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Presented by Pedram Argani, M.D. and prepared by Carla Ellis, M.D.
Case 3: This is a 45-year-old female with a 3 cm thyroid mass.
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1. Question
Week 447: Case 3
This is a 45-year-old female with a 3 cm thyroid mass.images/1Alex/08162010case3image1.jpg
images/1Alex/08162010case3image2.jpg
images/1Alex/08162010case3image3.jpgCorrect
Answer: Follicular variant of Papillary carcinoma
Histology: This is a well-delineated follicular patterned lesion which lacks the prominent lymphoid infiltrate seen in the surrounding nonneoplastic thyroid. The follicles are irregularly shaped, and have dark staining colloid. The follicles at the edge of the lesion are often elongated, and point to the central portions of the lesion. On high power, the nuclei lining the follicles demonstrate elongation, overlap, grooves, ovoid shape and occasional intranuclear inclusions. These are the cytologic features of the follicular variant of papillary carcinoma.
Discussion: A follicular adenoma would lack the cytologic features of follicular variant of papillary carcinoma, as would an adenomatoid nodule. Insular carcinoma would feature smaller cells with more prominent mitotic activity and frequent necrosis.
Incorrect
Answer: Follicular variant of Papillary carcinoma
Histology: This is a well-delineated follicular patterned lesion which lacks the prominent lymphoid infiltrate seen in the surrounding nonneoplastic thyroid. The follicles are irregularly shaped, and have dark staining colloid. The follicles at the edge of the lesion are often elongated, and point to the central portions of the lesion. On high power, the nuclei lining the follicles demonstrate elongation, overlap, grooves, ovoid shape and occasional intranuclear inclusions. These are the cytologic features of the follicular variant of papillary carcinoma.
Discussion: A follicular adenoma would lack the cytologic features of follicular variant of papillary carcinoma, as would an adenomatoid nodule. Insular carcinoma would feature smaller cells with more prominent mitotic activity and frequent necrosis.
