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Presented by Pedram Argani, M.D. and prepared by Carol Allan, M.D.
Case 5: 29-year-old female with multiple thyroid masses.
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1. Question
Week 76: Case 5
29-year-old female with multiple thyroid masses.images/pa5a.jpg
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images/pa5d.jpgCorrect
Answer: Papillary carcinoma, columnar cell type
Histology: The lesion has a papillary architecture. It has a striking composition of hyperchromatic, elongated, cigar-shaped nuclei which stratify similar to the pattern seen a colonic adenoma. There were small foci of necrosis present. These features are classic for columnar cell variant of papillary carcinoma of the thyroid.
Discussion: Metastatic colorectal carcinoma would be associated with more necrosis, less fine villiform folds, and greater nuclear atypia. Columnar cell carcinoma cells are, in fact, “tall cells”, in that they are greater than two fold as tall as they are wide. However, the classic tall cell carcinoma contains pink cytoplasm, and there is typically an associated lymphoid infiltrate. Diffuse sclerosing papillary carcinoma typically occurs in children, and presents as a nodular goiter which on cut section has a gritty surface due to permeation of the intrathyroidal lymphatics with carcinoma and psammoma bodies. Tall cell, columnar cell, and diffuse sclerosing are the three variants of papillary carcinoma associated with a diminished prognosis compared to usual papillary carcinoma, which has a relatively favorable prognosis.
Incorrect
Answer: Papillary carcinoma, columnar cell type
Histology: The lesion has a papillary architecture. It has a striking composition of hyperchromatic, elongated, cigar-shaped nuclei which stratify similar to the pattern seen a colonic adenoma. There were small foci of necrosis present. These features are classic for columnar cell variant of papillary carcinoma of the thyroid.
Discussion: Metastatic colorectal carcinoma would be associated with more necrosis, less fine villiform folds, and greater nuclear atypia. Columnar cell carcinoma cells are, in fact, “tall cells”, in that they are greater than two fold as tall as they are wide. However, the classic tall cell carcinoma contains pink cytoplasm, and there is typically an associated lymphoid infiltrate. Diffuse sclerosing papillary carcinoma typically occurs in children, and presents as a nodular goiter which on cut section has a gritty surface due to permeation of the intrathyroidal lymphatics with carcinoma and psammoma bodies. Tall cell, columnar cell, and diffuse sclerosing are the three variants of papillary carcinoma associated with a diminished prognosis compared to usual papillary carcinoma, which has a relatively favorable prognosis.
