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Presented by Justin A. Bishop, M.D. and prepared by Justin Poling, M.D.
Case 2: 46 year old woman with a thyroid gland nodule.
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Question 1 of 1
1. Question
Week 547: Case 2
46 year old woman with a thyroid gland nodule.images/poling/2112013/case2_1.jpg
images/poling/2112013/case2_2.jpg
images/poling/2112013/case2_3.jpgCorrect
Answer: Follicular variant of papillary carcinoma
Histology: The thyroid nodule is well circumscribed, with no evidence of invasive growth. The tumor has a microfollicular to solid growth pattern. The cells lining the follicles exhibit cyto-architectural atypia including dark-staining colloid, nuclear enlargement, chromatin clearing, overlapping, dyspolarization around the follicles, nuclear contour irregularities, and nuclear pseudoinclusions.
Discussion: These nuclear features warrant the diagnosis of follicular variant of papillary carcinoma. In addition, there are scattered cells showing bizarre atypia and multinucleation. These cells have a degenerative appearance, and are not associated with an increased mitotic rate or necrosis. This type of atypia has no prognostic significance (and may even be seen in benign nodules), and should not be mistaken for anaplastic transformation.
Incorrect
Answer: Follicular variant of papillary carcinoma
Histology: The thyroid nodule is well circumscribed, with no evidence of invasive growth. The tumor has a microfollicular to solid growth pattern. The cells lining the follicles exhibit cyto-architectural atypia including dark-staining colloid, nuclear enlargement, chromatin clearing, overlapping, dyspolarization around the follicles, nuclear contour irregularities, and nuclear pseudoinclusions.
Discussion: These nuclear features warrant the diagnosis of follicular variant of papillary carcinoma. In addition, there are scattered cells showing bizarre atypia and multinucleation. These cells have a degenerative appearance, and are not associated with an increased mitotic rate or necrosis. This type of atypia has no prognostic significance (and may even be seen in benign nodules), and should not be mistaken for anaplastic transformation.
