A 58-year-old woman undergoes thyroidectomy for a 2 cm nodule. Histology shows a papillary carcinoma in which more than 30% of the tumor consists of tall columnar cells with abundant eosinophilic cytoplasm, height at least twice their width, arranged perpendicular to the basement membrane. Compared with conventional papillary carcinoma, this variant is characterized by:

• A Uniform BRAF V600E negativity and RET/PTC rearrangement
• B An indolent course identical to conventional papillary carcinoma
• C Predominant hematogenous spread to bone with early distant metastasis
• D Higher rates of extrathyroidal extension and recurrence, with a worse prognosis ✓

Explanation

The tall cell variant of papillary carcinoma, defined by tall cells composing more than 30% of the tumor, behaves more aggressively than conventional papillary carcinoma, with greater extrathyroidal extension, higher recurrence rates, and presentation at older age. It is strongly associated with BRAF V600E mutation rather than being BRAF negative, and it spreads primarily by lymphatics like other papillary carcinomas, making option C incorrect.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.