Images hosted on other servers:
Aspergillus septic foci
Images hosted on other servers:
Aspergillus
Nocardia
Contributed by Ayana Suzuki, C.T.
Adequate with macrofollicles
Adequate with thick colloid only
Adequate with atypical cells
Adequate with thyroiditis
Inadequate / blood obscured
Nondiagnostic dried or acellular
Images hosted on other servers:
Inadequate / blood obscured
Nondiagnostic dried or acellular
Thyroid fine needle aspiration and smearing techniques
Essential thyroid cytopathology
Scroll to see all images:
Contributed by Andrey Bychkov, M.D., Ph.D.
AJCC / TNM charts
Images hosted on other servers:
Levels of the cervical lymph nodes
TNM sketches
T1N0
T2N0
T3N0 and T1N1
T3N1
T1M1
T2M1
Staging charts
Stage I, < 55 yo
Stage I, 55 yo
Stage II, < 55 yo
Stage II, > 55 yo
Stage III
Stage IVA
Stage IVB
Anaplastic cancer, stage IVA
Anaplastic cancer, stage IVB
Anaplastic cancer, stage IVC
Medullary cancer, stage I
Medullary cancer, stage II
Medullary cancer, stage III
Medullary cancer, stage IVA
Medullary cancer, stage IVB
Medullary cancer, stage IVC
Advanced thyroid carcinoma
Thyroid carcinoma
Staging thyroid cancer
Staging of medullary thyroid cancer
Staging animation
Contributed by Mark R. Wick, M.D.
Amiodarone thyroiditis
Images hosted on other servers:
Amiodarone induced thyrotoxicosis
AFIP images
Enlarged and bosselated with salmon cut surface
Images hosted on other servers:
Lipomatosis and amyloidosis
Contributed by Nazar M. T. Jawhar, M.D.
Various images
Case #247 and AFIP images
Amyloid and inflammatory cells
Apple green birefringence
Images hosted on other servers:
Birefringent apple green staining under polarized light
Images hosted on other servers:
Molecular landscape
Treatment of stage IVA - B
Treatment of stage IVC
Images hosted on other servers:
Neck CT, FDG PET scan, sonography
Neck CT
Neck CT
CT for staging
FDG PET before / after therapy
Images hosted on other servers:
Fungating neck mass
Contributed by Shipra Agarwal, M.D., Mark R. Wick, M.D. and AFIP
Variegated, fleshy
Large, tan, fleshy mass with hemorrhage
Metastases to stomach with ulcerated center
Images hosted on other servers:
Diffusely infiltrative, fleshy
Gray-white, fleshy
Contributed by Shipra Agarwal, M.D., Shuanzeng Wei, M.D., Ph.D., Stephen J. Schultenover, M.D. and AFIP
Malignant spindle cells
Nuclear hyperchromasia and pleomorphism
Squamoid cells
Tumor giant cells
Angiomatoid pattern
Neck muscle infiltration
Angioinvasion
Associated papillary thyroid carcinoma
Anaplastic carcinoma and adjacent papillary thyroid carcinoma
Anaplastic carcinoma with necrosis and inflammation
Malignant spindle cells
AE1 / AE3
CK903
Keratin stains many mesenchymal-like tumor cells
Thyroglobulin stain
Contributed by Shipra Agarwal, M.D. and Ayana Suzuki, C.T.
Necroinflammatory
background
Atypical mitoses
Epithelioid pattern
Sarcomatoid variant
Differentiated thyroid carcinoma component
Pleomorphism
Images hosted on other servers:
Hierarchical clustering
Genetic alterations
Involved molecular pathways
Recurrent MSK-IMPACT derived copy number alterations
Increased mutation burden
Cytology of ATC
Management of ATC
Images hosted on other servers:
Thyroidectomy
Relationship to other structures
Pyramidal lobe
Development of inverted U shaped thyroid gland
Anatomical variations
Blood supply
Images hosted on other servers:
On surgery
In situ
Inverted U shaped thyroid
W shaped thyroid
Zuckerkandl tubercle
Images hosted on other servers:
Surgical specimen
Levator glandulae thyroideae
Contributed by Andrey Bychkov, M.D., Ph.D.
Pyramidal lobe
Thyroid anatomy
Images hosted on other servers:
Embryological pathway of parathyroid migration
Anatomy
Contributed by Truong Phan Xuan Nguyen, M.D.
Normal parathyroid gland
Contributed by Truong Phan Xuan Nguyen, M.D.
Normal parathyroid gland
Chief cells
Oxyphil cells
Transitional cells
Water clear cells
Colloid type material, without oxalate crystals
Images hosted on other servers:
Parathyroid gland
Histology of parathyroid
AFIP images
Necrotic and hemorrhagic tumor
AFIP images
Solid and cellular areas
Abortive vascular lumina
Keratin+ tumor cells
Vimentin+
Plump endothelial, Factor VIII+
Ulex europaeus I lectin+
Type IV collagen stains basal lamina
Images hosted on other servers:
PAX8 mutation in thyroid hypoplasia
Images hosted on other servers:
Phenotype of congenital hypothyroidism
Hemiagenesis on CT
Hemiagenesis on scintiscan
Hemiagenesis on sonography
Images hosted on other servers:
Hashimoto thyroiditis in
thyroid hemiagenesis
Contributed by Ayana Suzuki, C.T.
Cytologic atypia
Architectural atypia
Hürthle cell atypia
Atypical lymphocytes
Images hosted on other servers:
Cytologic atypia
Atypical cyst lining cells
Architectural atypia
Atypical lymphocytes
Atypical thyroid FNA
Head and tail of the Bethesda system for thyroid
Thyroid cytology - Bethesda classification
Contributed by Ayana Suzuki, C.T.
Isoechoic nodule
Hypoechoic nodule
Large cyst
Large multilocular cyst
Contributed by Ayana Suzuki, C.T.
Colloid nodule
Adenomatous nodules
Hashimoto thyroiditis
Granulomatous thyroiditis
Thyroglossal duct cyst
Thyroid cytology: colloid nodule
Essential thyroid cytopathology
Contributed by Andrey Bychkov, M.D., Ph.D.
TBS 2017
TBS metrics
Contributed by Ayana Suzuki, C.T.
Unsatisfactory:
Hemorrhagic background
Muscle
Respiratory epithelium
Air dried smear
Cyst fluid only
Benign:
Watery colloid
Cracking colloid
Follicular clusters
3D structures
follicular lesion of undetermined significance:
FLUS - cellular
FLUS - architectural
FLUS - Hürthle
Atypical lymphocytes
suspicious for a follicular neoplasm:
Microfollicles
FN - Hürthle
Suspicious for malignancy:
Suspicious for papillary thyroid carcinoma
Suspicious for lymphoma
Hyalinizing trabecular tumor
Malignant:
Papillary carcinoma
Medullary carcinoma
Insular carcinoma
Anaplastic carcinoma
Lymphoma
Algorithmic approach to thyroid FNA
Head & tail of the Bethesda system
Thyroid cytology: approach
Thyroid cytology: cases
Thyroid cytology: ND/UNS, benign and FN/SFN
Thyroid cytology: malignant, SUS and AUS/FLUS
Thyroid cytopathology
Case #98
Thyroid gland with black pigment
Images hosted on other servers:
Black thyroid and follicular adenoma
Cut surface
Coal black coloration
Contributed by Andrey Bychkov, M.D., Ph.D. and Mark R. Wick M.D.
Perinuclear brown pigment
Minocycline induced pigmentation
Images hosted on other servers:
Pigmented cells and colloid
Fontana-Masson
Images hosted on other servers:
Pigment granules in cytoplasm and colloid space
Pigment deposits and Xray spectrogram
Experimental black thyroid, dog
Experimental black thyroid, monkey
Images hosted on other servers:
Branchial apparatus
Branchial cleft anomalies location
Anatomical relations
Images hosted on other servers:
Cystic lesion in left parotid gland
CT fistulogram
CT fistulogram
Infrahyoid cyst
Images hosted on other servers:
Fistula opening (1st branchial cleft anomaly)
First branchial cleft fistula opening
Bilateral fistula opening
Saliva coming out, third branchial fistula
Fistula opening above sternocleidomastoid muscle
Sinus originating from pyriform sinus
With cervical abscess
Fistulous tract in right pyriform sinus
Images hosted on other servers:
Fistula tract
Fistula tract ending in parotid gland
Collaural fistula
Third branchial fistula
Fistula tract exiting pharynx
Fourth branchial fistula
Contributed by Andrey Bychkov, M.D., Ph.D.
PTC: cystic node mimics branchial cyst
Hashimoto thyroiditis with lymphoepithelial cyst
Images hosted on other servers:
Cyst lined by stratified squamous epithelium
Sinus tract in parotid gland
Cyst wall with chronic inflammation
Fibrotic wall of a cyst
Lymphoid aggregates in cyst wall
Ciliated pseudostratified columnar epithelium
Images hosted on other servers:
Squamous cells, keratin debris
High power
Pap stain
Inflammation
Cholesterol crystals
Pharyngeal pouches
Contributed by Mark R. Wick, M.D.
Various images
AFIP images
Calcitonin staining:
C cells highlighted
Nodular CCH
C cells adjacent to follicular carcinoma
MEN2A patients:
Circumferential proliferation
Focal proliferation of C cells
Eccentric intrafollicular proliferation
MEN2A patients with early medullary carcinoma:
Group of C cells extends into interstitium
Images hosted on other servers:
Calcitonin staining, C cells form ring around follicle
Associated with nodular goiter
MEN2A patient
High power
Images hosted on other servers:
Eggshell calcified retrosternal thyroid
Images hosted on other servers:
Muddy appearance
Contributed by Andrey Bychkov, M.D., Ph.D.
Calcium oxalate crystals (abundant)
Calcium oxalate crystals
Papillary thyroid carcinoma
PTC follicular variant with ossification
Concentric layers of calcium deposition in tumor stroma
Psammoma bodies, laminated calcifications
Evolution in psammoma body in PTC
Psammoma bodies in benign appearing thyroid
Images hosted on other servers:
Extensive dystrophic calcification
Osseous metaplasia with fatty marrow
Calcification induced artifact
Pediatric thyroid nodules by A. Wassner and A. Bauer (2020)
Contributed by Julie Guilmette, M.D.
Predominantly follicular architecture
Clear cell features
Nuclear characteristics
HBME1 stain
AFIP images
Nodular hyperplasia with clear cell change
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Papillary thyroid carcinoma metastatic to cervical lymph node
Hashimoto thyroiditis with clear cells
Nodular hyperplasia
Clear cell change
Clear cell change
(follicular variant)
Follicular carcinoma
Follicular neoplasm with clear cell change
Signet ring follicular adenoma
Sharp demarcation between clear and oncocytic cells
Gradual transition from oncocytic to clear cells
Both patterns exist in same cell
Clear cell type
Adenoma is thyroglobulin+
AFIP images
Signet ring follicular adenoma
Marked dilation of cisternae
Images hosted on other servers:
Ultrasound
Images hosted on other servers:
Circumscribed and infiltrative
Contributed by Andrey Bychkov, M.D., Ph.D.
Papillary pattern
Pseudostratification
Tightly packed
Invasive
High Ki67
Contributed by Ayana Suzuki, C.T.
Papillary fragments
Nuclear features
Images hosted on other servers:
Heterogeneous, hypoechoic mass without calcifications
Images hosted on other servers:
Multifocal tumors throughout the entire thyroid
Contributed by Jonathan K. Lai, M.D., Drs. Safa Alshaikh and Aalaa Mohammed (Case #470) and Dr. Bin Xu (Case #528)
Encapsulated thyroid nodule
Complex architecture
Cribriform-morular architecture
Trabecular pattern
Sieve-like spaces and morules
Squamoid morules
Squamoid morules
Hallmark feature
19 year old woman with right sided neck swelling
Papillary and cribriform architecture
Scattered squamous morules
Scattered mitotic figures
Multifocal tumor necrosis
CK5/6
TTF1
TTF1
PAX8
Thyroglobulin
Beta catenin
Beta catenin
Estrogen receptor
CD10
CDX2
Contributed by Drs. Safa Alshaikh and Aalaa Mohammed (Case #470)
May-Grünwald-Giemsa
Pap stain
Images hosted on other servers:
Hypercellular, morular or papillary fragments
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Abundant calcium oxalate crystals
Follicular adenoma: calcium oxalate crystals
Calcium oxalate crystals in the colloid
Calcium oxalate crystals
Images hosted on other servers:
Calcium oxalate crystallite
Spherical apatite crystallites
Images hosted on other servers:
5 cm nodule on ultrasound
Images hosted on other servers:
Large with solid, fleshy areas
Thyroid mass, 6.2 cm
Contributed by Marc Pusztaszeri, M.D. (source: World Tumor Registry)
Comedonecrosis
Tall cell PTC with necrosis
Widely invasive
Tumor necrosis in FTC subtype
Tumor necrosis in FTC subtype
Increased mitotic activity
Mitotic activity in PTC subtype
NRAS Q61R in FTC subtype
BRAF V600E
Increased Ki67
Images hosted on other servers:
Bethesda V, suspicious for PTC
- See Diagrams
Special types of thyroid cancer with Dr. Virginia LiVolsi
Poorly differentiated carcinoma of the thyroid with Dr. Margaret Brandwein
What is new in the WHO 2022 in thyroid pathology
Contributed by Andrey Bychkov, M.D., Ph.D.
Infiltrative growth
Images hosted on other servers:
53 year old man with metastatic carcinoma
Images hosted on other servers:
Ultrasonographic features
AFIP images
Diffuse growth and fibrosis
Images hosted on other servers:
Fibrotic cut surface
Contributed by Livia Florianova, M.D., M.Sc. and Marc Pusztaszeri, M.D.
Lymphocytic infiltrate
Papillary pattern
Dense fibrosis
Dense sclerosing fibrosis
Infiltrative growth
Nuclear features
Psammoma bodies and sclerosis
Solid pattern
Squamous morule
Lymphovascular invasion
Lymph node metastasis
Contributed by Andrey Bychkov, M.D., Ph.D.
Multiple tumor nodules
Fibrosis and lymphocytic infiltration
Large psammoma bodies
Prominent sclerosis
Thick fibrous bands
Extensive squamous metaplasia
Contributed by Livia Florianova, M.D., M.Sc., Marc Pusztaszeri, M.D. and Manon Auger, M.D.C.M.
3D ball-like clusters
Protruding hobnail cells
Squamous metaplasia
Cytological atypia
3D ball-like clusters
Psammoma body
Cytological and architectural atypia
Cytological atypia
Cytological and architectural atypia
Psammoma bodies and lymphocytes
Nuclear features
Psammoma bodies and lymphocytes
Images hosted on other servers:
Pathophysiology
Mode of inheritance
Pedigree
Chromosome 22 abnormalities
Genetic mapping
Images hosted on other servers:
Absent thymus on CT
Subglottic stenosis on CT
Basal ganglia and periventricular calcification
Images hosted on other servers:
Facial dysmorphism
Images hosted on other servers:
Hypoplastic thyroid in mice
Various malformations in mice
Images hosted on other servers:
Deletion of 22q11.2 on FISH
Karyotype
Various techniques
DiGeorge syndrome
Pharyngeal apparatus
Images hosted on other servers:
Thyroid hormone synthesis
Mechanism of
dyshormonogenesis
Congenital hypothyroidism
Genetic causes of
dyshormonogenesis
Thyroid imaging in congenital hypothyroidism
Scintigraphic classification of dyshormonogenesis
Pedigrees
Images hosted on other servers:
Ultrasound of fetal goiter
Ultrasound of 26 year old man
Various defects
on scintigraphy
(NIS, TPO and PDS)
Scintigraphy
Images hosted on other servers:
Pendred syndrome
AFIP images
Marked nodular hyperplastic changes
Images hosted on other servers:
Enlarged multinodular thyroid
Excision
Follicular adenoma in a goiter
Scroll to see all images:
Contributed by Mark R. Wick, M.D. and AFIP
Various images
Resembles nodular hyperplasia
Hyperplastic nodules showing solid growth pattern
Marked fibrosis causes apparent increased lobularity
Images hosted on other servers:
Multinodularity
Fibrosis
Hypercellular nodule
Papillarity
Hyperplastic nodule
Scant colloid
Atypia
IHC in Pendred syndrome
Follicular adenoma in dyshormonogenetic goiter
Papillary microcarcinoma in dyshormonogenetic goiter
Papillary carcinoma in goiter
Images hosted on other servers:
Structure of TPO mutations
DUOXA2 mutation
Contributed by Andrey Bychkov, M.D., Ph.D. and Case #108
Aberrant parathyroid
Various images
Cytokeratin cocktail
Chromogranin
Synaptophysin
Parathyroid hormone
Images hosted on other servers:
Thymic tissue contains a mass of parathyroid cells
Images hosted on other servers:
Thyroid descent
Locations
Images hosted on other servers:
Neck ultrasound
Neck CT
Radionuclide scan
Abdominal MRI
Head MRI
Chest CT
Intracardiac thyroid
Images hosted on other servers:
Neck mass
Images hosted on other servers:
Submental mass
Ectopic thyroid, lateral neck
Intratracheal thyroid tissue, hyperplasia
Mediastinal mass
Cystic mass, adrenal gland
Contributed by Andrey Bychkov, M.D., Ph.D.
Perithyroid thyroid follicles
Images hosted on other servers:
Benign conditions
Ectopic vs. orthotopic thyroid
Posterior mediastinal mass
Adrenal mass
Adrenal mass, IHC
Adenoma, ectopic thyroid
PTC arising in ectopic thyroid
Anaplastic carcinoma
Images hosted on other servers:
Follicular cells
Summary table:
| Event | Week | Day |
| Specification of the thyroid domain in the ventral endoderm | week 3 | E20 - 22 |
| Thyroid bud (medial anlage) formation | weeks 3 - 4 | E20 - 24 |
| Thyroid bud begins migration | week 4 | E24 - 28 |
| Formation of the lateral anlagen (ultimobranchial bodies) | weeks 4 - 7 | |
| Migration of lateral anlagen | weeks 5 - 7 | |
| Thyroglossal duct disappears | weeks 5 - 6 | E30 - 40 |
| Thyroid migration is complete | weeks 7 - 8 | E45 - 50 |
| Fusion with ultimobranchial bodies | weeks 7 - 9 | E44 - 60 |
| Onset of folliculogenesis | week 10 | E70 |
| Release of thyroid hormone | weeks 10 - 12 | E80 |
Images hosted on other servers:
Embryonic development of thyroid gland
Branchial arches
Thyroglossal duct
Relation to vessels
Interplay of transcription factors
AFIP images
Human embryo 14 weeks
Images hosted on other servers:
Stages 13 and 22
Mouse model
TTF1 expression
Thyroid development
Development of pharyngeal area
AFIP images
Tumor surrounded by fibrous capsule
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Papillary carcinoma encapsulated variant
Transcapsular invasion
Thickened capsule is violated by tumor growth
Typical papillary appearance
Contributed by Andrey Bychkov, M.D., Ph.D.
Enlarged vesicular nuclei with irregular membranes
Evident major and minor diagnostic features
Minor diagnostic features
Free floating of small tumor fragment in vascular lumen
Small piece of tumor floats in vascular lumen
Images hosted on other servers:
lesion with nuclear
features of papillary
carcinoma (inset)
Capsular invasion
3 cm tumor in 51 year old man (fig. 1)
Images hosted on other servers:
Ultrafast Pap stain
Ultrafast Pap staining of
follicular adenoma and
follicular variant
Images hosted on other servers:
Endemic multinodular goiter
Images hosted on other servers:
Endemic multinodular goiter
Contributed by Ayana Suzuki, C.T.
Watery colloid
Cracking colloid
Follicular clusters
3D structures
Paravacuolar granules
Contributed by Andrey Bychkov, M.D., Ph.D.
AJCC / TNM charts
ATA initial stratification
WHO classification
Images hosted on other servers:
Levels of the cervical lymph nodes
Pattern of nodal metasatasis
Extranodal
Contributed by Chan Kwon Jung, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Papillary thyroid carcinoma - lymphatic invasion
Vascular invasion
Vascular invasion
Psammoma bodies
Microscopically positive margin
Extrathyroidal extension
Extrathyroidal extension
Extrathyroidal extension
Extrathyroidal extension
Extranodal extension
Extrathyroidal extension by J. Hernandez-Prera (2020)
Images hosted on other servers:
Ultrasound
Ultrasound elastography
Color doppler ultrasound
Images hosted on other servers:
Well demarcated, solid
Fibrotic nodule
Contributed by Ayana Suzuki, C.T.
Mixed epithelial-mesenchymal tumor
Fibromatosis type stroma
Beta catenin
Images hosted on other servers:
Stromal fragment
Contributed by Rachel Jug, M.B.B.Ch.
Ultrasound FNA techniques
Images hosted on other servers:
Risk based on appearance and nodule characteristics
Technique
Short, rapid strokes
with only slight
changes in direction
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
FNA induced alterations in thyroid nodule
Pseudo angiosarcomatous pattern
Fine needle
induced changes
in follicular
adenoma
FNA biopsy techniques
Thyroid FNA and smearing techniques
Superficial FNA technique
Images hosted on other servers:
Patchy lymphocytic inflammation
Small and large lymphocytes,
occasional plasma cells
Images hosted on other servers:
Coarsely
condensed
chromatin at
nuclear periphery
Images hosted on other servers:
Diagnostic capsular invasions
Incomplete / questionable capsular invasions
Images hosted on other servers:
Ultrasound
Ultrasound
Color Doppler sonogram
Color Doppler sonogram
Contributed by Andrey Bychkov, M.D., Ph.D., Mark R. Wick, M.D. and AFIP
Encapsulated thyroid nodule
Circumscribed thyroid nodule
Encapsulated, homogeneous tan cut surface
Bisected adenoma has fresh hemorrhage
Marked necrosis, hemorrhage and cystic change
Marked cystic degeneration
Images hosted on other servers:
Well circumscribed tumor
Well encapsulated
Central scar
Cystic and partially necrotic tumor
Contributed by Shipra Agarwal, M.D., Andrey Bychkov, M.D., Ph.D., Mark R. Wick, M.D., Asmaa Gaber Abdou, M.D. and AFIP
Capsule & compressed thyroid
Mixed micro and normofollicular pattern
Hyperchromatic, small round nuclei
Abundant crystals of calcium oxalate
Calcium oxalate crystals
Processing artifact with distorted nuclei
Distorted nuclei due to technical / processing artifact
Tissue degeneration
Circumscribed thyroid nodule
Cellular follicular adenoma
Cellular follicular adenoma
Trabecular type
Trabecular type
Thin and uniform fibrous capsule
Marked fibrosis and stromal hyalinization
Marked hyaline thickening of vessel walls
Marked fibrosis, hyalinization and calcium deposition
Marked vascularization
Capsular vessel with smooth muscle cells
Bizarre nuclei
Large, extremely irregular nuclei
With papillary hyperplasia
With papillary hyperplasia and adipose metaplasia
Cartilaginous metaplasia (adenochondroma)
Prominent, clear cell change
Squamous metaplasia
Mucin production
Thyroglobulin+
Alcian blue+
Solid, trabecular, microfollicular, macrofollicular patterns
Left: macrofollicular, right: solid pattern
Signet ring
Markedly cellular with irregular growth
Well formed follicles merge with solid pattern
Spindle cells mix with round cells
Not invasion:
Fine needle
induced changes
resemble invasion
Contributed by Shipra Agarwal, M.D. and Ayana Suzuki, C.T.
Cellular aspirate
Microfollicles and small round nuclei
Microfollicles
Images hosted on other servers:
Microfollicular
Microfollicular
Microfollicular
FNA
Round hyperchromatic nuclei
FNAC
Thyroid neoplasms
AFIP images
Abundant dilated endoplasmic reticulum
Microvilli project into well developed lumina
Signet ring follicular adenoma
Images hosted on other servers:
Gene expression analysis
CNV landscape of thyroid tumors
Driver mutations in thyroid tumors
Driver mutations and pathway analyses
Microarray and qRT PCR
Expression ratios of CRABP1, FABP4 and HMGA2
Clinicopathological features and mutation spectrum
Hierarchical clustering
Solitary thyroid nodule
Thyroid: compare and contrast
Histopathology thyroid: follicular adenoma (microfollicular)
Contributed by Ayana Suzuki, C.T. and Mark R. Wick, M.D.
Microfollicle
Images hosted on other servers:
Microfollicle
Follicular crowding
Trabecular pattern
Head and tail of the Bethesda system for thyroid
Thyroid cancer: fine needle aspiration, malignant or indeterminate results
Images hosted on other servers:
Schematic drawing for capsular invasion
Schematic drawing for vascular invasion
Contributed by Andrey Bychkov, M.D., Ph.D., Wafaey Fahmy Badawy Mohamed, M.D., Mark R. Wick, M.D. and AFIP
Minimal capsular invasion
Focal invasion
47 year old woman with follicular thyroid carcinoma and multinodular goiter
Various images
Minimally invasive follicular carcinoma
Indistinguishable from adenoma
Images hosted on other servers:
Apparently encapsulated
Widely invasive
Fig A: multiple white tan
nodules in thyroid tumor
Fig B: scalp metastases
show erosion through skull
Contributed by Andrey Bychkov, M.D., Ph.D., Mark R. Wick, M.D. and AFIP
False angioinvasion
Capsular vessel with tumor
Vascular invasion
Tumor in vascular space
Transcapsular penetration
Invasion through tumor capsule
Propagation of tumor embolus
Extensive necrosis
Tumor necrosis
Unusual brisk mitotic activity
TTF1: bone metastasis
Moderate pleomorphism
Mucin production
Capsular invasion
Metastases to iliac bone
Thick, irregular capsule
Images hosted on other servers:
Tumor, normal parenchyma
Insular type
Foci of tumor
beyond the border
Van Gieson stain
Penetration of former capsule
Not capsular invasion
Contributed by Ayana Suzuki, C.T., Xiaoyin "Sara" Jiang, M.D. and Jose Mellado, M.D.
Microfollicles
Follicular carcinoma
Follicular carcinoma, microfollicules with nuclear enlargement
AFIP images
Follicular cells converge toward central lumen
Contributed by LeicaBiosystems, Amsterdam
PPARG (3p25)
Thyroid carcinoma: gross and micro
Histopathology thyroid: follicular carcinoma
Images hosted on other servers:
Follicular variant
Contributed by Bin Xu, M.D., Ph.D.
Encapsulated follicular variant
Infiltrative follicular variant
Contributed by Bin Xu, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Follicular architecture & nuclear features
Infiltrative follicular variant
Encapsulated follicular variant
Ossification
Contributed by Ayana Suzuki, C. T.
Hypercellular aspirate
Microfollicular and trabecular pattern
Microfollicles
Irregular nuclei
Nuclear inclusions
Images hosted on other servers:
Cellular aspirates;
some microfollicular
aggregates, no colloid
Acinar arrangement with intranuclear inclusion
Grape-like nuclei of papillary thyroid carcinoma
Microfollicles in thyroid FNA smears
Comparison of a
tissue proven follicular
adenoma and variant
of papillary carcinoma
AFIP images
Nuclear features
Images hosted on other servers:
Follicular variant of papillary carcinoma
Images hosted on other servers:
Exophalmos, lid retraction
Rodney Dangerfield
Marty Feldman
Images hosted on other servers:
Markedly enlarged gland
Scroll to see all images:
Contributed by Swati Satturwar, M.D., Mark R. Wick, M.D. and Andrey Bychkov, M.D., Ph.D.
Benign thyroid follicles
Radiation changes with stromal fibrosis
Various images
Active tall epithelium with light vacuolated cytoplasm
Small nodule of atypical cells with bizarre nuclei
Large
eosinophilic cells
with prominent
bizarre nuclei
Compensatory nodular hyperplasia
Prominent nuclear atypia / pleomorphism
NIS membranous expression
AFIP images
Diffuse hyperplasia with well developed papillae
Follicular cells lining papillae are tall and columnar
Hyperplastic small follicles
Images hosted on other servers:
Prominent infoldings of hyperplastic epithelium
Epithelium is tall columnar, colloid shows scalloping
No nuclear changes of papillary thyroid carcinoma
Various images
Numerous plasma cells
Follicles with pale colloid
Irregular follicles,
pseudopapillary
epithelium and
sparse colloid
Colloid has scalloped margins
Lobulated parenchyma with irregular follicles
Images hosted on other servers:
Graves disease: flame cells
Graves gross and micro
Thyroid: compare and contrast
Histopathology thyroid: Graves disease
Images hosted on other servers:
Ink color scheme
How to serially section
Contributed by Andrey Bychkov, M.D., Ph.D.
Orientation of specimen by surgeon
Sampling encapsulated lesion
Detecting capsular invasion
Sampling papillary carcinoma
Gross appearance of main thyroid lesions: follicular adenoma and papillary carcinoma
Images hosted on other servers:
Orientation of specimen by surgeon
Sampling encapsulated lesion
Grossing by Weill Cornell
Grossing by Gross Cutting Room
Contributed by Ayana Suzuki, C.T.
Isoechoic nodule
Images hosted on other servers:
Ultrasound
Ultrasound
Contributed by Mark R. Wick, M.D.
Diffusely enlarged thyroid lobe
Images hosted on other servers:
Atrophic gland
Nodular gland
Contributed by Andrey Bychkov, M.D., Ph.D. and Shipra Agarwal, M.D.
Lymphoid follicles with germinal centers
Diffuse
lymphoplasmacytic
infiltration
Squamous metaplasia: p63+ cells in many follicles
Evolution of squamous metaplasia
Intense immunostaining
Lobulation of thyroid tissue by fibrotic bands
Vesicular nuclei of thyroid follicles similar to PTC nuclei
Aggregation of lymphoid follicles mimic thyroid nodule
Hashimoto thyroiditis with lymphoepithelial cyst
Nodular Hashimoto thyroiditis
Papillary microcarcinoma and Hashimoto thyroiditis
Oncocytic cell nodule
Contributed by Shipra Agarwal, M.D. and Ayana Suzuki, C.T.
Cellular aspirate
Crushed cells
Lymphocytes and oncocytes
Images hosted on other servers:
Oncocytic cells with atypical nuclei
Sheet of follicular cells with oncocytic change mixed with benign lymphoid cells
Resembles lymphoma
Grade I: mild lymphocytic inflammatory infiltrate
Grade II: moderate lymphocytic inflammation
Grade III: marked
inflammation with
polymorphous
lymphocytes
ThinPrep versus Pap stain
Lymphocytes and oncocytes
Follicular destruction by lymphocytes
Crushed cells
Grade 1, 2 and 3 thyroiditis
Thyroid: compare and contrast
Histopathology thyroid: Hashimoto thyroiditis
AFIP images
Metaplastic squamous follicles
Dilated lumen of metaplastic follicle
Various images
Contributed by Andrey Bychkov, M.D., Ph.D.
Perinuclear brown pigment
Oncocytes
Sanderson polster
Thyroid follicular epithelium
Follicular colloid
Normofollicular thyroid
Macrofollicular thyroid
Pyramidal lobe
Microfollicular thyroid
Pericapsular fat
Adipose metaplasia
Perithyroid thyroid follicles
Intrathyroidal muscle
Calcium oxalate crystals in the colloid
PAS staining
Thyroglobulin expression
Mucicarmine staining
TTF1 expression
PAX8 expression
TTF2 nuclear expression
NIS membranous expression
Cluster of C cells
Location of C cells in relation to follicle
Pericapillary location of C cells
Clustered distribution of C cells
Calcitonin IHC
Proliferation in adult thyroid
Prominent vascular network
Capillary network
Solid cell nests
Histologic mimics of SCN
Solid cell nests: p63
Solid cell nests: thyroglobulin-
AFIP images
stain); cells are
polyhedral and
spindled
Follicles lined by flattened epithelium
Normal adult follicles are round to oval
Follicles lined by cuboidal epithelium
Colloid is flocculent - most likely artifactual, not significant
Tangential section
of normal thyroid
follicle may resemble
C cell hyperplasia
Ectopic cartilage
Skeletal muscle
Squamous metaplasia
Images hosted on other servers:
Follicles lined by flattened epithelium and filled with colloid
Rich vascular supply
Thyroid and parathyroid glands
Papillary structures
C cells (calcitonin stain)
AFIP images
Follicles have luminal microvilli
Intrafollicular C cell
Images hosted on other servers:
Follicular cells
By John R. Minarcik, M.D.
Images hosted on other servers:
Summary of patients
Contributed by Andrey Bychkov, M.D., Ph.D.
Edematous papillae lined by discohesive epithelium
Oncocytic epithelium with loss of cohesiveness
Hobnail cells with apically placed nuclei
Apical decapitation of cells
Images hosted on other servers:
PTC hobnail variant on different magnifications
Group 2 papillary carcinoma of the thyroid
IHC
Images hosted on other servers:
Conventional smear
LBP
Images hosted on other servers:
Encapsulated gray white nodular lesion
Gray white with one area showing cystic degeneration
Contributed by Virginia A. Livolsi, M.D.
HTT thinly encapsulated
Solid trabecular growth
Trabecular pattern noted
Elongated nuclei
Prominent intranuclear inclusion
Nuclear clearing and grooves
Yellow bodies
Calcification in tumor stroma
Thyroglobulin stain variable
TTF1 decorates nuclei
Ki67 decorates membranes
Contributed by Ayana Suzuki, C.T.
Nuclear pseudoinclusions
Images hosted on other servers:
Calciphylaxis
Images hosted on other servers:
Gland composed mainly of chief cells with a rim of normal parathyroid tissue, no stromal fat
Chief cell hyperplasia and oncocytic cells
Calciphylaxis: ischaemic skin changes
Contributed by Andrey Bychkov, M.D., Ph.D.
Enlarged thyroid
Images hosted on other servers:
Diffuse hyperplasia of thyroid gland
Histopathology Thyroid - Graves Disease
Endocrinology overview
Images hosted on other servers:
CT scan
Ultrasound
Images hosted on other servers:
Lobulated, solid and tan colored
Tumor and trachea
Contributed by Shuanzeng Wei, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Tumor nests and fibrosis
Central necrosis
Tumor and thyroid tissue
Fibrous bands
Squamoid cells
Invasive growth
Images hosted on other servers:
Sheets and clusters with keratin
Discohesive polygonal to ovoid cells
Contributed by Andrey Bychkov, M.D., Ph.D. and Rachel Jug, M.B.B.Ch., B.A.O.
Vesicular nuclei with irregular membranes
Evident major and minor diagnostic features
Dark colloid with frequent scalloping and clefting
Free floating of small tumor fragment in vascular lumen
Small piece of tumor floats in vascular lumen
Capsular invasion and extrathyroidal extension
Tumor plug is associated with thrombus
Overlapping, elongation and a single mitotic figure
Irregular nuclear contours, grooves, pseudoinclusions
Clear chromatin with margination
Contributed by Xiaoyin "Sara" Jiang, M.D.
Microfollicles and nuclear enlargement
Images hosted on other servers:
Risk factor model
Images hosted on other servers:
Ultrasound
MRI
FDG-PET
Contributed by Somboon Keelawat, M.D. and Jijgee Munkhdelger, M.D., Ph.D.
Discrete nodule
Eosinophils
Follicular stuffing
LCH cells
LCH cells and eosinophils
Langerin
CD1a
Thyroglobulin
Images hosted on other servers:
FNA smear
S100 and CD1a
Images hosted on other servers:
Birbeck granules
Images hosted on other servers:
Sonogram and CT
Contributed by Andrey Bychkov, M.D., Ph.D.
Hashimoto thyroiditis with lymphoepithelial cyst
Lymphoepithelial cyst of thyroid
Images hosted on other servers:
H&E, p63, Ki67
Images hosted on other servers:
FNA
AFIP images
Diffuse large cell lymphoma: fish flesh cut surface
Hodgkin lymphoma:
nodular sclerosing
subtype
Contributed by Mark R. Wick, M.D.
Large cell type, reticulin stain
AFIP images
Diffuse large B cell lymphoma:
Tumor cells
Follicle in lower right
Fibrous bands
Tumor cells are CD45 (LCA)+
Keratin, thyroglobulin
Hodgkin lymphoma:
Nodular sclerosing subtype
Follicular lymphoma:
Residual thyroid follicles
Images hosted on other servers:
Large pleomorphic cells
Hodgkin lymphoma: nodular sclerosis type
Hodgkin lymphoma: CD30+
Follicular lymphoma: morphology
Follicular lymphoma: negative for bcl2 and IGH-BCL2
Follicular lymphoma: positive for bcl2 and IGH-BCL2
Contributed by Ayana Suzuki, C.T. and Mark R. Wick, M.D.
DLBCL
Large cell type
Images hosted on other servers:
Intermediate grade lymphoma
MALT lymphoma
Hodgkin lymphoma: Reed-Sternberg cell
Diffuse large B cell lymphoma:
Large and irregular lymphoid cells
Misdiagnosed as anaplastic carcinoma
High grade lymphoma
CD45 / LCA+, CD20+, keratin-
Images hosted on other servers:
Classification
Images hosted on other servers:
Skeletal deformities in mucopoly-saccharidoses
Images hosted on other servers:
Skeletal deformities in mucopolysaccharidoses
Case #164
Liver biopsy in Gaucher disease (H&E, PAS)
Images hosted on other servers:
Hepatic glycogenosis (H&E, PAS, Masson)
Niemann-Pick disease (hepatic steatosis)
Images hosted on other servers:
Gaucher cell in bone marrow
Images hosted on other servers:
Lamellated "zebra" bodies in Fabry disease (fig 10)
Leukocyte in mannosidosis
Histopathology of glycogen storage disease (heart, liver)
Primer in inherited metabolic disorders (2013)
Mechanism of LSDs (2014)
Lecture series on LSDs by Excellence in Pediatrics Institute (2014 - 2016)
Contributed by Shuanzeng Wei, M.D., Ph.D.
Nodal metastasis, macrofollicular variant PTC
Nodal metastasis, macrofollicular variant PTC
Images hosted on other servers:
Malakoplakia (arrows at Michaelis-Gutmann bodies), bladder
Michaelis-Gutmann
bodies; von Kossa
calcium stain
Contributed by Ayana Suzuki, C.T., Andrey Bychkov, M.D., Ph.D.
Papillary thyroid carcinoma
Medullary thyroid carcinoma
Poorly differentiated thyroid carcinoma
Anaplastic thyroid carcinoma
Primary thyroid lymphoma
Thyroid cytopathology
Contributed by Mark R. Wick, M.D.
Multifocal in MEN 2
AFIP images
MEN 2A patient with multiple tumor foci (arrows)
Nonfamilial tumor replaces entire left lobe and isthmus
Nodal metastasis
MEN 2A patient with single tumor focus
Left lobe tumor: well circumscribed, right lobe tumor: finely granular
Images hosted on other servers:
Large tumor with
hemorrhage, necrosis
and cystic degeneration
Contributed by Shuanzeng Wei, M.D., Ph.D., Joseph Christopher Castillo, M.D. and Mark R. Wick, M.D.
Low power
Background of amyloid
Tumor cells with finely stippled chromatin
H&E
H&E
Chromogranin
Thyroglobulin
Pseudopapillary variant
Signet ring cell variant
AFIP images
With melanin pigment
Stains
Amyloid
MEN 2A patients with early medullary carcinoma
Paraganglioma-like pattern
Small cell variant
Tubular (follicular) variant
Images hosted on other servers:
Oncocytic variant
Papillary variant
Contributed by Ayana Suzuki, C.T. and Shuanzeng Wei, M.D., Ph.D.
Salt and pepper chromatin
Cellular specimen
(Diff-Quik stain)
Plasmacytoid tumor cells
(Diff-Quik stain)
Variable sized plasmacytoid tumor cells
(Pap stain)
Tumor cells with intranuclear pseudoinclusions (Pap stain)
Diff-Quik
Pap
Cell block
Calcitonin
TTF1
AFIP images
Amyloid deposits
Numerous large type I granules in some cells
Tumor cells with sparse granules
Medullary thyroid carcinoma FNA
Medullary thyroid carcinoma
Images hosted on other servers:
Incidence and prognosis
Images hosted on other servers:
Ultrasound
AFIP images
Well circumscribed tumor of
Small irregular fibrotic tumor
Contributed by Nadine Demko, M.D.C.M., M.Sc., Livia Florianova, M.D., M.Sc. and Marc Pusztaszeri, M.D.
Follicular architecture
Nuclear features
Irregular contour with dystrophic calcification
Nuclear features
Infiltrative pattern
Tall cell features
Chronic thyroiditis background
Follicular architecture
Nuclear features
Tall cell features
Minimal extrathyroidal extension
Infiltrative pattern
Nuclear features
BRAF V600E
Contributed by Andrey Bychkov, M.D., Ph.D.
Incidental finding in multinodular goiter
Encapsulated papillary microcarcinoma
CK19, galectin3 and HBME1
Contributed by Nadine Demko, M.D.C.M., M.Sc., Livia Florianova, M.D., M.Sc. and Marc Pusztaszeri, M.D.
Cytological features
Contributed by Grace C.H. Yang, M.D.
Pap stained slides
Active surveillance
AFIP images
Tumor cells show lobular growth pattern
Scattered early follicle-like areas
Tumor cells form colloid containing follicles
Many cells have clear cytoplasm
Immunofluorescent staining
Images hosted on other servers:
Molecular pathways in thyroid cancer development
Stepwise mechanism of thyroid neoplasia
Progress in identifying
mutational markers
in thyroid cancer
MAPK pathway
PI3K-AKT pathway
Genomic landscape of PTC
Gene mutations in thyroid tumors
Gene fusions in PTC
BRAF vs. RAS in PTC
BRAF V600E and tumor recurrence
BRAF mutation and iodine uptake
TERT mutations
miRNAs in thyroid cancer
Drug targets in thyroid cancer
Images hosted on other servers:
ALK fusions
β-catenin (nuclear) in cribriform-morular PTC associated with FAP syndrome
BRAF V600E (sequencing)
BRAF V600E (MALDI-TOF)
BRAF K601E
BRAF V600E / VE1
KRAS mutations
NRAS mutations (sequencing)
NRAS mutations (pyrosequencing)
PPARγ IHC in FTC (A)
PTEN IHC (A - C)
PTEN loss in Cowden syndrome
PTEN evaluation (breast cancer)
RET / PTC rearrangements
TERT promoter mutations
Genetics and genomics of thyroid neoplasms (2013) by Dr. Electron Kebebew, NCI
Integrated genomic characterization of papillary thyroid carcinoma (2014) by Prof. Tom Giordano, University of Michigan
Advances in molecular pathogenesis of thyroid cancer (2014) by Prof. Pilar Santisteban, Universidad Autónoma de Madrid
Molecular influence in thyroid cancer (2014) by The American Head and Neck Society
Understanding the biology of medullary thyroid cancer (2015) by Prof. Gilbert Cote, MD Anderson Cancer Center
Molecular targeted therapeutics for medullary thyroid cancer (2015) by Dr. Ann Gramza, NCI
MAPK pathway
MAPK pathway
PI3K-AKT pathway
PI3K-AKT pathway
PI3K-AKT pathway
Images hosted on other servers:
Progress in identifying
mutational markers
in thyroid cancer
Gene mutations in thyroid tumors
Genomic landscape of PTC
Gene fusions in PTC
BRAF mutation and iodine uptake
BRAF V600E and tumor recurrence
TERT mutations
Drug targets in thyroid cancer
Contributed by Andrey Bychkov, M.D., Ph.D.
V600E mutant protein is diffusely expressed in tumor / cancer, but not normal tissue
Diffuse cytoplasmic staining
Images hosted on other servers:
ALK fusions
β-catenin (nuclear) in cribriform-morular PTC associated with FAP syndrome
BRAF V600E (sequencing)
BRAF V600E (MALDI-TOF)
BRAF K601E
BRAF V600E / VE1
KRAS mutations
NRAS mutations (sequencing)
NRAS mutations (pyrosequencing)
PPARγ IHC in FTC (A)
PTEN IHC (A - C)
PTEN loss in Cowden syndrome
PTEN evaluation (breast cancer)
RET / PTC rearrangements
TERT promoter mutations
Molecular influence in thyroid cancer (2014)
Biomarkers in thyroid cancer (2015)
Drugs in development for refractory thyroid cancer (2015)
Molecular targeted therapeutics for medullary thyroid cancer (2015)
Images hosted on other servers:
Overview of platforms and workflow
Proposed clinical algorithm
NPV and PPV of ThyroSeq v2.1
Genetics of thyroid tumors
Diagnostic performance
ThyroSeq testing by Y. Nikiforov (2020)
ThyGenX / ThyraMIR panel by Alidad Mireskandari (2018)
Images hosted on other servers:
Large tumor with
internal hypodensity
lesion
Images hosted on other servers:
White tan cut surface
AFIP images
Solid nest with mucin producing foci
Microcystic pattern of mucin producing cells
Images hosted on other servers:
Partially solid, glandular and papillary
Squamoid nests and
mucin secreting
component
Transition from follicular
variant of papillary carcinoma
to mucoepidermoid carcinoma
Immunohistochemistry
of TTF1 and
thyroglobulin
Contributed by David Poller, M.D.
Mutations in various types of thyroid tumors
Putative molecular pathogenesis of thyroid tumors
Indeterminate cytological diagnosis
Images hosted on other servers:
NIFTP incidence
Diagnostic algorithm
History of NIFTP
Images hosted on other servers:
Ultrasonography
Images hosted on other servers:
Gross and histology of EFVPTC
Contributed by Andrey Bychkov, M.D., Ph.D. and Rachel Jug, M.B.B.Ch.
Circumscribed follicular patterned nodule
Tumor interface with a thin capsule
Microfollicular pattern
Major and minor diagnostic features
Dark colloid with scalloping and clefting
Free floating tumor fragment in vessel
Small piece of tumor floats in vascular lumen
Processing artifact with distorted nuclei
Distorted nuclei due to artifact
Vesicular-like nuclei due to tissue degeneration
Clear circumscription of the encapsulated lesion with a predominantly follicular growth pattern
Clear circumscription of the encapsulated lesion with a predominantly follicular growth pattern
Nuclear features of PTC
Images hosted on other servers:
Noninvasive follicular thyroid neoplasm
Low power
Medium power
5.6 cm NIFTP
High power
NIFTP vs HCC
NIFTP vs PDTC
NIFTP vs FTC
NIFTP vs FVPTC
Encapsulated follicular patterned lesion
Nuclear features
Images hosted on other servers:
Microfollicular pattern, nuclear enlargement
Microfolliclar pattern
Microfollicles, nuclear grooves
Enlarged nuclei
Nomenclature change for thyroid tumors: NIFTP (2017) by Prof. Yuri Nikiforov, University of Pittsburg
NIFTP by R. Ghossein (2020)
Diagnostic dilemmas in NIFTP by N. Cipriani (2020)
Images hosted on other servers:
Ultrasound
Contributed by Andrey Bychkov, M.D., Ph.D.
Nucleoli and pseudoinclusions
Oncocytic cells with pseudoinclusions
Contributed by Shipra Agarwal, M.D.
Loose clusters of oncocytic cells
Predominant oncocytic cells
Intranuclear inclusions
Contributed by Mark R. Wick, M.D. and AFIP
Carcinoma
Adenoma with massive infarct
Carcinoma has focal capsular invasion
Contributed by Shuanzeng Wei, M.D., Ph.D., Andrey Bychkov, M.D., Ph.D., Grace C.H. Yang, M.D. and Mark R. Wick, M.D.
Vascular invasion
Follicular thyroid carcinoma (oncocytic variant)
Oncocytes
Hürthle cell adenoma
Hürthle cell adenoma
Adenoma with atypia
Hürthle cell carcinoma
Hürthle cell carcinoma
AFIP images
Adenoma:
Oncocytic adenoma has follicular pattern
Massive infarct due to fine needle biopsy
Pseudo-angiosarcomatous pattern
Well developed papillary growth pattern
Cytoplasm has fine,
homogeneously
distributed
granularity
Psammomatous-like calcifications in follicular lumina
Tumor has hyalinized area near capsule
Tumor has focal cells with large hyperchromatic nuclei
Focal papillary formations
Clear cell change:
Gradual transition from oncocytic to clear cells
Both patterns exist in same cell
Sharp demarcation
between clear
and oncocytic cells
Carcinoma:
Capsular invasion
Vascular invasion
Trabecular pattern
Multinodular pattern
Nesting pattern resembles insular carcinoma
Pseudopapillary formations due to tangential sectioning
Pulmonary metastasis
of tumor with
trabecular
growth pattern
Minimally invasive Hürthle cell carcinoma:
Fine needle biopsy induced necrosis
Images hosted on other servers:
Carcinoma:
Capsular invasion
Oncocytes with abundant eosinophilic granular cytoplasm (far right image is with intraluminal calcifications)
No capsular invasion evident
Tumor in internal jugular vein
Various images
Microfollicles
Metastasis to breast
Cells have
eosinophilic
cytoplasm and
prominent nucleoli
Minimally invasive Hürthle cell carcinoma:
Intracapsular vascular invasion
Vascular invasion
Distant metastasis to femur
Contributed by Ayana Suzuki, C.T. and Grace C.H. Yang, M.D.
Follicular neoplasm, Hürthle cell type
Hürthle cell adenoma
Images hosted on other servers:
Microfollicles of carcinoma
Contributed by Mark R. Wick, M.D. and AFIP
Carcinoma
Dilated mitochondria have reduced cristae
Cytoplasm packed
with large mitochondria
with myelin figures
Oncocytic lesions by Z. Baloch (2020)
Contributed by Ayana Suzuki, C.T.
Follicular neoplasm, Hürthle cell type
Hürthle cell clusters
Oncocytes and histiocytes
Contributed by Grace C.H. Yang, M.D.
Hürthle cell adenoma, Diff-Quik
Hürthle cell adenoma, Pap stain
Hürthle cell adenoma, Pap stain
Case 1
Case 2
Oncocytic lesions by Z. Baloch (2020)
Contributed by Ayana Suzuki, C.T.
Parathyroid cyst: large multilocular cyst
Contributed by Ayana Suzuki, C.T.
Parathyroid cyst: clear fluid
Images hosted on other servers:
Parathyroid cyst: islands of parathyroid tissue
CMV
parathyroiditis in
immunosuppressed
child
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Superficially
located nodule
Intrafollicular
granulomatous
reaction
Granulomatous folliculitis
Multinucleated giant cells
Histiocytes within follicle
Histiocytes are strongly lysozyme+
Images hosted on other servers:
Granuloma
Images hosted on other servers:
ATA nodule sonographic patterns
Contributed by Bin Xu, M.D., Ph.D.
Thyroid mass
Contributed by Bin Xu, M.D., Ph.D.
Papillary projections
Nuclear features
Psammoma body
Cystic change with BRAF V600E
Osseous metaplasia
Contributed by Bin Xu, M.D., Ph.D.
Papanicolaou stain
Images hosted on other servers:
Invasion of trachea
Enhancing nodular lesion
Diffuse lung metastases
Images hosted on other servers:
Cystic neck mass
Bulging neck mass
Contributed by Bin Xu, M.D., Ph.D., Andrey Bychkov, M.D., Ph.D. and Kseniya Korchagina, M.D.
PTC in thyroglossal duct
Peritumoral fibrosis
Grossing and sampling
Extrathyroidal extension
Cystic change
Contributed by Andrey Bychkov, M.D., Ph.D.
Nuclear features
Nuclear pseudoinclusions
Pseudonuclear inclusions and large vesicular nucleus
Nuclear enlargement, crowding / overlapping
Orphan Annie eye nuclei
Architectural patterns
True papillae with multiple branching
Arborizing papilla
Other histologic features
Psammoma bodies
Psammoma body (HBME1)
Giant cells
Different kinds of giant cells
Deposits in perithyroidal fat
Residual tumor in thyroid bed
Clear cell change
Cystic degeneration
Submucosal spread
Bone involvement
Lymph node replaced by metastasis
Large psammoma bodies
Ossification
Concentric calcium deposition
PTC with Hashimoto thyroiditis
Follicular adenoma, mimic of PTC
Stains
CK19, Galectin3, HBME1
CK19
Galectin3
HBME1
BRAFV600E
TTF1
PAX8
Contributed by Andrey Bychkov, M.D., Ph.D.
Papanicolaou stain
Papillary thyroid carcinoma, imprint cytology
AFIP images
Tall cuboidal cells
Surface microvilli
Images hosted on other servers:
TCGA
BRAF mutation
Papillary thyroid carcinoma: cystic
Thyroid carcinoma
Thyroid: compare and contrast
Histopathology thyroid: papillary carcinoma
Histopathology thyroid: Hashimoto thyroiditis, papillary carcinoma
Integrated genomic characterization of papillary thyroid carcinoma
An alphabet soup of thyroid neoplasms
Images hosted on other servers:
Neck ultrasonography
Color flow Doppler
Tracer uptake, lateral neck
Radiography of mediastinal mass
AFIP images
Nodular hyperplasia
Images hosted on other servers:
Mediastinal thyroid mass
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
2 perithyroidal lymph nodes
Specimen with signs of Hashimoto thyroiditis
Lymphoid follicles
Patient with Hashimoto
Hyperplastic nodule
Images hosted on other servers:
Parasitic nodule vs lymph node
Thyroid follicles
TTF1, Thyroglobulin
Images hosted on other servers:
99mTc MIBI scintigraphy
Images hosted on other servers:
Giant parathyroid adenoma (intraoperative)
Contributed by Mona Kandil, M.D and @Andrew_Fltv on Twitter
Parathyroid adenoma (black arrow) and thyroid
Parathyroid adenoma
Images hosted on other servers:
Right: parathyroid adenoma;
left: thymoma
Contributed by Diana Murro Lin, M.D. and @Andrew_Fltv on Twitter
Chief cells
Oxyphil adenoma
Oxyphil cells
Atypical adenoma and thyroid
Atypical adenoma fibrous bands
Parathyroid adenoma
Parathyroid adenoma
Contributed by Ayana Suzuki, C.T.
Sheet of chief cells
Images hosted on other servers:
Microfollicular and trabecular arrangement
Oncocytic adenoma
Parathyroid pathology
Images hosted on other servers:
Xray lytic lesion
Sestamibi scan
Bone scan
Tc MIBI scintigraphy and CT
Tc MIBI SPECT / CT
99mTc MIBI SPECT / CT and MRI
Images hosted on other servers:
Intraoperative dissection
Images hosted on other servers:
Large size and irregular cut surface
Contributed by Mehmet Kefeli, M.D.
Solid and nodular growth
Skeletal muscle invasion
Uniform cytomorphology
Numerous mitoses
Prominent nucleoli
PTH
GATA3
Thyroglobulin
TTF1
Ki67
Contributed by Mehmet Kefeli, M.D.
Cohesive clusters and sheets of cells
Parathyroid pathology
Images hosted on other servers:
3 and a half glands removed
Images hosted on other servers:
Nodular parathyroid hyperplasia (figures D / E)
Images hosted on other servers:
Sonogram
Intrathyroidal PT adenoma
MIBI scan
Technetium sestamibi scan
Parathyroid carcinoma
Parathyroid glands
Coronal oblique slices
Right sided neck mass
Images hosted on other servers:
Excised tissue
Resected thyroid
Parathyroid adenoma
Thyroid lobe
Intrathyroidal PT adenoma
Enlarged right thyroid lobe
Contributed by Andrey Bychkov, M.D., Ph.D.
Parathyroid histology
Images hosted on other servers:
Ectopic thymus and PT within thyroid
Surrounded by thyroid parenchyma
PT hyperplasia
Intrathyroidal PT cystic adenoma
Intrathyroidal PT adenoma
Intrathyroidal PT carcinoma
Images hosted on other servers:
Common and uncommon FNA features
FNA
Sestamibi Scans and How to See Your Parathyroid Glands
Images hosted on other servers:
Multinodular
Cut surface
Images hosted on other servers:
Plasma cells, lymphocytes and fibrous tissue
Clumps of plasma cells
Plasma cells around follicular epithelium
CD79a
Kappa and lambda light chains
Images hosted on other servers:
Gray, firm, fleshy
Thyroidectomy specimen
Case #394
10×
20×
40×
CD79a
CD138
Kappa
Lambda
Images hosted on other servers:
Mature and immature plasma cells
H&E, CD138+
(A) Kappa light chain+
(B) Lambda light chain-
Images hosted on other servers:
Intranuclear inclusion
Congo red+
Contributed by Mark R. Wick, M.D. and AFIP images
Various images
Poorly differentiated thyroid carcinoma
Massive cervical lymph node metastasis
Images hosted on other servers:
A well demarcated tumor
Tumor with invasive growth pattern
Contributed by Shuanzeng Wei, M.D., Ph.D., Andrey Bychkov, M.D., Ph.D.
Nests of tumor with necrosis
Follicular carcinoma with high grade progression
Case #435
Various images
Contributed by Ayana Suzuki, C.T. and Shuanzeng Wei, M.D., Ph.D.
Insular pattern
Diff-Quik stain
Pap stain
Corresponding histology shows mitosis and necrosis
Images hosted on other servers:
Nesting pattern of cells
Overlapping cells with round, regular nuclei
Large clusters and single cells
Cellular nests of loosely cohesive cells
Overlapping cells with mild atypia
Small microfollicle of tumor cells
Vacuolated cytoplasm with round nuclei
Poorly differentiated thyroid carcinoma by M. Brandwein (2020)
Images hosted on other servers:
Gross and microscopic findings
Images hosted on other servers:
Fragments of fibrocollagenous tissue
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Small nodule of atypical cells with bizarre nuclei
Large eosinophilic cells
Small regenerative nodule
Compensatory nodular hyperplasia
Prominent nuclear atypia / pleomorphism
Postnecrotic hyalinosis of colloid nodule
Intact parathyroid versus highly atrophic thyroid follicles
Hyalinized vessel wall
Bizarre nuclear changes
Papillary changes
Images hosted on other servers:
Hyperplastic epithelium and atypia
AFIP images
Atrophic thyroid follicles
Resembles papillary microcarcinoma
Follicles within scar irregular
Heavy inflammatory infiltrate, venous wall
Images hosted on other servers:
Massive scarring and lymphohistiocytic infiltrate
Obliterating phlebitis
Images hosted on other servers:
Leiomyosarcoma: nodule with heterogeneous uptake
Images hosted on other servers:
Synovial sarcoma:
well demarcated
lobulated, tan
solid mass
Images hosted on other servers:
Leiomyosarcoma:
Compactly cellular
Cigar shaped nuclei
Invades thyroid parenchyma
CK-
h-Caldesmon
Desmin
ER-
TTF1-
Chromogranin-, synaptophysin-
Liposarcoma
Synovial sarcoma: biphasic growth; cytokeratin & vimentin
UPS / MFH: residual thyroid follicles; intersecting bundles of atypical spindle cells
Images hosted on other servers:
Synovial sarcoma:
spindled and
epithelioid cells
Images hosted on other servers:
Synovial sarcoma:
solid nests of
epithelial cells
Images hosted on other servers:
Synovial sarcoma:
SYT-SSX fusion
gene transcript
Contributed by Mark R. Wick, M.D. and AFIP
Mucoepidermoid
carcinoma,
sclerosing type
Well circumscribed
tumor (not typical)
with dense fibrosis
Case #230 and AFIP
Small irregular strands of tumor cells
Images hosted on other servers:
Various images
Images hosted on other servers:
Epithelial pearl-like structure
Cell block
Cell block, p40
Images hosted on other servers:
ETV6-NTRK3 fusion
Images hosted on other servers:
Morphology
MASC vs. PTC
Immunophenotype
Images hosted on other servers:
FISH (separate signals)
AFIP images
Spindled cells with mesenchymal appearance
Images hosted on other servers:
Immunoprofile of S / T PTC and some mimickers
Images hosted on other servers:
Nodule on ultrasound / intranodular or peripheral vascularity on Doppler
Hypoechogenic solid nodule on ultrasound
FDG PET and ultrasound
Images hosted on other servers:
3.2 cm tumor
Total thyroidectomy specimen
Contributed by Marc Pusztaszeri, M.D. (source: World Tumor Registry)
Encapsulated solid PTC
Infiltrative solid PTC
Encapsulated solid PTC with capsular invasion
Solid architecture
Solid and trabecular architecture
Solid and insular architecture
Solid PTC with stromal hyalinization
Solid PTC with minor follicular component
Solid PTC with tight microfollicles
BRAF V600E immunostain
Images hosted on other servers:
Syncytial, tissue fragment pattern
Microfollicular pattern
Trabecular pattern
Dyshesive single cell pattern
Atypical epithelial cells
Epithelial cell cluster
Cluster of neoplastic cells
Trabeculae and solid nests of tumor cells
Solid aggregates of epithelial follicular cells
Monolayered epithelial cellular sheets
Enlarged nuclei with fine chromatin
Images hosted on other servers:
BRAF VK600-1E mutation
Gene mutations
Special types of thyroid cancer with Dr. Virginia LiVolsi
Contributed by Andrey Bychkov, M.D., Ph.D. and AFIP
Solid cell nests
Histologic mimics of SCN
Solid cell nests: p63
Solid cell nests: thyroglobulin-
Solid cell nests
Nested pattern
Cystic SCN
Clear cells
Occasional nuclear grooves
Type 1 and 2 solid cell nests
Images hosted on other servers:
Admixture of main and C cell
High mag of solid cell nests
Various stains
Galectin 3, CEA
Conventional solid cell nests
Images hosted on other servers:
4 variable risk stratification
Images hosted on other servers:
Ultrasound: heterogeneous, hyperechoic solitary nodule
CT: heterogeneous enhanced lesion
Images hosted on other servers:
Solid, well circumscribed white nodule
Encapsulated, tan-pink to tan-white mass
Contributed by Truong Phan Xuan Nguyen, M.D.
Well defined border
Entrapped thyroid follicles
Patternless proliferation of spindled cells
Staghorn-like vessels
Collagenous stroma
STAT6
CD34
Images hosted on other servers:
Scattered spindle-like cells with fusiform nuclei
Images hosted on other servers:
NAB2::STAT6 gene fusion variants
Images hosted on other servers:
Multiple hypoechoic lesions
Images hosted on other servers:
Hemangioma
Metastatic squamous cell carcinoma
Thyroid cytology: colloid nodule
Solitary thyroid nodule
Thyroid: compare and contrast
Images hosted on other servers:
Multiple hypoechoic lesions
Contributed by Sara Conway, M.D. and Momin Iqbal, M.D., M.B.B.S.
Follicular thyroid lesion
Oncocytic tumor
Papillary thyroid cancer
Contributed by Momin Iqbal, M.D., M.B.B.S. and Sara Conway, M.D.
Papillary thyroid carcinoma
Mushroom-like capsular invasion
Tall cell variant of PTC
Thyroid oncocytic / Hürthle cell tumor
Angioinvasive Hürthle cell tumor
Follicular thyroid adenoma
Follicular thyroid adenoma
Solitary thyroid nodule
Thyroid carcinoma I: pathology evaluation
Images hosted on other servers:
Ulceroproliferative
growth
Recurrent
ulceroproliferative
growth
Mass pressuring;
infiltrating trachea;
surrounding soft tissue
Images hosted on other servers:
Enlarged left lobe
White tumor with central necrosis
Contributed by Shuanzeng Wei, M.D., Ph.D.
Squamous cell carcinoma with necrosis
Images hosted on other servers:
Infiltrating squamous cell carcinoma
Images hosted on other servers:
Atypical squamoid cell
Images hosted on other servers:
Thyroid function
Contributed by Ayana Suzuki, C.T.
Hypoechoic nodule
Images hosted on other servers:
Hypoechoic nodule with poorly defined margin
High 18F-FDG uptake in enlarged right thyroid lobe
Contributed by Truong Phan Xuan Nguyen, M.D.
Follicular damage
Granuloma
Multinucleated giant cells
Contributed by Truong Phan Xuan Nguyen, M.D. and Ayana Suzuki, C.T.
Cellular smear
Multinucleated giant cells
Epithelioid cells
Giant cell
Contributed by Ayana Suzuki, C.T.
Suspicious for PTC
Hyalinizing trabecular tumor
Suspicious for lymphoma
Images hosted on other servers:
Suspicious for lymphoma
Suspicious for medullary thyroid carcinoma
Suspicious for papillary thyroid carcinoma
Suspicious for metastatic carcinoma
Images hosted on other servers:
Tall cell variant in 19 year old woman
Contributed by Andrey Bychkov, M.D., Ph.D.
Entire lobe
Muscular invasion
Contributed by Livia Florianova, M.D., M.Sc. and Marc Pusztaszeri, M.D.
Tram track pattern
Papillary architecture
Elongated papillae
Solid architecture
Trabecular architecture
Tall cells
Oncocytic-like cytoplasm
Extrathyroidal extension
Microcarcinoma with infiltrative borders
Nuclear features
HBME-1
Galectin 3
Cytokeratin 19
BRAF V600E
Contributed by Andrey Bychkov, M.D., Ph.D.
Long papillae with tall cells
Tram track pattern
Contributed by Papanicolaou Society and the Bethesda System for Reporting Thyroid Cytopathology, Manon Auger, M.D., C.M., Livia Florianova, M.D., M.Sc. and Marc Pusztaszeri, M.D.
Giemsa
Papanicolaou
Soap bubble nuclear pseudoinclusions
Tall cells
Papillae (cell block)
Tall cells (cell block)
High grade and poorly differentiated and anaplastic thyroid carcinoma
Ultrasound of tall cell variant of PTC
Images hosted on other servers:
Heterogeneously hypoechoic nodule
Large cystic fat-containing mass
Images hosted on other servers:
Well encapsulated, mixed solid and cystic mass
Lymph node involvement
AFIP images
Newborn infant
Images hosted on other servers:
Benign thyroid teratoma
Cartilage
Primitive neuroepithelial cells
Images hosted on other servers:
Thymus descending path
Images hosted on other servers:
Ectopic thymic tissue
Sonographic images
Intrathyroidal ectopic thymic tissue
Longitudinal US images
Hyperechoic nodule
CT scan
RAI scan
AFIP images
Intrathyroidal thymus gland
Images hosted on other servers:
Nodule < 1 cm
Contributed by Andrey Bychkov, M.D., Ph.D.
Hassall corpuscle
Images hosted on other servers:
Intrathyroidal thymic tissue
Degenerated Hassall corpuscle
Ectopic thymus and parathyroid
Subcapsular intrathyroidal thymus (E)
Subcapsular intrathyroid thymus, rats
Ectopic intrathyroidal thymoma
Images hosted on other servers:
Hassall corpuscle (D)
CK+ epithelial cells
Lymphocytes
Images hosted on other servers:
Neck ultrasound
Multicystic lesion
Calcification
Infrahyoid lesion
Low density
Axial and transverse
Cystic swelling
Thick septae
Solid component
Images hosted on other servers:
Neck mass
Intraoperative
Images hosted on other servers:
Thyroidectomy
Total resection
Thyroglossal duct
Thyroglossal cyst
Modified neck dissection
Sistrunk procedure
PTC in TGD cyst
Scroll to see all images:
Contributed by Andrey Bychkov, M.D., Ph.D.
Cystic papillary carcinoma
Papillary structures
Images hosted on other servers:
Papillary carcinoma
TGDC wall
Papillary pattern
Overcrowding nuclei
Columnar epithelium
Cystic neoplasm
Squamous epithelium
Papillary appearance
Irregular nucleus
Microcalcifications
Papillary carcinoma
Normal cyst wall lining
PTC tall cell variant
Squamous cell carcinoma
Mucoepidermoid tumor
TTF1, thyroglobulin
Thyroglobulin
CK19
Images hosted on other servers:
Papillary carcinoma in TGD cyst aspirate
Images hosted on other servers:
Thyroglossal tract
Thyroglossal duct cyst
Management algorithm
Sistrunk procedure
Contributed by Ayana Suzuki, C.T.
Large cyst
Images hosted on other servers:
Neck ultrasound
Neck CT
Neck CT
Scintigraphy
Contributed by Ayana Suzuki, C.T.
Flocculated appearance
Images hosted on other servers:
Neck mass
TGD cyst in children
Intra-operative
AFIP images
TGD cyst
Images hosted on other servers:
In situ
Contributed by Andrey Bychkov, M.D., Ph.D., Mark R. Wick, M.D. and AFIP
Perihyoid cystic and arborized tubular structure
Perihyoid cystic structures
Thyroglossal duct penetrates hyoid bone
Denuded TGD, perihoid location
Variable epithelial lining
Ciliated versus squamous epithelium
Thyroid follicles under ciliated epithelium
Thyroid follicles of various size
Thyroid follicles embedded within skeletal muscles
Seromucous glands
Rupture of the cyst wall
Cyst rupture
Thyroglobulin expression by thyroid follicles
Strong TTF1 expression
Thyroglossal duct cyst
Epithelium
Papillary changes
Images hosted on other servers:
Squamous epithelium
Pseudostratified
Cuboidal epithelium
Squamous stratified epithelium
Cyst wall
Epithelial lining
Respiratory epithelium
Thyroid follicles
Thyroglossal tract cyst
Cyst wall
With mucocele
Contributed by Andrey Bychkov, M.D., Ph.D., Ayana Suzuki, C.T., Ram Kumar Kurpad R, M.B.B.S., M.D. and Y. C. Spoorthy Rekha, M.B.B.S., M.D.
Sparsely cellular aspirate
Benign squamous cell
Histiocytes and squame
Ciliated epithelium and macrophages
Ciliated epithelium
Foamy macrophages
Images hosted on other servers:
Squames
Neutrophils and macrophages
Epithelial sheet
Sistrunks Procedure for Thyroglossal Duct Cyst
Contributed by Andrey Bychkov, M.D., Ph.D.
Diffuse positive staining for CK19, Galectin3 and HBME1
Thyroid carcinoma
Advanced thyroid carcinoma
Contributed by Mark R. Wick M.D.
Intrathoracic (ectopic) goiter
Images hosted on other servers:
Large goiter
Giant goiter
Contributed by Swati Satturwar, M.D. and Andrey Bychkov, M.D., Ph.D.
External surface
Cut surface
Nodular thyroid
AFIP images
Various sized nodules
Nodular hyperplasia
Numerous poorly circumscribed nodules
Nodular hyperplasia with clear cell change
Images hosted on other servers:
Colloid cyst
Colloid goiter
Nodular goiter
Retrosternal goiter
Contributed by Swati Satturwar, M.D., Andrey Bychkov, M.D., Ph.D. and Rajeshwari K. Muthusamy, M.D.
Dilated follicles
Nodule
Degenerative changes
Reactive fibrosis
False angioinvasion
Sanderson polsters
Adipose metaplasia
AFIP images
No capsule identified
Sanderson polster
With hypercellular focus
With adipose metaplasia of stroma
Papillary area
Clear cell change
Focal squamous metaplasia
Contributed by Ayana Suzuki, C.T.
Watery colloid
Cracking colloid
Follicular clusters
3D structures
Paravacuolar granules
Cyst fluid only
Images hosted on other servers:
Watery colloid and focal dense colloid
Large amounts of background colloid
Thyroid multinodular goiter
Histopathology thyroid: nodular goiter
Histopathology thyroid: colloid goiter
Contributed by Andrey Bychkov, M.D., Ph.D.
Differential diagnosis
AFIP images
Ectopic thyroid follicles
Images hosted on other servers:
Subcapsular nodal thyroid inclusion
Lymph node with metastatic papillary thyroid carcinoma
Thyroglobulin+ lymph node (potential pitfall)
Images hosted on other servers:
CT scan
Sonography
PET - CT
Metastatic renal cell carcinoma
Contributed by Mark R. Wick, M.D., Jose G. Mantilla, M.D. (Case #513) and AFIP
Metastatic renal cell carcinoma
Melanoma in OFA
Melanoma metastatic from skin primary
Images hosted on other servers:
Invasion by squamous cell carcinoma of larynx
Renal papillary carcinoma
Metastatic renal cell carcinoma
Surgical specimens
Surgical specimens
Scroll to see all images:
Contributed by Mark R. Wick, M.D.
Metastatic renal cell carcinoma
CD10, Keratin 8, RCC, thyroglobulin
Contributed by Jose G. Mantilla, M.D. (Case #513)
HCA capsule
Interface between components
Pigmented component
Hürthle cell component
Melanoma in OFA interface
Melanoma in OFA SOX10
Case #461
Clear cell RCC metastatic to the thyroid
CD10, 400x
RCC, 400x
Case #342
Metastatic leiomyosarcoma (frozen section slides)
Metastatic leiomyosarcoma (permanent sections)
AFIP images
Clear cell type
Cytoplasm is abundant and completely clear
Oil Red O stains cytoplasm strongly
False positive thyroglobulin staining
Breast carcinoma:
Lobular carcinoma and entrapped thyroid follicles
ER stains breast tumor but not papillary carcinoma
Falsely positive thyroglobulin staining
Lung:
Carcinoid tumor with well defined nesting pattern
Carcinoma metastatic to mediastinal thyroid gland
Skin:
Melanoma
Images hosted on other servers:
From rectum
Metastatic HCC in the thyroid gland
HCC stains for AFP
Clear cell type
Metastasis to goiter
Concurrent RCC and thyroid carcinoma
Central lesions inside
hyperplastic adenomatoid
nodules
FNA, histology and stains
CD10 and H&E
Tumor to tumor metastases
Lung-small cell carcinoma
Lung-squamous cell carcinoma
Melanoma
Parotid adenoid cystic carcinoma
Rectal carcinoma
to poorly
differentiated
thyroid carcinoma
Contributed by Mark R. Wick, M.D.
FNA: metastatic renal cell carcinoma
Images hosted on other servers:
Kidney: metastatic renal cell carcinoma, clear cell type
Kidney: bloody background with clusters of atypical cells; nuclei are somewhat pleomorphic with prominent nucleoli
Lung squamous cell carcinoma
Melanoma
Melanoma - HMB45
Parotid gland adenoid cystic carcinoma
Contributed by Rachel Jug, M.B.B.Ch.
Ultrasound FNA techniques
Images hosted on other servers:
Risk of thyroid cancer
ATA algorithm for
patients with
thyroid nodules
ATA association
ACR TI-RADS chart
Comparison of systems
Typical appearances of diffuse thyroid diseases
| Thyroid disorder | Grayscale ultrasound | Color Doppler | Key features |
|---|---|---|---|
| Graves thyroiditis | Enlarged, mildly hypoechoic, heterogeneous | Markedly ↑ | Markedly hyperemic; proptosis; hyperthyroid; + antithyroid antibodies |
| Hashimoto thyroiditis | Enlarged, heterogeneous with lobular margins; hypoechoic and micronodular, septal lines | Highly variable: both ↑ and ↓ flow possible | + Antithyroid antibodies, hypothyroidism; cervical adenopathy |
| Subacute lymphocytic thyroiditis (painless) | Hypoechoic | Insufficient data | + Antithyroid antibodies; postpartum; transient |
| De Quervain thyroiditis (subacute granulomatous) | Painful patchy areas of hypoechogenicity | ↓ in the hypoechoic patch | Thyroid pain over area of hypoechogenicity; ↑ erythrocyte sedimentation rate (ESR) |
| Acute suppurative thyroiditis | Abscess or infected linear tract in the thyroid | Normal background; no flow within an abscess | Acute presentation with signs of infection and pain; ↑ ESR; possible pyriform sinus fistula |
| Riedel thyroiditis | Large hypoechoic thyroid with coarse parenchyma | Insufficient data | Large, rock hard gland; encases adjacent structures |
| Medication induced (i.e., amiodarone induced thyrotoxicosis [AIT]) | Type 1: abnormal thyroid; type 2: normal thyroid | Type 1: ↑; type 2: absent | History of current or recent amiodarone use; hyperthyroid |
| Atrophic thyroiditis | Small, hypoechoic thyroid | ↓ | + Antithyroid antibodies; usually hypothyroid |
| Radiation thyroiditis | Small, hypoechoic thyroid | Variable | Known external beam or I131 administration |
| Thyroid lymphoma | Large, ill defined, markedly hypoechoic nodules or masses with ↑ through transmission on background of Hashimoto thyroiditis | ↓ in the hypoechoic mass | Rapidly enlarging neck mass in patient with history of Hashimoto, with or without adenopathy |
| Multinodular goiter | Closely opposed or interspersed, similar appearing nodules replace parenchyma, coarse calcifications, variable cystic changes in nodules | Variable | Confluent nodules in a normal or enlarged thyroid; with or without abnormal thyroid function tests |
Images hosted on other servers:
Calcified nodule
Complex cystic thyroid nodule
Multinodular goiter
17 year old girl with Graves disease
35 year old woman
with diffuse
Hashimoto
thyroiditis
50 year old woman
with colloid
multinodular
goiter
Hypoechoic nodule
Microcalcifications in a thyroid nodule
Intranodular vascularity in thyroid nodule
Oval shaped thyroid nodule
Fine needle aspiration (FNA) biopsy techniques - Dr. Britt Marie Ljung playlist
Neck ultrasonography basics
Thyroid ultrasound course
Contributed by Ayana Suzuki, C.T.
Hemorrhagic background
Muscle
Respiratory epithelium
Air dried smear
Cyst fluid only
Images hosted on other servers:
Hemorrhagic background
Muscle
Air dried smear
Cyst fluid only
Poor staining
Thyroid FNA and smearing techniques
Essential thyroid cytopathology
Head and tail of the Bethesda system for thyroid
Thyroid cytology - Bethesda classification
Images hosted on other servers:
Ultrasound
Images hosted on other servers:
Solid, gray-white
Contributed by Andrey Bychkov, M.D., Ph.D.
Enlarged papillae
Lymphoid follicle
Oncocytic epithelium
Background thyroiditis
Ki67
Contributed by Shipra Agarwal, M.D.
Inflammatory background
Lymphocytic permeation
Oncocytic cells
Images hosted on other servers:
Liquid based cytology and conventional smear
Images hosted on other servers:
Schematic drawing for capsular invasion
Schematic drawing for vascular invasion
Contributed by Shuanzeng Wei, M.D., Ph.D.
Questionable nuclear features of papillary carcinoma
Images hosted on other servers:
Cytological features of WDT-UMP
Contributed by Andrey Bychkov, M.D., Ph.D.
WHO classification: thyroid tumors
Adeniran: 2016
Ali: 2023
Boerner: 2016
Braverman: 2020
Duick: 2018
Gill: 2022
Gnepp: 2020
IARC: 2017
Jiang: 2023
Kakudo: 2024
Kini: 2015
Mete: 2016
Mody: 2022
Nikiforov: 2019
Nosé: 2022
Rosai: 2015
Stelow: 2020
Thompson: 2022
Wartofsky: 2016
Wenig: 2024
Find related Pathology books: cytopathology, head & neck/endocrine, GU/adrenal, GI
