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Presented by Justin A. Bishop, M.D. and prepared by Justin Poling, M.D.
Case 1: 46 year old woman with a mass in her thyroid gland.
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Question 1 of 1
1. Question
Week 547: Case 1
46 year old woman with a mass in her thyroid gland.images/poling/2112013/case1_1.jpg
images/poling/2112013/case1_2.jpg
images/poling/2112013/case1_3.jpgCorrect
Answer: Papillary carcinoma, poorly differentiated
Histology: The tumor is encapsulated, but there are numerous areas of invasion into intracapsular blood vessels. The tumor nuclei are elongated and overlapping, with partial chromatin clearing and scattered grooves. Areas of necrosis are seen, and the mitotic rate was 7 per 10 high power fields.
Discussion: Evaluation of a thyroid nodule begins with a low power examination of its capsule. In this case, numerous foci of invasion were identified, so a diagnosis of malignancy is easily attained. The tumor nuclei should also be examined. In this case, although the pattern of invasion is reminiscent of an angioinvasive follicular carcinoma, the nuclear atypia is more in keeping with a follicular variant of papillary carcinoma. It is important to recognize and report the presence of a poorly differentiated component in any thyroid carcinoma. The criteria for poorly differentiated thyroid carcinoma has been controversial, but in recent years these have been clarified to: presence of tumor necrosis and/or an elevated mitotic rate (greater than 3 or 4/10 hpf). The presence of a poorly differentiated component is a poor prognostic factor.
Incorrect
Answer: Papillary carcinoma, poorly differentiated
Histology: The tumor is encapsulated, but there are numerous areas of invasion into intracapsular blood vessels. The tumor nuclei are elongated and overlapping, with partial chromatin clearing and scattered grooves. Areas of necrosis are seen, and the mitotic rate was 7 per 10 high power fields.
Discussion: Evaluation of a thyroid nodule begins with a low power examination of its capsule. In this case, numerous foci of invasion were identified, so a diagnosis of malignancy is easily attained. The tumor nuclei should also be examined. In this case, although the pattern of invasion is reminiscent of an angioinvasive follicular carcinoma, the nuclear atypia is more in keeping with a follicular variant of papillary carcinoma. It is important to recognize and report the presence of a poorly differentiated component in any thyroid carcinoma. The criteria for poorly differentiated thyroid carcinoma has been controversial, but in recent years these have been clarified to: presence of tumor necrosis and/or an elevated mitotic rate (greater than 3 or 4/10 hpf). The presence of a poorly differentiated component is a poor prognostic factor.
