1. KCP 748 (P10-10309) 고려대학교 구로병원 서울대학교 병원 R4 김효진 대한세포병리학회 4 월 월례집담회

2. Brief History 58 세 남자 환자 1 년 6 개월 전 건강검진에서 발견된 갑상선 결절 추 적관찰 중 새로운 결절 발견 초음파 소견 : 갑상선 좌엽의 내측에 피막 바깥으로 돌출되어 있으면서 불분명한 격막 구조로 되어있는 1.3cm 의 결절 Liquid-based cytology

12. Cytologic feature Moderate to marked cellularity Isolated single cells with syncytial-like clusters Polymorphous cells  polygonal, plasmacytoid, spindle Abundant granular cytoplasm Mild nuclear pleomorphism Eccentric round nuclei with fine chromatin Inconspicuous or small nucleoli A few intranuclear pseudoinclusions

13. Differential diagnosis Non-neoplastic condition  Granulomatous thyroiditis Neoplastic lesions  Medullary thyroid carcinoma  Hűrthle cell neoplasm  Papillary carcinoma, oncocytic variant - Clusters of epithelioid histiocytes along with many multinucleated giant cells - Many neutrophils and eosinophils in early stage - Lymphocytes macrophages in late stage - Polygonal oncocytic cells, arranged in sheets or single cells - Eccentric nuclei with abundant granular cytoplasm - Nuclear feature of PTC

14. KCP 748Hűrthle cell neoplasm Pattern isolated single cells with syncytial-like clusters Cell typepolymorphous monomorphous anisocytosis Cytoplasmabundant, granular Nucleus mild pleomorphism eccentric, round Fine chromatin mild pleomorphism eccentric round smooth, fine chromatin Nucleoliinconspicuous or smallprominent macronucleoli Intranuclear pseudoinclusions present, a few

15. KCP 748MTC Pattern isolated single cells with syncytial-like clusters Cell typepolymorphous Cytoplasmabundant, granular Nucleus mild pleomorphism eccentric, round fine chromatin mild to moderate pleomorphism eccentric round “salt and pepper” chromatin Nucleoliinconspicuous or small Inconspicuous but can be prominent Intranuclear pseudoinclusions present, a fewoccasional Etc.amyloid

16. Diagnosis Dx> Thyroid, AC; Positive for malignancy ; suspected medullary thyroid carcinoma