The patient was a 55 year-old female who noted the sudden development of a nodule in the side of the neck.

1. Look at the back of the specimen in particular. What organ is shown?

2. How would you describe the main lesion?

3. What do you think it is?

4. What is your differential diagnosis?

5. How do you explain the clinical symptoms?

ANSWERS

1. The organ has a smooth surface with a mild degree of lobulation. The normal tissue has a spongy nature to it and so this is the thyroid gland.
2. There is a single nodule present measuring 3cm by 1.5cm. It is a solid nodule with areas of haemorrhage. It has a thin white to grey capsule and there appears to be compression of the adjacent gland.
3. The lesion is a neoplasm and because it is encapsulated it is most likely to be a follicular neoplasm. As invasion of the capsule or vascular invasion may only be detected microscopically, the distinction between an adenoma and a carcinoma can not be made at this time.
4. The main differential diagnosis is that of a hyperplastic nodule. This lesion tends not to be encapsulated, does not normally compress the adjacent thyroid and microscopically has a similar histology to that of the adjacent thyroid. The histology of this nodule confirmed the presence of a follicular adenoma but was an unusual one in that the tumour cells were large and had abundant eosinophilic granular cytoplasm. This variant is called a Hurthle cell adenoma.
5. The sudden development of a nodule in the neck is due to haemorrhage into the tumour.