Needle biopsy of solitary thyroid nodule in a young woman with palpable cervical lymph nodes on the same sides demonstrates amyloid in stroma of lesion. Likely diagnosis is
## **Core Concept**
The presence of amyloid in the stroma of a thyroid lesion, along with a solitary thyroid nodule and palpable cervical lymph nodes, points towards a specific type of thyroid cancer. Amyloid deposition is a characteristic feature of medullary thyroid carcinoma (MTC).
## **Why the Correct Answer is Right**
Medullary thyroid carcinoma (MTC) is a type of thyroid cancer that originates from the parafollicular cells (also known as C cells), which produce calcitonin. A key histopathological feature of MTC is the presence of amyloid in the stroma. The amyloid is typically derived from precalcitonin or other peptides produced by the tumor cells. MTC can present with a solitary thyroid nodule and may be associated with palpable cervical lymph nodes due to lymph node metastasis. This cancer can occur sporadically or as part of multiple endocrine neoplasia (MEN) syndromes.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, incorrect options might include other types of thyroid cancers or conditions that do not characteristically present with amyloid deposition in the stroma.
- **Option B:** If this option represents a different type of thyroid cancer, such as papillary or follicular thyroid carcinoma, these do not typically have amyloid deposition as a characteristic feature.
- **Option C:** Similarly, if this option represents another condition, it would not be associated with amyloid in the stroma.
- **Option D:** This option is also not provided, but any other thyroid condition or cancer not characterized by amyloid deposition would be incorrect.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that medullary thyroid carcinoma (MTC) can be associated with elevated calcitonin levels, which can be used as a tumor marker for diagnosis and follow-up. Additionally, MTC may be part of familial syndromes (MEN 2A and MEN 2B), and genetic screening for RET proto-oncogene mutations is recommended in familial cases.
## **Correct Answer:** C. Medullary thyroid carcinoma.