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

10/9- Pathology of the Thyroid Flashcards

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1
Q

What is this?

A

Thyroid!

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2
Q

What is seen here?

A

Follicular cells- originate from endoderm, from foramen cecum

Colloid-

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3
Q

What is seen here?

A

C cells

  • Brown-staining marks calcitonin-producing cells
  • Arise from ?
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4
Q

What is Ultrasound Guided FNAB?

A

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)
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5
Q

What is seen here?

A

Left: histological section

Right: cells from FNA

  • Round, regular nuclei
  • Cytoplasm fits together in honeycomb pattern; not much overlap
  • Very benign thyroid
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6
Q

Causes of hypothyroidism?

A
  • Hashimoto thyroiditis (most common cause)
  • Surgical or radioactive isotope ablation
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7
Q

Causes of hyperthyroidism?

A

- 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

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8
Q

Epidemiology of Hashimoto thyroiditis

  • # __ cause of hypothyroidism in iodine ____ regions
  • Demographic
  • # __ autoimmune endocrine disease
  • May result in what
  • Characteristic features
A
  • #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)
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9
Q

What is seen here?

A

Gross features of Hashimoto’s thyroiditis

  • More tan/tank-pink than normal (not as red)
  • Thyroid parenchyma infiltrated by lymphoid cells
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10
Q

What is seen here?

A

Hashimoto’s thyroiditis

  • Asymmetrical
  • Very intense thyroiditis (possibly also neoplasm)
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11
Q

What is seen here?

A

Hashimoto’s thyroiditis

  • Can see thyroid follicle with germinal center
  • Follicular cells show abnormal excess of eosinophilic cytoplasm
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12
Q

What is seen here?

A

Typical Hashimoto’s thyroiditis

  • Lymphoid cells crawling over normal follicular cells
  • Follicular epithelium slightly abnormal: pale nuclei
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13
Q

What is seen here?

A

Islands of atypical cells as the result of inflammation

  • Hyperchromasia
  • Nuclear grooves
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14
Q

Characteristics of Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Prognosis
  • Gender prevalence
  • Cause
  • Course
  • Features
A
  • 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
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15
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Intense area of thyroiditis
  • Makes clinical nodule
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16
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Destruction of follicle?
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17
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Follicle is being destroyed
  • Colloid leaks directly into bloodstream, leading to initial hyperthyroidism
  • After a time, depletion causes hypothyroidism
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18
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Multinucleated giant cells
  • Colloid on left
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19
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Multinucleated giant cells
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20
Q

What is Reidel Thyroiditis?

  • Prevalence
  • Pathology
  • Similar to what
A
  • Very rare
  • Dense fibrosis replacement of thyroid gland with extension into adjacent tissue
  • Simulates carcinoma clinically
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21
Q

What is seen here?

A

Reidel Thyroiditis

  • Dense lymphocytic infiltrate
  • Large ropey collagen bands between infiltrate
  • Few scattered follicles
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22
Q

What is seen here?

A

Reidel Thyroiditis

  • Few scattered follicles
  • Dense collagen bundles
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23
Q

What is seen here?

A

Reidel Thyroiditis

  • Dense fibrosis growing out into adjacent strap muscles around thyroid
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24
Q

Characteristics of Graves Disease

  • Demographic
  • Symptoms
  • Lab findings
  • Mechanism
A
  • 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
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25
What is seen here?
Graves?
26
What is seen here?
Graves - Follicles no longer round - Hyperplastic cells; pile up within follicles
27
What is seen here?
Normal thyroid - Cells relatively quiescent
28
What is seen here?
Graves Disease - Nuclei open - Actively synthesizing protein - Very active cells
29
What is seen here?
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?
Multinodular goiter - Typically asymmetrical
32
What is seen here?
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?
Multinodular goiter - Large follicles (100x normal) - Lots of colloid - Cells lining the follicles look normal
34
What is seen here?
Multinodular goiter - Hemosiderin lake of macrophages from area of old hemorrhage
35
What is seen here?
Multinodular goiter - Bland clusters of ? - Much background colloid
36
What is seen here?
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?
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?
**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?
- Fibrous capsule - Benign neoplasm forming small micro-follicles
42
What is seen here?
**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?
Follicular carcinoma: vascular invasion?
44
Papillary cancer typically metastasizes where? Follicular?
Papillary -\> local LNs Follicular -\> bones
45
What is seen here?
**Papillary cancer** - Not well encapsulated - Irregular border - Invasive - Fibrous look
46
What is seen here?
Papillary cancer - Clear nuclei; characteristic of this type of cancer!!
47
What is seen here?
Medullary carcinoma - Cancer of C cell (calictonin producing cell)
48
What is seen here?
**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?
Ultrastructural analysis of medullary carcinoma - Dense core neurosecretory granules; characteristic of tumors that drive neuroectoderm
50
What is seen here?
**Anaplastic carcinoma** - Rare; 1-2% of thyroid cancers - Poor prognosis; essentially incurable - Older individuals
51
What is seen here?
Anaplastic carcinoma - Tumor encased espohagus/epiglottis area
52
What is seen here?
**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?
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?
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?
Parathyroid adenoma
62
What is seen here?
Parathyroid adenoma - Diffuse population of relatively benign appearing cells (just too many of them)
63
What is seen here?
Parathyroid carcinoma
64
What is seen here?
Parathyroid carcinoma - Cells don't look benign - Nuclear irregularity
65
What is seen here?
Parathyroid adenoma
66
What is seen here?
Parathyroid carcinoma

MS2 Endocrine (25 decks)

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