The diagnostic accuracy of medullary carcinoma is very high because it commonly presents characteristic features, including a dispersed cell pattern formed by pleomorphic cells with extremely eccentric nuclei that contain coarsely granular to salt-pepper-type chromatin. However, medullary carcinoma cells sometimes demonstrate a monomorphic cell pattern, comprised exclusively of plasmacytoid cells with abundant eosinophilic cytoplasm and sharing strong similarity with oxyphilic cell neoplasms, thus constituting the important diagnostic pitfalls. A distinction between Hürthle cell neoplasm and medullary carcinoma can be made by the extremely marginal location of the nuclei with coarsely granular to salt-pepper-type chromatin for the medullary carcinoma cells and prominent macronucleoli for the Hürthle cells. Sometimes apparent cytoplasmic granularity could be observed in Hürthle cells, which is different from the fibrillar cytoplasm of medullary carcinoma cells with wet-fixation hematoxylin-eosin-stained preparation.
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