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Case Report Open Access

Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature

  • Authors:
    • Ari M. Abdullah
    • Rawa M. Ali
    • Abdulwahid M. Salih
    • Imad J. Habibullah
    • Hadeel A. Yasseen
    • Twana Omer Saeed
    • Shko H. Hassan
    • Harun Amanj Ahmed
    • Abdullah A. Qadir
    • Fahmi H. Kakamad

  • View Affiliations / Copyright

    Affiliations: Department of Scientific Affairs, Smart Health Tower, Sulaymaniyah 46001, Iraq
    Copyright: © Abdullah et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 8
    |
    Published online on: December 31, 2025
       https://doi.org/10.3892/wasj.2025.423
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Abstract

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer with a good prognosis. However, in rare cases, it can behave aggressively and exhibit unusual features such as squamous differentiation, where squamous cells appear alongside typical PTC cells. PTC with squamous differentiation (PTC‑SD) is extremely rare and is thus not well understood. The present study reports two cases of PTC‑SD. The first case was that of a 28‑year‑old female patient who presented with a neck mass and hoarseness, and another that of a 49‑year‑old male patient who presented with an incidental finding of a thyroid lesion during a neck ultrasound for a dental issue. Upon investigations, both patients had suspicious thyroid nodules. A total thyroidectomy was performed for both cases. A histopathological examination confirmed PTC‑SD. Levothyroxine was prescribed for both patients, and radioactive iodine ablation was scheduled for the first case. Squamous epithelium in the thyroid is rare and can result from various causes, including primary thyroid squamous cell carcinoma, anaplastic transformation, metastasis, or PTC‑SD. Although the available data are limited, they indicate that PTC‑SD may be associated with a poorer prognosis compared to conventional PTC. Herein, in a review of 4 cases reported in the literature, it was found that 1 patient succumbed and another experienced recurrence. Despite its rarity, recognizing this variant is crucial for an accurate diagnosis and appropriate treatment planning. Patients with PTC‑SD require careful monitoring, with the majority undergoing surgical resection. Though rare, clinicians should recognize that PTC can undergo squamous differentiation.
View Figures

Figure 1

(A) Histopathology results of case one illustrating well-formed papillary structures in the upper part of the image with an area below it illustrating squamous cell differentiation (blue arrows). The two areas are separate by a thick fibrous stroma (yellow star) (hematoxylin and eosin staining; magnification, x4). (B) Higher power view of the classical subtype of the papillary thyroid carcinoma, which is composed of complex papillary structures covered by follicular epithelial cells (black arrows) (hematoxylin and eosin staining; magnification, x10). (C) Higher power view of the squamous differentiation area, illustrating dyskeratotic squamous cells (black arrows) without nuclear features of papillary thyroid carcinoma in this area (hematoxylin and eosin staining; magnification, x40).

Figure 2

Immunohistochemistry results of case one. (A) CK5/6 immune staining illustrating a cytoplasmic staining pattern in the upper image (squamous cell area) and negative in the lower image (papillary thyroid carcinoma area). (B) TTF1 immune staining, illustrating nuclear positivity on the left side (papillary thyroid carcinoma area) and negative on the right side (squamous area). (C) P40 staining illustrating a diffuse, strong nuclear staining pattern in the squamous area.

Figure 3

(A) Histopathology results of case two illustrating complex papillary structures in the upper part of the image that are covered by follicular epithelial cells (black star) with an area of squamous differentiation in the lower part of the image (blue star) (hematoxylin and eosin staining; magnification, x4). (B) Higher power view of the same area in the above image, illustrating squamous differentiation with a clear eosinophilic cytoplasm that contains intracellular eosinophilic keratinous material accumulation (black arrows) (hematoxylin and eosin staining; magnification, x40).
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Copy and paste a formatted citation
Spandidos Publications style
Abdullah AM, Ali RM, Salih AM, Habibullah IJ, Yasseen HA, Saeed TO, Hassan SH, Ahmed HA, Qadir AA, Kakamad FH, Kakamad FH, et al: Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature. World Acad Sci J 8: 8, 2026.
APA
Abdullah, A.M., Ali, R.M., Salih, A.M., Habibullah, I.J., Yasseen, H.A., Saeed, T.O. ... Kakamad, F.H. (2026). Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature. World Academy of Sciences Journal, 8, 8. https://doi.org/10.3892/wasj.2025.423
MLA
Abdullah, A. M., Ali, R. M., Salih, A. M., Habibullah, I. J., Yasseen, H. A., Saeed, T. O., Hassan, S. H., Ahmed, H. A., Qadir, A. A., Kakamad, F. H."Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature". World Academy of Sciences Journal 8.1 (2026): 8.
Chicago
Abdullah, A. M., Ali, R. M., Salih, A. M., Habibullah, I. J., Yasseen, H. A., Saeed, T. O., Hassan, S. H., Ahmed, H. A., Qadir, A. A., Kakamad, F. H."Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature". World Academy of Sciences Journal 8, no. 1 (2026): 8. https://doi.org/10.3892/wasj.2025.423
Copy and paste a formatted citation
x
Spandidos Publications style
Abdullah AM, Ali RM, Salih AM, Habibullah IJ, Yasseen HA, Saeed TO, Hassan SH, Ahmed HA, Qadir AA, Kakamad FH, Kakamad FH, et al: Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature. World Acad Sci J 8: 8, 2026.
APA
Abdullah, A.M., Ali, R.M., Salih, A.M., Habibullah, I.J., Yasseen, H.A., Saeed, T.O. ... Kakamad, F.H. (2026). Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature. World Academy of Sciences Journal, 8, 8. https://doi.org/10.3892/wasj.2025.423
MLA
Abdullah, A. M., Ali, R. M., Salih, A. M., Habibullah, I. J., Yasseen, H. A., Saeed, T. O., Hassan, S. H., Ahmed, H. A., Qadir, A. A., Kakamad, F. H."Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature". World Academy of Sciences Journal 8.1 (2026): 8.
Chicago
Abdullah, A. M., Ali, R. M., Salih, A. M., Habibullah, I. J., Yasseen, H. A., Saeed, T. O., Hassan, S. H., Ahmed, H. A., Qadir, A. A., Kakamad, F. H."Papillary thyroid carcinoma with squamous differentiation: A report of two cases and a brief review of the literature". World Academy of Sciences Journal 8, no. 1 (2026): 8. https://doi.org/10.3892/wasj.2025.423
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