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Case History

The patient is a 57-year-old male with a history of squamous cell carcinoma of the tonsil now presenting with a left neck mass.

What is the diagnosis?

  1. Squamous cell carcinoma
  2. Acinic cell carcinoma
  3. PTC
  4. Basal cell adenoma

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 Answer: B. Papillary thyroid carcinoma


PTC is the most common thyroid malignancy in the United States. It can happen at any age with a female to male ratio of 3:1. The smear are usually cellular with sheets of follicular cells exhibiting nuclear overlapping and/or molding.  The cytoplasm can be scant or abundant [squamoid, oncocytic (Picture #2) or vacuolated]. Intranuclear pseudoinclusions (black arrow) are specific to PTC and represent cytoplasmic invaginations. Other non-specific nuclear features include grooves (blue arrow) and nucleoli. Another highly specific feature is the presence of papillae with fibrovascular cores (Picture #3).

Case contributed by: Morad Qarmali, M.D., Cytopathology Fellow, UAB Pathology