09 Endocrine Pathology

Question 1

Produced by recurrent episodes of hyperplasia and involution

Produce extreme thyroid enlargements

Answer 1

Multinodular colloid goiter

Question 2

In multinodular colloid goiter, the colloids can be likened to ______

Answer 2

Venetian blinds

Question 3

Briefly state the pathogenesis of thyroid enlargement in nodular goiter

Answer 3

Diffuse follicular hyperplasia

TSH&raquo_space; stimulatory effect on trophic and iodine metabolism

Question 4

Laboratory tests to confirm multinodular colloid goiter

Answer 4

Hormone test (TSH, fT3, fT4)
Antibody test (to distinguish form AI thyroiditis)
Ultrasonography (nodules)
MRI or CT (tracheal narrowing)
Thyroid scan (thyroid size)
Biopsy (malignancy)

Question 5

Autoimmune disease that results in destruction of thyroid gland and gradual and progressive thyroid failure
Symmetric and diffuse enlargement of gland

Answer 5

Hashimoto’s thyroiditis

Question 6

Histopathology associated with Hashimoto’s thyroiditis
Epithelial cells that contain abundant eosinophilic, granular cytoplasm
Metaplastic response of normally low cuboidal thyroid epithelium

Answer 6

Hurthle’s cells

Question 7

Extensive infiltration of the parenchyma by lymphocytes, plasma cells
Densely granular cytoplasm lining the atrophied follicle

Answer 7

Hashimoto’s thyroiditis

Question 8

Explain the etiopathogenesis of Hashimoto’s thyroiditis. Are patients hypo- or hyper- or euthyroid

Answer 8

Caused by a breakdown ins elf-tolerance to thyroid autoAgs

Hypothoid

Question 9

Describe the gross findings of Hashimotos’ findings

Answer 9

Painless, symmetrical and diffuse enlargement of the thyroid

Cut surface is firm, yellow-tan, firm and somewhat nodular

Question 10

Discrete, solitary masses of the thyroid derived from follicular epithelium
Well-defined capsule

Answer 10

Follicular adenoma

Question 11

Adenomas often contain ____, abundant eosinophilic cytoplasm and small regular nuclei

Answer 11

Hurthle cells

Question 12

Hallmark of follicular adenoma

Answer 12

Well-formed capsule

Question 13

Most common malignant thyroid cancer

Answer 13

Papillary carcinoma

Question 14

Papillary Ca is associated with

Answer 14

Previous exposure to ionizing radiation

Question 15

Contain branching papillae having a fibrovascular stalk covered by a single to multiple layers of cuboidal epithelial cells

Answer 15

Papillary Ca

Question 16

Ground-glass nuclei

Lined by cells with nuclei that appear optically clear on H & E staining after formalin fixation

Answer 16

Orphan Anni Eye nuclei

Question 17

Concentrically calcified structures found within the cores of papillae
Never found in follicular and medullary Ca

Answer 17

Psammoma body

Question 18

Cells that contain a nuclear groove found in papillary Ca

Answer 18

Coffe-bean sign

Question 19

Differentiate papillary from follicular carcinoma on the basis of incidence rates, metaplastic potential and genetic alteration

Answer 19

Incidence rate: P > F
Metaplastic potential: P-hematogenous metastasis to lungs and isolated cervical nodal metastasis; F - rare, regional and hematogenous spread to bones, lungs, liver
Genetic alteration: P: Follicular variant (RAS, BRAF, RET/PTC), Tall cell variant (BRAF with RET/PTC), diffuse sclerosing variant (lacks BRAF and RET/PTC); F: RAS, PAX8/PPARy rearrangement