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| *p63 +ve. | | *p63 +ve. |
| **-ve in clear cells. | | **-ve in clear cells. |
| *CEA +ve (polyconal).<ref name=pmid7509563>{{cite journal |author=Mizukami Y, Nonomura A, Michigishi T, ''et al.'' |title=Solid cell nests of the thyroid. A histologic and immunohistochemical study |journal=Am. J. Clin. Pathol. |volume=101 |issue=2 |pages=186–91 |year=1994 |month=February |pmid=7509563 |doi= |url=}}</ref> | | *[[CEA]] +ve (polyconal).<ref name=pmid7509563>{{cite journal |author=Mizukami Y, Nonomura A, Michigishi T, ''et al.'' |title=Solid cell nests of the thyroid. A histologic and immunohistochemical study |journal=Am. J. Clin. Pathol. |volume=101 |issue=2 |pages=186–91 |year=1994 |month=February |pmid=7509563 |doi= |url=}}</ref> |
| **+ve also in clear cells. | | **+ve also in clear cells. |
| *Chromogranin A +ve ~45% of cases.<ref name=pmid7509563/> | | *Chromogranin A +ve ~45% of cases.<ref name=pmid7509563/> |
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| ==Graves disease== | | ==Graves disease== |
| ===General===
| | {{Main|Graves' disease}} |
| *Often misspelled "Grave's disease".
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| *Autoimmune disease leading to hyperthyroidism.
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| *Eye problems not resolved with thyroid removal.{{fact}}
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| *Higher risk of [[papillary thyroid carcinoma]].
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| Clinical:
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| *TSH-receptor antibody +ve.<ref name=pmid19576193>{{Cite journal | last1 = Massart | first1 = C. | last2 = Gibassier | first2 = J. | last3 = d'Herbomez | first3 = M. | title = Clinical value of M22-based assays for TSH-receptor antibody (TRAb) in the follow-up of antithyroid drug treated Graves' disease: comparison with the second generation human TRAb assay. | journal = Clin Chim Acta | volume = 407 | issue = 1-2 | pages = 62-6 | month = Sep | year = 2009 | doi = 10.1016/j.cca.2009.06.033 | PMID = 19576193 }}</ref>
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| ===Gross===
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| Features:<ref>{{Ref EP|30}}</ref>
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| *Enlarged 50-150 g.
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| *"Beefy-red" appearance, looks like raw beef.
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| ===Microscopic===
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| Features:
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| *Classic:
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| **Hypercellular
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| **Patchy lymphocytes.
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| **Little colloid.
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| *Scalloping of colloid; colloid has undulating border.
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| **Non-specific finding.
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| *+/-Nuclear clearing.
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| *+/-Papillae (may mimic papillary thyroid carcinoma in this respect).
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| Notes:
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| *Usually has an unimpressive appearance... as it is treated, i.e. history is important.
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| *Nuclear clearing and papillae are usu. diffuse in Graves disease - unlike in papillary thyroid carcinoma.
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| Image:
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| *[http://library.med.utah.edu/WebPath/jpeg4/ENDO022.jpg Graves disease (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 4 December 2011.</ref>
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| ==Idiopathic granulomatous thyroiditis== | | ==Idiopathic granulomatous thyroiditis== |
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| ==Riedel thyroiditis== | | ==Riedel thyroiditis== |
| *[[AKA]] ''invasive fibrous thyroiditis''.<ref name=pmid21568724>{{Cite journal | last1 = Fatourechi | first1 = MM. | last2 = Hay | first2 = ID. | last3 = McIver | first3 = B. | last4 = Sebo | first4 = TJ. | last5 = Fatourechi | first5 = V. | title = Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008. | journal = Thyroid | volume = 21 | issue = 7 | pages = 765-72 | month = Jul | year = 2011 | doi = 10.1089/thy.2010.0453 | PMID = 21568724 }}</ref> | | *[[AKA]] ''invasive fibrous thyroiditis''.<ref name=pmid21568724>{{Cite journal | last1 = Fatourechi | first1 = MM. | last2 = Hay | first2 = ID. | last3 = McIver | first3 = B. | last4 = Sebo | first4 = TJ. | last5 = Fatourechi | first5 = V. | title = Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008. | journal = Thyroid | volume = 21 | issue = 7 | pages = 765-72 | month = Jul | year = 2011 | doi = 10.1089/thy.2010.0453 | PMID = 21568724 }}</ref> |
| ===General===
| | {{Main|Riedel thyroiditis}} |
| Clinical features:<ref name=pmid21568724/>
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| *Extremely rare.
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| *Women > men.
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| *Usually smokers.
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| *May be associated with ''[[retroperitoneal fibrosis]]''.
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| *May be hypothyroid.
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| *+/-Obstructive symptoms.
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| ===Microscopic===
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| Features:
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| *Fibrosis.
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| *Specimen often fragmented as it was difficult to remove.
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| DDx:
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| *[[Anaplastic thyroid carcinoma|Anaplastic carcinoma]], spindle cell variant.
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| ==Hashimoto thyroiditis== | | ==Hashimoto thyroiditis== |
| ===General===
| | {{Main|Hashimoto's thyroiditis}} |
| *'''This is a clinical diagnosis'''.
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| **The histomorphologic findings, generally, are '''not''' diagnostic.
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| Etiology:
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| *Autoimmune disease leading to hypothyroidism.
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| **Often genetic/part of a syndrome.
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| ====Clinical====
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| Serology:<ref name=pmid7813361>{{cite journal |author=Poropatich C, Marcus D, Oertel YC |title=Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases |journal=Diagn. Cytopathol. |volume=11 |issue=2 |pages=141–5 |year=1994 |pmid=7813361 |doi= |url=http://www3.interscience.wiley.com/journal/112701408/abstract?CRETRY=1&SRETRY=0}}</ref>
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| *Antimicrosomal (antithyroid peroxidase) +ve.
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| *Antithyroglobulin +ve.
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| Associated pathology:<ref name=pmid7813361/>
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| *Increased risk of B-cell lymphoma; these are classically:<ref name=pmid18018576 >{{Cite journal | last1 = Ohye | first1 = H. | last2 = Fukata | first2 = S. | last3 = Hirokawa | first3 = M. | title = [Malignant lymphoma of the thyroid]. | journal = Nihon Rinsho | volume = 65 | issue = 11 | pages = 2092-8 | month = Nov | year = 2007 | doi = | PMID = 18018576 }}</ref>
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| **[[MALT lymphoma]].
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| **[[Diffuse large B cell lymphoma]] (DLBCL).
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| ===Microscopic===
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| Features:
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| *Lymphocytic infiltrate - '''key feature'''.
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| *Nuclear clearing common.
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| **May confuse with [[papillary thyroid carcinoma]].
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| *Polymorphous lymphoplasmacytic infiltrate with germinal centres.<ref name=Ref_APBR672>{{Ref APBR|672}}</ref>
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| *+/-Oncocytic metaplasia.
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| Notes:
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| *Histologically often '''not''' possible to separate from "non-specific" thyroiditis.<ref name=Ref_Sternberg4_560>{{Ref Sternberg4|560}}</ref>
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| DDx:
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| *[[Lymphocytic thyroiditis]].
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| *[[Papillary thyroid carcinoma]].
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| *[[MALT lymphoma]].
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| *[[Diffuse large B cell lymphoma]].
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| ===IHC===
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| *Panel to exclude lymphoma may be required, e.g. CD3, CD20, CD10, BCL6, BCL2, kappa, lambda.
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| ===Molecular===
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| *Occasionally done to exclude lymphoma - see ''[[MALT lymphoma]]'' and ''[[DLBCL]]''.
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| ==C-cell hyperplasia== | | ==C-cell hyperplasia== |
| *Abbreviated ''CCH''. | | *Abbreviated ''CCH''. |
| ===General===
| | {{Main|C-cell hyperplasia}} |
| *Screening for C-cell hyperplasia/[[medullary thyroid carcinoma]] done with ''serum calcitonin level''.<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
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| ===Gross===
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| *Not visible.
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| ===Microscopic=== | | ==Adenolipoma of the thyroid== |
| Features:
| | {{Main|Adenolipoma of the thyroid}} |
| *Location:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf]. Accessed on: 7 April 2012.</ref>
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| **Mid portion of lobe to upper third of lobe.
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| ***Not at the poles.
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| ***Not in the isthmus.
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| *Definitions vary.<ref>SR. 17 January 2011.</ref>
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| One definition - either of the following:<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
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| #>50 C-cells per low-power field (x100).
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| #*This part of the definition suffers from [[LPFitis]]. The paper should have been rejected.
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| #Confined to the thyroid gland and no larger than 10 mm in greatest dimension.
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| Another definition:
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| *Invasion of the basement membrane with stromal reaction.
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| A third definition:
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| *"Several clusters" of more than six C cells.
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| ====Images====
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| *[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f2.html CCH - crappy B&W image (nature.com)].<ref>{{Cite journal | last1 = Guyétant | first1 = S. | last2 = Josselin | first2 = N. | last3 = Savagner | first3 = F. | last4 = Rohmer | first4 = V. | last5 = Michalak | first5 = S. | last6 = Saint-André | first6 = JP. | title = C-cell hyperplasia and medullary thyroid carcinoma: clinicopathological and genetic correlations in 66 consecutive patients. | journal = Mod Pathol | volume = 16 | issue = 8 | pages = 756-63 | month = Aug | year = 2003 | doi = 10.1097/01.MP.0000081727.75778.0C | PMID = 12920219 }}</ref>
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| *[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f3.htm CCH - crappy B&W image (nature.com)].
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| *[http://www.forpath.org/workshops/0201/photos/fullsize/cas7c.jpg CCH (forpath.org)].<ref>URL: [http://www.forpath.org/workshops/0201/html/case_7.asp http://www.forpath.org/workshops/0201/html/case_7.asp]. Accessed on: 21 May 2013.</ref>
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| *[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=4849 CCH (unibas.ch)].
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| *[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=10739 Nodular CCH (unibas.ch)].
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| =Malignant neoplasm= | | =Malignant neoplasm= |
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| *[[AKA]] ''hyalinizing trabecular adenoma''. | | *[[AKA]] ''hyalinizing trabecular adenoma''. |
| *Abbreviated ''HTT''. | | *Abbreviated ''HTT''. |
| ===General===
| | {{Main|Hyalinizing trabecular tumour}} |
| *Considered by some (e.g. Silvia Asa) to be a variant of [[papillary thyroid carcinoma]].<ref name=pmid11117782>{{cite journal |author=Cheung CC, Boerner SL, MacMillan CM, Ramyar L, Asa SL |title=Hyalinizing trabecular tumor of the thyroid: a variant of papillary carcinoma proved by molecular genetics |journal=Am. J. Surg. Pathol. |volume=24 |issue=12 |pages=1622–6 |year=2000 |month=December |pmid=11117782 |doi= |url=}}</ref>
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| *Behaviour similar to papillary thyroid carcinoma - indolent.
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| ===Microscopic===
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| Features:
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| *Trabecular arrangement of cells.
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| **May have "curved" trabeculae.
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| *Extracellular space has hyaline material - '''key feature'''.
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| *Cytoplasm mimics hyaline material in the extracellular space.
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| DDx:
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| *[[Papillary thyroid carcinoma]] (if one believes this is a separate entity).
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| *[[Medullary thyroid carcinoma]] - not trabecular, nuclei not [[PTC]]-like.
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| *[[Paraganglioma]].<ref>URL: [http://path.upmc.edu/cases/case465/dx.html http://path.upmc.edu/cases/case465/dx.html]. Accessed on: 17 January 2011.</ref>
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| ====Images====
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| <gallery>
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| Image: Hyalinized trabecular tumour - low mag.jpg | HHT - low mag. (WC)
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| Image: Hyalinized trabecular tumour - intermed mag.jpg | HHT - intermed. mag. (WC)
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| Image: Hyalinized trabecular tumour - high mag.jpg | HHT - high mag. (WC)
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| Image: Thyroid gland - high mag.jpg | Thyroid gland - high mag. (WC)
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| Image: Hyalinized trabecular tumour - 2 - intermed mag.jpg | HHT - intermed. mag. (WC)
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| Image: Hyalinized trabecular tumour - 2 - high mag.jpg | HHT - high mag. (WC)
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| Image: Hyalinized trabecular tumour - 3 - intermed mag.jpg | HHT - intermed. mag. (WC)
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| Image: Hyalinized trabecular tumour - 3 - high mag.jpg | HHT - high mag. (WC)
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| Image: Hyalinized trabecular tumour - 3 - very high mag.jpg | HHT - very high mag. (WC)
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| </gallery>
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| www:
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| *[http://archive.biomedcentral.com/1742-6413/3/17/figure/F2?highres=y HTT (biomedcentral.com)].<ref name=pmid16867191>{{Cite journal | last1 = Baloch | first1 = ZW. | last2 = Puttaswamy | first2 = K. | last3 = Brose | first3 = M. | last4 = LiVolsi | first4 = VA. | title = Lack of BRAF mutations in hyalinizing trabecular neoplasm. | journal = Cytojournal | volume = 3 | issue = | pages = 17 | month = | year = 2006 | doi = 10.1186/1742-6413-3-17 | PMID = 16867191 }}</ref>
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| *[http://www.ispub.com/journal/the-internet-journal-of-endocrinology/volume-2-number-1/hyalinizing-trabecular-neoplasm-of-the-thyroid-controversies-in-management.article-g01.fs.jpg HTT (ispub.com)].<ref>URL: [http://www.ispub.com/journal/the-internet-journal-of-endocrinology/volume-2-number-1/hyalinizing-trabecular-neoplasm-of-the-thyroid-controversies-in-management.html http://www.ispub.com/journal/the-internet-journal-of-endocrinology/volume-2-number-1/hyalinizing-trabecular-neoplasm-of-the-thyroid-controversies-in-management.html]. Accessed on: 1 January 2012.</ref>
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| ===IHC===
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| *Thyroglobulin +ve.
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| *NSE +ve.
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| ==Hürthle cell neoplasm== | | ==Hürthle cell neoplasm== |
| *[[AKA]] ''oncocytic neoplasm''. | | *[[AKA]] ''oncocytic neoplasm''. |
| *Also spelled ''Hurthle cell neoplasm''. | | *Also spelled ''Hurthle cell neoplasm''. |
| | | {{Main|Hürthle cell neoplasm}} |
| ===General===
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| *Incidence: uncommon.
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| *This is a general category - includes:
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| **Hürthle cell adenoma.
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| **Hürthle cell carcinoma.
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| *Some advocate ''total thyroidectomy'' for all Hürthle cell neoplasms, as it is difficult to reliably differentiate adenomas and carcinomas.<ref name=pmid9697901>{{Cite journal | last1 = Wasvary | first1 = H. | last2 = Czako | first2 = P. | last3 = Poulik | first3 = J. | last4 = Lucas | first4 = R. | title = Unilateral lobectomy for Hurthle cell adenoma. | journal = Am Surg | volume = 64 | issue = 8 | pages = 729-32; discussion 732-3 | month = Aug | year = 1998 | doi = | PMID = 9697901 }}</ref>
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| *It can be understood as a special type of ''follicular neoplasm'' (including ''[[follicular thyroid adenoma]]'' and ''[[follicular thyroid carcinoma]]'').<ref name=Ref_EP104>{{Ref EP|104}}</ref>
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| ====Adenoma vs. carcinoma====
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| Suggestive for carcinoma:<ref name=pmid9697901/>
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| *Male.
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| *>4 cm
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| **Adenomas usu. <3 cm.
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| Definite for carcinoma:<ref name=pmid9697901/>
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| *Lymphovascular invasion.
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| *Capsular invasion.
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| ===Gross===
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| *Yellow.
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| *Encapsulated.
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| ===Microscopic===
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| Features:<ref name=Ref_EP104>{{Ref EP|104}}</ref>
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| *Oncocytes >= 75% of cells:
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| **Abundant granular, eosinophilic cytoplasm.
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| **Round regular nucleus +/- prominent nucleolus.
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| *+/-Degenerative changes.
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| Negatives:
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| *Lack nuclear features of [[papillary thyroid carcinoma]].
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| *Lack features of [[medullary thyroid carcinoma]].
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| DDx:<ref name=pmid18684023>{{cite journal |author=Montone KT, Baloch ZW, LiVolsi VA |title=The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=8 |pages=1241–50 |year=2008 |month=August |pmid=18684023 |doi= |url=}}</ref>
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| *Papillary thyroid carcinoma oncocytic variant.
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| *Medullary thyroid carcinoma oncocytic variant.
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| *Others.
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| ==Minocycline associated thyroid pigmentation== | | ==Minocycline associated thyroid pigmentation== |
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| ===Stains=== | | ===Stains=== |
| *[[Fontana-Masson stain]] +ve.<ref name=pmid10615019>{{Cite journal | last1 = Sant'Ambrogio | first1 = S. | last2 = Connelly | first2 = J. | last3 = DiMaio | first3 = D. | title = Minocycline pigmentation of heart valves. | journal = Cardiovasc Pathol | volume = 8 | issue = 6 | pages = 329-32 | month = | year = | doi = | PMID = 10615019 }}</ref> | | *[[Fontana-Masson stain]] +ve.<ref name=pmid10615019>{{Cite journal | last1 = Sant'Ambrogio | first1 = S. | last2 = Connelly | first2 = J. | last3 = DiMaio | first3 = D. | title = Minocycline pigmentation of heart valves. | journal = Cardiovasc Pathol | volume = 8 | issue = 6 | pages = 329-32 | month = | year = | doi = | PMID = 10615019 }}</ref> |
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| | ==Sclerosing mucoepidermoid carcinoma with eosinophilia== |
| | {{Main|Sclerosing mucoepidermoid carcinoma with eosinophilia}} |
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| =See also= | | =See also= |