a 75 y/o woman with solitary hypo function cold nodule of upper pole of right lobe
TRANSCRIPT
A 75 y/o woman with Solitary hypo function cold nodule of upper pole of right lobe
Hyalinizing trabecular adenoma Papillary carcinoma Medullary carcinoma Hurthle cell carcinoma
Medullary carcinoma of the thyroid
Calcitonin
Calcitonin
Calcitonin
Prevalence : 3-10% of all thyroid malignancy
MEN II : Unilateral, young age, mannon MEN: womanSporadic: bilateral, 5-6 decades, woman
CellularityUsually very cellular
PresentationMostly isolated & rarely in tissue fragments forming nests , trabeculae, follicular or papillary. Dispersed pattern characteristic
CellsUniform to pleomorfic size: small to large shape: round, cuboidal, plasmacytoid, polygonal, racket-shaped, triangular, spindle-shaped ( unipolar ). Cell border : well to poorly defined
Nuclear locationAlways eccentric
Nuclear numberBi-multinucleation
Nuclear shape Round, oval, spindle, smooth nuclear membrane
ChromatinCoarsely granullar
Parachromtin clearing
Not common
Nucleoli+/-
Nuclear grooves-
Intranuclear inclusions
Almost always present
Mitotic activity-
cytoplasmScant to abundant. Clear, pale, granular to dense, cytoplasmic process. Azurophylic cytoplasmic granules
Psammoma bodiesRare
BackgroundHyaline, amorphous, fluffy, acellular material( positive for amyloid). Necrosis absent.
hystochemistryArgylophilic granules
IHCPositive for : calcitonin, LMWK, CEA, Neuroendocrine markers & TTF-1. Negative for TG
Ultra structuresElectron dense, membrane-bound neurosecretory granules
Nodular goiter Amyloidosis or amyloid goiter Follicular neoplasm ( HTA,Follicular Carcinoma &
adenoma ) Hurthle cell carcinoma Papillary carcinoma Insular carcinoma Anaplastic carcinoma Carcinoid tumor, lymphoma, melanoma
Medullary carcinomaHTA
CellularityVariableVariable
PresentationMostly isolated or loosely cohesive
isolated or loosely cohesive & tissue fragment or trabecular
CellsMonomorphic to pleomorphic, round, plasmacytoid, unipolar spindle cells, well to poorly defined borders, N/C ratio variable
Round, oval, bipolar spindle cells, well to poorly defined cell border, low N/C ratio
NucleusEccentric, bi- & multi, pleomorphic, round, oval, spindle, salt & pepper granular chromatin, not nucleoli, inclusion
Central to eccentric round to oval, bi & multi not seen micronucleoli, finely granular chromatin, inclusion
CytoplasmVariable, azurophilic granules
Abundant, pale
BackgroundClean, amorphus, acellular, amyloid
Clean, amorphus, cellular, Negative for amyloid
IHCCalcitonin +thyroglobulin _
Calcitonin –thyroglobulin +
Medullary carcinomafollicular adenoma or carcinoma
CellularityVariableVariable
PresentationMostly isolated or loosely cohesive
Syncytial tissue fragment with or without follicular pattern
CellsMonomorphic to pleomorphic, round, plasmacytoid, unipolar spindle cells, well to poorly defined borders, N/C ratio variable
Small,Round to cuboidal, ill defined cell border, high N/C ratio
NucleusEccentric, bi- & multi, pleomorphic, round, oval, spindle, salt & pepper granular chromatin, not nucleoli, inclusion
Central, round with smooth nuclear membrane, micronucleoli +/-, coarsely granular chromatin, inclusion absent
CytoplasmVariable, azurophilic granules
Scant, no cytoplasmic process
Backgroundamyloid +/-,colloid absentAmyloid absent, colloid+
IHCCalcitonin +thyroglobulin _
Calcitonin –thyroglobulin +
Medullary carcinomahurthle cell carcinoma
CellularityVariableHighly cellular
PresentationMostly isolated or loosely cohesiveisolated or groups, syncytial tissue fragment
CellsMonomorphic to pleomorphic, round, plasmacytoid, unipolar spindle cells, well to poorly defined borders, N/C ratio variable
Round, oval to plasmacytoid, uniform, well defined cell border, high N/C ratio
NucleusEccentric, bi- & multi, pleomorphic, round, oval, spindle, salt & pepper granular chromatin, not nucleoli, inclusion
Central to eccentric, binucleation frequent, round, macronucleoli, finely granular chromatin, inclusion+/-
CytoplasmVariable, azurophilic granulesVariable, usually scant, granular to dense, blue granules
BackgroundClean, amorphus, acellular, amyloid, colloid absent, necrosis -
+/- , Negative for amyloid, collloid necrosis +/-
IHCCalcitonin +thyroglobulin _
Calcitonin –thyroglobulin +
Ulra structureNeurosecretory granulesAbundant mitochondria
Medullary carcinomapapillary carcinoma
CellularityVariableHighly cellular
PresentationMostly isolated or loosely cohesiveMostly isolated or groups, rarely syncytial tissue fragment
CellsMonomorphic to pleomorphic, round, plasmacytoid, unipolar spindle cells, well to poorly defined borders, N/C ratio variable
Small, round to cuboidal, short columnar, well to ill-defined cell border, high N/C ratio
NucleusEccentric, bi- & multi, pleomorphic, round, oval, spindle, salt & pepper granular chromatin, not nucleoli, inclusion
Central to eccentric, round, oval, smooth nuclear membrane, powdery chromatin, inclusion always present
CytoplasmVariable, azurophilic granulesVariable, pale clear or vacuolated, azurophylic granules not present
BackgroundClean, amorphus, acellular, amyloid, colloid absent
Negative for amyloid, collloid +/-
IHCCalcitonin +thyroglobulin _
Calcitonin –thyroglobulin +
Medullary carcinomaAnaplastic carcinoma
CellularityVariableHighly cellular, can be low with markedly dismoplastic cancer
PresentationMostly isolated or loosely cohesiveisolated, loosely cohesive, syncytial tissue fragment
CellsMonomorphic to pleomorphic, round, plasmacytoid, unipolar spindle cells, well to poorly defined borders, N/C ratio variable
Variable sized, slender to plump spindle shape, well defined cell border, variable N/C ratio, giant form frequent
NucleusEccentric, bi- & multi, pleomorphic, round, oval, spindle, salt & pepper granular chromatin, not nucleoli, inclusion+, mitoses -
Central to eccentric, very pleomorphic, multinucleation coaesely granular chromatin, inclusion+, mitotic activity+ with normal or abnormal mitoses, multiple micro/macro nucleoli
CytoplasmVariable, azurophilic granules, uniplar cytoplasmic process
Variable, can be abundant & dense, cytoplasmic process rare
BackgroundClean, amorphus, acellular, amyloid, colloid absent, necrosis -
Amyloid -, collloid +/- , necrosis +
IHCCalcitonin +thyroglobulin _
Calcitonin –thyroglobulin -
Ulra structureNeurosecretory granulesNo Neurosecretory granules