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Presented by Dr. Pedram Argani and prepared by Dr. Robby Jones.
This is a 35 year old female with a thyroid nodule.
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1. Question
This is a 35 year old female with a thyroid nodule.
Correct
Answer: A
Histologic Description: This is a bland oncocytic lesion composed of cells with round nuclei and granular cytoplasm. The lesion is unencapsulated. Focally, the neoplastic cells surround native follicles, falsely creating the appearance of a follicular neoplasm. The lesional cells do not themselves form follicles, and have salt and pepper type neuroendocrine chromatin. This lesion labeled for chromogranin and calcitonin, consistent with medullary thyroid carcinoma.Differential Diagnosis: Follicular adenoma would not feature the neuroendocrine chromatin of the current lesion, and the cells themselves form follicles. Parathyroid tissue typically features smaller darker nuclei, and a more prominent capillary vasculature than thyroid tissue. Follicular carcinoma is defined as a thyroid follicle forming neoplasm that invades its capsule or blood vessels.
Medullary thyroid carcinoma demonstrates multiple histologic patterns, including pseudopapillary, follicular, giant cell, spindle cell, paraganglioma-like, oncocytic, clear cell, and angiosarcoma-like. The follicular like variant creates confusion with the more common follicular neoplasms of the thyroid.
Incorrect
Answer: A
Histologic Description: This is a bland oncocytic lesion composed of cells with round nuclei and granular cytoplasm. The lesion is unencapsulated. Focally, the neoplastic cells surround native follicles, falsely creating the appearance of a follicular neoplasm. The lesional cells do not themselves form follicles, and have salt and pepper type neuroendocrine chromatin. This lesion labeled for chromogranin and calcitonin, consistent with medullary thyroid carcinoma.Differential Diagnosis: Follicular adenoma would not feature the neuroendocrine chromatin of the current lesion, and the cells themselves form follicles. Parathyroid tissue typically features smaller darker nuclei, and a more prominent capillary vasculature than thyroid tissue. Follicular carcinoma is defined as a thyroid follicle forming neoplasm that invades its capsule or blood vessels.
Medullary thyroid carcinoma demonstrates multiple histologic patterns, including pseudopapillary, follicular, giant cell, spindle cell, paraganglioma-like, oncocytic, clear cell, and angiosarcoma-like. The follicular like variant creates confusion with the more common follicular neoplasms of the thyroid.
