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Thyroid gland
Other carcinoma
Medullary carcinoma

Reviewer: Shahidul Islam, M.D., Ph.D. (see Reviewers page)
Revised: 13 June 2013, last major update March 2009
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

See also variants: microcarcinoma, mixed medullary-follicular tumors, paraganglioma-like variant, small cell variant, tubular (follicular) variant

General
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Terminology
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Laboratory
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Prognostic factors
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Case reports
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Treatment
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Clinical description
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Gross description
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Gross images
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Large tumor with hemorrhage, necrosis and cystic degeneration
Well circumscribed tumor
MEN 2A patient with multiple tumor foci (arrows)
Contributed by Dr. Mark R. Wick
Multifocal in MEN2, contributed by Dr. Mark R. Wick
Images from AFIP:
MEN2A patient #1 with single tumor focus
#2 - Tumor of left lobe is well circumscribed and fleshy, tumor of right lobe is finely granular
Nonfamilial tumor replaces entire left lobe and isthmus
Nodal metastasis
Micro description
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Micro images
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Papillary and medullary carcinomas:
Follicular variant of papillary thyroid carcinoma (left) and medullary carcinoma (right)
Various images
Images from AFIP:
Lobular pattern accentuated by shrinkage artifact
Solid pattern with small spindle cells
Papillary pattern and extensive inflammatory infiltrate
Pseudopapillary pattern
Encapsulated variant
Amphicrine type
Round cells in nests
Round cells in nests with plasmacytoid nuclei
Polygonal cells with abundant cytoplasm
Spindle cells
Clusters of giant cells
Clear cells
Clear cells with large mucin filled vacuoles
Vascular invasion
Familial MTC (bottom) with amyloid, C cell hyperplasia (arrows)
With melanin pigment
Oncocytic foci
Oncocytic variant (left: H&E, right: calcitonin)
With squamous cell carcinoma and necrosis
Metastases to cervical lymph node are present in peripheral sinus
Images contributed by Dr. Mark R. Wick:
Dedifferentiated-anaplastic
Oncocytic variant
Pseudopapillary variant
Signet ring cell variant
Images from other sources:
Spindle cells
Tumor nodules
Oncocytic variant
Papillary variant
Amyloid
Tumor cells have abundant cytoplasm, round nuclei, finely dispersed chromatin
MEN2A patient with small tumor
MEN2A patient, tumor nodules and hyperplastic C cells
Comparison with laryngeal neuroendocrine carcinoma (H&E, TTF1, p53, figures b / d / f)
Stain images (AFIP):
Calcitonin
Variable calcitonin staining
Calcitonin+ liver metastasis
Low molecular weight keratin
Neuron specific enolase
CEA
Chromogranin A
Grimelius stain demonstrates fine argyrophilic granules
Thyroglobulin stains entrapped follicles, not tumor cells
Stain images contributed by Dr. Mark R. Wick:
CEA
Calcitonin
Chromogranin
Congo red
Stain images (other sources):
Calcitonin
Weak calcitonin staining
Amyloid (AFIP):
Prominent amyloid deposits
Amyloid replaces almost entire tumor, is calcified at periphery
Congo Red+ amyloid deposit
Apple green birefringence with Congo Red stain and polarized light
Amyloid (other sources):
Congo Red
Contributed by Dr. Mark R. Wick
With amyloid stroma, contributed by Dr. Mark R. Wick
Polarized congo red, contributed by Dr. Mark R. Wick
Virtual slides
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H&E
Congo Red stain
Cytology description
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Cytology images
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Dyscohesive plasmacytoid cells
Spindled cells with scanty ill-defined cytoplasm
Orange granular amyloid material
Spindle cells
Atypical spindle cells
Positive stains
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Negative stains
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Electron microscopy description
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Electron microscopy images
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Images from AFIP:
Amyloid deposits have amorphous or finely fibrillary structure
Numerous large type I granules in some cells
Tumor cells with sparse granules
Molecular / cytogenetics description
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Differential diagnosis
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Additional references
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Medullary microcarcinoma
General
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Epidemiology
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Prognostic factors
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Case reports
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Treatment
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Micro description
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Micro images
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Various images in prophylactic thyroidectomies
With C cell hyperplasia-calcitonin stain
MEN 2A patients with early medullary carcinoma (AFIP):
A group of C cells has extended into interstitium


Mixed medullary-follicular tumors
General
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Case reports
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Micro images
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Images from AFIP:
Tumor cells show lobular growth pattern
Scattered early follicle-like areas
Tumor cells form colloid-containing follicles
Many cells have clear cytoplasm
Immunofluorescent staining for thyroglobulin (green) and calcitonin (orange)
Positive stains
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Differential diagnosis
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Paraganglioma-like variant
General
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Micro description
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Micro images
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Paraganglioma-like pattern (AFIP)
Cytology description
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Positive stains
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Negative stains
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Differential diagnosis
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Small cell variant
General
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Micro images
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Images from AFIP:
Trabecular growth pattern
Oval cells with hyperchromatic nuclei
Foci of calcification
Positive stains
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Tubular (follicular) variant
General
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Case reports
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Micro images
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Tumor cells forming follicular structures (AFIP)
Positive stains
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Negative stains
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Electron microscopy description
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End of Thyroid gland > Other carcinoma > Medullary carcinoma


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