The patient presents with a solitary thyroid nodule without lymphadenopathy or distant metastases—a classic presentation of follicular carcinoma. The absence of voice changes or dysphagia suggests no local invasion at presentation.
The microfollicular pattern with increased mitotic activity and focal capsular invasion described in this case is diagnostic of follicular carcinoma.
| Feature | Follicular Adenoma | Follicular Carcinoma |
|---|---|---|
| Capsule | Present, intact | Present, invaded |
| Vascular invasion | Absent | Present (diagnostic) |
| Mitotic activity | Low | Increased |
| Lymph node involvement | No | Rare |
| Distant metastases | No | Common (bone, lung) |
| Prognosis | Excellent | Good to fair |
Follicular carcinoma typically spreads hematogenously (to bone and lung) rather than lymphatically, explaining the absence of cervical lymphadenopathy in this case. This contrasts sharply with papillary carcinoma, which spreads to regional lymph nodes early.
Once follicular carcinoma is diagnosed on histology (after thyroidectomy), the patient requires:
Robbins 10e Ch 24
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