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Presented by William Westra, M.D. and prepared by Marc Lewin, M.D.
Case 5: 60 year-old woman with solitary thyroid nodule.
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1. Question
Week 281: Case 5
60 year-old woman with solitary thyroid nodule/images/8-28-06case05a.jpg
/images/8-28-06case05b.jpg
/images/8-28-06case05c.jpgCorrect
Answer: Follicular adenolipoma
Histology: The nodule demonstrates a follicular pattern of growth. It is surrounded by a thin fibrous capsule without evidence of transcapsular extension or invasion of intracapsular blood vessels. The cells lining the follicles are uniformly distributed and without cytologic atypia. The follicles are separated by mature fat.
Discussion: Adenolipoma is an uncommon variant of a follicular adenoma where the neoplastic follicles are separated by zones of mature adipose tissue. The presence of adipose tissue within a follicular adenoma likely reflects fatty metaplasia of the thyroid stroma rather than a separate mesenchymal tumor (i.e. lipoma) arising in association with a follicular neoplasm. Similar metaplastic changes are commonly noted in normal thyroid parenchyma and multinodular hyperplasia. The finding of prominent stromal metaplasia within a follicular adenoma is of no prognostic relevance.
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Answer: Follicular adenolipoma
Histology: The nodule demonstrates a follicular pattern of growth. It is surrounded by a thin fibrous capsule without evidence of transcapsular extension or invasion of intracapsular blood vessels. The cells lining the follicles are uniformly distributed and without cytologic atypia. The follicles are separated by mature fat.
Discussion: Adenolipoma is an uncommon variant of a follicular adenoma where the neoplastic follicles are separated by zones of mature adipose tissue. The presence of adipose tissue within a follicular adenoma likely reflects fatty metaplasia of the thyroid stroma rather than a separate mesenchymal tumor (i.e. lipoma) arising in association with a follicular neoplasm. Similar metaplastic changes are commonly noted in normal thyroid parenchyma and multinodular hyperplasia. The finding of prominent stromal metaplasia within a follicular adenoma is of no prognostic relevance.
