1、Papillary Thyroid Carcinoma Part four,Yama Headquarters,Papillary carcinoma of the thyroid.,Cystic papillary carcinoma.,Papillary carcinoma of the left thyroid lobe with involvement of multiple lymph nodes.,Histologic section. Papillary carcinoma,A delicate papillary frond covered by epithelium with
2、 stratified, empty-looking nuclei presenting “eggs in the basket“ appearance.,A. Papillary carcinoma exhibiting a follicular pattern. B. These follicles from a papillary carcinoma are elongated and are arranged in a parallel fashion (railroad tracks).,Papillary carcinoma with squamous metaplasia.,Mu
3、ltiple psammoma bodies in papillary carcinoma.,Papillary carcinoma with multinucleated foreign-body type giant cell (arrow ).,Papillary carcinoma with marked desmoplasia.,Papillary carcinoma with lymphocytic infiltrate.,FNA. An overwhelmingly cellular aspirate of papillary carcinoma with many tissue
4、 fragments exhibiting a complex branching pattern; some large ones appear monolayered. The background is clean .,A: cellular aspirate showing papillary tissue fragments with complex branching. B: Large numbers of papillary-like (without visible central cores) tissue fragments. C: Varying-sized monol
5、ayered tissue (two-dimensional) fragments. D: Syncytial tissue fragments with anastomosing trabeculae. E: A follicular pattern. F: Single cell pattern.,Cells of papillary carcinoma . A. Small, oval, and short columnar cells. B. Medium-sized cuboidal cells. C. Medium-sized oval to plasmacytoid cells
6、. D. Cells with dense cytoplasm resembling Hurthle cells. E. Tissue fragment of very large cells . F. Pleomorphic, elongated, spindle to columnar cells . G. Cells of papillary carcinoma (Diff-Quik stain).,A. Round to oval nuclei with fine, dusty, powdery chromatin. B. Syncytial tissue fragment of ce
7、lls. C. Syncytial arrangement of cells. D. These papillary carcinoma cells are pleomorphic and elongated. E. Medium-sized round to cuboidal cells. The nuclei are slightly pleomorphic with finely granular chromatin, micronucleoli, grooves, and inclusions.,A. The tissue fragment is composed of carcino
8、ma cells. B,C. Syncytial tissue fragments with extreme crowding and overlapping of enlarged, round to oval nuclei. D. A syncytial tissue fragment of papillary carcinoma cells (Diff-Quik stain).,Papillary architecture . A. Tissue fragments with a complex branching pattern. B. Branching papillary tiss
9、ue fragments. C. Higher magnification D. A papillary frond with clearly visible blood-filled capillaries in the fibrovascular core. E. Branching papillary tissue fragments with central stromal cores.,Papillary architecture .,Syncytial-type tissue fragments with a follicular pattern .,A syncytial tis
10、sue fragment from papillary carcinoma,Monolayered tissue fragments . A,B. FNA of a papillary carcinoma showing monolayered (two-dimensional) tissue fragments . C,D. A monolayered but syncytial tissue fragment of papillary carcinoma cells .,A,B. Cellular swirls in an FNA of papillary arcinoma . C. Ti
11、ssue ragment of carcinoma cells with concentric arrangement like an onion-skin. D. Cartwheel attern with cells radiating from the center.,Squamous metaplasia in papillary carcinoma.,Psammoma bodies. A. Syncytial tissue fragment of malignant papillary carcinoma ells incorporating a single psammoma bo
12、dy. B,C. Multiple psammoma odies with concentric lamellations. D.Psammoma bodies within this tissue fragment appear refractile. E. Myriad of psammoma bodies with a striking display of colors.,Multinucleated giant cells in papillary carcinoma, often seen in association with issue fragments of carcino
13、ma cells.,Colloid in papillary carcinoma . A. Strands of dense sticky colloid . B. These spherical blobs of dense colloid . C. Thin, watery colloid in the background.,Papillary carcinoma cells with degeneration and hemorrhage.,A. An encapsulated neoplasm. B. The follicular architecture. The lining e
14、pithelium shows typical nuclear features of papillary carcinoma. C, D. varying-sized follicles containing colloid. Note the lining epithelium with dark hyperchromatic nuclei will not allow a specific diagnosis of the follicular variant of papillary carcinoma.,Follicular variant of papillary carcinom
15、a. A. The carcinoma demonstrates a follicular growth pattern. B. Higher magnification to show the follicular epithelium with granular chromatin. Intranuclear inclusions are present.,Follicular variant of papillary carcinoma. Histologic section showing clear cytoplasm. The colloid in the lumens shows
16、 peripheral scalloping.,FNA. A. Follicular variant of papillary carcinoma. Note the hypercellularity and the striking follicular pattern (low power). B. Higher magnification,A. Follicular variant of papillary carcinoma. Note the hypercellularity and the striking follicular pattern (low power). B. Hi
17、gher magnification.,A syncytial tissue fragment with follicular architecture. The nuclei are enlarged, round, and have finely granular to powdery chromatin. Nuclear inclusions and micronucleoli are seen.,Angulated, curvaceous syncytial tissue fragment with component cells exhibiting nuclear features
18、 of papillary carcinoma.,Discrete follicles lined by follicular cells. Their nuclei are enlarged, overlapped with altered polarity and contain micronucleoli, intranuclear inclusions, and grooves.,A. This syncytial tissue fragment of follicular cells shows a follicular pattern. The nuclei are enlarge
19、d, with finely granular chromatin, micronucleoli, grooves, and inclusions consistent with a follicular variant of papillary carcinoma. B. FNA of a follicular variant of papillary carcinoma (Diff-Quik stain).,The syncytial tissue fragment of follicular cells shows minimal follicular architecture. The
20、 nuclei, however, show typical features of papillary carcinoma.,FNA of a follicular variant of papillary carcinoma.,FNA of a follicular variant of papillary carcinoma.,This aspirate was interpreted as cellular follicular adenoma. It was histologically diagnosed as a follicular variant of papillary c
21、arcinoma.,The cytologic features are consistent with a cellular follicular adenoma. Thyroidectomy revealed a follicular variant of papillary carcinoma.,Tall Cell Variant . The pleomorphic cells are loosely cohesive and discrete, large, elongated to columnar-shaped, with well-defined cell borders. Th
22、eir cytoplasm is abundant and dense. Several nuclei contain sharp cytoplasmic inclusions, some with a “soap-bubble appearance“ (arrows ).,FNA of a different case of a tall cell variant of papillary carcinoma.,FNA of a tall cell variant of papillary carcinoma.,FNA of a tall cell variant of papillary
23、carcinoma.,Columnar cell variant of papillary carcinoma .,Columnar cell variant of papillary carcinoma .,G. Histologic section demonstrating typical architecture of the columnar cellvariant of papillary carcinoma. H. Higher magnification highlighting the columnar cells, stratification, and pale cyto
24、plasm.,Oxyphilic variant of papillary carcinoma . AD. FNA . E,f. Histologic section,Oxyphilic variant of papillary carcinoma . A,B. FNA . C,D. Histologic section,Hurthle cell carcinoma, papillary type . AC. FNA . Df. Histologic section,Solid variant of papillary carcinoma . A. Histologic section. Th
25、e growth pattern is solid with an attempt at follicle formation. B,C. FNA .,Diffuse sclerosing variant of papillary carcinoma . Ac. Histologic section . D,E. Fine-needle biopsy from the same case. F. A tissue fragment of malignant cells incorporating psammoma bodies.,AC. Histologic section of Papill
26、ary carcinoma with nodular fasciitis-like stroma.,Macrofollicular variant of papillary carcinoma . Histologic section. A. The large, varying-sized follicles distended with colloid present a deceptively bland pattern.B. Higher magnification to highlight the nuclear morphology.,Macrofollicular variant
27、 of papillary carcinoma . A. Marginally cellular specimen with few tissue fragments in the background of abundant colloid, low power. B. Higher magnification showing syncytial architecture with nuclei exhibiting typical feature of papillary carcinoma.,Macrofollicular variant of papillary carcinoma .
28、 Different example showing powdery chromatin and intranuclear inclusions. Note abundant colloid in the background.,Papillary carcinoma with clear cell change .,Cribriform-morular variant. AD. Histologic section. EH. FNA of this case.,Papillary carcinoma with Warthins tumor-like features . AC. Histol
29、ogic section. DF. FNA of this case.,Papillary microcarcinoma .,FNA. Two separate examples of papillary carcinomas with a single cell pattern in aspirates.,Gross photograph of a cystic papillary carcinoma.,Gross photograph of a unilocular cystic papillary carcinoma bordered by a thick capsule.,The pa
30、tient presented with a cystic neck mass that was aspirated and interpreted as papillary carcinoma. A. Gross photograph . B. Thyroidectomy revealed a large cystic papillary carcinoma.,Histologic section of a cystic papillary carcinoma. Note the thick fibrotic capsule.,Histologic section of a cystic p
31、apillary carcinoma filled with detached papillae, and psammoma bodies.,Histologic section of a cystic papillary carcinoma.,Thyroid cyst fluid with diagnostic features of papillary carcinoma. Syncytial tissue fragments with intranuclear inclusions.,FNA of a cystic papillary carcinoma. AD. These tissu
32、e fragments are syncytial. E. This syncytial tissue fragment of follicular cells show marked vacuolization of the cytoplasm.,F. Degenerating follicular cells from nodular goiter. Although the cytoplasm is bubbly, the nuclei are small and very uniform. These histiocytoid cells may cause diagnostic di
33、fficulties. G,H. Cystic papillary carcinoma. Note syncytial arrangement of cells and large cytoplasmic vacuoles (Diff-Quik stain).,FNA of a cystic papillary carcinoma. The fluid was grossly blood-tinged. A. Against the background of blood and a large number of histiocytes, these three syncytial tiss
34、ue fragments of follicular cells depict scalloped borders. B,C.Some nuclei contain nucleoli. Inclusions and grooves are not present . Thyroidectomy confirmed papillary carcinoma.,Cystic papillary carcinoma. These tissue fragments are composed of large cells with abundant pale, vacuolated to dense cy
35、toplasm.,Cystic papillary carcinoma.,A. The fluid aspirated from this carcinomaB. A cell block preparation of the sediment,AC. The aspirated fluid from this cystic thyroid lesion was grossly clear. D. Thyroidectomy confirmed a cystic papillary carcinoma.,The aspirated bloody fluid from a cystic thyr
36、oid nodule,FNA of a cystic metastasis in neck from a papillary thyroid carcinoma. A,B. FNA of the cystic neck mass. C. The cells reacted strongly to thyroglobulin, confirming the thyroid origin.,FNA of a cystic nodular goiter misinterpreted as suspicious for papillary carcinoma. A,B,C. Monolayered t
37、issue fragments with minimal nuclear overlapping and crowding. D. Histologic section of the thyroid showing features of nodular goiter with cystic degeneration. E. Higher magnification showing mild nuclear atypia.,A. This aspirate shows partially air-dried cells with pale chromatin . B. This smear f
38、rom a papillary carcinoma is unsatisfactory for evaluation. C. This case represents a false-negative diagnosis. D. Repeat biopsy one year later showed classic features of papillary carcinoma.,An example of a true false-negative aspirate of papillary carcinoma. Thyroidectomy revealed a cystic papilla
39、ry carcinoma.,There were no well-preserved follicular cells. The structure seen here (arrow ) suggests a formation of psammoma body. This aspirate was interpreted as negative but should have been interpreted as inadequate. A repeat aspiration biopsy was in order.,A hemorrhagic fluid from a cystic ca
40、rcinoma, showing rare groups of atypical follicular cells that have features such as dense and vacuolated cytoplasm and well-defined cell borders.,This aspirate was poorly cellular and showed a rare group of large pleomorphic cells with dense cytoplasm and pleomorphic nuclei .,This aspirate was poor
41、ly cellular but showed rare tissue fragments of follicular cells that demonstrated atypical nuclear features.,Air-dried cells in a syncytial arrangement with enlarged nuclei containing intranuclear inclusions.,This aspirate is adequately cellular but air-dried with poor cellular details. The syncyti
42、al architecture and suggestion of intranuclear inclusions render this aspirate suspicious for papillary carcinoma, confirmed on surgery.,AC. An adequately cellular specimen with several syncytial tissue fragments of follicular cells. D. The detached fragments of papillary fronds were floating within
43、 the cystic cavity. E. Higher magnification.,The syncytial tissue fragments of follicular cells demonstrate all the nuclear features of papillary carcinoma.,Minimal criteria. All six images show syncytial tissue fragments without any specific architectural configuration. The cells display varied typ
44、es, but their nuclei are enlarged and contain fine, powdery chromatin with nucleoli, grooves, and inclusions.,Papillary tissue fragments in nodular goiter versus papillary carcinoma. A,B.Extremely cellular aspirate. The large numbers of tissue fragments with papillary-like. B. The honeycomb arrangem
45、ent of small cells with uniform round nuclei, containing granular chromatin supports the diagnosis of hyperplastic goiter.,Papillary tissue fragments in nodular goiter versus papillary carcinoma. AC. hyperplastic goiter. D,F. FNA of a papillary carcinoma for comparison.,Papillary tissue fragments in
46、 a cystic nodular goiter versus papillary carcinoma. A,B. The cellular aspirate appears to be in syncytial arrangement with crowding and overlapping. C,D. Histologic sections reveal a cystic nodular goiter with papillary hyperplasia.,Papillary tissue fragments in follicular adenoma with papillary ch
47、ange versus papillary carcinoma. AC. FNA of a thyroid nodule. D,E. Histologic sections. The papillae covered by uniform follicular cells, lacking stratification and pale watery nuclei.,Papillary tissue fragments in follicular adenoma with papillary change versus Papillary carcinoma . Another example
48、 of a false-positive cytologic diagnosis. AD. FNA of an isthmic nodule. E,F. Histologic section. Note the lack of typical features of papillary carcinoma.,Nuclear atypia and papillary hyperplasia in the background of Hashimotos thyroiditis versus papillary carcinoma in the background of thyroiditis
49、. A,B. This syncytial tissue fragment shows a papillary-like configuration. C,D. Histologic section,Differential Diagnosis of monolayered tissue fragments . AC. FNA of ahyperplastic nodular goiter. DF. FNA of a papillary carcinoma .,Another example of hyperplastic goiter with a cellular aspirate con
50、sisting of a large number of monolayered tissue fragments that may lead to a false-positive diagnosis of papillary carcinoma.,FNA of a papillary carcinoma consisting of predominantly monolayered tissue fragments for comparison with the case illustrated in Figure 9.96.,Follicular adenoma versus papillary carcinoma . A,B. FNA of a thyroid nodule . C,D. Thyroidectomy revealed an encapsulated simple-type follicular adenoma. E,F. Another example of cellular follicular adenoma, interpreted as suspicious for papillary carcinoma. G,H. Thyroidectomy showed an encapsulated cellular follicular adenoma,
