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A 40-Year-Old Woman Comes to the Physician Because of a Small

Question 464

Multiple Choice

A 40-year-old woman comes to the physician because of a small lump on the right side of her neck that she noticed while putting lotion on 1 week ago. She has not had any weight change, palpitations, or altered bowel habits. The patient's father died of thyroid cancer in his 30s. Menses occur at regular 30-day intervals and last for 4 days. She appears well. Her temperature is 37.0°C (98.6° F) , pulse is 88/min, and blood pressure is 116/74 mm Hg. Examination shows a small nodule on the right side of the neck that moves with swallowing. There is no lymphadenopathy. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. Ultrasound of the neck shows a hypoechoic 0.9-cm (0.35-in) right lobe thyroid mass. Fine-needle biopsy of the nodule is consistent with a subtype of thyroid cancer.  The patient undergoes total thyroidectomy with central neck dissection.  Which of the following is the most likely histological finding?


A) Branching structures with interspersed calcified bodies
B) Follicular hyperplasia with tall cells forming intrafollicular projections
C) Nests of polygonal cells with Congo red-positive deposits
D) Pleomorphic giant cell nests with occasional multinucleated cells
E) Sheets of uniform cells forming small follicles

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