10/22- Lab: Endocrine Pathology Flashcards
What structures do you think if someone feels “a lump” in their throat, but only on one side?
- Thyroid
- Esophagus
- Trachea (surrounding muscles, lymph nodes)
- Large cystic structure in skin
What is seen here?
Radioactive iodine uptake scan (RAIUS)
- Single cold nodule
- This is probably a tumor (could also be an abscess, but those are less common)
What is seen here?
Radioactive iodine uptake scan (RIUS)
- Increased area of absorption
- Probably suppressing the rest of the thyroid (?)
What is seen here?
- Benign or malignant?
- The central nuclei look pretty regular, but those on the left are larger, varying sizes, with a high N:C ratio
- Abnormal nuclei are roughly normally spaced with eosinophilic cytoplasm
- This is benign
- Appearance of large atypical cells are common in thyroid (lymphoid?) tumors; can’t really diagnose as malignant unless vascular/other invasion
What is seen here?
- Normal thyroid is dark red/magenta
- See central mass that is well encapsulated and is pushing thyroid off to the side
- This confirms the benign diagnosis from the FNA
What is seen here?
Normal thyroid
- Colloid is comprised mostly of secreted T3 and T4
What is seen here?
Abnormal thyroid
- Much more cellular
- Struggling to form some follicles
- Can see fibrous encapsulation of tumor
- Can base malignancy based on capsule invasion(?) but hard to evaluate entire margin in a thyroid specimen
What is this malignancy specifically?
- Benign
- Gland forming
- Thyroid origin
Thus thyroid adenoma
- This is a follicular adenoma
(The chromatin here is a fixation artifact)
What is the difference between a thyroid adenoma and a multi-nodular goiter? (student question)
- MNG is a reaction to a stimulus
- Lack (or excess) of iodide
- Hypothalamic stimulus (excess TSH)
- Etc.
- Adenoma is a true tumor; loss of cellular regulation
Case 2)
- Another patient feeling lump in throat
- FHx of breast cancer with BRCA gene; worried about met
- Skip FNA and excise the lump
What is seen?
- Central mass is very dark; much vascularization
- Leading edge is pushing through surrounding thyroid and fat
What is seen here? What kind of mass is this?
- Structures
- Cell types
- Benign vs. malignant
- Circular glandular structures
- Attempting to form colloid
- See cells with open chromatin but also some are hyperchromatic
- This is probably malignant
What is seen here?
Mass invading all the way through fibrous capsule
- Malignant, no matter how well-differentiated it is
- Invading the capsule is what distinguishes between benign and malignant!!
What is seen here?
- Circular structure; has some very flattened endothelial cells
- Endothelial cell structure here is filled with tumor (rather than blood or lymphatic fluid)
This is tumor invading lymphatics
- Multiple lymph nodes on patient’s neck filled with tumor
Case 3)
- Patient comes in feeling a little hoarse/raspy and has a lump in her throat
- No smoking history; does not drink alcohol
What could be a reason for hoarseness with mass in the neck?
Impaction of recurrent laryngeal nerve
- This symptom alone is indicative of a malignancy
What is the prognosis for thyroid tumors?
Even metastatic anaplastic thyroid tumors have a 90% cure rate; with papillary and follicular 100%
What is seen here?
- Cells are not all same size/shape
- Cells in bottom right are “coffee-bean nuclei”
- Very few tumors have this characteristic nuclei appearance
What is seen here?
- Can see normal dark red/magenta of thyroid
- Mass is lumpy, see areas of necrosis and vasculature (confirms malignant diagnosis)
What is seen here?
- All of the cells are squashed on top of each other due to rapid growth
- Fingerlike projection of cells
- On top right, can see very small capillary (central capillary core with tumor arrange around it = papillary structure)
What is seen here?
- Malignant
- Epithelial origin
- Papillary
- Thyroid origin
Thus, this is a papillary thyroid carcinoma
- Can be poorly-> well differentiated (this one is moderately-to-well differentiated)
What are pointed out here?
“Orphan Annie” appearance of inclusions
Case 4)
- Young male adult comes in very jittery and nervous with massive headache
- BP is 220/190
- Find 4 cm mass over kidney on imaging
- Resected out
What is seen here?
Abnormal adrenal gland
- Can see whitish yellow rim around mass indicative of some kind of fatty tissue; something in the center has pushed the adrenal cortex to this side
What is seen here?
Normal adrenal gland
- Tricorn/pyramidal shape
What is seen here?
Normal adrenal layers
- Medulla at bottom
What is seen here?
- Structures
- Cell type
- Hypercellular
- Intense vascularity
Form balls of cells (Z—)
Nuclei of “salt and pepper” chromatin distribution
- Very characteristic of neuroendocrine endocrine tumors
- Seem to be of adrenal medulla origin
What tumors arise in the adrenal medulla?
Basically just pheochromocytoma
- Other types are extraordinarily rare
What is the prognosis of pheochromocytoma?
Good
- 10% malignant; to tell, would have to pick up metastasis somewhere else
- 10% arise outside of adrenal medulla, so hard to tell if those are primary or metastatic
What is seen here?
Accumulation of neuroendocrine neurosecratory granules (pheochromocytoma)
What is seen here?
Electron dense granules in lesion of adrenal = pheochromocytoma
- Crystallized versions of E/NE
What is seen here?
Malignant variant of pheochromocytoma
