Pathology of the Thyroid II Flashcards Preview

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Flashcards in Pathology of the Thyroid II Deck (53):
1

goiter

enlargement of thyroid

impaired synthesis of thyroid hormon

most often - dietary iodine deficiency

2

diffuse nontoxic goiter

simple**

enlargement of entire gland without nodularity

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endemic goiter

areas with low iodine

can lead to diffuse nontoxic simple goiter

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sporadic goiter

less frequent than endemic

-more in female around puberty or young adult life

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increased TSH levels

lead to hypertrophy and hyperplasia of thyroid follicular cells


with simple goiter

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phases of nontoxic goiter formation

hyperplastic phase
-diffuse and symmetric enlargement

colloid involution
-if increased dietary iodine or demand for thyroid hormone decreases - stimulated follicular epithelium involutes - resulting in enlarged colloid rich gland

7

simple goiter clinical

typically euthyroid

clinical problems - mass effects

normal T3 and T4 with elevated TSH

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multinodular goiter

over time - recurrent episodes of hyperplasia and involution

irregular enlargement of thyroid

often mistaken for neoplasms

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female with tickle in throat, solid lesion near thyroid

multinodular goiter

but need to see if is neoplasm

male - more likely to be noeplastic

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plunging goiter

multinodular goiter growing behind sternum and clavicles

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multinodular goiter morph

asymmetrically enalrged

colloid rich follicles lined by flattened inactive epithelium and areas of follicular hyperplasia

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follicular neoplasm of thyroid

prominent capsule between hyperplastic nodule and residual compressed thyroid parenchyma

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multinodular goiter clinical

often see mass effects

airway obstruction, dysphagia, superior vena cava syndrome**

most patients euthyroid

small number of patients - toxic multinodular goiter (hyperthyroidism)

14

plummer syndrome

toxic multinodular goiter

has NO dermopathy or ophthalmopathy - as in graves

15

uneven iodine uptake

solitary thyroid nodule

dominant nodule in multinodular goiter

can mimic a thyroid noeplasm

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solitary thyroid nodule

more common in women

majority are localized and non-neoplastic

benign neoplasms outnumber thyroid carcinomas 10:1

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clinical criteria for thyroid nodule

solitary - more likely neoplastic

younger patient - more likely neoplastic

males - more likely neoplastic

radiation history - more likely thyroid malignancy

functional - take up radioiodine - hot nodule - tend to be benign

18

52yo M, lump in neck, solitary thyroid nodule, TSH and T4 normal

cold nodule radioiodine
fusion scan shows vascularity

male, solitary, cold nodule - worried about neoplasm

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fusion scan

shows vasculature

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follicular adenoma

adenoma of thyroid

discrete solitary mass derived from epithelium

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toxic adenoma

produce thyroid hormone

independent of TSH stimulation

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solitary spherical lesion in thyroid with capsule

thyroid adenoma

multinodular goiter - no capsule

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follicular adenoma vs. carcinoma

evaluation for invasion of capsule is critical**

24

hurthle cell change

implies aggressiveness

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cold nodule

does not take up radioiodine
-10% are malignant**

need to evaluate capsular integrity

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majority of thyroid carcinoma

papillary carcinoma

85% of cases

5-15% follicular
5% anaplastic
5% medullary

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papillary carcinoma of thyroid

good prognosis

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follicular carcinoma of thyroid

worse prognosis

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most common form of thyroid carcinoma

papillary carcinoma

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white tumor of thyroid

papillary carcinoma

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optically clear nuclei

in papillary carcinoma of thyroid

good prognosis

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orphan annie eye nuclei

optically clear nuclei

papillary carcinoma

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lymph node mets in papillary carcinoma

still good prognosis**

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35yo cuts neck shaving, feels lump in neck

surgeon removes metastatic papillary carcinoma

prognosis?

good**

mets don't change prognosis

papillary thyroid carcinoma - has excellent prognosis - 10 yr survival 95%

35

hemorrhagic red lesion in thyroid

follicular carcinoma

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follicular carcinoma

areas with dietary iodine deficiency

women age 40-60yo

spread is hematogenous - to lung and bone

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scintigram

radioactive tracer distribution in organ

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follicular carcinoma

often cold nodule
-may be warm

hematogenous spread common - mets to bone, lung, and liver

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prognosis of follicular carcinoma of thyroid

widely invasive - systemic mets - bad

minimally invasive - not as bad - 10yr survival 90%

40

monitor recurrence of follicular thyroid carcinoma

thyroglobulin levels

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mutations of RAS or PI-3K/AKT pathways

follicular carcinomas

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anaplastic carcinoma of thyroid

undifferentiated
-less than 5%
-bad prognosis - 100% mortality

age 65yo

1/4 patients have history of well-differentiated thyroid carcinoma

43

pleomorphic giant cells and spindle cells

anaplastic carcinoma of thyroid

44

rapidly enlarging neck mass, dyspnea, dysphagia, hoarseness, cough

anaplastic carcinoma of thyroid

death less than 1 year

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medullary carcinoma of thyroid

neuroendocrine neoplasm of parafollicular C cells**

46

C cells

secrete calcitonin from thyroid

cells in medullary carcinoma

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diagnosis of medullary carcinoma of thyroid

calcitonin levels

also important for post-op follow up

48

medullary carcinoma

70% arise sporadically

remainder from MEN 2a and 2b or FMTC

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bilateral and multicentric medullary carcinoma

familial cases

50

amyloid

in medullary carcinoma of thyroid

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carcinoembryonic antigen

biomarker for medullary carcinoma

useful in presurgical tumor assessment of tumor load and calcitonin negative tumors

52

more aggressive medullary carcinomas

context of MEN-2B

more frequent mets and more aggressive

53

RET mutation

offered prophylactic thyroidectomy

asymptomatic MEN-2 patients

because 100% get medullary carcinoma of thyroid