PMC6949678_01
Right arm radiographic. There is a lytic bone lesion on her shoulder with infiltration of local soft tissue. Core biopsies were performed from this site.
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Right arm radiography (Figure 1) demonstrated a lytic bone lesion on her shoulder, apparently involving the surrounding soft tissues.
(a) (H&E, 400x and 20x). Right arm lesion biopsy. There are two images. The small one is a panoramic view with many fragments of the sample. The large one, with a high magnification, demonstrates the follicular aspect of the atypical cells. (b) (400x, TTF1). The neoplastic cells are positive for TTF1, indicating thyroid as a possibility of primary site for this case. (c) (400x, thyroglobulin). Besides the positivity for TTF1, the thyroglobulin pattern of positivity indicates thyroid as primary site of the cancer.
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The patient was submitted to a biopsy of the lesion (Figure 2), which revealed a high-grade malignant neoplasm with an epithelioid aspect on the histological examination.
Nuclear magnetic resonance (NMR) revealed a suspected nodule localized in left lobe of thyroid, measuring approximately 4.0 cm in diameter. Besides this, the thyroid increased in size and, clinically, the lesion may extend from the left for the right side.
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The ultrasonography (US) and magnetic resonance imaging (MRI) revealed a suspected nodule localized in the left lobe of the thyroid, measuring 4.0 cm in diameter (Figure 3).
(400x, Giemsa). FNA of thyroid nodule. There is a hypercellular smear with atypical cells and small follicle indicated by a yellow arrow. Other cells have a oncocytic aspect.
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An FNA was performed, and cytological evaluation was consistent with category IV of Bethesda Classification, suspected for follicular neoplasm (Figure 4).
Thyroid, marcocopy image. The tumor measured 4.0 x 4.0 x 3.0 cm, in the left thyroid lobe. It was an expansive tumor with macroscopic infiltration of the capsule, as demonstrated by the arrow.
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It was an expansive tumor with macroscopic infiltration of the capsule (Figure 5).
(a) (20x, H&E). A1:A tumor image which demonstrated the aggressiveness of the neoplasm. There is an expansive pattern of growing and the area of capsule infiltration. This area is the upper part of the figure. A2:Vascular infiltration by the tumor cells. A3:Necrosis and neoplasm. (b) (400x, H&E). The neoplasm has nuclear pattern of follicular carcinoma. There are no nuclear grooves or pseudo inclusions. Papillary differentiation was declined. (c) (400x, thyroglobulin). The lesion is positive in a diffuse pattern for thyroglobulin which confirms the thyroid carcinoma.
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Immunohistochemistry results were the same (Figure 6).