Question

A 25-year-old male presented with a 2 cm thyroid nodule. A thyroidectomy was done and the histology is shown below. What could be the diagnosis?

• A. Papillary carcinoma thyroid
• B. Follicular adenoma
• C. Graves disease
• D. Adenomatous goitre

Hint:

The nuclear features, clear chromatin and psammoma bodies, clinch this thyroid malignancy.

Answer 1

The Correct Option is A

Step 1: The histology shows neoplastic papillae with dense fibrovascular cores lined by cells with overlapping nuclei that have finely dispersed, optically clear chromatin. These ground glass or Orphan Annie eye nuclei are diagnostic of papillary carcinoma of the thyroid.

Step 2: Supporting features include nuclear grooves, intranuclear pseudoinclusions and concentrically calcified psammoma bodies within the papillae. Foci of lymphatic permeation are common, explaining its lymphatic spread.

Step 3: Why the others are wrong. Follicular adenoma is an encapsulated follicular lesion with no papillae or clear nuclei. Graves disease shows hyperplastic papillae with tall columnar cells but the papillae lack fibrovascular cores and the nuclei are normal. Adenomatous (multinodular) goitre shows variably sized colloid-filled follicles, not malignant nuclear features.

Ref: Robbins Basic Pathology, 9th edition, pg 736.