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Case 06

View the images and select the correct diagnosis from the list below.

Looks can be deceiving!

An FNA was obtained from a small thyroid nodule in a 34-year-old female:

 

 

 

 

Select the correct diagnosis:

You answered: Follicular neoplasm
Sorry, that is INCORRECT

The correct diagnosis is: Papillary carcinoma, follicular variant

CYTOPATHOLOGY:

  • Smears are cellular containing numerous variably cohesive follicular epithelial cells in trabecular and microfollicular patterns.
  • Rare follicular epithelial cells reveal well defined intra-nuclear inclusions. Pap-stained smears (not available with this case) are more helpful in identifying powdery chromatin and nuclear grooves.
  • There is a small amount of dense colloid.

DISCUSSION:

  • The biopsy reveals a single focus of papillary carcinoma, mixed conventional and follicular type. The cytologic and histologic diagnosis both rest on nuclear features (powdery chromatin, intranuclear inclusions, and nuclear grooves) with follicle formation suggesting the follicular variant. If the nuclear features are poorly developed the diagnosis may not be possible.
  • The follicular variant of papillary thyroid carcinoma is a common morphologic subtype, and has a similar clinical and pathological behaviour to pure papillary carcinoma. Aspirates are often interpreted as follicular neoplasm (adenoma or minimally invasive follicular carcinoma) or suspicious for papillary carcinoma rather than malignant. Since there are important differences in biologic behaviour and management, accurate diagnosis is important.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Jain M, Khan A, Patwardhan N, Reale F, Safran M. Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract. 2001 Mar-Apr;7(2):79-84.



Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival. Cancer 2003;97:1181-5.



DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; 733-4.



Gray W, McKee GT. Diagnostic Cytopathology, 2nd edition. London: Churchill Livingstone, 2003; 590-4

You answered: Papillary carcinoma, follicular variant
That is CORRECT!!

CYTOPATHOLOGY:

  • Smears are cellular containing numerous variably cohesive follicular epithelial cells in trabecular and microfollicular patterns.
  • Rare follicular epithelial cells reveal well defined intra-nuclear inclusions. Pap-stained smears (not available with this case) are more helpful in identifying powdery chromatin and nuclear grooves.
  • There is a small amount of dense colloid.

DISCUSSION:

  • The biopsy reveals a single focus of papillary carcinoma, mixed conventional and follicular type. The cytologic and histologic diagnosis both rest on nuclear features (powdery chromatin, intranuclear inclusions, and nuclear grooves) with follicle formation suggesting the follicular variant. If the nuclear features are poorly developed the diagnosis may not be possible.
  • The follicular variant of papillary thyroid carcinoma is a common morphologic subtype, and has a similar clinical and pathological behaviour to pure papillary carcinoma. Aspirates are often interpreted as follicular neoplasm (adenoma or minimally invasive follicular carcinoma) or suspicious for papillary carcinoma rather than malignant. Since there are important differences in biologic behaviour and management, accurate diagnosis is important.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Jain M, Khan A, Patwardhan N, Reale F, Safran M. Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract. 2001 Mar-Apr;7(2):79-84.



Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival. Cancer 2003;97:1181-5.



DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; 733-4.



Gray W, McKee GT. Diagnostic Cytopathology, 2nd edition. London: Churchill Livingstone, 2003; 590-4

You answered: Hyalinizing trabecular adenoma
Sorry, that is INCORRECT

The correct diagnosis is: Papillary carcinoma, follicular variant

CYTOPATHOLOGY:

  • Smears are cellular containing numerous variably cohesive follicular epithelial cells in trabecular and microfollicular patterns.
  • Rare follicular epithelial cells reveal well defined intra-nuclear inclusions. Pap-stained smears (not available with this case) are more helpful in identifying powdery chromatin and nuclear grooves.
  • There is a small amount of dense colloid.

DISCUSSION:

  • The biopsy reveals a single focus of papillary carcinoma, mixed conventional and follicular type. The cytologic and histologic diagnosis both rest on nuclear features (powdery chromatin, intranuclear inclusions, and nuclear grooves) with follicle formation suggesting the follicular variant. If the nuclear features are poorly developed the diagnosis may not be possible.
  • The follicular variant of papillary thyroid carcinoma is a common morphologic subtype, and has a similar clinical and pathological behaviour to pure papillary carcinoma. Aspirates are often interpreted as follicular neoplasm (adenoma or minimally invasive follicular carcinoma) or suspicious for papillary carcinoma rather than malignant. Since there are important differences in biologic behaviour and management, accurate diagnosis is important.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Jain M, Khan A, Patwardhan N, Reale F, Safran M. Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract. 2001 Mar-Apr;7(2):79-84.



Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival. Cancer 2003;97:1181-5.



DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; 733-4.



Gray W, McKee GT. Diagnostic Cytopathology, 2nd edition. London: Churchill Livingstone, 2003; 590-4

You answered: Hyperplastic nodular goiter
Sorry, that is INCORRECT

The correct diagnosis is: Papillary carcinoma, follicular variant

CYTOPATHOLOGY:

  • Smears are cellular containing numerous variably cohesive follicular epithelial cells in trabecular and microfollicular patterns.
  • Rare follicular epithelial cells reveal well defined intra-nuclear inclusions. Pap-stained smears (not available with this case) are more helpful in identifying powdery chromatin and nuclear grooves.
  • There is a small amount of dense colloid.

DISCUSSION:

  • The biopsy reveals a single focus of papillary carcinoma, mixed conventional and follicular type. The cytologic and histologic diagnosis both rest on nuclear features (powdery chromatin, intranuclear inclusions, and nuclear grooves) with follicle formation suggesting the follicular variant. If the nuclear features are poorly developed the diagnosis may not be possible.
  • The follicular variant of papillary thyroid carcinoma is a common morphologic subtype, and has a similar clinical and pathological behaviour to pure papillary carcinoma. Aspirates are often interpreted as follicular neoplasm (adenoma or minimally invasive follicular carcinoma) or suspicious for papillary carcinoma rather than malignant. Since there are important differences in biologic behaviour and management, accurate diagnosis is important.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Jain M, Khan A, Patwardhan N, Reale F, Safran M. Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients. Endocr Pract. 2001 Mar-Apr;7(2):79-84.



Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival. Cancer 2003;97:1181-5.



DeMay RM. The Art & Science of Cytopathology. Chicago: ASCP Press, 1996; 733-4.



Gray W, McKee GT. Diagnostic Cytopathology, 2nd edition. London: Churchill Livingstone, 2003; 590-4

From the Cytopathology files of the BC Cancer Agency
Submitted by: Brenda Smith, BSc and Tom Thomson, MD

SOURCE: Case 06 ( )
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