The Path Report

Pathology cases, simplified and shared

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  • Case 2: An incidental thyroid nodule

    Clinical History

    A 32-year-old woman presents with a 1.8 cm right thyroid nodule. On ultrasound, the nodule is solid, hypoechoic, and demonstrates microcalcifications. Fine-needle aspiration is performed under ultrasound guidance.

    Cytologic Features

    • Moderately cellular specimen
    • Papillary tissue fragments
    • Enlarged nuclei with overlapping and crowding
    • Irregular nuclear contours (important clue)
    • Nuclear grooves
    • Intranuclear pseudoinclusions
    • Pale (optically clear) chromatin

    Interpretation

    Features consistent with papillary thyroid carcinoma (Bethesda Category VI – Malignant)

    Making the Diagnosis

    The diagnosis is supported by a moderately cellular aspirate showing true papillary fragments lined by follicular cells demonstrating enlarged, elongated nuclei with irregular membranes, pale chromatin, and nuclear grooves. Occasional intranuclear pseudoinclusions are seen. The chromatin is pale. The nuclear features and architectural pattern are diagnostic of papillary thyroid carcinoma (PTC).

    According to the Bethesda System for Reporting Thyroid Cytopathology, this case falls under Category VI, malignant.

  • Case #1: FNA of a Slowly Enlarging Submandibular Mass

    Clinical history

    A 55-year-old man presents with a slowly enlarging, painless mass in the left submandibular region, present for approximately 8 months. Imaging reveals an ill-defined, solid mass in the submandibular gland. Fine-needle aspiration (FNA) is performed.

    .
    A cellular aspirate showing uniform basaloid cells and hyaline globules.
    Cellular aspirate showing small, uniform basaloid cells and cribriform arrangements, characteristic of Adenoid Cystic Carcinoma.

    Cytologic Features

    • Cellular aspirate
    • Small, uniform basaloid cells
    • Scant cytoplasm, round to oval nuclei
    • Sheets and cribriform arrangements
    • Hyaline globules (basement membrane material) within and around cell groups
    • No significant pleomorphism

    Interpretation

    Features consistent with adenoid cystic carcinoma (AdCC)

    Making the Diagnosis

    The diagnosis is supported by a cellular basaloid neoplasm arranged in predominantly cribriform groups associated with well-defined, rounded hyaline globules present within the clusters. The nuclei are uniform, and the background is clean. These findings are characteristic of adenoid cystic carcinoma. According to the Milan System for Reporting Salivary Gland Cytopathology, this case falls under Category VI – Malignant.

    In limited sampling, the differential diagnosis may include basal cell adenoma and other basaloid salivary neoplasms with overlapping features, though the overall pattern here is typical for AdCC.