Endocrine > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

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1
Q

What is a development abnormality of the thyroid?

What about from inflammation?

A
  • Developmental abnormalities - Thyroglossal duct cyst
  • Inflammation - Autoimmune thyroiditis (Hashimoto) - Subacute thyroiditis (de Quervain) - Chronic fibrosing thyroiditis (Riedel)
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2
Q

Hyperplasia in the thyroid is d/t

A
  • Iodine deficiency (diffuse or nodular goiter)
  • Autoimmune (Graves’ disease
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3
Q

What neoplasias do we see in the thryoid gland?

A

Neoplasia - Benign tumors (follicular adenoma)

  • Malignant tumors (carcinoma, sarcoma, lymphoma, etc)
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4
Q

Hashimoto Thyroiditis is an autoimmune disorder, what antibodies do we see in this disease?

A

Anti-TPO, anti-Tg

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5
Q

Gross appereance of hashimotos

A

diffuse enlargement and very nodular looking

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6
Q

Lymphocytic inflammation

– Germinal centers

– Hurthle cell change

All microscopic findings in:

A

Hashimoto thyroiditis

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7
Q
A
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8
Q

What type of cell is in the pictuer that is seen in Hashimotos?

A

Hurthle cells; have more cytoplasm; its more pink and is dt inflammation

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9
Q

Suppurative (neutrophils)

Granulomatous (giant cells)

seen in what thyroid disease?

A

Subacute Thyroiditis (de Quervain)

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10
Q

Causes of Subacute Thyroiditis (de Quervain)

A

Viral or postviral response • Painful, self-limited disease

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11
Q

Describe Riedel or Fibrous Thyroiditis

A
  • Hard and fixed thyroid
  • Painless
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12
Q

– Dense fibrosis • Collagen fibers

– Fibrosis can extend outside of thyroid

seen in what type of thyroiditis?

A

Fibrious or Riedel Thyroiditis

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13
Q

Autoimmune disease causing thyroid hyperplasia, most common cause of endogenous hyperthryroidism

A

Graves

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14
Q

Describe the apperance of Graves thryoid on microscopy

A

See irregular follicles and scalloped colloid

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15
Q

Histology of a Goiter

  • Follicles lined by crowded_____ cells
  • ____ sized follicles
  • _____ colloid
A

columnar

Variably

Abundant

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16
Q

What happens overtime in pt with recurrent episodes of goiter?

A

Recurrent episodes lead to a multinodular gland (i.e., “multinodular goiter”) • With time will develop degenerative changes (cysts, fibrosis, calcification, hemorrhage)

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17
Q

Describe the histology seen from goiter below

A

variable sized colloid filled follicles and see nodule throuhgout

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18
Q

How common are solitary thyroid nodules?

are they often benign or maligant?

A

Incidence in US is between 1 and 10%

  • Four times more common in women
  • Majority are non-neoplastic (focal hyperplasia, simple cysts) or benign (adenomas)
  • Carcinoma is relatively uncommon (<1% of all solitary thyroid nodules)
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19
Q

When would a FNA be useful?

A
  • Useful initial approach of solitary nodule
  • Quick, inexpensive, minimal complications •

Can be diagnostic in papillary carcinoma, medullary carcinoma, lymphoma and metastatic tumors

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20
Q

What is a limitiation of FNA?

A

Cannot differentiate follicular adenoma from follicular carcinoma or from hyperplastic nodules

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21
Q

Benign neoplasm with various morphologic appearances (follicular, microfollicular, trabecular, Hurthle cell, etc.); however, this is not clinically significant

• Most are nonfunctional

A

Follicular Adenoma

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22
Q

Are we concerend about follicular adenomas progressing to cancer? What if they are funcitonal?

A

nope

functional = toxic adenomas and cause thyrotoxicosis

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23
Q
  • Solitary
  • Completely surrounded by a fibrous capsule – No capsular or vascular invasion
  • Different growth pattern from adjacent normal gland
A

key findings of Follicular Adenoma

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25
Below is an image of a mass in someones thyroid.What is it and how can you tell
Follicula adenoma there are some normal thyroid follices seperated by a fibrous capsule and then tons of small follicles and there is NO invasion
26
Etiology of Thyroid cancer
* Thyroid cancer is uncommon – 1.5% of all cancers * Mortality is low – 0.4% of all cancer deaths * More common in **women** than in men * Occurs in **all ages i**ncluding children * Most significant proven risk factor for development of thyroid cancer is exposure to **ionizing radiation**
27
What is the most common type of thyroid caner?
* Papillary CA – 85% to 95% of cases * Follicular CA – 5% of cases * Medullary CA – 5% of cases * Anaplastic CA – \<1% of cases
28
What is the genetic abnormality seen in papillary CA?
BRAF oncogene: inv 10 RAS: t:(10:17)
29
What is the gentic mutation in follicular CA?
30
What is teh genetic mutation seen in Medullary CA?
RET germinline mutation
31
Age pts get Papillary carcinoma mode of metastatisis
Most occur in younger age group (20s – 40s) • Preferentially metastasize by way of lymphatics to regional lymph nodes • Cervical nodes involved in up to 50% of cases
32
Prognosis of Papillary thyroid carcionma
* Excellent prognosis (\>95% survival at 20 years) * Adverse prognostic factors include: age \> 40, tumor \> 5 cm, extrathyroidal extension, and osseous metastasis
33
What is the gross appereance of a papillary thyroid carcinoma? Is this enough to make a Dx?
Very bulbous and fleshy appereaning but dx made based on nuclear study, IE, fine needle aspiration
34
* “Chewing gum” colloid * **Psammoma** bodies * Multinucleated giant cells
Papillary CA
35
What are the three nuclear features we see w/ Papillary CA?
– Clear nuclei “Orphan Annie eyes” – Intranuclear cytoplasmic inclusions – Intranuclear grooves
36
Key feature below is orphan annie eyes seen in:
Papillary Carcinoma of thyroid
37
What type of architecture do you see in papillary carcioma of thryoid
papillary, but can vary
38
What is shown in the image below?
– Intranuclear cytoplasmic inclusions KEY diagnostic feature of papillary carcinoma
39
what do we see in the histo below? when do we see this?
longitudinal nuclear grooves seen in papillary CA
40
See image with overlapping nuclei and lots of clear cells. what is teh Dx
Papillary Thyroid carcinoma
41
* Second most common thyroid cancer * Present at older age than papillary (40s to 50s) * Slowly enlarging painless nodule
Follicular Carcinoma of thyroid
42
What is the pattern of spread in follicular CA?
Vascular spread to bone, lungs, liver, etc (papillary is via lymphatics)
43
PRognosis of follicular thyroid CA
Prognosis depends on stage at presentation (generally a worse prognosis than papillary thyroid carcinoma) and extent of invasion
44
What is teh key feature to distinguish follicular adenoma from carcinoma?
45
What is a challenge when dx follicular thyroid CA?
No cytologic features of malignancy (i.e., no atypia, mitoses, nuclear pleomorphism, etc) • Most tumors are “well-differentiated” Minimally invasive carcinomas are difficult to distinguish from follicular adenomas and extensive sampling of the capsule is required
46
Origin of MEdullary CA and what do they secreate?
Neuroendocrine tumors derived from the parafollicular (C-cells) of the thyroid • Tumor cells secrete calcitonin
47
Cause of Medullary CA?
* 80% are sporadic * 20% occur within families especially as part of the MEN-2 syndrome
48
Peak incidence and prognosis in Medullary CA
* Peak incidence in the 40s and 50s except in MEN-2 (can occur in childhood) * 40% - 60% survival at 10 years
49
The histologist describes a section to you as full of neuroendocrine nests and points out pink amyloid stroma. What is the likely suspect for this?
MEdullary CA amlyoid will also have apple green birefringence
50
What stains do we see in Medullary CA?
• Calcitonin + • Chromogranin + • Synaptophysin + • CEA + • Keratin + • Thyroglobulin -
51
* Undifferentiated tumors of follicular epithelium – Do not stain with thyroid specific immunostains * Mean age at presentation is 65 years * May have a history of long-standing goiter, differentiated thyroid carcinoma or concurrent papillary carcinoma
Anaplastic CA
52
Prognosis of pts with Anaplastic CA
• Most have extrathyroidal spread or distant metastasis at presentation – Hoarseness and neck pain • Mortality rate is virtually 100% • Mean survival is 6 months
53
Microscopic appereance of anaplatic CA
Spindle cells, epithelioid cells, giant cells – All cells are pleomorphic
54
lymphocytic thyroiditis with germinal centers
Hashimoto thyroiditis –
55
Irregular follicular contours and scalloped colloid
Graves’ disease –
56
is most common thyroid cancer and is diagnosed based on nuclear features: pseudoinclusions, grooves, clearing
Papillary carcinoma
57
\_\_\_\_\_\_\_carcinoma is diagnosed by demonstrating capsular or vascular invasion
Follicular
58
Medullary carcinoma secretes
calcitonin and is associated with amyloid
Endocrine
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