Pathology Notes

Practice question III answers Pathology of thyroid ©Jun Wang, MD, PhD   1. B. This lesion is characterized by capsulated nodular growth of packed small follicles with normal appearing follicular cells. This can be either follicular adenoma , if no invasion can be seen, or follicular carcinoma , if vascular or capsular invasion is seen. Capsular invasion is seen in this case, characterized by capsule disconnected due to follicular tissue. Hashimoto thyroiditis is characterized by follicular destruction in a background of diffuse polyclonal lymphoid infiltrate, with or without lymphoid follicle formation. Multinodular goiter is characterized by unevenly benign enlargement of thyroid with nodular growth pattern and follicles markedly various in size. Papillary thyroid carcinoma , including follicular variant, is diagnosed based on typical nuclear features, such as enlarged nuclei, washed out chromatin, nuclear grooves or inclusion. 2. B. PAX8, PTEN and RAS/PI3KCA mutation can

Practice question III Pathology of thyroid © Jun Wang, MD, PhD   1. Use this case and image for the next three questions . A 54-year-old woman presents with hoarseness for 3 months. She denies other symptoms. Her past medical history is unremarkable. She has a 30 pack-year history of cigarette smoking and is a social drinker. She denies usage of illicit drugs. Physical examination reveals left vocal cord paralysis. The mucosa of her vocal cords are unremarkable. No other abnormalities are seen. Laboratory tests are all within normal ranges. Sonographic examination reveals a 2.5 cm mass at the lower posterior portion of her left thyroid. Fine needle aspiration reveals small clusters of follicular cells without significant cytological atypia. Partial thyroidectomy was performed. An image of the microscopic findings is shown. No nuclear enlargement, nuclear inclusion or grooves are seen. What is the diagnosis? (Image credit: Nephron [CC BY-SA 4.0 (https://creativecommons.org/licens

Practice question II   Pathology of thyroid © Jun Wang, MD, PhD 1. Use this case for the next three questions . A 39-year-old woman from mountain area of south America presents with slowly growing anterior neck mass for 13 years. She denies other symptoms. Her past medical history is unremarkable. She does not take iodized salt or any seafood. She has a family history of Hashimoto thyroiditis. Physical examination reveals a 12 cm lobulated mass at anterior neck, extending from chin to supra-sternal notch. No other abnormality is noted. Laboratory tests including thyroid functional are within normal ranges. No thyroid peroxidase antibody is identified. Sonographic examination reveals a diffusely enlarged thyroid glands without recognizable mass.   What is the diagnosis? A. Diffuse simple goiter B. Follicular adenoma C. Graves disease D. Hashimoto thyroiditis E. Papillary thyroid carcinoma 2. A 39-year-old woman from mountain area of south America presents with s