WBR0443
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| Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | USMLE Step 1 |
| Main Category | Pathology |
| Sub Category | 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?
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| Answer A | 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 | 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 | 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 | 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 | Papillary thyroid cancer |
| Answer E Explanation | [[AnswerEExp::On pathology of Papillary thyroid cancer, the most common thyroid cancer, there is papillary architecture.]] |
| Right Answer | 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”. |
| Approved | Yes |
| Keyword | Papillary thyroid cancer, Cancer, Biopsy, Psammoma bodies, Thyroid, FNA, Carcinoma |
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