Abstract
Thyroid tumours with mixed follicular histological components present a great challenge for pathologists. Poorly differentiated carcinoma (or insular carcinoma) is intermediate tumour between well differentiated and anaplastic carcinomas of thyroid which may be associated with papillary and follicular thyroid carcinoma. It is important to differentiate the insular component and medullary carcinoma. We present an uncommon case of mixed follicular thyroid carcinoma with an insular component and follicular papillary variant in a 30 year old female which cannot be accurately diagnosed without application of immunohistochemistry.
Highlights
Accurate classification of follicular thyroid lesions is a diagnostic challenge for the pathologists especially in resource challenged environments
We present an uncommon case of mixed follicular thyroid carcinoma with an insular component and follicular papillary variant in a 30 year old female and discuss the diagnostic challenges for a pathologist in diagnosing such tumours, which cannot be accurately diagnosed without application of immunohistochemistry
Insular growth pattern may be associated with papillary and follicular thyroid carcinoma [2]. Thyroid tumours with these mixed follicular histological components present a great challenge for pathologists [1]
Summary
Accurate classification of follicular thyroid lesions is a diagnostic challenge for the pathologists especially in resource challenged environments. We present an uncommon case of mixed follicular thyroid carcinoma with an insular component and follicular papillary variant in a 30 year old female and discuss the diagnostic challenges for a pathologist in diagnosing such tumours, which cannot be accurately diagnosed without application of immunohistochemistry. Microscopic sections of the right lobe showed two microscopic foci of follicular type of papillary carcinoma with characteristic nuclear features and remaining tissue was multiple colloid filled nodules with focal hyperplastic change and chronic inflammation. Left sided nodular mass showed follicular neoplasm with capsule invasion at places by tongues of tumour cells. A diagnosis of minimally invasive follicular carcinoma with insular pattern with foci of microscopicfollicular variant of papillary carcinoma was made. (Immunohistochemistry, 10X) Figure 3D: Areas of follicular variant of papillary carcinoma with insular component.
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