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Virtual Pathology Slide Atlas

 

20.6 Male in 40’s, thyroid nodule, hyperparathyroidism. This is a Follicular Variant of Papillary Carcinoma showing nuclear and architectural features of follicular variant of papillary carcinoma

 

19.8:Female mid 50’s, firm nodule in thyroid isthmus 14mm in size. Most members thought this was Papillary Carcinoma of the Thyroid, some saying that this was the oncocytic variant, others tall cell, others columnar cell. It was commented that the architectural and cytological features apart from the nuclear features were those of papillary carcinoma. 

 

20.1  Female, mid 30’s total thyroidectomy with level VI dissection, 25mm nodule in right lobe of thyroid, single H+E 

 

The consensus diagnosis in this case was papillary carcinoma of the thyroid, with many members pointing out that this lesion showed features of tall cell variant 

 

21.5 Female in mid 20’s, hard node left lobe/isthmus of thyroid, left thyroid lobectomy, weighing 6g. 

 

Diagnosis was papillary thyroid carcinoma, diffuse sclerosing variant, 10.6mm, with infiltrative margins, minimal extrathyroidal extension, lymphovascular space invasion and one (of four) lymph nodes positive with another containing a naked psammoma body. 

 

Discussion points: 

 

Naked psammoma bodies in lymph nodes – should attempt to find epithelium (e.g. levels, immunohistochemistry) but otherwise just report what we see, i.e. a naked psammoma body. 

 

Rules for diffuse sclerosing variant – vary publication to publication.  Some areas of this typical, others not diffuse or sclerosed enough. 

 

Size – should TNM staging be based on the microscopic or macroscopic size? Issue of shrinkage factors with fixation then processing, also shear factors during microtomy 

 

18. 1 male, aged 80’s, incidental R thyroid lump, 30mm solid and cystic lesion replacing most of right lobe.  

 

A range of differential diagnoses were offered in this case from follicular adenoma, FVPC, poorly differentiated carcinoma and papillary carcinoma with dedifferentiation. There was lack of agreement in this case as to the final diagnosis, although the proffered diagnosis was poorly differentiated thyroid carcinoma. Vascular invasion was present in this case in other sections although it was not evident in the slide circulated  

 

18. 2:female, aged in 40’s, 15mm thyroid lesion, thyroid showed multinodular goitre, weighed 131g. 

 

This was another controversial case. A range of diagnoses was offered including medullary carcinoma, follicular adenoma, insular carcinoma, and poorly differentiated follicular carcinoma. The proffered diagnosis was incidental insular carcinoma of the thyroid 

 

19.6: female mid 60’s, left thyroid mass, cytology follicular, left thyroid lobectomy weighing 39g with a mass occupying most of the lobe. 

 

Most members thought that this was a poorly differentiated carcinoma/insular carcinoma with vascular invasion although others thought it was a neuroendocrine or follicular carcinoma. The neuroendocrine markers; calcitonin, chromogranin and Cd56 were negative, and Ck19 was largely negative in the tumour nuclei.  

 

21.7 18996/09. Female, late 60’s, left thyroid lobectomy 16mm non-encapsulated hard white tumour.  

 

Proffered diagnosis was medullary thyroid carcinoma.  Congo red was positive and birefringent. Calcitonin & CEA were positive, and CK19 was negative.  Additional tumour foci / C cell hyperplasia were seen elsewhere in the lobe, but C cell hyperplasia was not confirmed in the completion specimen.  An incidental micropapillary thyroid carcinoma was noted. 

Pre-op FNA had been difficult – suspicious of papillary thyroid carcinoma, sent for external review – follicular-patterned lesion with DD including FVPTC.  No mention of MTC by either.  The cytology contained “thick colloid” - ?amyloid, and three dimensional groups of cells with crowded nuclei, high nuclear cytoplasmic ratios and follicular formations. 

 

References

Livolsi. C cell hyperplasia / neoplasia.J Clin Endocrinol Metab1997;82:39-41 

Mete & Asa. Composite medullary and papillary thyroid carcinoma in a patient withMSN2B. Case report and review of C-cell lesions of the thyroid. Pathol Case Rev 2009;14:208-13 

 

 

21.3Male, mid 60’s, palliative radiotherapy for pain control and bony metastases, total thyroidectomy, section from right lobe. Diagnosis was poorly differentiated thyroid carcinoma with features approaching an anaplastic carcinoma, infiltrating throughout both lobes.  Prior to this, a lymph node biopsy had been reported as metastatic lung carcinoma with TTF1-positivity. No lung cancer was found and the histology was reviewed, thyroglobulin was done and was positive, then total thyroidectomy was performed. UKEPS members commented on the unusual infiltrative pattern between the thyroid follicles. The gross specimen had not contained a main tumour mass. One member had noted an aggregate of clear cells and wondered about renal clear cell carcinoma.