10/22- Lab: Endocrine Pathology Flashcards Preview

MS2 Endocrine > 10/22- Lab: Endocrine Pathology > Flashcards

Flashcards in 10/22- Lab: Endocrine Pathology Deck (29):

What structures do you think if someone feels "a lump" in their throat, but only on one side?

- Thyroid

- Esophagus

- Trachea (surrounding muscles, lymph nodes)

- Large cystic structure in skin


What is seen here?

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Radioactive iodine uptake scan (RAIUS)

- Single cold nodule

- This is probably a tumor (could also be an abscess, but those are less common)


What is seen here?

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Radioactive iodine uptake scan (RIUS)

- Increased area of absorption

- Probably suppressing the rest of the thyroid (?)


What is seen here?

- Benign or malignant? 

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- The central nuclei look pretty regular, but those on the left are larger, varying sizes, with a high N:C ratio

- Abnormal nuclei are roughly normally spaced with eosinophilic cytoplasm

- This is benign

  • Appearance of large atypical cells are common in thyroid (lymphoid?) tumors; can't really diagnose as malignant unless vascular/other invasion


What is seen here?

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- Normal thyroid is dark red/magenta

- See central mass that is well encapsulated and is pushing thyroid off to the side

- This confirms the benign diagnosis from the FNA


What is seen here? 

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Normal thyroid

- Colloid is comprised mostly of secreted T3 and T4



What is seen here?

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Abnormal thyroid

- Much more cellular

- Struggling to form some follicles

- Can see fibrous encapsulation of tumor

- Can base malignancy based on capsule invasion(?) but hard to evaluate entire margin in a thyroid specimen


What is this malignancy specifically?

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- Benign

- Gland forming

- Thyroid origin

Thus thyroid adenoma

- This is a follicular adenoma

(The chromatin here is a fixation artifact)


What is the difference between a thyroid adenoma and a multi-nodular goiter? (student question)

- MNG is a reaction to a stimulus

  • Lack (or excess) of iodide
  • Hypothalamic stimulus (excess TSH)
  • Etc. 

- Adenoma is a true tumor; loss of cellular regulation


Case 2)

- Another patient feeling lump in throat

- FHx of breast cancer with BRCA gene; worried about met

- Skip FNA and excise the lump

What is seen?

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- Central mass is very dark; much vascularization

- Leading edge is pushing through surrounding thyroid and fat



What is seen here? What kind of mass is this?

- Structures

- Cell types

- Benign vs. malignant

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- Circular glandular structures

- Attempting to form colloid

- See cells with open chromatin but also some are hyperchromatic

- This is probably malignant


What is seen here?

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Mass invading all the way through fibrous capsule

- Malignant, no matter how well-differentiated it is

- Invading the capsule is what distinguishes between benign and malignant!!


What is seen here?

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- Circular structure; has some very flattened endothelial cells

- Endothelial cell structure here is filled with tumor (rather than blood or lymphatic fluid)

This is tumor invading lymphatics

- Multiple lymph nodes on patient's neck filled with tumor


Case 3)

- Patient comes in feeling a little hoarse/raspy and has a lump in her throat

- No smoking history; does not drink alcohol

What could be a reason for hoarseness with mass in the neck?

Impaction of recurrent laryngeal nerve

- This symptom alone is indicative of a malignancy


What is the prognosis for thyroid tumors?

Even metastatic anaplastic thyroid tumors have a 90% cure rate; with papillary and follicular 100%


What is seen here?

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- Cells are not all same size/shape

- Cells in bottom right are "coffee-bean nuclei"

  • Very few tumors have this characteristic nuclei appearance


What is seen here?

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- Can see normal dark red/magenta of thyroid

 - Mass is lumpy, see areas of necrosis and vasculature (confirms malignant diagnosis)


What is seen here?

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- All of the cells are squashed on top of each other due to rapid growth

- Fingerlike projection of cells

- On top right, can see very small capillary (central capillary core with tumor arrange around it = papillary structure)


What is seen here?

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- Malignant

- Epithelial origin

- Papillary

- Thyroid origin

Thus, this is a papillary thyroid carcinoma

- Can be poorly-> well differentiated (this one is moderately-to-well differentiated)


What are pointed out here?

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"Orphan Annie" appearance of inclusions


Case 4)

- Young male adult comes in very jittery and nervous with massive headache

- BP is 220/190

- Find 4 cm mass over kidney on imaging

- Resected out

What is seen here?


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Abnormal adrenal gland

- Can see whitish yellow rim around mass indicative of some kind of fatty tissue; something in the center has pushed the adrenal cortex to this side


What is seen here?

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Normal adrenal gland

- Tricorn/pyramidal shape


What is seen here?

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Normal adrenal layers

- Medulla at bottom


What is seen here?

- Structures

- Cell type

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- Hypercellular

- Intense vascularity

Form balls of cells (Z---)

Nuclei of "salt and pepper" chromatin distribution

- Very characteristic of neuroendocrine endocrine tumors

- Seem to be of adrenal medulla origin


What tumors arise in the adrenal medulla?

Basically just pheochromocytoma

- Other types are extraordinarily rare


What is the prognosis of pheochromocytoma?


- 10% malignant; to tell, would have to pick up metastasis somewhere else

- 10% arise outside of adrenal medulla, so hard to tell if those are primary or metastatic


What is seen here?

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Accumulation of neuroendocrine neurosecratory granules (pheochromocytoma)



What is seen here?

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Electron dense granules in lesion of adrenal = pheochromocytoma

- Crystallized versions of E/NE


What is seen here?

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Malignant variant of pheochromocytoma