10/9- Pathology of the Thyroid Flashcards Preview

MS2 Endocrine > 10/9- Pathology of the Thyroid > Flashcards

Flashcards in 10/9- Pathology of the Thyroid Deck (66):
1

What is this? 

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Thyroid!

2

What is seen here? 

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Follicular cells- originate from endoderm, from foramen cecum

Colloid-

3

What is seen here? 

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C cells

- Brown-staining marks calcitonin-producing cells

- Arise from ?

4

What is Ultrasound Guided FNAB?

Fine Needle Aspiration Biopsy

- Really cut down on amount of thyroidectomies that were performed

- Before FNA, only indication for thyroidectomy was existence of a cold nodule (many benign taken out)

5

What is seen here? 

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Left: histological section

Right: cells from FNA

- Round, regular nuclei

- Cytoplasm fits together in honeycomb pattern; not much overlap

- Very benign thyroid

6

Causes of hypothyroidism?

- Hashimoto thyroiditis (most common cause)

- Surgical or radioactive isotope ablation

7

Causes of hyperthyroidism?

- Diffuse Toxic Hyperplasia (Grave's Disease)

  • Typically in younger women

- Toxic Nodule in Multinodular Goiter (Plummer syndrome)

  • Typically in older women

- Toxic adenoma

- Metastatic Follicular Carcinoma of thyroid

- Excess exogenous thyroid hormone

8

Epidemiology of Hashimoto thyroiditis

- #__ cause of hypothyroidism in iodine ____ regions

- Demographic

- #__ autoimmune endocrine disease

- May result in what

- Characteristic features

- #1 cause of hypothyroidism in iodine sufficient regions

- Young-middle aged women

- #1 autoimmune endocrine disease

- May result in asymmetric enlargement and be confused with a neoplasm

- Lymphoid follicles, oncocytic metaplasia of follicular cells (Hurthle cells)

9

What is seen here? 

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Gross features of Hashimoto's thyroiditis

- More tan/tank-pink than normal (not as red)

- Thyroid parenchyma infiltrated by lymphoid cells

10

What is seen here?

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Hashimoto's thyroiditis

- Asymmetrical

- Very intense thyroiditis (possibly also neoplasm)

11

What is seen here?

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Hashimoto's thyroiditis

- Can see thyroid follicle with germinal center

- Follicular cells show abnormal excess of eosinophilic cytoplasm

12

What is seen here? 

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Typical Hashimoto's thyroiditis

- Lymphoid cells crawling over normal follicular cells

- Follicular epithelium slightly abnormal: pale nuclei

13

What is seen here?

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Islands of atypical cells as the result of inflammation

- Hyperchromasia

- Nuclear grooves

14

Characteristics of Subacute Thyroiditis (Granulomatous, DeQuervain)

- Prognosis

- Gender prevalence

- Cause

- Course

- Features

- Self limited, frequently after URI

- Female 3-5x more affected

- Fever and tender/painful enlargement of thyroid

- Course of 6-8 weeks, with hyperthyroidism to hypothyroidism to normal

- Multinucleated giant cells and acute inflammation with destruction of follicles

15

What is seen here? 

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Subacute Thyroiditis (Granulomatous, DeQuervain)

- Intense area of thyroiditis

- Makes clinical nodule

16

What is seen here? 

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Subacute Thyroiditis (Granulomatous, DeQuervain)

- Destruction of follicle?

17

What is seen here?

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Subacute Thyroiditis (Granulomatous, DeQuervain)

- Follicle is being destroyed

- Colloid leaks directly into bloodstream, leading to initial hyperthyroidism

- After a time, depletion causes hypothyroidism

18

What is seen here? 

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Subacute Thyroiditis (Granulomatous, DeQuervain)

- Multinucleated giant cells

- Colloid on left

19

What is seen here?

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Subacute Thyroiditis (Granulomatous, DeQuervain)

- Multinucleated giant cells

20

What is Reidel Thyroiditis?

- Prevalence

- Pathology

- Similar to what

- Very rare

- Dense fibrosis replacement of thyroid gland with extension into adjacent tissue

- Simulates carcinoma clinically

21

What is seen here? 

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Reidel Thyroiditis

- Dense lymphocytic infiltrate

- Large ropey collagen bands between infiltrate

- Few scattered follicles

22

What is seen here?

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Reidel Thyroiditis

- Few scattered follicles

- Dense collagen bundles

23

What is seen here?

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Reidel Thyroiditis

- Dense fibrosis growing out into adjacent strap muscles around thyroid

24

Characteristics of Graves Disease

- Demographic

- Symptoms

- Lab findings

- Mechanism

- Aka diffuse toxic goiter

- 1-2 % of women (females 7x more)

- Exophthalmos common

- Autoantibodies activate TSH receptor

- Increase in size of gland with hyperplasia of the follicular cells

25

What is seen here? 

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Graves?

26

What is seen here? 

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Graves

- Follicles no longer round

- Hyperplastic cells; pile up within follicles

27

What is seen here? 

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Normal thyroid

- Cells relatively quiescent

28

What is seen here? 

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Graves Disease

- Nuclei open

- Actively synthesizing protein

- Very active cells

29

What is seen here? 

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Radioactive scan of thyroid in Grave's disease

- Diffuse concentration

30

What is a multinodular goiter?

- Etiology

- Similar to

- Symptoms

- Transformation

- Much more in women

- Etiology other than iodine deficiency unclear

- Most common mimic of thyroid neoplasia clinically

- May produce extreme enlargement

- Component nodule is “adenomatous” or hyperplastic nodule

- Multiple ill defined nodules with colloid lakes (colloid nodules)

- An individual nodule may become toxic (Plummer’s syndrome) later in life

31

What is seen here?

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Multinodular goiter

- Typically asymmetrical

32

What is seen here?

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Multinodular goiter- cut section (Benign adenomatous nodule)

- Colloid lakes (areas of degeneration)

- Not well capsulated; ill-defined

- Vague hyperplastic nodules replace thyroid parenchyma

33

What is seen here? 

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Multinodular goiter

- Large follicles (100x normal)

- Lots of colloid

- Cells lining the follicles look normal

34

What is seen here?

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Multinodular goiter

- Hemosiderin lake of macrophages from area of old hemorrhage

35

What is seen here? 

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Multinodular goiter

- Bland clusters of ?

- Much background colloid

36

What is seen here?

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Adenomatous nodule that underwent cystic degeneration

- Nodule itself has internal septi

- Some adenomatous nodule remaining on rim

- Remnant could be targeted with US

- Vast majority of cystic nodules like this are adenomatous with cystic degeneration (rarely cystic papillary adenoma)

37

What is seen here? 

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Scan of pt with Plummer syndrome

- Can see some nodularity with hyperfunctioning that is suppressing much of the rest of the gland function

- Autonomously functioning thyroid nodule arising from multinodular goiter

38

Most tumors of thyroid derive from what?

Follicular epithelium

- Can be adenoma or carcinoma

- Nodules are typically composed of discrete thyroid follicles (small or normal sized)

- Well defined capsule

- Surrounding thyroid is relatively normal

39

What is seen here? 

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Thyroid adenoma

- White discrete fibrous capsule; well-defined

- Normal surrounding thyroid

40

Which is more common: follicular adenoma or carcinoma?

Adenoma is 10x more common than carcinoma (?)

41

What is seen here? 

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- Fibrous capsule

- Benign neoplasm forming small micro-follicles

42

What is seen here?

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Follicular carcinoma

- Tumor on the bottom

- Compressed normal thyroid adjacent

- Carcinoma breaking through dense fibrous capsule into surrounding gland (capuslar invasion)

43

What is seen here? 

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Follicular carcinoma: vascular invasion?

44

Papillary cancer typically metastasizes where? Follicular?

Papillary -> local LNs

Follicular -> bones

45

What is seen here?

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Papillary cancer

- Not well encapsulated

- Irregular border

- Invasive

- Fibrous look

46

What is seen here?

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Papillary cancer

- Clear nuclei; characteristic of this type of cancer!!

47

What is seen here? 

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Medullary carcinoma

- Cancer of C cell (calictonin producing cell)

48

What is seen here?

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Medullary carcinoma

- Relatively small cells

- Not forming follicles or papilla

- Background pink amyloid (beta-pleated sheet pattern) due to hormones (Calcitonin)

49

What is seen here? 

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Ultrastructural analysis of medullary carcinoma

- Dense core neurosecretory granules; characteristic of tumors that drive neuroectoderm

50

What is seen here?

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Anaplastic carcinoma

- Rare; 1-2% of thyroid cancers

- Poor prognosis; essentially incurable

- Older individuals

51

What is seen here?

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Anaplastic carcinoma

- Tumor encased espohagus/epiglottis area

52

What is seen here?

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Low grade papillary carcinoma

- Developed rapidly growing cancer within this (on the right)

- Cells on the right are much more anaplastic (huge nucleolus, many mitotic figures)...

53

Embryologic development of the thyroid?

- Derives from foramen cecum, midline base of tongue (not degraded by GIT; can take orally)

- Descends in the midline neck, may result in lingual throid, thryoglossal duct cyst or pyramidal lobe

54

What are the main cell types of the thyroid? Origin?

- Follicular cells (endoderm)

- C-cells (neural crest)

55

What is seen here? 

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Thyroglossal duct cyst

- Cells lining cystic space proliferate, die, produce necrotic material that accumulates in this cystic space -> enlargement

56

Parathyroid glands originate from what embryological structure(s)

3rd and 4th pharyngeal pouch

57

How many parathyroids are there?

Typically 4

58

What is seen here? 

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Adipose tissue and chief cells, oxolytic cells, etc. all in parathyroid gland

59

What are causes of primary hyperparathyroidism?

- Parathyroid adenoma (85%)

  • More common in women (40s/50s)

- Parathryoid hyperplasia (15%)

- Parathryoid carcinoma (under 1%)

60

What are some causes of hypercalcemia?

Malignancy

- Osteolytic metastases

- PTH-like hormone production

Hyperparathyroidism

Other

61

What is seen here? 

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Parathyroid adenoma

62

What is seen here?

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Parathyroid adenoma

- Diffuse population of relatively benign appearing cells (just too many of them)

63

What is seen here? 

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Parathyroid carcinoma

64

What is seen here?

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Parathyroid carcinoma

- Cells don't look benign

- Nuclear irregularity

65

What is seen here? 

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Parathyroid adenoma

66

What is seen here? 

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Parathyroid carcinoma