Case 4 -

Noninvasive Poorly-Differentiated Thyroid Carcinoma Bruce M. Wenig, Beth Israel Medical Center, New York, NY

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Click here to download handout in 1-up pdf format for the current section Click here to download handout in 6-up pdf format for the current section Clinical History 22 year old female presented with asymmetric enlargement of the left lobe of the thyroid gland. No information available relative to a prior fine needle aspiration biopsy. A left lobectomy was performed. Intraoperative consultation diagnosis was "Folliuclar pattern lesion, defer to permanent section." Pertinent Laboratory Data: Gross description: Left thyroid lobe measuring 6.5 x 3.5 x 3.5cm showing multiple circumscribed but not grossly encapsulated lesions, including a dominant nodule measuring 3.5cm in greatest dimension with a tan-yellow appearance and central hemorrhagic appearing area. Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 Case 4 - Figure 8 Case 4 - Figure 9 Case 4 - Figure 10 PAS Differential Diagnoses: Papillary carcinoma, solid variant Thyroid medullary carcinoma Undifferentiated (anaplastic) carcinoma Benign follicular lesions/neoplasms with atypia Final Diagnosis: Noninvasive Poorly-Differentiated Thyroid Carcinoma References: Asioli S et al: Poorly differentiated carcinoma of the thyroid: validation of the Turin proposal and analysis of IMP3 expression. Mod Pathol 23(9):1269-78, 2010. Catalano MG et al: Emerging molecular therapies of advanced thyroid cancer. Mol Aspects Med 31(2):215-26, 2010. Rivera M et al: Encapsulated thyroid tumors of follicular cell origin with high grade features (high mitotic rate/ tumor necrosis): a clinicopathologic and molecular study. Hum Pathol 41(2):172-80, 2010. Volante M et al: Poorly differentiated thyroid carcinoma: 5 years after the 2004 WHO classification of endocrine tumours Endocr Pathol. 21(1):1-6, 2010. Pacini F et al: Targeted therapy in radioiodine refractory thyroid cancer. Q J Nucl Med Mol Imaging 53(5):520-5, 2009. Pita JM et al: Gene expression profiling associated with the progression to poorly differentiated thyroid carcinomas. Br J Cancer 101(10):1782-91, 2009. Pinto AE et al: Aneuploidy and high S-phase as biomarkers of poor clinical outcome in poorly differentiated and anaplastic thyroid carcinoma. Oncol Rep 20(4):913-9, 2008. Volante M et al: Poorly differentiated thyroid carcinoma: diagnostic features and controversial issues. Endocr Pathol 19(3):150-5, 2008. Jung TS et al: Clinical features and prognostic factors for survival in patients with poorly differentiated thyroid carcinoma and comparison to the patients with the aggressive variants of papillary thyroid carcinoma. Endocr J 54(2):265-74, 2007. Lin JD et al: Clinical characteristics of poorly differentiated thyroid carcinomas compared with those of classical papillary thyroid carcinomas. Clin Endocrinol (Oxf) 66(2):224-8, 2007. Sanders EM Jr et al: An evidence-based review of poorly differentiated thyroid cancer. World J Surg 31(5):934-45, 2007. Volante M et al: Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 31(8):1256-64, 2007. Hiltzik D et al: Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients. Cancer 106(6):1286-95, 2006. Nikiforov YE: Genetic alterations involved in the transition from well-differentiated to poorly differentiated and anaplastic thyroid carcinomas. Endocr Pathol 15(4):319-27, 2004. Sakamoto A: Definition of poorly differentiated carcinoma of the thyroid: the Japanese experience. Endocr Pathol 15(4):307-11, 2004. Soares P et al: BRAF mutations typical of papillary thyroid carcinoma are more frequently detected in undifferentiated than in insular and insular-like poorly differentiated carcinomas. Virchows Arch 444(6):572-6, 2004. Volante M et al: Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients. Cancer 100(5):950-7, 2004. Volante M et al: Prognostic factors of clinical interest in poorly differentiated carcinomas of the thyroid. Endocr Pathol 15(4):313-7, 2004. Sobrinho-Simões M et al: Poorly differentiated carcinomas of the thyroid gland: a review of the clinicopathologic features of a series of 28 cases of a heterogeneous, clinically aggressive group of thyroid tumors. Int J Surg Pathol 10(2):123-31, 2002. Carcangiu ML et al: Poorly differentiated ("insular") thyroid carcinoma. A reinterpretation of Langhans' "wuchernde Struma". Am J Surg Pathol 8(9):655-668, 1984.