KCP 777 강북삼성병원 서울대학교병원 R3 조화진.

Presentation on theme: "KCP 777 강북삼성병원 서울대학교병원 R3 조화진."— Presentation transcript:

1 KCP 777 강북삼성병원 서울대학교병원 R3 조화진

2 Clinical History 40세 남자 주 증상: 좌측 흉통 호소  좌측늑골골절 및 종괴 의심되어 전원.
Chest MDCT: 1. 좌측 9번째 늑골 외측 주위에 골피질을 파괴하는 3.9 x 2.9 x 2.7 cm의 종괴가 발견됨. 종양 내부에 골생성이나 석회화는 없음.  골육종 혹은 유잉육종 등 원발성 골종양과 전이성 암종 을 의심. 2. 우연히 갑상선 좌측엽에 직경 3.2 cm 정도의 난원형 종괴 발견. 갑상선 초음파: 종괴는 불균질, 저음영 양상.

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10 Differential diagnosis
Hyperplastic nodular goiter Follicular nodule in Hashimoto’s thyroiditis Follicular neoplasm or suspicious for follicular neoplasm - Follicular adenoma cellular type (Microfollicular and Trabecular type) - Follicular carcinoma Follicular variant of Papillary carcinoma

11 Hyperplastic nodular goiter

12 Follicular nodule in Hashimoto’s thyroiditis

13 Follicular adenoma cellular type

14 Follicular carcinoma

15 Follicular variant of Papillary carcinoma

16 1pap) Diagnosis) Thyroid, left, aspiration cytology: Follicular neoplasm or suspicious for follicular neoplasm The Bethesda System for Reporting Thyroid Cytopathology

17 Follicular neolasm/ Suspicious for a Follicular neoplasm
제22차 병리의사를 위한 세포병리교육 2011년 겨울학기 Pf.정찬권 Follicular neolasm/ Suspicious for a Follicular neoplasm microfollicles trabeculae Cellular specimen Colloid: scant or absent Monotonous cell papulation Nuclear overlapping and crowding Normal-sized or larger follicular cells Nuclei: round and slightly hyperchromatic, inconspicuous nucleoli

18 fewer than 15 cells arranged in a flat circle with
a lumen that was at least two-thirds complete

19 Macrofollicular adenoma Microfollicular adenoma
제22차 병리의사를 위한 세포병리교육 2011년 겨울학기 Pf.정찬권 FNA is unable to distinguish microfollicular adenoma from a follicular carcinoma Histological diagnosis Nodular hyperplasia Macrofollicular adenoma Microfollicular adenoma Follicular carcinoma Cytological Nodular hyperplasia/ Follicular cell lesion Follicular neoplasm Morphological features Cellularity Microfollicle Nuclear size Colloid “FNA is unable to distinguish nodular goiter from a colloid-rich, macrofollicular adenoma”

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21 40세 남자 갑상선 종괴 3.2cm 늑골 종괴 3.9cm

22 1pap) Diagnosis) Thyroid, left, aspiration cytology: Follicular neoplasm or suspicious for follicular neoplasm

23 감사합니다