Tg Ab) may cause Tg levels to be erroneously low. For this reason, the follow-up of Tg levels is favourable for patients, who underwent thyroidectomy only and for patients left with no or very little thyroid tissue. In order to evaluate Tg levels correctly, follow-up of Tg levels together with anti-Tg Ab levels is advisable as persisting high levels of anti-Tg Ab indicate a persistent disease.3 In our case, Plasma T3, T4, TSH and Tg level were normal and normal parenchymal vasculature was identified by ultrasonography of the thyroid gland. Anti-Tg Ab level can’t be performed due to patient’s refusal. Logani et al., 2001 was commented the absence of normal thyroid tissue and features of teratoma, in favour of a metastatic lesion originating from thyroid gland.10 In the presented case, histologic evidence of mature teratoma, normal thyroid tissue along foci of papillary thyroid carcinoma, and positive immunohistochemical stain for thyroid transcription factor-1(TTF-1) indicates primary thyroid carcinoma arising within MCT.
Whether further therapy with total thyroidectomy and radioiodine ablation may be beneficial is unknown. The rarity of MCT cases undergoing PTC transformation impedes the establishment of a protocol for treatment and follow-up. We recommend that a long-term follow-up of these cases is needed to know more about the prognosis and to see any local recurrence or metastasis.