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Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
Thyroid Nodule
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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

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