Pathology of the Thyroid Flashcards Preview

Endocrine/Repro > Pathology of the Thyroid > Flashcards

Flashcards in Pathology of the Thyroid Deck (31)
Loading flashcards...
1

What is an example of infectious thyroiditis?

TB - caseasting granulomatous inflammation

2

Hashimoto Thyroiditis is an autoimmune process mediated by anti-TPO, anti-TG antibodies. What are the microscopic characteristics?

Lymphocytic inflammation 

Germinal Centers

Hurthle cell change

3

What is this and what is it seen in?

Hurthle Cells

Hashimoto Thyroiditis

4

What is this and what is it seen in?

Germinal centers in the thyroid

Hashimoto Thyroiditis

5

A 40 year old woman presents with a painful thyroid. She recalls recently recovering from a viral infection about a week ago. What is it and do you need to biopsy it?

Subacute (de Quervain) Thyroiditis

Self-limiting, no need for biopsy

Suppurative (neutrophils) and granulomatous (giant cells) inflammation

6

This biopsy shows dense fibrosis from a hard and fixed, painless thyroid. What is it?

Fibrous (Riedel) Thyroiditis

Fibrosis (collagen) can extend out of thyroid

7

Graves' Disease is an autoimmune process causing hyperplasia of the thyroid. What are the microscopic features?

Irregular follicles

Scalloped colloid

8

What disease is this seen in? What causes it?

Scalloped colloid in Graves' Disease

Hyperactivity of the thyroid and pushing hormone out - "deflates baloon"

9

Goiter shows follicles lined by crowded _________ cells, _________ sized follicles and ___________ colloid.

  1. Columnar
  2. Variable
  3. Abundant

10

Inital stages of goiter result in symmetrical diffuse enlargement, what do recurrent episodes lead to? Will degenerative changes develop?

Multinodular gland (Multinodular goiter)

Yes, with time - cysts, fibrosis, calcification, hermorrhage 

11

What is this an example of?

Nodular Hyperplasia

Variable sized follicles filled with colloid

12

Solitary palpable thyroid nodules are more 4x more common in ______ and the majority are _________ or _________. 

Women

Non-neoplastic (focal hyperplasia, simple cysts)

Benign (adenoma)

13

How do you work up a solitary palpable nodule? What are the limitations?

Fine Needle Aspiration

Cannot differentiate between follicular adenoma, follicular carcinoma, or hyperplastic nodules.

14

Follicular Adenoma

Benign, doesn't progress to CA

Mostly non-functional (may produce thyrotoxicosis)

Smaller follicles, less colloid

Completely surrounded by fibrous capsule - no invasion

Solitary

15

Assuming there is no invasion of the capsule, what is this?

Follicular Adenoma

16

What is the most significant risk factor for thyroid cancer?

Exposure to ionizing radiation

More common in women, occurs in all ages

17

What is the most common form of thyroid cancer? Who gets it?

Papillary Thyroid Cancer

Younger women

Excellent prognosis

18

What are 3 adverse prognostic factors of Papillary Thryoid Cancer?

Age > 40

Tumor > 5cm

Extrathyroidal extension

*Commonly mets to LN, cervical nodes - not a poor prognostic marker

19

What are the key features to diagnose papillary carcinoma?

FNA - Nuclear features

Clear nuclei "Orphan Annie eyes"

Intranuclear cytoplasmic pseudoinclusions

Intranuclear grooves

Psammoma bodies, chewing gum colloid, multinucleated giant cells also seen

20

What is this?

Orphan Annie Nuclei

Longitudinal nuclear grooves 

Intranuclear pseudoinclusions 

21

What mutation is found in follicular thyroid carcinoma and what predisposes to it?

Ras

Nodular goiter

22

Who gets follicular thyroid carcinoma and how does it present?

40s-50s

Slowly enlarging, painless nodule

Vascular spread to bone, lungs liver

23

How do you diagnose follicular carcinoma?

Capsular or vascular invasion

Difficult to distinuish from follicular adenoma

24

What is this?

Follicular Carcinoma - capsular invasion

25

What mutation is associated with Medullary Carcinoma and what cell is proliferating?

RET germline mutation - 80% sporadic, 20% familial MEN-2

Neuroendocrine tumors derived from the parafollicular C-cells of thyroid (calcitonin)

 

26

The presence of nests of neuroendocrine cells and amyloid stroma below is characterisitc of what thyroid carcinoma? What will it stain for?

Medullary Carcinoma

+ Calcitonin, Chromogranin, Synaptophysin, CEA, Keratin

- Thyroglobulin

27

How does Anaplastic Carcinoma of the thyroid present?

Mean age 65

Rapidly growing neck mass, hoarseness and neck pain, extrathyroidal spread or mets

May have hx of goiter, follicular or papillary carcinoma

28

What does anaplastic carcinoma look like?

Undifferentiated tumors of follicular epithelium

Variable cell types

All cells are pleomorphic

29

What is this?

Anaplastic Thyroid Carcinoma

30

What is this? What other thyroid disease is associated with this?

Papillary Carcinoma

Hashimoto thyroiditis