Papillary carcinomas - Figure 18. Differential diagnostics: Graves' disease.

Graves' disease is rarely encountered among differential diagnostic problems of papillary carcinoma. Nevertheless, papillary structures can be observed occasionally in hyperthyroid phase of Graves' disease. The other issue is the presence of nuclear atypia, i.e. grooves or inclusions in a pateint with Graves' disease. Fortunately, this is a very rare phenomenon.

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Graves' disease - case 30
Coexistent Graves' disease and papillary cancer. Graves' disease - case 5

Note the presence of grooves and an inclusion and the peripheral condensation of chromatin. We could not exclude the possibility of papillary carcinoma.

On the presence of inclusions we had to raise the possibility of a papillary carcinoma.

Graves' disease - case 13

Coexistent Graves' disease and papillary cancer. Papillary carcinomas - case 39
The cause for suspicion of papillary carcinoma was the presence of several inclusions, the nuclear crowding and the presence of multinucleated cell on the smear.
 Inclusions with such frequency are diagnostic for a paillary carcinoma. The presence of lymphocytes within follicular cell group is the consequence of the underlying autoimmune disease.