Nidhi Agrawal MD Valerie peck MD Division of endocrinology diabetes and metabolism New York university medical center CASE 31 yo F Referred to our clinic with abnormal bone density Found to have a small multinodular goiter ID: 586788
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Sonographic Extranodular and Intranodular Microcalcifications
Nidhi Agrawal, MD
Valerie peck, MD
Division of endocrinology, diabetes and metabolism
New York university medical centerSlide2
CASE
31 y/o F
Referred to our clinic with abnormal bone density
Found to have a small multi-nodular goiter
No history of head/neck radiation
Asymptomatic
No compressive symptoms
No symptoms suggestive of hypothyroidism or hyperthyroidismSlide3
CASE
PMH
Turner’s syndrome
Endometrial polyps
FH
Non-contributory
No family history of thyroid disease
Medications
Estradiol
ProveraSlide4
On ExamVitals normalWeight 110 pounds, Height 5’ 1”, BMI 20.86
Neck:
Small goiter with several bilateral nodules
Non tender, no bruits
No palpable lymph nodes
Respiratory/ Cardiovascular/Gastrointestinal exam: Normal
Neuro: Grossly Normal
No pedal edemaSlide5
Relevant labsTSH 4.80 mIU/L (0.4-4.0 mIU/L)
Free T4 1.1 ng/dL (0.7-2.2 ng/dL)
Thyroid Peroxidase Antibody: 0.5 IU/ml (0- 5.5 IU/ml)Slide6
Ultrasound of the neckSlide7Slide8
Ultrasound of the neckSlide9
Ultrasound of the neckSlide10
Case
FNA consistent with Bethesda VI Papillary Thyroid Carcinoma
Patient underwent a total thyroidectomy and modified neck dissection
Uneventful post-operative course
Received 125
mCi
of RAISlide11
Surgical PathologySlide12
Surgical PathologySlide13
Surgical pathologyPapillary Thyroid Carcinoma foci in both lobes Marked fibrosis, infiltrative pattern of growth
Focal tall cell features
Lymph nodes positive for metastatic PTC
Presence of diffuse Psammoma bodiesSlide14
MicrocalcificationsMicrocalcifications help in identifying papillary
cancers as a single
ultrasonographic
sign:
Specificity (93%)
Poor sensitivity (36%)
PPV (94.2%)
High Accuracy
Probably correspond to clusters of
Psammoma
bodies on HPE
THYROID Volume 18, Number 9, 2008Slide15
Psammoma bodies
A
B
THYROID Volume 18, Number 9, 2008Slide16
Psammoma bodiesMost commonly seen in PTC, meningioma, and ovarian malignancy
Represent “ghosts” of dead papillae which attract calcium deposits
May be formed by necrosis and calcification of tumor thrombiSlide17
Ultrasound Med 2007; 26:1349–1355Slide18
Psammoma Bodies are found in 50% of PTC
258 patients with surgically resected classical PTC
All patients underwent preoperative US and FNABSlide19
Pyo JS et al the prognostic relevance of psammoma bodies and ultrasonographic intratumoral
calcifications in papillary thyroid carcinoma. World J Surg. 2013 Slide20
Pyo JS et al the prognostic relevance of psammoma bodies and ultrasonographic intratumoral
calcifications in papillary thyroid carcinoma. World J Surg. 2013 Slide21
Conclusion
Sonographic
microcalcifications
in a thyroid nodule are suggestive of malignancy and correlate with
Psammoma
body clusters
Extratumoral
Psammoma
bodies have been shown to be associated with:
S
pread of tumor cells via vascular or lymphatic channels
More aggressive PTC
Our case suggests that the detection of
extranodular
microcalcifications
, which correlate with
extranodular
psammoma
bodies, may be a useful prognostic indicator of aggressive PTC