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ATLAS OF TUMOR PATHOLOGY

Third Series
Fascicle 5

TUMORS OF THE THYROID GLAND
by
JUAN ROSAI, M.D.
Department of Pathology
Memorial Sloan-Kettering Cancer Center
New York, New York 10021

MARIA LUISA CARCANGIU, M.D.
Department of Pathology
Yale University School of Medicine
New Haven, Connecticut 06510
and
RONALD A. DELELLIS, M.D.
Department of Pathology
Tufts University School of Medicine
and the New England Medical Center
Boston, Massachusetts 02111

ATLAS OF TUMOR PATHOLOGY

EDITOR
JUAN ROSAI, M.D.
Department of Pathology
Memorial Sloan-Kettering Cancer Center
New York, New York 10021-6007

ASSOCIATE EDITOR
LESLIE H. SOBIN, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000

EDITORIAL ADVISORY BOARD

Jeffrey Cossman, M.D.
Georgetown University School of Medicine
Washington, D.C. 20007

Ronald A. DeLellis, M.D.
Tufts University School of Medicine
Boston, Massachusetts 02111

Glauco Frizzera, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000

Leonard B. Kahn, M.D.
Long Island Jewish Hospital
New Hyde Park, New York 11042

Richard L. Kempson, M.D.
Stanford University Medical School
Stanford, California 94305

Paul Peter Rosen, M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York 10021

Robert E. Scully, M.D.
Harvard Medical School and
Massachusetts General Hospital
Boston, Massachusetts 02114

Steven G. Silverberg, M.D.
The George Washington University School of
Medicine
Washington, D.C. 20037

Sharon Weiss, M.D.
University of Michigan School of Medicine
Ann Arbor, Michigan 48109-0602

EDITORS' NOTE
The Atlas of Tumor Pathology has a long and
distinguished history. It was first conceived at a
Cancer Research Meeting held in St. Louis in
September 1947 as an attempt to standardize the
nomenclature of neoplastic diseases. The first
series was sponsored by the National Academy
of Sciences-National Research Council. The
organization of this Sisyphean effort was
entrusted to the Subcommittee on Oncology of
the Committee on Pathology, and Dr. Arthur
Purdy Stout was the first editor-in-chief. Many of
the illustrations were provided by the Medical
Illustration Service of the Armed Forces Institute
of Pathology, the type was set by the
Government Printing Office, and the final printing
was done at the Armed Forces Institute of
Pathology (hence the colloquial appellation "AFIP
Fascicles"). The American Registry of Pathology
purchased the Fascicles from the Government
Printing Office and sold them virtually at cost.
Over a period of 20 years, approximately 15,000
copies each of nearly 40 Fascicles were
produced. The worldwide impact that these
publications have had over the years has largely
surpassed the original goal. They quickly became
among the most influential publications on tumor
pathology ever written, primarily because of their
overall high quality but also because their low
cost made them easily accessible to pathologists
and other students of oncology the world over.

Upon completion of the first series, the National
Academy of Sciences-National Research Council
handed further pursuit of the project over to the
newly created Universities Associated for
Research and Education in Pathology (UAREP).
A second series was started, generously
supported by grants from the AFIP, the National
Cancer Institute, and the American Cancer
Society. Dr. Harlan I. Firminger became the
editor-in-chief and was succeeded by Dr. William
H. Hartmann. The second series Fascicles were
produced as bound volumes instead of loose
leaflets. They featured a more comprehensive
coverage of the subjects, to the extent that the
Fascicles could no longer be regarded as
"atlases" but rather as monographs describing
and illustrating in detail the tumors and tumor-like
conditions of the various organs and systems.

Once the second series was completed, with a
success that matched that of the first, UAREP
and AFIP decided to embark on a third series. A
new editor-in-chief and an associate editor were
selected, and a distinguished editorial board was
appointed. The mandate for the third series
remains the same as for the previous ones, i.e.,
to oversee the production of an eminently
practical publication with surgical pathologists as
its primary audience, but also aimed at other
workers in oncology. The main purposes of this
series are to promote a consistent, unified, and
biologically sound nomenclature; to guide the
surgical pathologist in the diagnosis of the various
tumors and tumor-like lesions; and to provide
relevant histogenetic, pathogenetic, and
clinicopathologic information on these entities.
Just as the second series included data obtained
from ultrastructural (and, in the more recent
Fascicles, immunohistochemical) examination,
the third series will, in addition, incorporate
pertinent information obtained with the newer
molecular biology techniques. As in the past, a
continuous attempt will be made to correlate,
whenever possible, the nomenclature used in the
Fascicles with that proposed by the World Health
Organization's International Histological
Classification of Tumors. The format of the third
series has been changed in order to incorporate
additional items and to ensure a consistency of
style throughout. This includes the dropping of
the 's possessive in eponymic terms, in
accordance with the WHO and the International
Nomenclature of Diseases. Close cooperation
between the various authors and their respective
liaisons from the editorial board will be
emphasized to minimize unnecessary repetition
and discrepancies in the text and illustrations.

To its everlasting credit, the participation and
commitment of the AFIP to this venture is even
more substantial and encompassing than in
previous series. It now extends to virtually all
scientific, technical, and financial aspects of the
production.

The task confronting the organizations and
individuals involved in the third series is even
more daunting than in the preceding efforts
because of the ever-increasing complexity of the
matter at hand. It is hoped that this combined
effort -- of which, needless to say, that
represented by the authors is first and foremost --
will result in a series worthy of its two illustrious
predecessors and will be a suitable introduction
to the tumor pathology of the twenty-first century.

Juan Rosai, M.D. Leslie H. Sobin, M.D.

ACKNOWLEDGMENTS
Many are the individuals to whom we are indebted
for their contributions to the preparation of this
Fascicle. Drs. Shields Warren and William A.
Meissner, as the co-authors of the First and
Second Series of this Fascicle, provided us with
a succinct but superb model upon which to build,
both in terms of text and illustrations. Many
pathologists have generously supplied us with
material that we have used in this Fascicle,
whether by submitting cases to us for an opinion
or by contributing slides or photographs for this
specific purpose. Due to space limitations, only
the latter have been specifically acknowledged in
the corresponding legends. Special thanks are
due to Dr. Robert A. Erlandson, Director of the
Diagnostic Electron Microscopy Laboratory of the
Department of Pathology of Memorial
Sloan-Kettering Cancer Center, New York, New
York, for the many excellent electron
micrographs he contributed, and to Dr. Sudha R.
Kini, Director of the Cytopathology Laboratory of
the Department of Pathology of Henry Ford
Hospital, Detroit, Michigan, for having allowed us
to reproduce many of the photographs of her
outstanding book on aspiration biopsy of the
thyroid gland.

The two anonymous reviewers of this Fascicle
made an extremely detailed and highly welcomed
list of useful suggestions, practically all of which
have been incorporated into the final version of the
manuscript.

Ms. Andrea Mae Feldman typed and edited
countless versions of this work with great skill,
celerity, and patience, while performing a great
deal of editing as an added bonus. Mr. Henry
Douglas and Mr. Gerry Parker provided expert
assistance with the photographic reproductions.

Last, but not least, we would like to express our
deep appreciation to Professor Giancarlo Zampi,
Chairman of the Institute of Anatomic Pathology
of the University of Florence Medical School,
Florence, Italy, for having generously made
available his outstanding collection of thyroid
tumors, for providing the institutional support
needed to evaluate this material, for having
sponsored an extremely informative and
enjoyable International Symposium on Thyroid
Tumors in San Miniato, Italy, and for having
shared with us his many thoughtful
considerations and opinions on the subject.

Juan Rosai, M.D. Maria Luisa Carcangiu,
M.D. Ronald A. DeLellis, M.D.

Permission to use copyrighted illustrations has
been granted by:

Appleton & Lange: Pathol Annu 16(pt.2):25-52,
1981. For figure 237.

Cahners Publishing Company: Am J Surg
52:82-5, 1941. For figure 292.

C.V. Mosby Company: Ackerman and Del
Regato's Cancer. Diagnosis, Treatment and
Prognosis, 6th ed., 1985. For figure 3.

Igaku-Shoin Medical Publishers, Inc.: Guides to
Clinical Aspiration Biopsy. Thyroid. 1987. For
figures 24-28, 83-86, 88, 89, 102, 142, 143, 161,
162, 210, 211, 249, and 263.

Massachusetts Medical Society: N Engl J Med
270:927-32, 1964. For figure 297.

Raven Press Ltd.: Am J Surg Pathol 5:438-48,
1991. For figures 186 and 187.

Springer-Verlag Heidelberg: Virchows Arch [A]
189:69-52, 1907. For figure 115.

Williams and Wilkins Company: Lab Invest
36:237-48, 1977. For figures 229, 233, and 238.

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