Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

Like this? Share it with your network

Share

Thyroid Nodule

on

  • 1,449 views

 

Statistics

Views

Total Views
1,449
Views on SlideShare
1,439
Embed Views
10

Actions

Likes
1
Downloads
51
Comments
0

1 Embed 10

http://www.slideshare.net 10

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Thyroid Nodule Presentation Transcript

  • 1. An interesting thyroid nodule Dr Nidhi Bhatt St Georges Hospital May 2006
  • 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. 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. Dilated thin- walled central blood vessels Closely packed nests of clear cells
  • 5. Adjacent normal thyroid follicles Encapsulation
  • 6. Clear cytoplasm, angulated nuclei, mild nuclear pleomorphism Fibrovascular stroma with delicate septa
  • 7. Differential Diagnoses Clear cell change in 1 º thyroid tumours Parathyroid neoplasms Metastatic renal clear cell carcinoma
  • 8. Further steps Clinical correlation Histochemical stains Immunostains
  • 9. Special stains
    • PAS +/- diastase
    • Thyroglobulin
    • TTF-1
    • CAM
    • CK7/20
    • Vimentin
    • CD10
    • Calcitonin
  • 10. TTF -Ve
  • 11. CD10 +ve
  • 12. Vimentin +ve
  • 13. Other results
    • Cytoplasmic PAS-positive globules
    • CK7/ 20 -ve
    • CAM 5.2 +ve
    • Thyroglobulin -ve
    • Calcitonin -ve
    • Neuroendocrine markers -ve
  • 14. Metastatic clear cell renal carcinoma
  • 15. Case discussed at the head & neck MDT Renal tumour removed 25 years ago in 1984, diagnosed as Clear cell carcinoma , G2, pT2
  • 16. Further Ix
    • No metastases in other organs
    • No lymph nodes
    • Other kidney normal
  • 17. 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. 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. Moral of the story New thyroid mass in a patient with previous history of malignancy Think of metastatic deposits
  • 20. When in doubt, take the case to MDM !
  • 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