PMC9483828_01
The thyroid ultrasound and CT images of case 1: (a) thyroid ultrasound showed the nodules measuring 34.1 mm x 28.9 mm x 30.3 mm in the left lobar thyroid and 26.5 mm x 22.2 mm x 23.9 mm in the right lobar thyroid and (b) CT showed a multi-low-density image and spot calcification in the whole enlarged thyroid lobe.
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No enlarged lymph nodes in the neck were observed by the ultrasound (Figure 1a). No other features from the imaging suggested lesions at the other sites of the thyroid lobe (Figure 1b). TG, TTF-1, Galectin-3, MC, BRAFV600E, CD117, CD5, and Ki-67. The proliferative index was approximately 30% (Figure 3a-d, Table 1).
HE images of case 1: (a) these cells were cohesive and arranged in nest and sheet patterns in the low-power field, HE x100 and (b) presence of keratinization was noted, and the tumor cells exhibited hyper-chromatic nuclei, prominent eosinophilic nucleoli, and abundant eosinophilic cytoplasm in the high-power field, HE x400.
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Microscopically, collagen fibers were seen prominently in the background and the presence of keratinization was noted in the low-power field, which was focally apparent in those with poorly differentiated tumors (Figure 2a). Intercellular bridges and mitotic figures were noted in the high-power field (Figure 2b).
Immunochemistry images of case 1: (a) SCCT cells were positive for p40, p40 immunostaining, x200, (b) immunochemistry shows SCCT cells positive for CK19, CK19 immunostaining, x200, (c) SCCT cells were negative for TTF-1, TTF-1 immunostaining, x200, and (d) Ki-67 proliferative index was approximately 30%, Ki-67 immunostaining, x200.
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TG, TTF-1, Galectin-3, MC, BRAFV600E, CD117, CD5, and Ki-67. The proliferative index was approximately 30% (Figure 3a-d, Table 1).
PMC9483828_02
The thyroid ultrasound and CT images of case 2: (a) thyroid ultrasound showed a 25.2 mm x 22.2 mm x 18.8 mm hypoechoic nodule in the right lobar thyroid, (b) CT showed an irregular mass that appeared as soft tissue density in the right lobar thyroid, and (c) upper gastrointestinal endoscopy showed an ulcerative mass measuring 3.0 cm in 28-31 cm from an incisor tooth.
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TI-RADS 4b. The left lobar thyroid was unremarkable (Figure 4a). Mass effected the right wall of the trachea, but without invasion of the structures, and there was also no evidence of cervical lymph node metastasis (Figure 4b). Hence, the frozen biopsy was followed up by an upper gastrointestinal endoscopy that detected an ulcerative mass measuring of 3.0 cm in the esophagus present at the junction between 28 and 31 cm from the incisor tooth (Figure 4c).
HE images of case 2: (a) solid nests of neoplastic cells are infiltrating widely in the normal thyroid follicles, HE x100 and (b) tumor cells showed the feature of moderately differentiated SCC, HE x200.
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Solid nests of neoplastic cells widely infiltrating the normal thyroid follicles, showing the features of moderately differentiated SCC were noted (Figure 5a and b).
Immunochemistry images of case 2: (a) SCCT cells were positive for p40, p40 immunostaining, x200, (b) SCCT cells were positive for CK5/6, CK5/6 immunostaining, x200, and (c) SCCT cells were negative for TG, TG immunostaining, x200.
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TG, TTF-1, Galectin-3, MC, BRAFV600E, and Ki-67. The proliferative index was approximately 50% (Figure 6a-c).