L88- Thyroid PAthology Flashcards Preview

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Flashcards in L88- Thyroid PAthology Deck (21):
1

What is a Thyroglossal Duct cyst? 

What is the differential diagnosis for those? 

Vestigial remnants from thyroid migration the become cystic 

can occur at any age and occurs anywhere in midline neck - anterior to trachea

See Squamous or Thyroid follicular lining cells w/ limphoid infiltrate

 

DDX: Squamous cell carcinoma or Branchial cleft cyst (typically more lateral) 

 

 

2

What does Iodine Deficiency cause? 

Diffuse non-toxic goiter

3

The best way to biopsy a thyroid nodule is FNA. But the best way to know if carcinoma vs adenoma is w/ capsular and vascular invasion which you can't see on FNA. How do we reconicile this? How can architecture help? 

use cellular : colloid ratio! 

See picture

Classified as 

Benign - Lots of colloid and less cellularity

AUS - middle

Suspicious for Follicular Neoplasm - more cellularity vs colloid 

 

Also Architecture can help - Macrofollicles more favor benign and Micro Follicles, trabeculae and nests favor malignant 

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4

In General, what are features of benign follicular lesions? 

Abundant colloid and low cellularity

Macrofollicular

Corresponds to Hyperplastic Nodules and Adenomas

<1% risk of malignancy

5

In general, what are features of Suspicious follicular neosplasms? 

Scant/absent colloid, marked cellularity, predominantly microfollicular / solid/ trabecular architecture

 

corresonds to follicular adenoma, carcinoma etc 

Hemithyroidectomy apropriate bc risk of malignancy is 20-30%

6

In general, what are features of AUS? What do you do when you see that? 

Mixed features and can indicate either limited cellularity or compromised specimen 

Risk of malignancy 5-10% 

 

Repeat FNA often helpful 3-6 months - can typically wait bc more indolent tumors

7

What do you see grossly and histologically in Grave's Disease? What else has similar histology? 

Gross: Diffusely enlarged, thyroid, homogenous, no nodules

 

Micro: Crowded follicular cells, papillary ingrowths (hyperplastic), pale colloid w/ scalloped border and lymphoid infiltrate w/ germinal centers 

See picture 

(similar histo to diffuse non-toxic goiter from iodine deficiency) 

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8

What is Hashimoot's? Who gets it? What does it make you at risk for? 

Most common cause of hypothyroidism; females?males, ages 45-65

Autooimmune destruction of Thyroid w/ TPO and TGB antibodies

 

scarring process

 

*Increased risk of lymphoma and papillary thyroid carcinoma 

9

What do you see grossly and microscopically in Hashimotos? 

Gross - Enlarged, firm gland that is vaguely nodular/lobular

Micro - lymphoid/PLasma cell infiltrate w/ Germinal Center formation, Follicular cell destruction

*Oncocytic / Hurthle Cell change: abudnant pink granular cytoplasms (eosinophilic) 

See picture

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10

What is Granulomatous Thyroiditis? Other names for it? What happens there/ Presentation? 

AKA Subacute Thyroiditis or DeQuervain's Thyroiditis

 

May be secondary to viral infection 

Self-limited Hyperthyroidism 

THYROID PAIN + HYPERTHYROID!!!!

resolves spontaneously in 2-6 weeks

11

What do yo usee grossly and micro in Thyroiditis? 

Gross - enlarged, firm gland and involved areas a firm, yellow-white

Micro - patchy distribution, early neutrophils and then later Giant cells that are eating colloid and lymphoid aggregates / macrophages, eventually fibrosis 

 

see picture

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12

What's happening in Multinodular Goiter? Clinical Significance? What do you see grossly and microscopically? 

Euthyroid presentation (sometimes hyperthyroid) 

Clinical significance from size can lead to airway obstruction, dysphagia, or cosmetic complaints

Gross - multinodular and large, nodules range from soft, gelatinous and brown --> Firm and tan 

(more colloid then softer and better) 

see picture

Micro - normal appearing follicular cells, NO CAPSULE around nodules 

see picture

A image thumb
13

What is the most common neoplasm of the thyroid? What is the most common malignancy of they tyroid ?

Neoplasm - follicular adenoma

Malignancy - papillary carcinoma

14

What do you see in a follicular adenoma? 

 

Solitary nodule, usually non-fuctioning, benign course

Gross - spherical, encapsulated and sharply demarcated

- Hemorrhage, Fibrosis, CAlcifications

Colloid rich = tan-brown and gelly

Cellular = white-tan, firm 

Micro - follicular cells and follicles, well-defined capsule and tumor within

Can see Hurthe cell changes! 

 

Follicular Carcinoma different bc invasion!! 

15

Who is more likely to get Follicular Carcinoma? How does it invade? differences from papillary? Treatment? 

Older people more likely to get follicular carcinoma (Older than papillary) and Female > Male 

Minimal invasion = vascular or capsular only and good prognoiss

Wide invasion = into surrounding tissue and distant Mets at presentation

HEMATOGENOUS spread to bone, lung, liver  (vs papillary which is LN spread) 

See Microfollicles, similar to adenoma, and Hurthle cell changes 

Tx = thyroidectomy and radioactive Iodine therapy

A image thumb
16

Papillary Carcinoma - who gets it? How does it spread? Adverse prognostic indiactors? 

Most common thyroid carcinoma that people can get at ANY age 25-50 yo (slightly younger than follicular) 

Presents as indolent nodules or LN mets

 

GOOD PROGNOSIS - BEST ONE TO GET

Lymphatic Metastasis (cervical LN but does NOT worsen prognosis) 

Adverse prognostic indicators:

- age > 40 

- Extrathyroid extension

- mets beyond neck

17

What do you see gross/histo in Papillary carcinoma? What are subtypes? 

Poorly defined margines and more fibrus thna adenoma

Papillary Fronds and Psammoma bodies 

Intranueclear Pseudoinclusions

Pale, finely granular chromatin - Orphan Annie Eyes

see pic

 

Follicular variant - looks like follicular architecture but better prognosis 

Microcarcinoma - < 1cm and does not metastasize 

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18

What is anaplastic Carcinoma? How does it present? DDX? 

Highly aggressive malignancy and will die within 1 year

Mean age 65 - rapidly enlarging mass and HOARSENESS presentation 

Arise from well-differentiated carcinoma 

see pic

DDX is mets or primary SCC

Gross - large mass invading beyong thyroid

Micro- anaplastic, Spindlied (sarcomatoid) cells, Giant cells, Atypia, Necrosis 

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19

What is the Calcitonin carcinoma eh? What is the familial syndrome that causes this 30% of the time? 

Medullary Carcinoma! 

 

MEN2!!! 

 

Can measure calcitonin in blood but no hypocalcemia

20

Medullary carcinoma - presentation, cells, micro/gross, etc 

What's the most interesting and indicattive thing that you see in these tumors?!?!?!?!!

Presents as mass w/ paraneoplastic syndromes from ACTH or VIP production. Can mimic other thyroid tymors in terms of looks (ex. Papillary w/ Pseudopap archi and Intranuclear pseudoinclusions OR Hurhtle cell neosplasms w/ eosinophilic cyto) 

NEUROENDOCRINE - SEcretes CALCITONIN

Gross - firm, tan-gray, infiltrative

Micro- plasmacytoid or spindled cells

***AMYLOID DEPOSITION*** 

can also see bi or multi-nucleation 

21

How does lymphoma arise in the thyroid? What types of lymphoma do you see? 

most arise in setting of Hashimoto thyroiditis

3 types:

MALT - small mature B cells

-  Diffuse LArge B cell Lymphoma

- mized