Flashcards in ENT Deck (440)
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Granulomatous thyroiditis:
A. Age group.
B. Symptoms.
A. Middle-aged women.
B. Thyroidal tenderness, fever, sore throat, malaise.
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Granulomatous thyroiditis: Hormonal status.
Initial phase: T4 and T3 often elevated.
Resolution: Usually euthyroid, but can be hypothyroid.
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Granulomatous thyroiditis: Histology (3).
Foreign-body granulomas centered on follicles.
Giant cells with ingested colloid; neutrophils early; mononuclear cells.
Variable fibrosis.
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Granulomatous thyroiditis vs. sarcoidosis.
Sarcoidosis: Granulomas are in the interstitium rather than centered on follicles.
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Granulomatous thyroiditis vs. fungal thyroiditis.
Fungal thyroiditis: Usually acute inflammation with necrosis; granulomas are less frequent.
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Granulomatous thyroiditis vs. Hashimoto's thyroiditis.
Hashimoto's thyroiditis:
- Germinal centers.
- Oncocytic change.
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Granulomatous thyroiditis vs. palpation thyroiditis.
Palpation thyroiditis:
- Fewer giant cells and mononuclear cells within thyroid follicles.
- No neutrophils.
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Hashimoto's thyroiditis:
A. Geography.
B. Associated HLA types.
A. Areas with abundant iodine.
B. DR3, DR5.
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Hashimoto's thyroiditis: Associated genetic diseases (3).
Turner's syndrome.
Down's syndrome.
Familial Alzheimer's disease.
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Hashimoto's thyroiditis: Pitfalls in diagnosis (2).
Parasitic nodules may be confused with nodal metastases.
Optically clear nuclei may be overdiagnosed as papillary thyroid carcinoma.
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Hashimoto's thyroiditis: Lymphocytes.
Mixture of B and T cells.
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Hashimoto's thyroiditis vs. nonspecific lymphocytic thyroiditis (3).
Nonspecific lymphocytic thyroiditis:
− Fewer germinal centers.
− No oncocytic change.
− Minimal fibrosis.
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Riedel's thyroiditis:
A. Age group.
B. Associated fibrosing disorders (3).
A. Peak in the fifth decade.
B. Mediastinal fibrosis; retroperitoneal fibrosis; sclerosing cholangitis.
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Riedel's thyroiditis: Inflammation.
Lymphocytes, plasma cells, neutrophils, histiocytes, eosinophils.
No giant cells, no germinal centers.
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Riedel's thyroiditis: Vascular change.
"Occlusive phlebitis": Lymphocytes and plasma cells cause thickened wall and myxoid change.
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Riedel's thyroiditis vs. undifferentiated thyroid carcinoma.
The carcinoma contains scattered malignant cells; IHC may help.
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Riedel's thyroiditis:
A. Treatment.
B. Outcome.
A. Corticosteroids or tamoxifen; surgery as needed.
B. Hypothyroidism in half of cases.
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Graves' disease: Associated HLA types.
DR3, B8.
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Histology of Graves' disease:
A. Untreated.
B. After treatment with radioactive iodine.
A. Hyperplastic thyroid follicles with decreased colloid; variable lymphocytic inflammation.
B. Nuclear atypia, stromal fibrosis, more colloid.
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Amyloid goiter:
A. Location of amyloid.
B. Other histologic features (2).
A. Around vessels and between thyroid follicles.
B. Squamous metaplasia, secondary atrophy of follicles.
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Dyshormogenetic goiter: Most common functional defect.
Inability to incorporate iodine.
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Dyshormogenetic goiter: Most commonly associated malignancy.
Follicular carcinoma.
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Dyshormogenetic goiter: Gross appearance.
Enlarged, nodular thyroid gland.
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Dyshormogenetic goiter: Histologic architecture (2).
Small follicles contain scant colloid and form clusters that are separated from one another by fibrous bands.
Follicular cells may form papillae.
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Dyshormogenetic goiter: Cytology.
Often hypercellular and pleomorphic.
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Thyroglossal-duct cyst:
A. Lining epithelium.
B. Stroma.
A. Respiratory or squamous.
B. Mucus glands and thyroid follicles.
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Thyroglossal-duct cyst: Most commonly associated malignancy.
Papillary thyroid carcinoma.
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Causes of finding of ciliated cells on FNA of the thyroid gland (2).
Thyroglossal-duct cyst.
Tracheal aspirate.
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Branchial-cleft cyst:
A. Anatomic site.
B. Origins (4).
A. Anterolateral neck.
B. 1st, 2nd, 3rd, or 4th branchial pouch.
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