Papillary thyroid carcinoma has a number of unique morphologic features. I mentioned psammoma bodies a few days ago. Illustrated above is another characteristic feature: Orphan Annie nuclei. These are so named because they have a “cleared-out” appearance, similar to Little Orphan Annie’s eyes. In fact, you can think of papillary thyroid carcinoma as the Little Orphan Annie tumor because:

1. It stays around for years and years without getting any bigger (papillary carcinoma is slow growing).
2. It is well-behaved and seldom kills people (overall, the 10-year survival for papillary carcinoma is >90%, which is better than the prognosis of any of the other types of thyroid carcinoma).
3.  The nuclei resemble Little Orphan Annie’s eyes.
4.  It often has psammoma bodies (derived from the Greek psammos, or sand): Annie’s dog is named Sandy.

I wish I could say I came up with this, but it comes from Ed’s Pathology Notes, a really wonderful pathology site for students (and anyone interested in pathology) at

7 Responses to The Little Orphan Annie tumor

  1. mark says:

    Add Annie is drawn on paper (PAPillary)

  2. Lindsey says:

    What does the term “papillary” refer to?

  3. Kristine says:

    “Papillary” refers to the way the tumor cells are arranged. Papillae are long, branching structures that have a fibrovascular core and are lined by tumor cells. They kind of look like tree trunks with branches. A papillary pattern is seen in lots of different kinds of tumors (like papillary thyroid carcinoma and papillary cystadenoma of the ovary).

  4. Hui Mei says:

    Is intranuclear inclusion body which make the tumor cell looks like orphan Annie eye?

  5. Kristine says:

    No – it is the arrangement of the chomatin in the tumor cells that gives the nuclei the Little Orphan Annie eyes (it condenses around the periphery of the nucleus, leaving the middle of the nucleus “empty”).

  6. avnika says:

    why is this orphan annie appearance seen only on paraffin sections and not on cytology smears?

  7. Kristine says:

    It’s an artifact of fixation – so not present on smears.

Leave a Reply

Your email address will not be published. Required fields are marked *