Medullary Thyroid Carcinoma

This case was provided by Treant Hospital, Bethesda, Hoogeveen, The Netherlands

ADS-01504 Rev. 001 © 2016 Hologic, Inc. All rights reserved.

Overview

• Medullary Thyroid Carcinoma

• Sporadic or familial

• Tumor of the parafollicular C cells

• Elevated serum calcitonin levels

• Congo red stain for amyloid and immunohistochemical stains aid in the diagnosis

– Immunohistochemistry:

�Positive: calcitonin, CEA, chromogranin, synaptophysin

�Negative: thyroglobulin

DeMay RM. The Art & Science of Cytopathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

Overview Continued

• Differential Diagnoses:

– Hürthle Cell Carcinoma

– Papillary Thyroid Carcinoma

– Follicular Neoplasm

– Anaplastic Thyroid Carcinoma

– Nodular Goiter

– Amyloid Goiter

DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

Malignant Findings Cytology

• Medullary Thyroid Carcinoma

• Isolated, noncohesive cells are the predominant pattern

• Cell clusters can be present

• Cells may be many different shapes: round, polygonal, plasmacytoid, and spindled

• Amyloid is frequently present and stains red with Congo red stain, but when polarized light is applied changes to apple-green

Continued on next slide

DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

Malignant FindingsCytology

• Medullary Thyroid Carcinoma

• Binucleation and multinucleation common

• Nuclei eccentrically located and typically round to oval

• Spindle cell variant: elongated nuclei

• Chromatin is coarsely granular with small nucleoli (less frequently, prominent nucleoli)

• Cytoplasm commonly abundant and finely granular

• Nuclear pseudoinclusions may be seen

DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

Patient History

• 53-year-old male

• History of Multiple Endocrine Neoplasia-2

• Family history of thyroid disease

• Ultrasound of left thyroid lobe appears as

multilobular goiter with microcalcifications

• FNA of left thyroid performed

DeMay, RM. The Art & Science of Cyotpathology: Superficial Aspiration Cytology. 2nd ed. Chicago, IL: American Society for Clinical Pathology Press; 2012.

Cytologic Diagnosis: Follicular Lesion, Bethesda III

• Sheets showing spindle cells with elongated nuclei• Salt and pepper chromatin• Absence of colloid

ThinPrep® Pap Stain

• Single epithelial cells lacking intranuclear invaginations• Small nucleoli present

ThinPrep® Pap Stain

Cytologic Diagnosis: Follicular Lesion, Bethesda III

Patient Follow-up

• Repeat thyroid FNA within microcalcifications

• Cytologic diagnosis: Suspect for medullary

thyroid carcinoma, Bethesda V

• Remainder of sample in ThinPrep® vial used

for Cellient® cell block

Cellient® Cell Block: CEA Stain

Strongly positive plasmacytoid and spindle cells are also seen with Synaptophysin, Chromogranin and TTF-1

Cellient® Cell Block: Calcitonin Stain

Positive calcitonin staining confirms diagnosis of medullary thyroid carcinoma

Cellient® Cell Block: H&E Stain

Additional Patient Follow-up

• FNA of cervical lymph node was performed

• Cytologic diagnosis: Malignant cells

consistent with medullary thyroid carcinoma

• Patient underwent total thyroidectomy and

cervical lymph nodectomy

Macroscopic Thyroidectomy

Thyroidectomy: H&E Stain

Histologic diagnosis: Bilateral medullary thyroid carcinoma with lymph angioinvasion

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