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| LMDDx = | | LMDDx = | ||
| Stains = congo red +ve (amyloid deposits) | | Stains = congo red +ve (amyloid deposits) | ||
| IHC = calcitonin +ve, CEA +ve, chromogranin A +ve, synaptophysin +ve, thyroglobulin -ve (usually) | | IHC = calcitonin +ve, [[CEA]] +ve, chromogranin A +ve, synaptophysin +ve, thyroglobulin -ve (usually) | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
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| Gross = usu. well-circumscribed, white, gray or yellow, gritty, firm | | Gross = usu. well-circumscribed, white, gray or yellow, gritty, firm | ||
| Grossing = | | Grossing = | ||
| Staging = [[thyroid cancer staging]] | |||
| Site = [[thyroid gland]] | | Site = [[thyroid gland]] | ||
| Assdx = [[C-cell hyperplasia]] | | Assdx = [[C-cell hyperplasia]] | ||
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*Amphophilic, somewhat granular cytoplasm | *Amphophilic, somewhat granular cytoplasm | ||
*Cells may have a more bizarre appearance | *Cells may have a more bizarre appearance | ||
* | *Cells may appear to be 'falling apart'due to interstitial oedema. | ||
Stroma | Stroma | ||
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**Coarse chromatin (''salt and pepper nuclei''). | **Coarse chromatin (''salt and pepper nuclei''). | ||
Surrounding Thyroid | |||
*+/-[[C-cell hyperplasia]] - seen with familial forms of MTC. | *+/-[[C-cell hyperplasia]] - seen with familial forms of MTC. | ||
**C cells (AKA ''parafollicular cell''): abundant cytoplasm - clear/pale. | **C cells (AKA ''parafollicular cell''): abundant cytoplasm - clear/pale. | ||
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DDx: | DDx: | ||
*[[Anaplastic thyroid carcinoma]]. | *Other thyroid tumours: | ||
*[[Papillary thyroid carcinoma]]. | **[[Anaplastic thyroid carcinoma]]. | ||
* | **[[Papillary thyroid carcinoma]]. | ||
**[[Hurthle cell carcinoma]] | |||
***The oncocytic variant of medullary carcinoma can be confused with [[Hurthle cell carcinoma]]. Clues to suggest medullary carcinoma: | |||
*[[Hurthle cell carcinoma]] | ****Cytoplasm is amphophilic as opposed to eosinophilic | ||
**The oncocytic variant of medullary carcinoma can be confused with Hurthle cell carcinoma. Clues to suggest medullary carcinoma: | ****Nests of tumour cells separated by fibrous septa | ||
***Cytoplasm is amphophilic as opposed to eosinophilic | *[[C-cell hyperplasia]]. | ||
***Nests of tumour cells separated by fibrous septa | **Invasive medullary carcinoma shows fibrosis around tumor cells and stains more weakly for calcitonin. | ||
*Other neuroendocrine tumours - primary or metastatic: | |||
**[[Paraganglioma]] - negative for keratin, calcitonin and [[CEA]]. | |||
**[[Carcinoid]] - negative for calcitonin. | |||
*Metastatic [[melanoma]]. | |||
**Pigment. | |||
**Melanoma markers positive, calcitonin and CEA negative. | |||
===Images=== | ===Images=== | ||
www: | www: | ||
*[http://www.anatomyatlases.org/MicroscopicAnatomy/Images/Plate287.jpg Parafollicular cells (anatomyatlases.org)]. | *[http://www.anatomyatlases.org/MicroscopicAnatomy/Images/Plate287.jpg Parafollicular cells (anatomyatlases.org)]. | ||
<gallery> | <gallery> | ||
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**[[Chromogranin A]]. | **[[Chromogranin A]]. | ||
**[[Synaptophysin]]. | **[[Synaptophysin]]. | ||
*CEA +ve (often better staining than calcitonin).<ref>SB. 7 January 2010.</ref> | *[[CEA]] +ve (often better staining than calcitonin).<ref>SB. 7 January 2010.</ref> | ||
*Thyroglobulin usu. -ve.<ref name=pmid8454270>{{Cite journal | last1 = de Micco | first1 = C. | last2 = Chapel | first2 = F. | last3 = Dor | first3 = AM. | last4 = Garcia | first4 = S. | last5 = Ruf | first5 = J. | last6 = Carayon | first6 = P. | last7 = Henry | first7 = JF. | last8 = Lebreuil | first8 = G. | title = Thyroglobulin in medullary thyroid carcinoma: immunohistochemical study with polyclonal and monoclonal antibodies. | journal = Hum Pathol | volume = 24 | issue = 3 | pages = 256-62 | month = Mar | year = 1993 | doi = | PMID = 8454270 }}</ref> | *Thyroglobulin usu. -ve.<ref name=pmid8454270>{{Cite journal | last1 = de Micco | first1 = C. | last2 = Chapel | first2 = F. | last3 = Dor | first3 = AM. | last4 = Garcia | first4 = S. | last5 = Ruf | first5 = J. | last6 = Carayon | first6 = P. | last7 = Henry | first7 = JF. | last8 = Lebreuil | first8 = G. | title = Thyroglobulin in medullary thyroid carcinoma: immunohistochemical study with polyclonal and monoclonal antibodies. | journal = Hum Pathol | volume = 24 | issue = 3 | pages = 256-62 | month = Mar | year = 1993 | doi = | PMID = 8454270 }}</ref> | ||
*TTF-1 +ve | |||
==EM== | ==EM== | ||
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Images: [http://pathhsw5m54.ucsf.edu/case7/image77.html Neurosecretory granules (ucsf.edu)]. | Images: [http://pathhsw5m54.ucsf.edu/case7/image77.html Neurosecretory granules (ucsf.edu)]. | ||
==Sign out== | |||
<pre> | |||
Lesion, Liver, Core Biopsy: | |||
- METASTATIC MEDULLARY THYROID CARCINOMA, see comment. | |||
Comment: | |||
Stains/IHC confirm the morphologic findings; the tumour stains as follows: | |||
POSITIVE: calcitonin, CEAp, synaptophysin, CD56, TTF-1 (focal, moderate), congo red (confirms the presence of amyloid). | |||
NEGATIVE: thyroglobulin, CDX2. | |||
</pre> | |||
===Micro=== | |||
The sections show cells of intermediate size without apparent nucleoli, moderate eosinophilic cytoplasm, arranged in nests, focally associated with amorphous acellular cotton candy-like material. | |||
The cotton candy-like material has a light apple-green appearance when polarized. | |||
==See also== | ==See also== |
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