CASE N°09 – Medullary Thyroid carcinoma

Clinical History:

Age: 66

Sex:  female

Check up: occasional reply of multinodular goiter. Right lobe:  calcify nodule about 2 cm. in diameter, cytology examination was suggested.

Cytological Images:

Cytological material: Thyroid FNA

 PAP 40X

 PAP100X

 PAP200X

 PAP200X

 PAP400X

 GIEMSA 600X

 GIEMSA 600X

Cytological Report:

Positive for malignant cells. Possible medullary thyroid carcinoma.

Histological Images:

Hystological material: Thyroidectomy

 HE 40X

 HE 100X

 CALCITONIN (+)

 TYREOGLOBULIN (-)

 TTF-1 (+)

Histological Report:

Medullary thyroid carcinoma.

Discussion:

Cytology pictures: neoplastic cells are organized in aggregates and isolated, sometimes with elongated nuclei and “salt & pepper” chromatin pattern. Isolated cells presents with eccentric nuclei and with Giemsa stain they have metachromatic cytoplasm.

Medullary carcinoma is the third most common of all thyroid cancers (5 to 8 %). This type of Tumors arise from the parafollicular cells (also called C cells) of the thyroid, placed to the calcitonina production  (thus their name). Medullary carcinoma has a much lower cure rate than papillary and follicular carcinomas, but higher than anaplastic thyroid cancer.

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