Objective: Mucin-producing thyroid tumors are extremely rare. Nonetheless, we have encountered three such cases in fine-needle aspiration. We report the cytologic and histologic findings and review the literature. Study Design: Cytologic features were studied on direct smears using Romanovsky stain to detect background substance and Papanicolaou stain to analyze nuclear and cytoplasmic features. The cytologic features were correlated with histology. Mucin was demonstrated by mucicarmine, Alcian Blue/PAS, and Alcian Blue (pH 2.5). Results: The cytologic features related to mucin include: (1) thick luminal mucin globules and signet ring cells aspirated from an 83-year-old woman with a 3-cm signet ring cell follicular adenoma, (2) abundant fluffy mucin containing signet ring cells in cohesive fragments aspirated from a 75-year-old man with the bilateral signet ring cell follicular variant of papillary carcinoma, which is the first case in the English literature, and (3) abundant thin mucoid mucin aspirated from the lymph node of an 86-year-old woman with a 5-cm mucinous poorly differentiated thyroid carcinoma. Conclusion: The occurrence of mucin in thyroid fine-needle aspiration does not necessarily indicate metastasis, and the presence of mucin in cervical lymph nodes does not exclude the thyroid gland as a possible primary.

Keywords:
Signet ring cell follicular adenoma, Signet ring cell follicular variant of papillary carcinoma, Mucinous poorly differentiated thyroid carcinoma, Thyroid, Fine-needle aspiration
1.
Foster EA, Levine AJ: Mucin production in metastatic carcinomas. Cancer 1963;16:506–509.
2.
Sobrinho-Simoes M, Cameselle-Teijeiro J, Harach HR: Mucinous carcinoma; in DeLellis RA, et al (eds): Pathology and Genetics of Tumours of Endocrine Organs: WHO Classification of Tumours. Lyon, IARC Press, 2004, vol 8, p 85.
3.
Mueller W: Über myxomatoses Adenom der Schilddrüse und dessen Beziehung zum sog. Gallertkrebs. Jena Z Med Naturwiss Leipzig 1871;6:481–495.
4.
Diaz-Perez R, Quiroz H, Nishiyama RH: Primary mucinous adenocarcinoma of thyroid gland. Cancer 1976;38:1325–1327.
5.
Zaatari GS, Saigo PE, Huvos AG: Mucin production in medullary carcinoma of the thyroid. Arch Pathol Lab Med 1983;107:70–74.
6.
Mlynek ML, Richter HJ, Leder LD: Mucins in carcinomas of the thyroid. Cancer 1985;56:2647–2650.
7.
Chan JK, Tse CC: Mucin production in metastatic papillary carcinoma of the thyroid. Hum Pathol 1988;19:195–200.
8.
Mendelsohn G: Signet-cell-simulating microfollicular adenoma of the thyroid. Am J Surg Pathol 1984;8:605–608.
9.
Rigaud C, Peltier F, Bogomoletz WV: Mucin producing microfollicular adenoma of the thyroid. J Clin Pathol 1985;38:277–280.
10.
Gheradi G: Signet ring cell ‘mucinous’ thyroid adenoma: a follicle cell tumour with abnormal accumulation of thryoglobulin and a peculiar histochemical profile. Histopathology 1987;11:317–326.
11.
Markaki S, Prevedorou D, Kyratsis G, Bouropoulou V: Follicular thyroid adenoma: signet ring cell variant. Arch Anat Cytol Pathol 1990;38:114–116.
12.
Yoshida J, Tanimura A, Yamashita H, Matsuo K: Signet ring cell adenoma of the thyroid with mucin predominance. Thyroid 1999;9:401–404.
13.
El-Sahrigy D, Zhang XM, Elhosseiny A, Mealmed MR: Signet-ring follicular adenoma of the thyroid diagnosed by fine needle aspiration: report of a case with cytologic description. Acta Cytol 2004;48:87–90.
14.
Murakami S, Sakata H, Okubo K, Tsuji Y, Kayano H: Thyroid adenoma with extensive extracellular mucin deposition: report of a case. Surg Today 2007;37:226–229.
15.
Galera-Davidson H: Diagnostic problems in thyroid FNAs. Diagn Cytopathol 1997;17:422–428.
16.
Morrison C, Wakely P Jr: Aspiration cytopathology of metastatic mucinous papillary thyroid carcinoma: Mod Pathol 2001;14:361–365.
17.
Fernandes BJ, Bedard YC, Rosen I: Mucus-producing medullary cell carcinoma of the thyroid gland. Am J Clin Pathol 1982;78:536–540.
18.
Haleem A, Akhtar M, Ali MA, Iqbal Z: Fine-needle aspiration biopsy of mucus-producing medullary carcinoma of thyroid – report of a case with cytologic, histologic, and ultrastructural correlations. Diagn Cytopathol 1990;2:112–117.
19.
Uccella S, La Rosa S, Finzi G, Erba S, Sessa F: Mixed mucus-secreting and oncocytic carcinoma of the thyroid: pathological, histochemical, immunohistochemical, and ultrastructural study of a case. Arch Pathol Lab Med 2000;124:1547–1552.
20.
Cretney A, Mow C: Mucinous variant of follicular carcinoma of the thyroid gland. Pathology 2006;38:184–186.
21.
Deligdisch L, Subhani Z, Gordon RE: Primary mucinous carcinoma of the thyroid gland: report of a case and ultrastructural study. Cancer 1980;45:2564–2567.
22.
Sobrinho-Simoes M, Nesland JM, Johannessen JV: A mucin producing tumor in the thyroid gland. Ultrastruct Pathol 1985;9:277–281.
23.
Sobrinho-Simoes M, Stenwig AE, Nesland JM, Holm R, Johannessen JV: A mucinous carcinoma of the thyroid. Pathol Res Pract 1986;181:464–471.
24.
Mizukami Y, Nakajima H, Annen Y, Michigishi T, Nonomura A, Nakamura S: Mucin-producing poorly differentiated adenocarcinoma of the thyroid – a case report. Pathol Res Pract 1993;189:608–612.
25.
Levine TS, Hore I, Stearns M, Brown C: Cytological findings in a mucin-secreting follicular carcinoma of the thyroid. Cytopathology 2000;11:185–190.
26.
Kondo T, Kato K, Nakazawa T, Miyata K, Murata S, Katoh R: Mucinous carcinoma (poorly differentiated carcinoma with extensive extracellular mucin deposition) of the thyroid: a case report with immunohistochemical studies. Hum Pathol 2005;36:698–701.
27.
D’Antonio A, Addesso M, De Dominicis G, Boscaino A, Liguori G, Nappi O: Mucinous carcinoma of thyroid gland: report of a primary and a metastatic mucinous tumour from ovarian adenocarcinoma with immunohistochemical study and review of literature. Virchows Arch 2007;45:847–851.
28.
Schröder S, Böcker W: Signet-ring-cell thyroid tumors. Follicle cell tumors with arrest of folliculogenesis. Am J Surg Pathol 1985;9:619–629.
29.
LiVolsi VA: Mucin-producing poorly differentiated adenocarcinoma of the thyroid: critical commentary. Pathol Res Pract 1993;189:613–615.
30.
Baloch ZW, Solomon AC, LiVolsi VA: Primary mucoepidermoid carcinoma and sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland: a report of nine cases. Mod Pathol 2000;13:802–807.
31.
Bieche I, Ruffet E, Zweibaum A, Vilde F, Lidereau R, Franc B: MUC1 mucin gene, transcripts, and protein in adenoma and papillary carcinoma of the thyroid. Thyroid 1997;7:725–731.
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2011
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