PMC7784110_01
(A) Ultrasound shows a 0.58 cm solid mass (red arrow); (B) shows a 3.08 x 2.82 x 2.11 cm ovoid cystic mass (yellow arrow) both located at the right thyroid lobe; (C) shows a 0.21 cm ovoid cyst (black arrow) at left thyroid lobe.
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Baseline ultrasound revealed normal thyroid glands with multiple nodules: On the right thyroid was a small 0.58 cm ovoid solid mass (Figure 1A); and a big 3.08 x 2.82 x 2.11 cm ovoid cystic mass (Figure 1B); while on the left thyroid there was a small 0.21 cm ovoid cyst (Figure 1C).
0.5 cm solid nodule seen on ultrasound. (A) Black arrows show papillae with fibrovascular cores (H&E, 40x); (B) Red arrow shows cuboidal cells with overlapping nuclei (H&E, 100x).
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Microscopically, the reddish nodule is composed of randomly oriented papillae with fibrovascular cores (Figure 2A). Furthermore, some tumor cells have prominent grooves and occasional pseudoinclusions (Figure 2B).
3.08 x 2.82 x 2.11 cm ovoid cystic mass on ultrasound. (A) Black arrows show papillae formation (H&E, 40x); (B) On higher magnification (H&E, 400x), yellow arrow shows clear or empty nucleus commonly termed as "Orphan Annie Eye.H There is also no extensive infiltration by lymphocytes or macrophages noted and the follicules have abundant colloid material.
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The cystic cavity, on the other hand, is surrounded by tissues compose of variable sized dilated follicles with flattened to hyperplastic epithelium forming papillae projections into the lumen (Figure 3A). The cells lining the papillary projections were noted to show occasional optical clearing (Figure 3B) thus the pathologist requested for Hector Battifora Mesothelial-1 (HBME-1).
(A) Staining for HBME-1 which appears as a brownish tan stain (HBME-1, 40x); (B) On higher magnification, shows HBME-1 positive seen within the plasma membrane of the tumor cells (HBME-1, 400x).
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The HBME-1 immunostain showed a diffuse membranous staining of the tumor cells (Figure 4).