slide seminar€¦ · slide seminar. case 1 clinical setting, 13-year-old rapidly growing nodule of...
TRANSCRIPT
![Page 1: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/1.jpg)
Department of Pathology, Hospital de S. João
Department of Pathology, Medical Faculty of University of Porto
Institute of Molecular Pathology and Immunology of University of Porto,
Porto, Portugal.
Catarina Eloy
Slide Seminar
![Page 2: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/2.jpg)
Case 1Clinical setting
, 13-year-old
Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid
![Page 3: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/3.jpg)
Case 1
H&E, low magnification
![Page 4: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/4.jpg)
Case 1
H&E, 20x H&E,40x
![Page 5: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/5.jpg)
Case 1H&E, 200x H&E,400x
![Page 6: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/6.jpg)
Case 1H&E, 200x H&E, 400x
![Page 7: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/7.jpg)
Case 1
??Medullary thyroid carcinoma
?Spindle cell follicular adenoma
?Spindle cell papillary thyroid carcinoma
?Other…
What to do?Thyroglobulin
CalcitoninTTF-1
![Page 8: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/8.jpg)
Case 1Thyroglobulin, 100x, 200x Calcitonin, 100x, 200x TTF-1, 200x
![Page 9: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/9.jpg)
Case 1
And now?
We go for SETTLE!
![Page 10: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/10.jpg)
Case 1CK7, 200x 34βE12, 200x CAM5.2, 200x
![Page 11: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/11.jpg)
Case 1Bcl-2, 200x CK5, 200x p63, 200x, 400x
![Page 12: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/12.jpg)
Case 1Immunohistochemistry panel
PRIMARY ANTIBODY Tumor
Cytokeratins 34βE12 +s
Cytokeratin 5 +s
Cytokeratin 7 -
Cytokeratin 20 -
TTF-1 -
Thyroglobulin -
Calcitonin -
p63 +
Bcl-2 +
CEA -
CD5 -
Ki-67 <1%
![Page 13: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/13.jpg)
Case 1Diagnosis
SETTLESpindle cell tumor with thymus-like elements
![Page 14: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/14.jpg)
Case 2Clinical setting
, 42-year-old
-Thyroid nodule measuring 2.5x2.0x1.5
cm in the left lobe
-No further complains
-FNAC: Follicular tumor
No radiation exposure or familial history of thyroid
pathology Thyroid function tests including calcitonin - OK
![Page 15: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/15.jpg)
Case 2
H&E, 20xH&E, low magnification
![Page 16: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/16.jpg)
Case 2
H&E, 40x H&E, 200xc
H&E, 200x
![Page 17: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/17.jpg)
Case 2
H&E, 400x
H&E, 400x
H&E, 400x
H&E, 200x
![Page 18: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/18.jpg)
Case 2
H&E, 100x H&E, 400x H&E, 400x
![Page 19: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/19.jpg)
Case 2
H&E, 200x H&E, 400x
![Page 20: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/20.jpg)
Case 2
H&E, 20x H&E, 100x
![Page 21: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/21.jpg)
Case 2
??PTC foci and poorly differentiated carcinoma
? PTC foci and small cell medulary carcinoma
?CASTLE
?Metastasis
?Other…
What to do?Thyroglobulin
CalcitoninTTF-1
![Page 22: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/22.jpg)
Case 2
Thyroglobulin, 200x Calcitonin, 100x
![Page 23: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/23.jpg)
Case 2
TTF-1, 400x TTF-1, 200x
![Page 24: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/24.jpg)
Case 2
Bcl-2, 200x CD5, 100x
![Page 25: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/25.jpg)
Case 2
And now?
Small cell carcinoma?In thyroid?
![Page 26: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/26.jpg)
Case 2
AE1AE3, 200x CAM5.2, 200x CK7, 200xCK19, 200x
![Page 27: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/27.jpg)
Case 2
CK5, 200x 34βE12, 400x CEA, 400x p63, 400x
![Page 28: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/28.jpg)
Case 2Chromogranin A, Synaptophysin, N-CAM, NSE, 200x
EM, lead citrate and uranylacetate, 24 000x, 30 000x
![Page 29: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/29.jpg)
Case 2Immunohistochemistry panel PRIMARY ANTIBODY Tumor
Cytokeratins AE1AE3 +
Cytokeratin 34βE12 -
Cytokeratin CAM 5.2 +
Cytokeratin 5,7, 20 -
Cytokeratin 19 +
TTF-1 -
Thyroglobulin -
Calcitonin -
Chromogranin, Synaptophysin, N-CAM, NSE -
p63 +
Bcl-2 -
CEA -
CD5 -
C-KIT +
Ki-67 <1%
![Page 30: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/30.jpg)
Case 2
Small cell (basaloid) thyroid carcinomaNotice: no neuroendocrine differentiation
Diagnosis
Courtesy of Dr João Cruz, Hospital Cuf Descobertas, Lisboa
![Page 31: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/31.jpg)
Case 3
H&E, 40x
H&E, 200x p63, 400x
, 70-year-old, thyroid nodule of
3.2cm
N-RAS Q61R
H&E, 400x
![Page 32: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/32.jpg)
Case 3Diagnosis
Basaloid tumor with solid cell nests features
![Page 33: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/33.jpg)
Discussion
Ectopic
hamartomatous
thymoma
Ectopic cervical
thymoma
SETTLE
CASTLE
?Small cell (basaloid) thyroid
carcinoma
Basaloid tumor with solid
![Page 34: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/34.jpg)
Discussion
![Page 35: Slide Seminar€¦ · Slide Seminar. Case 1 Clinical setting, 13-year-old Rapidly growing nodule of 2.7x2.0cm in the right lobe of the thyroid. Case 1 H&E, low magnification. Case](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0bfe197e708231d4333a2c/html5/thumbnails/35.jpg)
Discussion
Ectopic
hamartomatous
thymoma
Ectopic cervical
thymoma
SETTLE
CASTLE
Small cell (basaloid)
thyroid carcinoma
Basaloid tumor with solid
cell nests features
Mucoepidermoid carcinoma
Squamoid morphologyP63 positive cells
PTC associated
Solid cell nests
PATSE
PTC Associated Tumors
with
Solid cell nests-like