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Presented by Dr. Pedram Argani and prepared by Dr. Jennifer Bynum
This is a 64 year old male with a thyroid mass.
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1. Question
Week 629: Case 3
This is a 64 year old male with a thyroid mass.Correct
Answer: C
Histologic Description: This is a solid cellular nodule with areas of follicular formation which mimics a follicular adenoma. However, on closer inspection, one can appropriate that the nuclei are round and hyperchromatic, and are supported by delicate capillary vascular pattern. Oxalate crystals are not identified. Immunohistochemistry for parathyroid hormone confirms that tissue represents a parathyroid adenoma.
Differential Diagnosis: Follicular adenoma is distinguished from parathyroid adenoma in the thyroid by differences in cytology (follicular adenoma typically has more open chromatin), presence of calcium oxalate crystals, and absence of immunoreactivity for parathormone. Follicular carcinoma would demonstrate angioinvasion or capsular invasion which is not seen in the current case. Follicular variant of papillary thyroid carcinoma would demonstrate more irregular nuclei with open chromatin and prominent nuclear overlap. None of these features are seen in the current case.
Incorrect
Answer: C
Histologic Description: This is a solid cellular nodule with areas of follicular formation which mimics a follicular adenoma. However, on closer inspection, one can appropriate that the nuclei are round and hyperchromatic, and are supported by delicate capillary vascular pattern. Oxalate crystals are not identified. Immunohistochemistry for parathyroid hormone confirms that tissue represents a parathyroid adenoma.
Differential Diagnosis: Follicular adenoma is distinguished from parathyroid adenoma in the thyroid by differences in cytology (follicular adenoma typically has more open chromatin), presence of calcium oxalate crystals, and absence of immunoreactivity for parathormone. Follicular carcinoma would demonstrate angioinvasion or capsular invasion which is not seen in the current case. Follicular variant of papillary thyroid carcinoma would demonstrate more irregular nuclei with open chromatin and prominent nuclear overlap. None of these features are seen in the current case.