thyroid patho pots

Question 1

Gross Graves Disease (3)

Answer 1

1. Beefy red appearance - increased vascular flow
2. diffused symmetrical enlargement
3. no distinct nodules

Question 2

Histo Graves Disease (3)

Answer 2

1 .follicles are large and irregular, show infoldings
2. Follicles have pseudopapillary hyperplastic infoldings - no true fibrovascular cores
3. scalloping of colloid - resorption by follicular cells

Question 3

Gross Hashimotos Thyroiditis (4)

Answer 3

1. diffusely enlarged and firm
2. pale tan cut surface, homogenous appearance
3. no discrete nodule
4. no haemorrhage or necrosis

Question 4

Histo Hashimotos Thyroiditis (2)

Answer 4

1. lymphoid follicles with germinal centers
2. atrophic thyroid follicles - hurthle cell changes (oncocytic) granular cytoplasm

Question 5

Gross Multinodular Goitre (6)

Answer 5

1. multinodular enlargement
2. cut surface has multiple variable nodules
3. brownish spongy appearance
4. cystic degeneration
5. foci of haemorrhage
6. areas of fibrosis

Question 6

Histo MNG

Answer 6

1. colloid-rich follicles lined by crowded columnar epi, giving rise to pseudopapillae
2. no fibrous capsule around mass - distinguish from follicular adenomas and carcinomas

Question 7

Gross Follicular Thyroid Adenoma (4)

Answer 7

1. well encapsulated, circumscribed single nodule
2. cut surface is brown and homogenous
3. focal haemorrhage
4. no necrosis or cystic change or other nodules

Question 8

Histo Follicular Thyroid Adenoma (5)

Answer 8

1. no capsule invasion
2. no vascular invasion
3. follicles containing colloid of varying sizes (mixed micro and macro)
4. nuclei of follicular cells is rounded and euchromatic
5. rest of thyroid is normal

Question 9

Gross Follicular Thyroid Carcinoma (4)

Answer 9

1. non-encapsulated mass
2. invasion into neighbouring structures
3. tan fleshy cut surface
4. foci of necrosis and haemorrhage

Question 10

Histo Follicular Thyroid Carcinoma (4)

Answer 10

1. capsular invasion
2. vascular invasion
3. within the tumour, microfollicles containing small amount of colloid
4. nuclei are small, round and uniform with speckled chromatin

Question 11

Gross Papillary Thyroid Carcinoma (3)

Answer 11

1. multinodular neoplasms
2. non-encapsulated and invasive growth with irregular borders
3. cut surface is pale tan (look for papillary structures)

Question 12

Histo Papillary Thyroid Carcinoma (5)

Answer 12

1. Ground Glass nuclei/ Orphan Annie eye nuclei - from diffused chromatin
2. Cytoplasmic Inclusions in nuclei
3. Nuclear Grooves (coffee bean nucleus)
4. maybe psammoma bodies in vasculature - calcification
5. papillary structure with fibrovascular cores lined by these atypical follicular cells

Question 13

Gross medullary thyroid Carcinoma (4)

Answer 13

1. Multiple pale nodules
2. Irregular borders, non-encapsulated with invasive borders
3. pale tan cut surface
4. necrosis or haemorrhage

Question 14

Histo medullary Thyroid Carcinoma (4)

Answer 14

1. islands/ nests of malignant cells
2. nuclei with salt and pepper chromatin
3. extracellular pink amyloid material
4. Congo red stain shows pink amyloid deposit on light microscopy