PMC7431615_01
Ultrasonography images of primary squamous cell carcinoma of the thyroid. (A) Longitudinal gray-scale sonography revealed a solid marked hypoechoic thyroid nodule in the inferior part of the left lobe. (B) Color Doppler flow imaging showed a poor blood flow signal inside this nodule. (C) Contrast-enhanced ultrasound image showed a persistent low peak enhancement of the nodule at 37 s. (D) Time-intensity curves displayed the wash-in time of 10 s, TTP of 37 s, peak signal intensity of 24.5%, and wash-out time of 70 s for the thyroid tumor.
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F1
Thyroid ultrasonography revealed a solitary 3.1 x 2.8 x 2.6-cm3 marked hypoechoic thyroid nodule with an unclear boundary in the inferior part of the left lobe (Figure 1A). Color Doppler flow imaging (CDFI) showed poor blood flow signals in the nodule (Figure 1B). Then, the nodule slowly declined until all the microbubbles washed out at 70 s (Figures 1C,D).
(A) A positron emission tomography-computed tomography scan showed increased 18F-fluorodeoxyglucose metabolism in the left neck mass. (B) Preoperative fine-needle aspiration cytology of the mass demonstrated a few sheets of malignant-looking tumor cells with giant deep stained nuclei (hematoxylin and eosin, magnification x 400).
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F2
Positron emission tomography-computed tomography showed a mass with increased glucose metabolism in the inferior part of the left thyroid lobe (Figure 2A), which indicated it as a malignant mass, whereas there was no evidence of lymph nodes metastasis and distant metastases. Cytologic examination by fine-needle aspiration (FNA) revealed sheets of tumor cells with giant deep-stained nuclei (Bethesda category V) (Figure 2B).
Hematoxylin and eosin staining of primary squamous cell carcinoma of the thyroid: (A) magnification x 8, (B) magnification x 20, (C) magnification x 100, (D) magnification x 400.
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F3
Histopathological examination of hematoxylin and eosin staining showed that a carcinoma in the inferior part of the thyroid lobe (Figure 3A) had no obvious palisade arrangement, intercellular bridges, or keratinization with a cancer pearl (Figures 3B-D).
Immunohistochemical staining of primary squamous cell carcinoma of the thyroid (magnification x 200). Immunohistochemical staining for (A) CK19, (B) CK5/6, (C) EMA, (D) p40, all of which were deeply stained (positive).
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F4
Immunohistochemically, tumor cells were positive for cytokeratin 19 (CK19, Figure 4A), cytokeratin 5 and 6 (CK5/6, Figure 4B), epithelial membrane antigen (EMA, Figure 4C), p40 (Figure 4D), p63 (Figure 5A), and Ki-67 (30%+, Figure 5B) and negative for thyroglobulin (TG, Figure 5C) and thyroid transcription factor 1 (TTF-1, Figure 5D).
Immunohistochemical staining of primary squamous cell carcinoma of the thyroid (magnification x 200). Immunohistochemical staining for (A) p63, (B) Ki 67, (C) TG, (D) TTF-1, and p63 was deeply stain (positive); Ki67 proliferation index was 30%; TG and TTF-1 did not stain (negative).
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F5
Immunohistochemically, tumor cells were positive for cytokeratin 19 (CK19, Figure 4A), cytokeratin 5 and 6 (CK5/6, Figure 4B), epithelial membrane antigen (EMA, Figure 4C), p40 (Figure 4D), p63 (Figure 5A), and Ki-67 (30%+, Figure 5B) and negative for thyroglobulin (TG, Figure 5C) and thyroid transcription factor 1 (TTF-1, Figure 5D).