PMC9833981_01
Ultrasonographic and color doppler image of a hypoechoic nodule in the left lobe of the thyroid gland.
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A USG scan performed in October 2021 revealed a 3.5 x 3.5 x 4.5 mm nodule with indistinct borders, hypoechoic, lobule contour, and dense central and peripheral blood supply in the anterior left lobe of the thyroid gland. (Figure 1).
(A) Thyroid fine-needle aspiration cytology; cribriform fields (PAP x 1000). (B) Thyroid fine-needle aspiration cytology; squamous morular formation (PAP x 1000).
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Fine-needle aspiration biopsy of the nodule in the left lobe of the thyroid was reported as "Malignant cytology, compatible with papillary carcinoma." (Figure 2) Left lobectomy, isthmectomy, pyramidal lobectomy, and central lymph node dissection were performed due to the following: the patient had no pathologic lymph nodes detected in the neck USG scan; no family history; was not a smoker; and possibly had a parathyroid gland whose volume may have decreased due to radiotherapy (Figure 3).
Macroscopic image of thyroid left lobe; isthmus.
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Fine-needle aspiration biopsy of the nodule in the left lobe of the thyroid was reported as "Malignant cytology, compatible with papillary carcinoma." (Figure 2) Left lobectomy, isthmectomy, pyramidal lobectomy, and central lymph node dissection were performed due to the following: the patient had no pathologic lymph nodes detected in the neck USG scan; no family history; was not a smoker; and possibly had a parathyroid gland whose volume may have decreased due to radiotherapy (Figure 3).
Tumoral lesion with rare nuclear clefts and inclusions with prismatic cytoplasm forming follicles, showing morule formations in cribriform architectures (H&E x 400).
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Health Organization (WHO) published a new classification set for endocrine tumors in 2022. Histopathologic examination revealed a tumoral lesion (Figure 4) with a cribriform architecture that showed morule formations, prismatic cytoplasm, rare nuclear clefts, and inclusions in the subcapsular area, which were relatively well-demarcated from normal thyroid tissue (Figure 5).
Focus of microcarcinoma relatively well-demarcated from normal thyroid tissue (H&E x 40).
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Health Organization (WHO) published a new classification set for endocrine tumors in 2022. Histopathologic examination revealed a tumoral lesion (Figure 4) with a cribriform architecture that showed morule formations, prismatic cytoplasm, rare nuclear clefts, and inclusions in the subcapsular area, which were relatively well-demarcated from normal thyroid tissue (Figure 5).
Focal patchy membranous HBME1 expression in tumor cells on immunohistochemical examination.
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Patchy strong nuclear staining in squamoid morule areas with CDX 2.
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CDX2 (Figure 7), and diffuse strong beta-catenin expression (Figure 8) in the tumor cells. Cribriformity became prominent with Cytokeratin 19 (Figure 9).
Strong cytoplasmic and nuclear staining with beta-catenin in cribriform and morular areas.
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CDX2 (Figure 7), and diffuse strong beta-catenin expression (Figure 8) in the tumor cells. Cribriformity became prominent with Cytokeratin 19 (Figure 9).
Cytoplasmic-membranous staining with CK19 (Cytokeratin 19), revealing cribriformity and morule formations.
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CDX2 (Figure 7), and diffuse strong beta-catenin expression (Figure 8) in the tumor cells. Cribriformity became prominent with Cytokeratin 19 (Figure 9).