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Figure 2: Histologic features of thyroid follicular carcinoma with signet ring cells. (a) Nested pattern of follicular cells, some with intracytoplasmic vacuoles imparting a signet ring cell appearance, and surrounding fine vasculature (H and E, ×400); (b) An area with marked cellular atypia (H and E, ×200). (c) Vascular invasion within the capsule, with fibrin thrombus formation associated with neoplastic follicular cells (arrow) (H and E, ×400). (d) ERG transcription factor immunohistochemistry, highlighting the endothelial cells (double arrows) lining the vascular space with neoplastic follicular cells within the lumen (×400). (e) Neoplastic cells negative for mucin (Mucicarmine, ×400). (f) Neoplastic cells positive for thyroglobulin (Thyroglobulin, ×200)

Figure 2: Histologic features of thyroid follicular carcinoma with signet ring cells. (a) Nested pattern of follicular cells, some with intracytoplasmic vacuoles imparting a signet ring cell appearance, and surrounding fine vasculature (H and E, ×400); (b) An area with marked cellular atypia (H and E, ×200). (c) Vascular invasion within the capsule, with fibrin thrombus formation associated with neoplastic follicular cells (arrow) (H and E, ×400). (d) ERG transcription factor immunohistochemistry, highlighting the endothelial cells (double arrows) lining the vascular space with neoplastic follicular cells within the lumen (×400). (e) Neoplastic cells negative for mucin (Mucicarmine, ×400). (f) Neoplastic cells positive for thyroglobulin (Thyroglobulin, ×200)