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OTHER PATTERNS 1-Spindle cell predominant pattern 2-Squamous cells 3-Pleomorphic

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(1)

OTHER PATTERNS

1-Spindle cell predominant pattern

2-Squamous cells

3-Pleomorphic

NB

(2)

1- Spindle Cell Pattern

COMMON

LESS COMMON

RARE

1-Medullary carcinoma

1- Schwannoma

1- Hyalinizing trabecular

adenoma

2-Metastatic carcinoma

2- Papillary carcinoma

2- Carcinoid

3- Anaplastic carcinoma

3- Melanoma

3- Ectopic thymoma

4- Cyst lining cells &

histiocytes

4- Nodular fasciitis

4- SETLE

5- Colloid nodule

5- CASTLE

(3)

1.1-Medullary carcinoma

FEATURES

1- Dyshesive & no colloid

2- Cells:small, round, cuboidal, oval to plasmacytoid, racket

shaped, triangular or spindle

3-Nuclei of MTC cells are always eccentric,Salt & pepper

chromatin and absent nucleolus +/- intranuclear inclusions

4- Amyloid

WORK UP

1- +ve: CK -Calcitonin-

Chromogranin-NSE-Synaptophysin-CEA-Congo red

2- Thyroglobulin & PTH -ve

PITFALLS

1- Metastatic carcinoma & Melanoma

2-Insular carcinioma

3- Parathyroid adenoma

4- Papillary ca & (Hyalinizing trab adenoma(histol)

5- Follicular neoplasm

5-Hurthle cell carcinoma(Blue cytoplasmic granules with Giemsa

6- Anaplastic carcinoma

7-Metastatic carcinoma ( Macronucleoli)

(4)

1.2-

Metastatic

sarcomatoid carcinoma

FEATURES

1- Non specific

WORK UP

HISTORY OF 1ry

1- +ve CK)

2- Thyroglobulin –ve

3-TTF 1 +ve lung & thyroid

PITFALLS

1- Anaplastic thyroid carcinoma

2- Sarcoma

SIGN OUT

Malignant

Most consistent with sarcomatoid carcinoma

(5)

1.3- Metastatic small cell

carcinoma

FEATURES

1- Non specific

WORK UP

HISTORY OF 1ry

1- CK & TTF 1( lung thyroid) +ve

2- Thyroglobulin –ve

PITFALLS

1- 1ry thyroid carcinoma

2- Medullary carcinoma

SIGN OUT

Malignant

Favor metastatic small cell carcinoma but

1ry thyroid carcinoma cant be ruled out

(6)

1.4- Anaplastic thyroid

carcinoma

FEATURES

1- Non specific but often pleomorphic

2-Eccentric placement of the nuclei with prominent

nucleoli t

3- thick globoid cytoplasm

WORK UP

1- CK & TTF 1 +ve/-ve

2- Thyroglobulin +ve/-ve

3- LCA & CD 30 –ve

4- PAX 8 +ve on 75% of cases

PITFALLS

1- Metastatic carcinoma

SIGN OUT

Malignant

Anaplastic thyroid carcinoma

(7)

1.5-Cyst lining cells

FEATURES

1- Scant cells

2- Hemosiderin laden macrophages in

background abundant proteinacious material

3- Elongated cell appearance

4- Abundant granular cytoplasm

5- Round nuclei with pale chromatin & grooves

PITFALLS

1- Medullary carcinoma

2- Nodular fascitis

3- Metastatic carcinoma

4- Sarcoma

5- Papillary carcinoma

SIGN OUT

Atypical Follicular lesion

Favour cyst lining cells

(8)

2-Squamous Cell Pattern

COMMON

LESS COMMON

RARE

1- Metastatic carcinoma (

usually head & neck)

1- Papillary carcinoma

1- 1ry muccoepidermoid

carcinoma

2- Thyroglossal duct cyst

2- Anaplastic Large cell

Lymphoma

2- Ectopic thymoma

3- Branchial cleft cyst

3- Melanoma

3- SETLE

4- Skin

5- Salivary gland lesion

6- CASTLE

(9)

2.1-Metastatic carcinoma

commonly head & neck or lung

FEATURES

1- Squamous cells with atypia

WORK UP

HISTORY OF 1ry

1- CK+ve

2- TTF 1( variable only lung +ve)

3- Thyroglobulin –ve

PITFALLS

1-Benign cysts

2- thyroid carcinoma

SIGN OUT

Malignant

Most consistent with patients primary or

carcinoma with squamous differentiation

(10)

2.1-Metastatic carcinoma

commonly head & neck or lung

(11)

2.2-Thyroglossal cyst

FEATURES

1- Bland squamous cells

2- +/-Focal atypia

3-proteinacious background

4- Macrophages

5-Thyroid cells

WORK UP

1- CK +ve

2- Thyroglobulin –ve squamous cells

PITFALLS

1- Branchial cleft cyst

2- SCC

3- 1ry thyroid tumour with squamous differentiation

SIGN OUT

sq epithelium

Suggestive of a benign cyst but cannot rule out

carcinoma

(12)

2.3-Branchial cleft cyst

FEATURES

1- Bland squamous cells +/- respiratory epi

2- +/-Focal atypia

3-proteinacious background

4- Macrophages

WORK UP

1- CK +ve

2- Thyroglobulin –ve

PITFALLS

1- Thyroglossal duct cyst

2- SCC

3- !ry thyroid tumour with squamous differentiation

SIGN OUT

sq epithelium

Suggestive of a benign cyst but cannot rule out

carcinoma

(13)

3-Pleomorphic Cell Pattern

COMMON

LESS COMMON

RARE

1- Metastatic

carcinoma

1- Melanoma

1- Medullary

carcinoma

2- Anaplastic thyroid

carcinoma

2- Hashimoto

2- Salivary gland lesion

3- Papillary carcinoma 3- Large cell

lymphoma ( mostly) &

Anaplastic lymphoma

3- Other

(14)

3.1-Metastatic carcinoma

commonly head & neck or lung

FEATURES

1- Non specific

WORK UP

1- CK & TTF 1 +ve

2- Thyroglobulin -ve

PITFALLS

1- Anaplastic thyroid carcinoma

SIGN OUT

Malignant

Non small cell carcinoma favor metastatic

but cant rule out 1ry thyroid carcinoma

(15)

3.2-Anaplastic thyroid

carcinoma

FEATURES

1- Non specific but often pleomorphic

2-Eccentric placement of the nuclei with prominent

nucleoli

3-Thick globoid cytoplasm

WORK UP

1- CK & TTF 1 +ve but may be –ve

2- Thyroglobulin +ve/ -ve

3- LCA & CD 30 –ve

4- PAX8 +ve in 75% of cases

PITFALLS

1- Metastatic carcinoma

2- Lymphoma

3- Melanoma

SIGN OUT

Malignant

Anaplastic thyroid carcino

ma

(16)

3.3-Papillary carcinoma

FEATURES

1- Enlarged nuclei with overcrowding ,

overlapping and angulation onuclear

membrane

2-Papillae

3- Psammoma bodies

4- Pale chromatin,intranuclear grooves,

pseudoinclusions

WORK UP

+ve TTF1, CK & thyroglobulin CD 68 –ve

PITFALLS

1- Benign Nodule

2- Follicular neoplasm

3- Hurthle cell neoplasm

SIGN OUT

Malignant

papillary carcinoma

(17)

3.4-Radiation change

FEATURES

1- Isolatred cells with Enlarged nuclei with

overcrowding , overlapping and angulation

onuclear membrane

2-Irregular chromatin

3-,intranuclear inclusions

WORK UP

History of radioactive iodine

PITFALLS

1- Papillary carcinoma

2- Anaplastic carcinoma

SIGN OUT

Atypical follicular lesion

Rare atypical cells carcinoma cant be

excluded

(18)

•NONDIAGNOSTIC or UNSATISFACTORY or INSUFFICIENT FOR

DIAGNOSIS

repeat +/-US guidance

•BENIGN

Follow up clinically

•FOLLICULAR LESION No Atypia: Benign with :

Follow up

clinically

•FOLLICULAR NEOPLASM or SUSPICIOUS FOR A FOLLICULAR

NEOPLASM or Follicular Lesion with ATYPIA

Lobectomy & if

proves malignant complete with thyroidectomy

•SUSPICIOUS FOR MALIGNANCY

Lobectomy/ thyroidectomy

*

•MALIGNANT (5-20%)

thyroidectomy

(19)
(20)

Background

A

B

C

D

E

cyst watery fluid background with

scattered macrophages

cyst bloody fluid background with

scattered macrophages

Colloid with cracks

Colloid with follicular benign cells as a

macrofollicle- Colloid nodule

Amyloid No cracks

(21)

Abscess

Background dominant PATTERN-

Neutrophil Rich

(22)

Cyst inflammation

Background dominant

Macrophage rich

Hemosiderin

laden

macrophages

(23)
(24)

Granulomatous subacute

(25)

MONTONOUS 1 cell -Big blue

cells

(26)

MONTONOUS 1 cell

Big Blue Cells

Papillary carcinoma

(27)

RESOURCES:

A compilation from:

•

Personal collection

•

Various web sites

•

Image searches

•

Flicker

(28)
(29)

References

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