GPR: 2021 - Week 14

From MGH Learn Pathology

Clinical history

69 yo man with a painful 6.2 cm heterogeneous mass in the left thyroid with extrathyroidal extension


GPR21-10-4be33df5-e724-43c5-bbbc-ea01931c07be.jpeg


Registered users must be logged in to access the interactive quiz.


GPR21-10-4be33df5-e724-43c5-bbbc-ea01931c07be.jpeg

 
Anaplastic thyroid carcinoma
  • Highly aggressive carcinoma composed of undifferentiated follicular cells
  • Rapidly enlarging mass causing hoarseness, dyspnea, and dysphagia
  • Median survival 4 months; 1 year survival rate 10-20%
  • Cut surface: light tan and fleshy, areas of necrosis and hemorrhage
  • Majority are infiltrating into adjacent structures
 

GPR21-10-3551fb84-baac-490e-98da-4902de5a42ad.jpeg

 

Papillary thyroid carcinoma

  • Most common type of thyroid carcinoma (80-93%)
  • Excellent prognosis with a life expectancy similar to general population
  • Solid, white, firm
  • 20% are multifocal, 10% are encapsulated
  • Variable cysts, fibrosis, and calcification
  • Tall cell variant: often larger (>5 cm) and grossly apparent extrathyroidal extension
 

GPR21-10-d765d4dd-fdd8-4f93-a0a2-2ce2b16397f6.jpeg

 

Hurthle cell carcinoma

  • Follicular neoplasm composed of >75% oncocytic tumor cells
  • More aggressive than conventional follicular carcinoma
  • Solid, lobulated, bright brown to mahogany color
  • May have central scar
  • Prone to infarction or hemorrhage
 

GPR21-10-d0286719-fd22-43ae-88bb-6e79f8537f97.jpeg

 

Medullary thyroid carcinoma

  • Neuroendocrine tumor derived from C cells (calcitonin)
  • 1-2% of thyroid carcinomas
  • 70% sporadic, 30% familial (MEN2A or MEN2B syndrome)
  • 5 year survival: 65-90%
  • Solid, firm, gray-tan-yellow
  • May have hemorrhage and necrosis
 
  • Kara Tassinari
  • Derek Kingman
  • Justin Susterich

This week's Gross Pathology Roundup was presented by Lisa Yuen, MD, PhD on Mon, Apr 05, 2021.