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- Neck FNA
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Just got this case early this week. This is a 60-year-old female had a total thyroidectomy in 2004 for papillary thyroid carcinoma. Now she has a 1.5 cm nodule developed in the neck. What's your diagnosis/differential diagnosis?
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I agree with most of the people here. The neck FNA is this recurrent thyroid carcinoma, which shows Hurthle cell features. Immunostains were performed to rule out medullary carcinoma. The outside diagnosis for this case is "papillary carcinoma, Hurthle cell varaint", we feel that the nuclear features are focal and not enough for papillary carcinoma, so we called this Hurthle cell carcinoma.
The differential diagnosis for thyroid neoplasm with Hurthle cell features should always include Hurthle cell neoplasm, Hurthle cell variant of papillary carcinoma, medullary carcinoma, and metastatic malignancies, such as renal cell carcinoma. Hope this case illustrates that.
Some variants of papillary thyroid carcinoma can show no typical nuclear features of papillary carcinoma, such as columnar-cell variant. By the way, how many variants(亚型） of papillary carcinoma are there? Can you give me a list.
I post this case along with the other thyroid FNA case at the same time because I would like to address the issue of medullary carcinoma and papillary carcinoma, usually, these two tumors look very different and should not pose any diagnostic difficulties, occasionally, you can confuse the two tumor. More discussion will be on the other case.
Back to this case, the thyroid surgon is going to excise the nodule this week and I have requested the outside slides of her original "papillary carcinoma". I will keep you posted on the final results.
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Ok. I did some immunostains on the cell block, the cells are negative for calcitonin and CEA. I would like to try more stains, but only got limited amount of cells on cell block. The thyroid surgeon also checked her serum calcitonin, which is normal. My question to this forum is: can any papillary thyroid carcinoma look like this? Before you give the patient second neoplasm, you better make sure that this is not recurrent papillary carcinoma, which is more likely to the clinicians?
