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An interesting thyroid noduleAn interesting thyroid nodule
Dr Nidhi BhattDr Nidhi Bhatt
St Georges Hospital
May 2006
Case History
 66 y, male
 Multinodular goitre- two nodules felt
 Long standing, painless
 No other history provided
 ...
Macroscopic specimen
 Lobectomy specimen 78g and 80x50x35
mm
 Lobulated surface
 Multiple nodules on C/S-
 Well-circum...
Dilated thin-
walled
central
blood
vessels
Closely
packed
nestsof
clearcells
Adjacent
normal
thyroid
follicles
Encapsulatio
n
Clear cytoplasm,
angulated
nuclei, mild
nuclear
pleomorphism
Fibrovascular stroma
with delicate septa
Differential Diagnoses
Clear cell change in
1º thyroid tumours
Parathyroid
neoplasms
Metastatic renal
clear cell
carcinoma
Further steps
Clinical correlation
Histochemical stains
Immunostains
Special stains
 PAS +/- diastase
 Thyroglobulin
 TTF-1
 CAM
 CK7/20
 Vimentin
 CD10
 Calcitonin
TTF -Ve
CD10 +ve
Vimentin +ve
Other results
 Cytoplasmic PAS-positive globules
 CK7/ 20 -ve
 CAM 5.2 +ve
 Thyroglobulin -ve
 Calcitonin -ve
 Neuro...
Metastatic clear cellMetastatic clear cell
renal carcinomarenal carcinoma
Case discussed at the head &
neck MDT
Renal tumour removed 25 years ago in
1984, diagnosed as Clear cell carcinoma,
G2, pT2
Further Ix
 No metastases in other organs
 No lymph nodes
 Other kidney normal
Arch Pathol Lab Med 1998;122(1):37-41, Cancer 1997;79(3
Discussion
 Intrathyroidal mets do occur
 0.6-1.2 % in thyroidec...
Contd…
 Average interval
 0-19 years
 25 years in the present case
 Prognosis depends on
 Primary site
 Completeness...
Moral of the story
New thyroid mass in a patient with previous
history of malignancy
Think of
metastatic
deposits
When in doubt,When in doubt,
take the case to MDMtake the case to MDM !!
References
 Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatis disease to the thyroid gland. World...
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Thyroid Nodule

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Transcript of "Thyroid Nodule"

  1. 1. An interesting thyroid noduleAn interesting thyroid nodule Dr Nidhi BhattDr Nidhi Bhatt St Georges Hospital May 2006
  2. 2. Case History  66 y, male  Multinodular goitre- two nodules felt  Long standing, painless  No other history provided  FNA  Cellular follicular lesion  Excision advised
  3. 3. Macroscopic specimen  Lobectomy specimen 78g and 80x50x35 mm  Lobulated surface  Multiple nodules on C/S-  Well-circumscribed  Encapsulated  Cream-coloured homogenous  Occ. foci of haemorrhage
  4. 4. Dilated thin- walled central blood vessels Closely packed nestsof clearcells
  5. 5. Adjacent normal thyroid follicles Encapsulatio n
  6. 6. Clear cytoplasm, angulated nuclei, mild nuclear pleomorphism Fibrovascular stroma with delicate septa
  7. 7. Differential Diagnoses Clear cell change in 1º thyroid tumours Parathyroid neoplasms Metastatic renal clear cell carcinoma
  8. 8. Further steps Clinical correlation Histochemical stains Immunostains
  9. 9. Special stains  PAS +/- diastase  Thyroglobulin  TTF-1  CAM  CK7/20  Vimentin  CD10  Calcitonin
  10. 10. TTF -Ve
  11. 11. CD10 +ve
  12. 12. Vimentin +ve
  13. 13. Other results  Cytoplasmic PAS-positive globules  CK7/ 20 -ve  CAM 5.2 +ve  Thyroglobulin -ve  Calcitonin -ve  Neuroendocrine markers -ve
  14. 14. Metastatic clear cellMetastatic clear cell renal carcinomarenal carcinoma
  15. 15. Case discussed at the head & neck MDT Renal tumour removed 25 years ago in 1984, diagnosed as Clear cell carcinoma, G2, pT2
  16. 16. Further Ix  No metastases in other organs  No lymph nodes  Other kidney normal
  17. 17. Arch Pathol Lab Med 1998;122(1):37-41, Cancer 1997;79(3 Discussion  Intrathyroidal mets do occur  0.6-1.2 % in thyroidectomies  0.5-24% at autopsy  Most common primary sites  Lung (16-43%)  Kidney (5.5-33%)  Breast (1-16%)  Stomach (8%)  Uterus (7%)
  18. 18. Contd…  Average interval  0-19 years  25 years in the present case  Prognosis depends on  Primary site  Completeness of resection  Rx  Thyroidectomy to avoid morbidity of tumour recurrence in neck
  19. 19. Moral of the story New thyroid mass in a patient with previous history of malignancy Think of metastatic deposits
  20. 20. When in doubt,When in doubt, take the case to MDMtake the case to MDM !!
  21. 21. References  Chen H, Nicol TL, Udelsman R. Clinically significant, isolated metastatis disease to the thyroid gland. World J Surg 1999;23(2):177-80  Dequanter D, Lothaire P, Larsimont D etal. Intrathyroid metastasis:11 cases Ann Endocrinol (Paris) 2004;65(3):205-8  Lam KY, Lo CY. Metastatic tumours of the thyroid gland: a study of 79 cases in Chinese patients. Arch Pathol Lab Med 1998;122(1):37-41  Nakhjavani MK, Gharib H, Goelner JR, van Heerden JA. Metastasis to the thyroid gland. A report of 43 cases. Cancer 1997;79(3):574-8
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