A, B, C. The sections show lymph nodes invaded by a papillae-forming neoplasm with scattered, easy-to-find pseudonuclear inclusions, prominent nucleoli, focal nuclear membrane overlap, nuclear clearing, mild-to-moderate nuclear size variation, nuclear grooves and rare psammomatous calcifications. Mitotic activity is not identified.
Part A only: Thymus is present with focal degeneration of the thymic corpulses, tingible-body macrophages, and focal lymphocyte drop-out. There is benign parathyroid tissue with scant adipose tissue. There is a cluster of tumour cells (as described above) that is not adjacent to encapulated lymphoid tissue.
A. Central neck mass, excision
- Four of five lymph nodes positive for papillary thyroid carcinoma ( 4 / 5 ), see comment 1.
- Benign parathyroid gland.
- Thymus with mild-to-moderate stress reaction.
B. Neck mass, level 3-4, excision - Four of eleven lymph nodes positive for papillary thryoid carcinoma ( 4 / 11).
C. Neck mass, zone 2, excision - One of six lymph nodes positive for papillary thyroid carcinoma.
See diagnosis comment 2.
Comment 1: There is a cluster of tumour cells without adjacent lymphoid tissue. This is thought to represent extranodal extension; however, it may represent a tumour deposit.
Comment 2: The lymph node counts in part A, B and C are estimates, as the lymph nodes were matted.
A. The sections show thyroid gland with extensive fibrosis and lymphoid follicles, with well-developed germinal centres and tingible-body macrophages. Follicular cells show focal enlargement and nucleoli in association with a lymphoplasmic infiltrate. There is no nuclear clearing, no nuclear grooves and no nuclear pseudoinclusions. There is no evidence of malignancy.
One focus of benign parathyroid tissue is present. There are three benign lymph nodes with sinus histiocytosis. The sinus histiocytes have round nuclei less than two times the size of a mature lymphocyte.
A. Hemithyroid, right, hemithyroidectomy -
i) Lymphocytic thyroiditis
ii) Parathyroid tissue present
iii) Three benign lymph nodes with sinus histiocytosis.