Case 1 Female, right thyroid lobectomy with a 23mm solid nodule. The
diagnosis in this case is
Follicular variant of papillary thyroid carcinoma and hyalinising trabecular
tumour. This slide shows a
neoplastic follicular lesion of the thyroid with
foci of vascular and capsular invasion with nuclei with equivocal appearances with
some features of papillary carcinoma and others of follicular carcinoma. Papillary carcinoma nuclei were
confirmed in other blocks. There was also a
hyalinising trabecular tumour in this section
see also here that showed strong membrane staining for MIB1 and was calcitonin –ve.
Case 2 Male, thyroid nodule, hyperparathyroidism. This is a f
ollicular variant of papillary carcinoma showing
architectural features of follicular variant of papillary carcinoma.
19.8 Case 3 Female, firm nodule in
thyroid isthmus 14mm in size. This case shows classical papillary carcinoma of
the thyroid, with some features suggestive of the oncocytic, tall cell, or columnar cell variants,
with architectural and cytological features 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
21.5 Female in mid 20’s, hard node left lobe/isthmus of thyroid, left thyroid lobectomy, weighing
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.
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
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
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
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
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
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
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.