{"id":44885,"date":"2025-08-05T14:04:17","date_gmt":"2025-08-05T06:04:17","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=44885"},"modified":"2025-08-05T15:17:21","modified_gmt":"2025-08-05T07:17:21","slug":"thy-3","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/","title":{"rendered":"Mystery cases &#8211; Thyroid 3"},"content":{"rendered":"\n<h2>\n\t\tthyroid case 3\n\t<\/h2>\n\t<h1>Anterior neck mass<\/h1>\n\t<p><strong>Clinical history:\u00a0<\/strong>A 50-year-old lady presented with dysphagia, significant weight loss and a palpable thyroid mass. She was a smoker, and had a self-reported history of total thyroidectomy more than 2 decades ago.<\/p>\n<p>Fine needle aspiration of the thyroid mass was performed.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png\" alt=\"Thyroid case 3\" itemprop=\"image\" height=\"779\" width=\"1039\" title=\"THY19\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY20.png\" alt=\"THY20\" itemprop=\"image\" height=\"1125\" width=\"1500\" title=\"THY20\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY21.png\" alt=\"THY21\" itemprop=\"image\" height=\"779\" width=\"1039\" title=\"THY21\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li>Highly atypical epithelial cells arranged in clusters<\/li>\n<li>Pleomorphic nuclei with irregular outlines, coarse chromatin and occasional small nucleoli<\/li>\n<li>Moderate to abundant cytoplasm<\/li>\n<li>Necrosis and atypical mitotic figures are seen<\/li>\n<li>Benign thyroid follicular cells are present (first image)<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Approach and differential diagnoses<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nThe malignant cells show features of adenocarcinoma.\n<p>Elimination of &#8220;suspects&#8221; based on the options in the Bethesda System for Reporting Thyroid Cytopathology:<\/p>\n<p>The appearance of the tumour cells is NOT typical of primary thyroid carcinoma (follicular carcinoma, papillary thyroid carcinoma, medullary thyroid carcinoma or anaplastic carcinoma).<\/p>\n<p>Possible remaining options:<\/p>\n<ol>\n<li>Metastatic malignancy: This is the favoured diagnosis as a second distinct population of benign thyroid cells are admixed with the carcinoma (see below).<\/li>\n<li>Poorly differentiated carcinoma (of the thyroid): this is often associated with differentiated carcinoma, which we may consider given the patient&#8217;s self-reported history of a previous thyroid operation.<\/li>\n<\/ol>\n<p>Note: Dysphagia may be seen in advanced thyroid carcinoma but is not common.<\/p>\n<p>Possible primary sources of a metastatic adenocarcinoma to the thyroid to consider:<\/p>\n<ul>\n<li>Lung adenocarcinoma<\/li>\n<li>Renal cell carcinoma (not likely the clear cell type)<\/li>\n<li>Breast carcinoma (invasive carcinoma of no special type)<\/li>\n<li>Gastrointestinal tract\/pancreatobiliary adenocarcinoma<\/li>\n<\/ul>\n<p>Knowledge of relevant clinical history and immunocytochemistry on cell block would be very helpful in the DDx.<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Histology and immunohistochemistry<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nIn view of the history of dysphagia and significant weight loss, the patient underwent an OGD, and a gastro-oesophageal junction tumour and a skip lesion proximally were seen.\n<p>Biopsy of the gastro-oesophageal tumour:<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY22.png\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY23.png\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Biopsy of the gastro-oesophageal junction tumour and the skip lesion showed similar findings.<\/p>\n<p>They both contained carcinoma which was composed of solid sheets and nests of tumour cells with focal gland formation.<\/p>\n<p>The morphology of the carcinoma cells in the thyroid FNA sample was similar to that of this sample.<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY24.png\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY25.png\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>The tumour cells were positive for CK7 and negative for CK5\/6.<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-3\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-3\">Diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-3\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<strong>Metastatic adenocarcinoma (oesophageal primary)<\/strong>\n\t<p><em>Case writer: Dr Wan Jing Tay<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>thyroid case 3 Anterior neck mass Clinical history:\u00a0A 50-year-old lady presented with dysphagia, significant weight loss and a palpable thyroid mass. She was a smoker, and had a self-reported history of total thyroidectomy more than 2 decades ago. Fine needle aspiration of the thyroid mass was performed. Cytologic findings Expand &nbsp; Highly atypical epithelial cells [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-44885","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"thyroid case 3 Anterior neck mass Clinical history:\u00a0A 50-year-old lady presented with dysphagia, significant weight loss and a palpable thyroid mass. She was a smoker, and had a self-reported history of total thyroidectomy more than 2 decades ago. Fine needle aspiration of the thyroid mass was performed. Cytologic findings Expand &nbsp; Highly atypical epithelial cells [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/\" \/>\n<meta property=\"og:site_name\" content=\"NUS Pathweb\" \/>\n<meta property=\"article:modified_time\" content=\"2025-08-05T07:17:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/\",\"name\":\"\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png\",\"datePublished\":\"2025-08-05T06:04:17+00:00\",\"dateModified\":\"2025-08-05T07:17:21+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#primaryimage\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png\",\"width\":1039,\"height\":779,\"caption\":\"Thyroid case 3\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Cytopathology\",\"item\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Cytopathology Mystery Cases\",\"item\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Mystery cases &#8211; Thyroid 3\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/\",\"name\":\"NUS Pathweb\",\"description\":\"Pathology made easy\",\"publisher\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization\",\"name\":\"NUS Medicine PathWeb\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png\",\"width\":300,\"height\":61,\"caption\":\"NUS Medicine PathWeb\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.instagram.com\/pathweb\/\",\"https:\/\/www.youtube.com\/channel\/UC3FweZwONWAicB72vF9P5ew\/playlists\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"NUS Pathweb","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/","og_locale":"en_US","og_type":"article","og_description":"thyroid case 3 Anterior neck mass Clinical history:\u00a0A 50-year-old lady presented with dysphagia, significant weight loss and a palpable thyroid mass. She was a smoker, and had a self-reported history of total thyroidectomy more than 2 decades ago. Fine needle aspiration of the thyroid mass was performed. Cytologic findings Expand &nbsp; Highly atypical epithelial cells [&hellip;]","og_url":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/","og_site_name":"NUS Pathweb","article_modified_time":"2025-08-05T07:17:21+00:00","og_image":[{"url":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/","name":"","isPartOf":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#website"},"primaryImageOfPage":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#primaryimage"},"image":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#primaryimage"},"thumbnailUrl":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png","datePublished":"2025-08-05T06:04:17+00:00","dateModified":"2025-08-05T07:17:21+00:00","breadcrumb":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#primaryimage","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png","contentUrl":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/THY19.png","width":1039,"height":779,"caption":"Thyroid case 3"},{"@type":"BreadcrumbList","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/thy-3\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/medicine.nus.edu.sg\/pathweb\/"},{"@type":"ListItem","position":2,"name":"Cytopathology","item":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/"},{"@type":"ListItem","position":3,"name":"Cytopathology Mystery Cases","item":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/"},{"@type":"ListItem","position":4,"name":"Mystery cases &#8211; Thyroid 3"}]},{"@type":"WebSite","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#website","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/","name":"NUS Pathweb","description":"Pathology made easy","publisher":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/medicine.nus.edu.sg\/pathweb\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization","name":"NUS Medicine PathWeb","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png","contentUrl":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png","width":300,"height":61,"caption":"NUS Medicine PathWeb"},"image":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.instagram.com\/pathweb\/","https:\/\/www.youtube.com\/channel\/UC3FweZwONWAicB72vF9P5ew\/playlists"]}]}},"_links":{"self":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/44885"}],"collection":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/users\/828"}],"replies":[{"embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/comments?post=44885"}],"version-history":[{"count":8,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/44885\/revisions"}],"predecessor-version":[{"id":45449,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/44885\/revisions\/45449"}],"up":[{"embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/44933"}],"wp:attachment":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/media?parent=44885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}