3.

3 Carcinoma

Is trabecular, solid, microfollicular (fetal) and NOT macrofollicular or normofollicular. Macrofollicular growth pattern is probably FVPTC ( Follicular Variant of Papillary Carcinoma). FTC peak : 60-70 year older age group. If there is any inflammation it is probably not FC but PTC. No lymphoid infiltrate in FC and near always in PTC

Arch Pathol Lab Med vol 130, july 2006

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Vascular invasion Should be assessed in vessels located within or beyond the capsule Plugs of tumor cells floating within vascular lumens unattached to the vessel wall do not qualify for vascular invasion. CAVE: Reactive vascular proliferation
Rosai in Histopathology,49, 107-120, 2006: Pitfalls in thyroid tumour pathology

Arch Pathol Lab Med vol 130, july 2006

z

Vascular invasion, bis. To qualify for vascular invasion the tumor cells should be covered by a partial or full layer of endothelium. Some authors will accept nonendothelialized tumor thrombi as evidence of vascular invasion if they are attached to the vessel wall.

Virchows Arch (2006) 448; 385-393

z z z z

Capsular breakthrough Penetration of tumour through the whole capsule, deflecting the collagen fibres of the capsule. Contact of tumour with the surrounding non neoplastic thyroid tissue. A concomitant vascular invasion is not required even if metastasis are already present. Tumour foci within the capsule are not sufficient for the diagnosis. They represent, most likely, tumour trapping and distortion by fibrosis.

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Small nodules found outside the tumour capsule showing a similar morphology to the main tumour mass should not be regarded as capsular invasion. Free floating islands of tumour cells present within the capsule without connection with the tumour mass should not be regarded as capsular invasion.

More sections to find the breaktrough

Pseudocapsule