Thyroidectomy- Multi nodular Goiter
A. The specimen is received in formalin labeled “left thyroid lobe” and consists of an oriented, 10.0 g, 5.7 x 2.3 x 1.5 cm, partial thyroidectomy specimen holding a single suture designating superior pole of the left lobe and a double suture designating the isthmus.
The external surface is red-brown, mildly congested, diffusely involved by thin, thread-like, fibrous adhesions, and is distorted by at least 5 well-circumscribed subcapsular nodules. No parathyroid glands are identified. The left lobe is inked in black and the isthmus is inked in orange.
Serial sectioning from superior to inferior pole reveals multiple tan-yellow, well-circumscribed, soft, nodules ranging from 0.3 to 1.5 cm in greatest dimension among a homogenously maroon-red, soft parenchyma. The nodules are within 0.1 cm of the left lobe surface and within 0.1 cm of the isthmic surface. The nodules in the mid lobe display prominent cystic change filled with thin, red-brown, hemorrhagic fluid. The unilocular cyst walls measure up to 0.2 cm in greatest thickness. Representative sections from superior to inferior pole are submitted in cassettes A1-A8.
Thyroidectomy – Carcinoma
The specimen is received fresh labeled “thyroid “and consists of an oriented, total thyroidectomy specimen (6.5 x 5.5 x 2.5 cm) that weighs 24.1 g. There is one long black suture designating the right upper lobe and one long black suture designating the left lower lobe. The right lobe measures 5.5 cm (superior to inferior) x 2.5 cm (anterior to posterior) x 3.2 cm (lateral to medial). It is markedly enlarged and congested. The left lobe measures 3.0 cm (superior to inferior) x 0.7 cm (anterior to posterior) x 1.5 cm (lateral to medial). The connecting isthmus measures 1.4 cm in length and 1.3 cm in diameter. No parathyroid glands are grossly identified. The anterior surface is inked in yellow, posterior in black, and isthmus in orange.
The specimen is serially and sequentially sectioned from superior to inferior to reveal a hemorrhagic and degenerated parenchyma within the superior pole of the right lobe. There is a 3.8 x 3.3 x 2.2 cm, tan-gray, poorly delineated, firm, encapsulated mass which primarily involves the superior to mid right lobe. It measures 0.2 cm from the closest anterior surface and 0.2 cm from the closest posterior surface. The capsule ranges from 0.1-0.3 cm in thickness. Capsular invasion does not appear to be grossly present but cannot be assessed with certainty. The inferior right lobe is homogeneously red-brown and unremarkable. The isthmus contains a discrete area of calcification that measures 0.5 x 0.3 x 0.3 cm. Sectioning through the left lobe reveals a maroon-red cut surface with no areas of hemorrhage, necrosis, or other grossly discrete lesions.
- A1-A5: 3 full cross sections of tumor (from superior to inferior)
- A6-A14: Entire capsule (from superior to inferior)
- A15: Inferior right lobe
- A16-A17: Calcified isthmus, submitted after decalcification
- A18: Uninvolved left lobe
Total Laryngectomy- Carcinoma
The specimen is received fresh labeled “total laryngectomy” and consists of a total laryngectomy specimen (10.0 x 1.5 x 3.8 cm) including bilateral hyoid bones, larynx from epiglottis to subglottis, 4 tracheal rings, and an attached (4.5 x 2.0 x 1.0 cm) left thyroid lobe. The left half of the resection margin is inked in black and the right half of the resection margin is inked in red.
The specimen is opened along the posterior surface to reveal a 3.5 x 1.0 x 0.5 cm, bulging, tan-white mass on the anterior wall. The mass appears to grossly involve the left false vocal cord but not the true vocal cord. The mass is located approximately 0.5 cm from the proximal margin (left aryepiglottic fold) and approximately 5.5 cm away from the distal tracheal margin. Sectioning through the lesion reveals a gray-tan and firm cut surface with irregular borders and gross extension across the midline. The tumor grossly invades the thyroid perichondrium without evidence of transcartilaginous extension. The epiglottis, anterior musculature, anterior strap muscles, and attached thyroid appear to be grossly uninvolved by tumor.
Representative sections are taken and submitted as follows:
- C1: Tracheal margin
- C2: Left aryepiglottic fold margin
- C3: Right aryepiglottic fold margin
- C4-C5: Tumor, full thickness
- C6: Midline, full thickness
- C7: Right side, opposite to tumor
- C8: Epiglottis
- C9-C11: (additional) sections of tumor, full thickness
- C12-C13: Base of tongue
- C14: Anterior musculature
- C15-C16: Thyroid
ALINA MAYSTERCHUK 