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Thyroid Nodule

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  • 1. An interesting thyroid noduleAn interesting thyroid nodule Dr Nidhi BhattDr 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 nestsof clearcells
  • 5. Adjacent normal thyroid follicles Encapsulatio n
  • 6. Clear cytoplasm, angulated nuclei, mild nuclear pleomorphism Fibrovascular stroma with delicate septa
  • 7. Differential Diagnoses Clear cell change in 1º 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 cellMetastatic clear cell renal carcinomarenal 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. 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. 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,When in doubt, take the case to MDMtake 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