10/22- Lab: Endocrine Pathology Flashcards
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?
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?
Radioactive iodine uptake scan (RIUS)
- Increased area of absorption
- Probably suppressing the rest of the thyroid (?)
What is seen here?
- Benign or malignant?
- 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?
- 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?
Normal thyroid
- Colloid is comprised mostly of secreted T3 and T4
What is seen here?
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?
- 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?
- 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
- 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?
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?
- 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?
- 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?
- Can see normal dark red/magenta of thyroid
- Mass is lumpy, see areas of necrosis and vasculature (confirms malignant diagnosis)
What is seen here?
- 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?
- 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?
“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?
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?
Normal adrenal gland
- Tricorn/pyramidal shape
What is seen here?
Normal adrenal layers
- Medulla at bottom
What is seen here?
- Structures
- Cell type
- 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 is seen here?
Accumulation of neuroendocrine neurosecratory granules (pheochromocytoma)
What is seen here?
Electron dense granules in lesion of adrenal = pheochromocytoma
- Crystallized versions of E/NE
What is seen here?
Malignant variant of pheochromocytoma
