PMC5059640_01
(a) Gross photograph showing the anterior surface of the right lung depicting the extensive involvement by metastatic papillary thyroid carcinoma and transformation to anaplastic thyroid carcinoma (confirmed histologically). (b) Gross photograph showing the left lung with near total encasement by metastatic papillary thyroid carcinoma and anaplastic thyroid carcinoma. (c) Cut surface of the right lung showing extensive tumor involvement with multiple tumoral nodules and complete obliteration of the lung parenchyma (top).
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Metastatic papillary thyroid carcinoma (the bulk majority of tumor present) and coexistent multifocal anaplastic thyroid carcinoma were identified at autopsy involving the bilateral lungs and pleura, pulmonary artery, aorta, pericardium, right adrenal gland, hepatic surface, diaphragm, mediastinal lymph nodes, abdominal lymph nodes, and hilar lymph nodes (Figure 1).
(a) 10x: papillary thyroid carcinoma (lower) with transformation to anaplastic carcinoma (upper). (b) 20x: higher power view of the anaplastic carcinoma component with enlarged nuclei, prominent nucleoli, and moderate amounts of eosinophilic cytoplasm.
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Microscopic examination revealed diffuse involvement of the lung parenchyma by papillary thyroid carcinoma with adjacent areas of anaplastic transformation (Figure 2).
(a) 50x: PAX-8 immunohistochemical stain depicting diffuse nuclear staining in the papillary component of the tumor. (b) 20x: PAX-8 immunohistochemical stain in the solid component of the tumor.
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TTF-1, PAX8 (Figure 3), Napsin-A and were negative for thyroglobulin (Figure 4). The right adrenal gland was essentially replaced by anaplastic tumor, which showed extensive areas of necrosis and a slightly different morphology when compared to the anaplastic component found in the lungs (Figure 5).
(a) 20x: Napsin-A immunohistochemical stain depicting a focus of diffuse cytoplasmic staining. (b) 20x: thyroglobulin immunohistochemical stain which is negative in the tumor.
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TTF-1, PAX8 (Figure 3), Napsin-A and were negative for thyroglobulin (Figure 4). The right adrenal gland was essentially replaced by anaplastic tumor, which showed extensive areas of necrosis and a slightly different morphology when compared to the anaplastic component found in the lungs (Figure 5).
20x: photomicrograph depicting the anaplastic component found to nearly replace the entire right adrenal gland. The cellular morphology here is slightly different from that found in the lung; here we see slightly less eosinophilic cytoplasm and the nucleoli are less prominent.
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TTF-1, PAX8 (Figure 3), Napsin-A and were negative for thyroglobulin (Figure 4). The right adrenal gland was essentially replaced by anaplastic tumor, which showed extensive areas of necrosis and a slightly different morphology when compared to the anaplastic component found in the lungs (Figure 5).