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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{Rim}} {{Alison}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Endocrine
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Endocrine
|SubCategory=Endocrine
|Prompt=A 45 year old female patient presents to her physician’s office for a painless mass in her neck.  The physician suspects a thyroid disease.  Following thyroidectomy, a biopsy of the thyroid mass is shown in the image below.  What is the most likely diagnosis?
|Prompt=A 45-year-old female presents to the physician’s office with a painless mass in her neck.  The physician, suspecting a thyroid disease, orders a thyroidectomy. A biopsy of the thyroid mass is illustrated below.  Which of the following diagnoses most likely corresponds with the biopsy findings?


[[Image:Papillary Thyroid Cancer Pathology.jpg|400px]]
[[Image:Papillary Thyroid Cancer Pathology.jpg|400px]]
|Explanation=[[Papillary thyroid cancer]] (PTC) is the most common thyroid malignancy accounting for more than 70% of all thyroid cancers.  It is associated with an excellent [[prognosis]] with overall survival approximating 90%.  Diagnosis of PTC is by [[fine needle aspiration]] ([[FNA]]).  First line treatment for PTC is [[thyroidectomy]].   
|Explanation=[[Papillary thyroid cancer]] (PTC), the most common thyroid malignancy accounting for more than 70% of all thyroid cancers, is associated with an excellent [[prognosis]] and an overall survival rate approximating 90%.  Diagnosis of PTC is by [[fine needle aspiration]] ([[FNA]]).  First line treatment for PTC is [[thyroidectomy]].  On pathology, PTC manifests with characteristic papillary projections on the thyroid tissue.  Other characteristic features of PTC are [[psammoma bodies]] and large clear areas within nuclei frequently called “orphan annie eyes”.
 
On pathology, PTC shows thyroid tissue that has characteristic papillary projections.  Other characteristic features that are not shown in the above image are [[psammoma bodies]] and large clear areas within nuclei called “little orphan annie eyes”.
 
Educational Objective:
Papillary thyroid cancer (PTC)  on pathology shows thyroid tissue that has characteristic papillary projections.  Other characteristic features that are not shown in the above image are psammoma bodies and large clear areas within nuclei called “little orphan annie eyes”.
 
|AnswerA=Hashimoto thyroiditis
|AnswerA=Hashimoto thyroiditis
 
|AnswerAExp=[[Hashimoto thyroiditis]], the most common cause of hypothyroidism, is an autoimmune disease that is characterized on biopsy by lymphocytic infiltration with germinal centers.
|AnswerAExp=Hashimoto thyroiditis is the most common cause of hypothyroidism.  It is an autoimmune disease that is characterized on biopsy by lymphocytic infiltration with germinal centers.
|AnswerB=Reidel thyroiditis
|AnswerB=Reidel’s thyroiditis
|AnswerBExp=[[Reidel thyroiditis]] is a benign thyroid disease characterized by fibrosis of thyroid tissue going beyond the borders of the thyroid gland.
 
 
|AnswerBExp=Reidel’s thyroiditis is a benign thyroid disease characterized by fibrosis of thyroid tissue that goes beyond the borders of the thyroid gland.
|AnswerC=Follicular thyroid cancer
|AnswerC=Follicular thyroid cancer
|AnswerCExp=Follicular thyroid cancer is the only thyroid cancer that cannot be diagnosed by FNA. Biopsy shows uniform follicles.
|AnswerCExp=[[Follicular thyroid cancer]] is the only thyroid cancer that cannot be diagnosed by FNA. Biopsy demonstrates uniform follicles.
|AnswerD=Medullary thyroid cancer
|AnswerD=Medullary thyroid cancer
 
|AnswerDExp=[[Medullary thyroid cancer]], diagnosed by FNA, is a cancer of the parafollicular, or C cells, of the thyroid gland. On pathology, medullary thyroid cancer manifests as sheets of cells in amyloid stroma.
|AnswerDExp=Medullary thyroid cancer is a cancer of the parafollicular or C cells of the thyroid gland. It is diagnosed by FNA.  On pathology, medullary thyroid cancer shows sheets of cells in amyloid stroma.  
|AnswerE=Papillary thyroid cancer
|AnswerE=Papillary thyroid cancer
|AnswerEExp=Papillary thyroid cancer is the most common thyroid cancer. On pathology, there is papillary architecture.
|AnswerEExp=On pathology of [[Papillary thyroid cancer]], the most common thyroid cancer, there is papillary architecture.
|EducationalObjectives=On pathology, papillary thyroid carcinoma (PTC) manifests with characteristic papillary projections on the thyroid tissue.  Other characteristic features of PTC are [[psammoma bodies]] and large clear areas within nuclei frequently called “orphan annie eyes”.
|References=First Aid 2014 page 323
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Papillary, thyroid, cancer
|WBRKeyword=Papillary thyroid cancer, Cancer, Biopsy, Psammoma bodies, Thyroid, FNA, Carcinoma,
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 00:35, 28 October 2020
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Endocrine
Prompt [[Prompt::A 45-year-old female presents to the physician’s office with a painless mass in her neck. The physician, suspecting a thyroid disease, orders a thyroidectomy. A biopsy of the thyroid mass is illustrated below. Which of the following diagnoses most likely corresponds with the biopsy findings?

]]

Answer A AnswerA::Hashimoto thyroiditis
Answer A Explanation [[AnswerAExp::Hashimoto thyroiditis, the most common cause of hypothyroidism, is an autoimmune disease that is characterized on biopsy by lymphocytic infiltration with germinal centers.]]
Answer B AnswerB::Reidel thyroiditis
Answer B Explanation [[AnswerBExp::Reidel thyroiditis is a benign thyroid disease characterized by fibrosis of thyroid tissue going beyond the borders of the thyroid gland.]]
Answer C AnswerC::Follicular thyroid cancer
Answer C Explanation [[AnswerCExp::Follicular thyroid cancer is the only thyroid cancer that cannot be diagnosed by FNA. Biopsy demonstrates uniform follicles.]]
Answer D AnswerD::Medullary thyroid cancer
Answer D Explanation [[AnswerDExp::Medullary thyroid cancer, diagnosed by FNA, is a cancer of the parafollicular, or C cells, of the thyroid gland. On pathology, medullary thyroid cancer manifests as sheets of cells in amyloid stroma.]]
Answer E AnswerE::Papillary thyroid cancer
Answer E Explanation [[AnswerEExp::On pathology of Papillary thyroid cancer, the most common thyroid cancer, there is papillary architecture.]]
Right Answer RightAnswer::E
Explanation [[Explanation::Papillary thyroid cancer (PTC), the most common thyroid malignancy accounting for more than 70% of all thyroid cancers, is associated with an excellent prognosis and an overall survival rate approximating 90%. Diagnosis of PTC is by fine needle aspiration (FNA). First line treatment for PTC is thyroidectomy. On pathology, PTC manifests with characteristic papillary projections on the thyroid tissue. Other characteristic features of PTC are psammoma bodies and large clear areas within nuclei frequently called “orphan annie eyes”.

Educational Objective: On pathology, papillary thyroid carcinoma (PTC) manifests with characteristic papillary projections on the thyroid tissue. Other characteristic features of PTC are psammoma bodies and large clear areas within nuclei frequently called “orphan annie eyes”.
References: First Aid 2014 page 323]]

Approved Approved::Yes
Keyword WBRKeyword::Papillary thyroid cancer, WBRKeyword::Cancer, WBRKeyword::Biopsy, WBRKeyword::Psammoma bodies, WBRKeyword::Thyroid, WBRKeyword::FNA, WBRKeyword::Carcinoma
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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