medullary thyroid carcinoma - pdfs.semanticscholar.org file– hürthle cell carcinoma – papillary...
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Medullary Thyroid Carcinoma
This case was provided by Treant Hospital, Bethesda, Hoogeveen, The Netherlands
ADS-01504 Rev. 001 © 2016 Hologic, Inc. All rights reserved.
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Overview
• Medullary Thyroid Carcinoma
• Sporadic or familial
• Tumor of the parafollicular C cells
• Elevated serum calcitonin levels
• Congo red stain for amyloid and immunohistochemical stains aid in the diagnosis
– Immunohistochemistry:
�Positive: calcitonin, CEA, chromogranin, synaptophysin
�Negative: thyroglobulin
DeMay RM. The Art & Science of Cytopathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.
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Overview Continued
• Differential Diagnoses:
– Hürthle Cell Carcinoma
– Papillary Thyroid Carcinoma
– Follicular Neoplasm
– Anaplastic Thyroid Carcinoma
– Nodular Goiter
– Amyloid Goiter
DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.
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Malignant Findings Cytology
• Medullary Thyroid Carcinoma
• Isolated, noncohesive cells are the predominant pattern
• Cell clusters can be present
• Cells may be many different shapes: round, polygonal, plasmacytoid, and spindled
• Amyloid is frequently present and stains red with Congo red stain, but when polarized light is applied changes to apple-green
Continued on next slide
DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.
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Malignant FindingsCytology
• Medullary Thyroid Carcinoma
• Binucleation and multinucleation common
• Nuclei eccentrically located and typically round to oval
• Spindle cell variant: elongated nuclei
• Chromatin is coarsely granular with small nucleoli (less frequently, prominent nucleoli)
• Cytoplasm commonly abundant and finely granular
• Nuclear pseudoinclusions may be seen
DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.
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Patient History
• 53-year-old male
• History of Multiple Endocrine Neoplasia-2
• Family history of thyroid disease
• Ultrasound of left thyroid lobe appears as
multilobular goiter with microcalcifications
• FNA of left thyroid performed
DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.
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Cytologic Diagnosis: Follicular Lesion, Bethesda III
• Sheets showing spindle cells with elongated nuclei• Salt and pepper chromatin• Absence of colloid
ThinPrep® Pap Stain
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• Single epithelial cells lacking intranuclear invaginations• Small nucleoli present
ThinPrep® Pap Stain
Cytologic Diagnosis: Follicular Lesion, Bethesda III
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Patient Follow-up
• Repeat thyroid FNA within microcalcifications
• Cytologic diagnosis: Suspect for medullary
thyroid carcinoma, Bethesda V
• Remainder of sample in ThinPrep® vial used
for Cellient® cell block
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Cellient® Cell Block: CEA Stain
Strongly positive plasmacytoid and spindle cells are also seen with Synaptophysin, Chromogranin and TTF-1
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Cellient® Cell Block: Calcitonin Stain
Positive calcitonin staining confirms diagnosis of medullary thyroid carcinoma
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Cellient® Cell Block: H&E Stain
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Additional Patient Follow-up
• FNA of cervical lymph node was performed
• Cytologic diagnosis: Malignant cells
consistent with medullary thyroid carcinoma
• Patient underwent total thyroidectomy and
cervical lymph nodectomy
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Macroscopic Thyroidectomy
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Thyroidectomy: H&E Stain
Histologic diagnosis: Bilateral medullary thyroid carcinoma with lymph angioinvasion
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