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Presented by Division of Cytopathology and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 3: 52 year-old woman who relates a history of thyroidectomy but could not recall the final diagnosis.
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1. Question
Week 259: Case 3
52 year-old woman who relates a history of thyroidectomy but could not recall the final diagnosis. Aspiration of mass in thyroid bed.images/c04-17720a.jpg
images/c04-17720b.jpg
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images/c04-17720d.jpgCorrect
Answer: Medullary thyroid carcinoma
Histology: Numerous loosely cohesive cells having lymphoplasmacytoid features are seen. Dense clumps of metachromatic material in the stroma are scattered throughout. The nuclei are round and have a characteristic “salt-and-pepper” appearance.
Discussion: Medullary thyroid carcinoma is characterized by neoplastic neuroendocrine cells with a distinctive “salt-and-pepper” chromatin pattern. While cases of medullary thyroid carcinoma may have Hurthloid and spindle cells, proportions vary from case to case and the lymphoplasmacytoid population predominates here. Amyloid in the stroma, another feature of medullary thyroid carcinoma, can be confirmed with “apple-green” birefringence on Congo red stains. Review of the original thyroidectomy material from an outside hospital confirmed the initial diagnosis of medullary thyroid carcinoma.
Incorrect
Answer: Medullary thyroid carcinoma
Histology: Numerous loosely cohesive cells having lymphoplasmacytoid features are seen. Dense clumps of metachromatic material in the stroma are scattered throughout. The nuclei are round and have a characteristic “salt-and-pepper” appearance.
Discussion: Medullary thyroid carcinoma is characterized by neoplastic neuroendocrine cells with a distinctive “salt-and-pepper” chromatin pattern. While cases of medullary thyroid carcinoma may have Hurthloid and spindle cells, proportions vary from case to case and the lymphoplasmacytoid population predominates here. Amyloid in the stroma, another feature of medullary thyroid carcinoma, can be confirmed with “apple-green” birefringence on Congo red stains. Review of the original thyroidectomy material from an outside hospital confirmed the initial diagnosis of medullary thyroid carcinoma.
