PMC5721497_01
Ultrasonography of the thyroid gland with 7.8 mm anechoic lesion in the isthmus of right lobe
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F1
No significantly enlarged cervical lymphadenopathy was noted [Figure 1].
(a) The cytologic findings revealed a hemorrhagic background with high cellularity which is composed of variable-sized nests and scattered naked cells (H and E, x40). (b) The ovoid to spindle tumor cells form clusters with storiform arrangement (H and E, x100)
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F2
The overall cytologic feature showed large quantity of either single or clustered ovoid to spindle cells [Figure 2a]. The tumor cells formed small and large three-dimensional compact clusters with ragged edges [Figure 2b].
(a) Monotonous oval to spindle shaped nuclei with fine granular chromatin, inconspicuous nucleoli and scant cytoplasm (H and E, x400). (b) The scattered cells similar to clustered tumor cells (H and E, x400)
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F3
The cytoplasm was scanty and pale, making the nuclei resemble naked nuclei [Figure 3a]. The cytologic features of single cells were similar to those of cluster-forming cells, suggesting that single cells had become detached from clusters [Figure 3b].
(a) 0.8 cm sized high cellular tumor without capulation (circle, H and E, x20). (b) Well-demarcated mass from normal thyroid tissue (H and E, x40). (c) Histopathology of mass in thyroid gland showing spindle-shaped tumor cells with storiform and admixed with various inflammatory cells (H and E, x100). (d) Fine granular nuclei with inconspicuous nucleoli and scant cytoplasm (H and E, x400)
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F4
Grossly, the thyroid mass was a solid lesion with the greatest dimension of 0.8 cm and revealed irregular shape with no capsule [Figure 4a]. Microscopically, the tumor was composed of ovoid to spindle tumor cells, forming fascicles with an interlacing arrangement [Figure 4b]. Some inflammatory cells such as lymphocytes and eosinophils were admixed with tumor cells [Figure 4c and 4d].
Immunohistochemical expression of EMA (a), CK (b), vimentin (c), and transduction-like enhancing protein 1 (d) in tumor cells
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F5
Immunohistochemistry exhibited the positive reactivity for epithelial membrane antigen [Figure 5a], pancytokeratin (CK) [Figure 5b], vimentin [Figure 5c], and transduction-like enhancing protein 1 [Figure 5d].
Fluorescence in situ hybridization showing t (X; 18) using a dual-color break-apart probe. The 3' probe proximal to the SYT gene (green) and the 5' distal probe (red) are separated in abnormal cells expressing the translocation
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F6
Consequently, the diagnosis was made as SS [Figure 6].