Normal Thyroid vs Papillary Thyroid Carcinoma

in STEMGeeks8 days ago

The following three images are the normal architecture of the thyroid gland and then followed up by a case of papillary thyroid carcinoma. Thyroid tissue is made up follicles containing colloid and lined by simple cuboidal epithelium. If you recall your biology class, cuboidal cells are cuboids in shape and the form associated with glands. The cells have round, normochromatic nuclei with inconspicuous nucleoli and moderate cytoplasm.

Taken at Scanner View (40x)

Thyroid Tissue Scan.png

Taken at Low Power View (100x)

Thyroid Tissue LPF.png

Taken at High Power View (400x)

Thyroid Tissue HPF.png

Diagnosis of Papillary Thyroid Carcinoma (PTC) depends on the nuclear features rather than overall architecture. PTC has a lot of histologic variants and some have variable prognosis that are associated with worse prognosis like Tall-Cell variants but I won’t be dwelling on that.

The tumor cells are described as optically clear nuclei (Orphan Annie Nuclei) that can overlap with each other, nuclear grooving and has pseudoinclusions as classic features. Seeing pseudoinclusions raises the confidence that it’s PTC but sometimes you don’t get to see these features all the time. Whenever I see nuclear grooving, optical clearing and overlapping.

Taken at Scanner View (40x)

Papillary Thyroid Carcinoma Scan.png

Taken at Low Power View (100x)

Papillary Thyroid Carcinoma LPF.png

Taken at High Power View (400x)

Papillary Thyroid Carcinoma HPF.png

Malignant cells don’t respect personal space that’s why they overlap. Some look like round cells being folded longitudinally (nuclear grooving), and the chromatin inside the nuclei can be optically clear (Orphan-Annie). The staging and prognosis is favorable for people less than 55 years of age and prompt treatment.

Look at this turtle looking lymphocyte on a peripheral blood smear, looked funny.

Lymphocyte.jpg

If you made it this far reading, thank you for your time.

Posted with STEMGeeks

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 7 days ago 

Haha, you found the turtle.

!discovery 37

We can see clearly the difference, do you think that this is one of the easiest ones to differentiate from a normal tissue behavior for a not trained eye?
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The differences here are on easy mode given that it's from tissue sections. When we get aspirate specimens, these can be difficult to appreciate especially for bloody smears. The classic features may not be readily distinguishable so further resampling may be recommended.

Tissue biopsy is recommended but the choice to operate isn't something to be taken lightly as one could require only one lobe to remove or two depending on the extent of tumor involvement on imaging.

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