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Presented by Dr. Pedram Argani and prepared by Dr. Kevan Salimian
This is a 65 year old male with a 4cm thyroid nodule.
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Question 1 of 1
1. Question
This is a 65 year old male with a 4cm thyroid nodule. Choose the correct diagnosis.
Correct
Answer: Hurthle cell carcinoma
Histologic Description: This is a lesion of oncocytic cells that have both follicular and trabecular architecture. A worrisome feature of this lesion is the thickness of the capsule, which raises concern for a follicular pattern carcinoma. At least focally, one can appreciate tongues of tumor cells extending into vascular spaces within the capsule, and other areas there are signs of capsular penetration. These features of diagnostic of Hurthle cell carcinoma.
Differential diagnosis: Adenomatoid nodules typically demonstrate less cellularity than carcinomas and more variation in the presence/thickness of their capsules. Hurthle cell adenomas are well delineated from normal thyroid; however, they tend to have thinner capsules and importantly lack capsular/vascular invasion. Medullary carcinoma of the thyroid may have oncocytic and follicular patterns; however, this neoplasm is characterized by amphophilic cells with uniform chromatin that has a salt and pepper appearance.
Incorrect
Answer: Hurthle cell carcinoma
Histologic Description: This is a lesion of oncocytic cells that have both follicular and trabecular architecture. A worrisome feature of this lesion is the thickness of the capsule, which raises concern for a follicular pattern carcinoma. At least focally, one can appreciate tongues of tumor cells extending into vascular spaces within the capsule, and other areas there are signs of capsular penetration. These features of diagnostic of Hurthle cell carcinoma.
Differential diagnosis: Adenomatoid nodules typically demonstrate less cellularity than carcinomas and more variation in the presence/thickness of their capsules. Hurthle cell adenomas are well delineated from normal thyroid; however, they tend to have thinner capsules and importantly lack capsular/vascular invasion. Medullary carcinoma of the thyroid may have oncocytic and follicular patterns; however, this neoplasm is characterized by amphophilic cells with uniform chromatin that has a salt and pepper appearance.
