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- Thyroid FNA
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wfbjwt: you brought up a very important question. Amyloid and dense colloid have almost the same staining quality on Pap and Diff-Quick stains. Congo-Red stain is needed to reliably identify amyloid. In this case, we suspect those background materials as amyloid, because the cells make us think about medullary carcinoma, not other way around. Although the presence of amyloid is a very help feature, it is neither necessary, nor a sufficient condition for the diagnosis of medullary carcinoma. Hope this is helpful.
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Thank you all for the responses! Most of the people have the same ideas as mine. The cells and background of possible amyloid all point to medullary carcinoma. When I got the case, I tried to make a cell block to do immunostains of Calcitonin and CEA, in addition, I asked the clinician to check the patient's serum calcitonin level. Although the cell block did not work, the serum calcitonin was significantly elevated. I signed the case out as medullary carcinoma. The picture here is the picture of the resection specimen.
Medullary carcinoma of the thyroid has a nickname of "melanoma of the thyroid", it means that it can mimic other thyroid neoplasm. So, in practice, I follow thediagnostic pearl that if a thyroid FNA looks wierd, think about the possibility of medullary carcinoma.
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