Thyroid FNA - Part 2

Question 1

Numerous monotonous follicular cells
Predominantly microfollicular pattern
Crowding, overlapping
Scant to absent colloid
Increased nuclear size
Granular to coarse chromatin
Significant alterations to follicular cell architecture
Presents as solitary nodule

Answer 1

Follicular Neoplasm (BCT IV)

Question 2

Follicular cells arranged in acinar or rosette formations
Follicular cells may or may not be enlarged and they tend to form concentric, circular arrangements
They are not small sheets of follicular cells, rather morphologic equivalents of the thyroid follicle (histology)

Answer 2

Microfollicular

Question 3

Abundant groups of follicular cells in microfollicular arrangements. The cells have enlarged ovoid nuclei and slight nuclear crowding, and overlap are appreciated.

Answer 3

Neo: Follicular - BCT IV

Question 4

Histology: Well encapsulated lesion (thin fibrous capsule)
No capsular or vascular invasion
Cuboidal to low columnar cells
Pale staining with inconspicuous nucleoli

Answer 4

Follicular Adenoma

Question 5

Follicular Carcinoma has —- invasion

Answer 5

Capsular Invasion

Question 6

Exclusive population of Hurthle cells with mild nuclear atypia in macro and microfollicular arrangements
NO LYC

Answer 6

Hurtle cell Neoplasm: BCT IV

Question 7

Most common thyroid cancer (80%)
More common in females then males (3:1 ratio)
May occur in childhood, but often seen from ages 30-50
-can happen in any age group
Regional lymph node spread is common (neck, cervical)
Overall cure rate is extremely high
Synthroid- synthetic thyroxine is administered for patients with thyroidectomies

Answer 7

Papillary Thyroid Carcinoma

Question 8

What are the risk factors to PTC?

Answer 8

-Exposure to ionizing radiation
-Cold nodule
-Post- Chernobyl
-Hashimoto’s thyroiditis (slight association)

Question 9

PTC: 100% survival if under age of —- , 98% 10-year survival

Answer 9

20, over 20

Question 10

Nuclear creases or grooves***
intranuclear cytoplasmic inclusions (“Orphan Annie” nuclei); nuclei completely cleared out
psammoma bodies (20%)
HSC / multinucleated giant cells
Areas of oncocytic change & SQM may occur
Little colloid ( thick “bubble gum” colloid)
May be cystic

Answer 10

PTC

Question 11

Histology of PTC: The fronds of tissue have thin —— ?

Answer 11

Fibrovascular Cores

Question 12

Contain cells arranged in microfollicular structures with enlarged, crowded, overlapping nuclei ad small clusters with indistinct borders (~follicular carcinoma)
Nuclei = ground glass, micronucleoli, intranuclear inclusions, nuclear grooves (~PPC)

Answer 12

PTC: Follicular Variant

Question 13

Endocrine neoplasm
Arises from parafollicular “C” cells
Single lying cells, small clusters
Papillary or follicular patterns are not evident
3 types of cells seen:
small rounded oval cuboidal cells with scanty cytoplasm
large polygonal or triangular cells with abundant eosinophilic cytoplasm
Variable morphologies

Answer 13

Medullary Thyroid Carcinoma

Question 14

What marker can be used to test if a Ca is MTC?

Answer 14

Calcitonin

Question 15

What test can be used to help dx MTC?

Answer 15

Amyloid Test - Congo Red (+)

Question 16

What stain is used in Amyloid Test?

Answer 16

Congo Red

Question 17

Thyroglobulin is a marker for —– ?

Answer 17

Follicular Cells

Question 18

MTC stains with — ?

Answer 18

Calcitonin,
Synaptophysin, Chromogranin,
NSE, TTF-1

Question 19

Spindle shaped cells
round-oval nuclei with coarse, granular (“salt and pepper) chromatin and nucleoli
Plasmacytoid morphology may be observed
may see intranuclear cytoplasmic inclusions
bi-multinucleated cells
homogeneous deposits of amyloid - Congo red (+) may be seen
Can be seen in MEN syndrome

Answer 19

MTC

Question 20

What color is amyloid when stained w/ Congo Red?

Answer 20

Apple Green

Question 21

Highly Pleomorphic
Pts need to be treated immediately for this
Big ugly cells; nucleoli gigantic
- Tumor compresses the Trachea
- Rare

Answer 21

Anaplastic Carcinoma

Question 22

What dx can be used for: Occasional nuclear pallor, enlargement, groove or pseudo inclusions
Microfollicles
Patients are often referred for genetic testing: Affirma and Thyroseq

Answer 22

AUS

Question 23

Most common Mets to Thyroid?

Answer 23

Renal Cell Carcinoma (clear- cell)
Lung
Breast
Esophagus