Invasive follicular variant of papillary thyroid cancer harboring the NRAS mutation Q61K and presenting with bone metastasis—A case report Raman Mehrzad,

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Invasive follicular variant of papillary thyroid cancer harboring the NRAS mutation Q61K and presenting with bone metastasis—A case report Raman Mehrzad, Michiya Nishino, Carmelo Nucera, Dora Dias-Santagata, James V. Hennessey, Per-Olof Hasselgren International Journal of Surgery Case Reports Volume 38, Pages 180-184 (January 2017) DOI: 10.1016/j.ijscr.2017.06.067 Copyright © 2017 The Author(s) Terms and Conditions

Fig. 1 Abdominal/pelvic CT obtained when the patient presented to the ER with right hip pain. International Journal of Surgery Case Reports 2017 38, 180-184DOI: (10.1016/j.ijscr.2017.06.067) Copyright © 2017 The Author(s) Terms and Conditions

Fig. 2 Core biopsy of right iliac lesion. (A) Follicular cells with ovoid nuclei, chromatin pallor, and mild nuclear contour irregularity (hematoxylin & eosin, 400× magnification). Tumor cells are positive for thyroglobulin (B) and TTF-1 (C) by immunohistochemistry (400× magnification). International Journal of Surgery Case Reports 2017 38, 180-184DOI: (10.1016/j.ijscr.2017.06.067) Copyright © 2017 The Author(s) Terms and Conditions

Fig. 3 Thyroid ultrasound demonstrating a 1.4×1.5×2cm heterogenous nodule with internal calcifications in the right thyroid lobe. International Journal of Surgery Case Reports 2017 38, 180-184DOI: (10.1016/j.ijscr.2017.06.067) Copyright © 2017 The Author(s) Terms and Conditions

Fig. 4 Total thyroidectomy. (A) Thyroid tumor partially surrounded by fibrous capsule (dotted line), with infiltrative growth into the surrounding thyroid parenchyma (20× magnification). (B) Tumor cells show follicular architecture and nuclear atypia characteristic of papillary thyroid carcinoma, including nuclear crowding, mild nuclear contour irregularity, nuclear grooves (arrows), and chromatin pallor (400× magnification). (C) Tumor shows vascular invasion (arrow; 100× magnification). Hematoxylin & eosin. International Journal of Surgery Case Reports 2017 38, 180-184DOI: (10.1016/j.ijscr.2017.06.067) Copyright © 2017 The Author(s) Terms and Conditions