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Thyroid gland
Other carcinoma
Follicular carcinoma

Reviewer: Shahidul Islam, M.D., Ph.D. (see Reviewers page)
Revised: 28 February 2014, last major update March 2009
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

See also minimally invasive follicular carcinoma below

General
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Epidemiology
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Clinical features
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Prognostic factors
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Case reports
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Treatment
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Gross description
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Gross images
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Indistinguishable from adenoma (AFIP)
Apparently encapsulated
Widely invasive
Focal invasion
A: multiple white tan nodules in thyroid tumor, B: scalp metastases show erosion through skull
Contributed by Dr. Mark R. Wick


47 year old woman

Micro description
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Micro images
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Tumor has distinct border, but separate foci of invasive tumor lie beyond the border
Fig A: H&E, B: extensive lymphovascular invasion, C: CD34+ vessels, D: Ki-67 shows minimal cell proliferation
Focally abutting the normal parenchyma
Contributed by Dr. Mark R. Wick


47 year old woman with enlarged thyroid gland
Insular type
Insular type - resembles an endocrine tumor
Images from AFIP:
Small closely packed follicles
Trabecular growth pattern
Moderate to marked pleomorphism
Mucin production in extracellular space
Capsular invasion:
Complete capsular penetration
With clear cell change (inset, AFIP)
Follicular tumor capsular invasion penetrating the broad collagenous capsule
Invasive tumor has penetrated former capsule and is surrounded by a new capsule
Capsular and vascular invasion
Minimal capsular invasion (AFIP)
Marked capsular invasion (AFIP)
Van Gieson stain
Incomplete capsular invasion
Equivocal capsular invasion
Not capsular invasion
Vascular invasion:
Venous invasion by follicular carcinoma
Carcinoma embolus is attached to vessel wall
Vascular invasion in tumor capsule
Tumor cells invading capsular vessel
Vascular invasion images from AFIP:
Vessel is in capsule
Massive vascular invasion
Minimal vascular invasion
Endothelial cells covering tumor thrombus
Factor VIII stains endothelial cells
Metastases:
Giant scalp metastases
Scalp metastases show well differentiated follicular epithelium that is TTF1+
Fig 1: Incidental renal cysts, fig 2: occult bony metastasis
Metastases to iliac bone are solid or micro-follicular (AFIP)
Virtual slides
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Follicular carcinoma
Cytology description
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Cytology images
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Various images
Figures 9A / 9B
Nuclei are larger than in adenoma
Positive stains
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Electron microscopy images
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Follicular cells converge toward central lumen (AFIP)
Molecular / cytogenetics description
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Videos
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"Histopathology Thyroid--Follicular carcinoma"
by John R. Minarcik, M.D.

Differential diagnosis
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Additional references
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Minimally invasive follicular carcinoma
General
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Prognostic factors
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Gross description
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Gross images
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Images from AFIP:
Fleshy tumor with irregular central scar
Thicker and irregular capsule than adenoma
Micro description
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Micro images
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Capsular invasion
Capsular invasion with regressive changes (AFIP)
Capsular invasion and mimics
Not vascular invasion
Tumor is surrounded by thick, irregular capsule (AFIP)
Varying degrees of capsular penetration
Small (A-C), medium (D-E) and large (F) vessel invasion
Insular pattern
Oxyphilic change with focal capsular penetration
Tumor necrosis
Differential diagnosis
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End of Thyroid gland > Other carcinoma > Follicular carcinoma


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