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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 1: This is a 31 yr old female with a thyroid nodule.
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1. Question
Week 526: Case 1
This is a 31 yr old female with a thyroid nodule.images/vincent/5521_01.jpg
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images/vincent/5521_04.jpgCorrect
Answer: Papillary hyperplasia
Histology: This is a highly complex papillary lesion, which at low power certainly raises the differential diagnosis of papillary carcinoma. However, careful attention to the architecture reveals there are thyroid follicles within the stalks of some of the fibrovascular cores, referred to as Sanderson’s polster which favors papillary hyperplasia. More importantly, the cytology of the lesion is benign; that is, the nuclei are generally rounded and basally located in the cells. One does not see prominent grooves, intranuclear inclusions, or psammoma bodies. These are the typical features of papillary hyperplasia. This lesion is likely occurring as a degenerative change in adenomatoid nodule.
Discussion: Papillary carcinoma has the cytologic features described above which are not present in the current lesion. Hurthle cell adenomas may acquire a pseudopapillary appearance; however, these cells are extensively oncocytic unlike the current lesion. Follicular adenomas lack the papillary architecture of the current lesion.
Incorrect
Answer: Papillary hyperplasia
Histology: This is a highly complex papillary lesion, which at low power certainly raises the differential diagnosis of papillary carcinoma. However, careful attention to the architecture reveals there are thyroid follicles within the stalks of some of the fibrovascular cores, referred to as Sanderson’s polster which favors papillary hyperplasia. More importantly, the cytology of the lesion is benign; that is, the nuclei are generally rounded and basally located in the cells. One does not see prominent grooves, intranuclear inclusions, or psammoma bodies. These are the typical features of papillary hyperplasia. This lesion is likely occurring as a degenerative change in adenomatoid nodule.
Discussion: Papillary carcinoma has the cytologic features described above which are not present in the current lesion. Hurthle cell adenomas may acquire a pseudopapillary appearance; however, these cells are extensively oncocytic unlike the current lesion. Follicular adenomas lack the papillary architecture of the current lesion.
