PMC4899664_01
88-year-old female with follicular thyroid carcinoma. Contrast-enhanced sagittal CT shows a rounded soft-tissue lesion (arrow) of the midthoracic spine with destruction of the T9 vertebral body and associated focal kyphosis. The T8 and T10 vertebrae demonstrate severe height loss and sclerosis.
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T9, and T10 vertebral bodies (Fig. 1). The T9 vertebral body was largely destroyed, with only the spinous process remaining. The T8 vertebral body showed greater than 70% height loss, and T10 approximately 10% height loss.
88-year-old female with follicular thyroid carcinoma. Sagittal T1WI sequence with fat suppression and gadolinium contrast (A) demonstrates enhancement of the destructive lesion involving the T8 through T10 vertebrae. Sagittal STIR sequence (B) shows severe effacement of the central canal with posterior displacement of the spinal cord. No definite cord signal abnormality is identified.
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Subsequent gadolinium-enhanced MR imaging demonstrated extensive vertebral marrow infiltration by enhancing tumor (Fig. 2). There was severe effacement of the central canal and of both neuroforamina at T9-10, with marked displacement but no significant cord flattening or signal abnormality (Fig. 2).
88-year-old female with follicular thyroid carcinoma. Coronal (A) and axial (B) contrast-enhanced CT demonstrates a complex, multiseptated nodule (arrows) arising from the inferior aspect of the left lobe of the thyroid gland.
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Also present was a complex, multiseptated nodule arising from the inferior aspect of the left thyroid lobe measuring 2.8 x 2.8 x 3.0 cm (Fig. 3).
88-year-old female with follicular thyroid carcinoma. Follicular carcinoma metastatic to the vertebral body, medium-power view, H&E stained section. The biopsy consists of well-defined follicular tissue with variable-sized follicles containing homogeneous acellular material (colloid). The degree of differentiation results in a micro- and normofollicular appearance indistinguishable from that of a thyroid adenoma or a non-neoplastic thyroid condition.
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The needle-core biopsy consisted of micro- and normofollicular tissue with follicles containing homogeneous material, histologically indistinguishable from that of an adenoma or a non-neoplastic thyroid (Fig. 4).
88-year-old female with follicular thyroid carcinoma. Follicular carcinoma metastatic to the vertebral body, high-power view, thyroid transcription factor (TTF-1) immunostain. The carcinoma follicular epithelium demonstrates strong nuclear TTF-1 positivity consistent with thyroid immunophenotype. However, in this patient with pulmonary nodules, broncho-pulmonary tumor of primary origin enters the histologic differential diagnosis. The thyroglobulin expression (Fig. 6) resolved this issue.
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The tissue's expression of Thyroid Transcription Factor 1 and Thyroglobulin (Figure 5, Figure 6, respectively) confirmed its thyroid immunophenotype, sealing the diagnosis of metastatic thyroid follicular carcinoma.
88-year-old female with follicular thyroid carcinoma. Follicular carcinoma metastatic to the vertebral body, high-power view, thyroglobulin immunostain. The carcinoma demonstrates diagnostic primary thyroid immunophenotype with strong thyroglobulin expression, especially within colloid pools.
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The tissue's expression of Thyroid Transcription Factor 1 and Thyroglobulin (Figure 5, Figure 6, respectively) confirmed its thyroid immunophenotype, sealing the diagnosis of metastatic thyroid follicular carcinoma.