Head & Neck Case Review 2020-01

Head & Neck Case Review

January, 2020


A 74-year-old woman presented with respiratory failure. The patient had a 3-month history of cough and progressive dyspnea with rapidly increasing neck swelling. CT Imaging revealed massive thyromegaly and lymphadenopathy with metastases to the lung, liver, kidney, and iliac bone. Patient underwent thyroid surgical resection to relieve the airway compression. Gross examination of the thyroid showed diffuse replacement by multiple masses, the largest measuring 7.6 × 5.3 × 2.7 cm, with infiltrative borders and extension into surrounding adipose tissue. H&E slides and immunostains are shown.


Virtual H&E slide


Q1. What is the characteristic genetic alteration in this tumor?

  • A. t(12;15)(p13,q25) ETV6-NTRK3
  • B. t(2;22)(q33;q12) FEV-EWS
  • C. t(11;19)(q21;p13) CRTC1-MAML2
  • D. BRAF V600E mutation

Q2. Adjuvant therapy with radioactive iodine would be effective.

  • A. True
  • B. False



Mitra Mehrad, M.D.
Assistant Professor
Department of Pathology, Microbiology and Immunology
Vanderbilt University Medical Center, Nashville, TN

One Reply to “Head & Neck Case Review 2020-01”

  1. Terrific case; I worked up a secretory carcinoma (1cm mass of the parotid in a 12 year old) a few years ago and experience similar IHC findings, in addition to diffuse strong mammaglobin reactivity; Dr. Seethala and Dr. Chiosea at UPMC assisted with molecular analysis.

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