Medullary Thyroid Carcinoma. This case was provided by Treant Hospital, Bethesda, Hoogeveen, The Netherlands

Transcription

1 Medullary Thyroid Carcinoma This case was provided by Treant Hospital, Bethesda, Hoogeveen, The Netherlands ADS Rev Hologic, Inc. All rights reserved.

2 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. 2 nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

3 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. 2 nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

4 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. 2 nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

5 Malignant Findings Cytology 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. 2 nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

6 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. 2 nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

7 Cytologic Diagnosis: Follicular Lesion, Bethesda III ThinPrep Pap Stain Sheets showing spindle cells with elongated nuclei Salt and pepper chromatin Absence of colloid

8 Cytologic Diagnosis: Follicular Lesion, Bethesda III ThinPrep Pap Stain Single epithelial cells lacking intranuclear invaginations Small nucleoli present

9 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

10 Cellient Cell Block: CEA Stain Strongly positive plasmacytoid and spindle cells are also seen with Synaptophysin, Chromogranin and TTF-1

11 Cellient Cell Block: Calcitonin Stain Positive calcitonin staining confirms diagnosis of medullary thyroid carcinoma

12 Cellient Cell Block: H&E Stain

13 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

14 Macroscopic Thyroidectomy

15 Thyroidectomy: H&E Stain Histologic diagnosis: Bilateral medullary thyroid carcinoma with lymph angioinvasion

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