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MS2 Endocrine > 10/9- Pathology of the Thyroid > Flashcards

10/9- Pathology of the Thyroid Flashcards

1
Q

What is this?

A

Thyroid!

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2
Q

What is seen here?

A

Follicular cells- originate from endoderm, from foramen cecum

Colloid-

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3
Q

What is seen here?

A

C cells

  • Brown-staining marks calcitonin-producing cells
  • Arise from ?
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4
Q

What is Ultrasound Guided FNAB?

A

Fine Needle Aspiration Biopsy

  • Really cut down on amount of thyroidectomies that were performed
  • Before FNA, only indication for thyroidectomy was existence of a cold nodule (many benign taken out)
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5
Q

What is seen here?

A

Left: histological section

Right: cells from FNA

  • Round, regular nuclei
  • Cytoplasm fits together in honeycomb pattern; not much overlap
  • Very benign thyroid
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6
Q

Causes of hypothyroidism?

A
  • Hashimoto thyroiditis (most common cause)
  • Surgical or radioactive isotope ablation
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7
Q

Causes of hyperthyroidism?

A

- Diffuse Toxic Hyperplasia (Grave’s Disease)

  • Typically in younger women

- Toxic Nodule in Multinodular Goiter (Plummer syndrome)

  • Typically in older women

- Toxic adenoma

- Metastatic Follicular Carcinoma of thyroid

- Excess exogenous thyroid hormone

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8
Q

Epidemiology of Hashimoto thyroiditis

  • # __ cause of hypothyroidism in iodine ____ regions
  • Demographic
  • # __ autoimmune endocrine disease
  • May result in what
  • Characteristic features
A
  • #1 cause of hypothyroidism in iodine sufficient regions
  • Young-middle aged women
  • #1 autoimmune endocrine disease
  • May result in asymmetric enlargement and be confused with a neoplasm
  • Lymphoid follicles, oncocytic metaplasia of follicular cells (Hurthle cells)
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9
Q

What is seen here?

A

Gross features of Hashimoto’s thyroiditis

  • More tan/tank-pink than normal (not as red)
  • Thyroid parenchyma infiltrated by lymphoid cells
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10
Q

What is seen here?

A

Hashimoto’s thyroiditis

  • Asymmetrical
  • Very intense thyroiditis (possibly also neoplasm)
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11
Q

What is seen here?

A

Hashimoto’s thyroiditis

  • Can see thyroid follicle with germinal center
  • Follicular cells show abnormal excess of eosinophilic cytoplasm
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12
Q

What is seen here?

A

Typical Hashimoto’s thyroiditis

  • Lymphoid cells crawling over normal follicular cells
  • Follicular epithelium slightly abnormal: pale nuclei
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13
Q

What is seen here?

A

Islands of atypical cells as the result of inflammation

  • Hyperchromasia
  • Nuclear grooves
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14
Q

Characteristics of Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Prognosis
  • Gender prevalence
  • Cause
  • Course
  • Features
A
  • Self limited, frequently after URI
  • Female 3-5x more affected
  • Fever and tender/painful enlargement of thyroid
  • Course of 6-8 weeks, with hyperthyroidism to hypothyroidism to normal
  • Multinucleated giant cells and acute inflammation with destruction of follicles
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15
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Intense area of thyroiditis
  • Makes clinical nodule
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16
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Destruction of follicle?
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17
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Follicle is being destroyed
  • Colloid leaks directly into bloodstream, leading to initial hyperthyroidism
  • After a time, depletion causes hypothyroidism
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18
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Multinucleated giant cells
  • Colloid on left
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19
Q

What is seen here?

A

Subacute Thyroiditis (Granulomatous, DeQuervain)

  • Multinucleated giant cells
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20
Q

What is Reidel Thyroiditis?

  • Prevalence
  • Pathology
  • Similar to what
A
  • Very rare
  • Dense fibrosis replacement of thyroid gland with extension into adjacent tissue
  • Simulates carcinoma clinically
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21
Q

What is seen here?

A

Reidel Thyroiditis

  • Dense lymphocytic infiltrate
  • Large ropey collagen bands between infiltrate
  • Few scattered follicles
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22
Q

What is seen here?

A

Reidel Thyroiditis

  • Few scattered follicles
  • Dense collagen bundles
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23
Q

What is seen here?

A

Reidel Thyroiditis

  • Dense fibrosis growing out into adjacent strap muscles around thyroid
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24
Q

Characteristics of Graves Disease

  • Demographic
  • Symptoms
  • Lab findings
  • Mechanism
A
  • Aka diffuse toxic goiter
  • 1-2 % of women (females 7x more)
  • Exophthalmos common
  • Autoantibodies activate TSH receptor
  • Increase in size of gland with hyperplasia of the follicular cells
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25
Q

What is seen here?

A

Graves?

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26
Q

What is seen here?

A

Graves

  • Follicles no longer round
  • Hyperplastic cells; pile up within follicles
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27
Q

What is seen here?

A

Normal thyroid

  • Cells relatively quiescent
28
Q

What is seen here?

A

Graves Disease

  • Nuclei open
  • Actively synthesizing protein
  • Very active cells
29
Q

What is seen here?

A

Radioactive scan of thyroid in Grave’s disease

  • Diffuse concentration
30
Q

What is a multinodular goiter?

  • Etiology
  • Similar to
  • Symptoms
  • Transformation
A
  • Much more in women
  • Etiology other than iodine deficiency unclear
  • Most common mimic of thyroid neoplasia clinically
  • May produce extreme enlargement
  • Component nodule is “adenomatous” or hyperplastic nodule
  • Multiple ill defined nodules with colloid lakes (colloid nodules)
  • An individual nodule may become toxic (Plummer’s syndrome) later in life
31
Q

What is seen here?

A

Multinodular goiter

  • Typically asymmetrical
32
Q

What is seen here?

A

Multinodular goiter- cut section (Benign adenomatous nodule)

  • Colloid lakes (areas of degeneration)
  • Not well capsulated; ill-defined
  • Vague hyperplastic nodules replace thyroid parenchyma
33
Q

What is seen here?

A

Multinodular goiter

  • Large follicles (100x normal)
  • Lots of colloid
  • Cells lining the follicles look normal
34
Q

What is seen here?

A

Multinodular goiter

  • Hemosiderin lake of macrophages from area of old hemorrhage
35
Q

What is seen here?

A

Multinodular goiter

  • Bland clusters of ?
  • Much background colloid
36
Q

What is seen here?

A

Adenomatous nodule that underwent cystic degeneration

  • Nodule itself has internal septi
  • Some adenomatous nodule remaining on rim
  • Remnant could be targeted with US
  • Vast majority of cystic nodules like this are adenomatous with cystic degeneration (rarely cystic papillary adenoma)
37
Q

What is seen here?

A

Scan of pt with Plummer syndrome

  • Can see some nodularity with hyperfunctioning that is suppressing much of the rest of the gland function
  • Autonomously functioning thyroid nodule arising from multinodular goiter
38
Q

Most tumors of thyroid derive from what?

A

Follicular epithelium

  • Can be adenoma or carcinoma
  • Nodules are typically composed of discrete thyroid follicles (small or normal sized)
  • Well defined capsule
  • Surrounding thyroid is relatively normal
39
Q

What is seen here?

A

Thyroid adenoma

  • White discrete fibrous capsule; well-defined
  • Normal surrounding thyroid
40
Q

Which is more common: follicular adenoma or carcinoma?

A

Adenoma is 10x more common than carcinoma (?)

41
Q

What is seen here?

A
  • Fibrous capsule
  • Benign neoplasm forming small micro-follicles
42
Q

What is seen here?

A

Follicular carcinoma

  • Tumor on the bottom
  • Compressed normal thyroid adjacent
  • Carcinoma breaking through dense fibrous capsule into surrounding gland (capuslar invasion)
43
Q

What is seen here?

A

Follicular carcinoma: vascular invasion?

44
Q

Papillary cancer typically metastasizes where? Follicular?

A

Papillary -> local LNs

Follicular -> bones

45
Q

What is seen here?

A

Papillary cancer

  • Not well encapsulated
  • Irregular border
  • Invasive
  • Fibrous look
46
Q

What is seen here?

A

Papillary cancer

  • Clear nuclei; characteristic of this type of cancer!!
47
Q

What is seen here?

A

Medullary carcinoma

  • Cancer of C cell (calictonin producing cell)
48
Q

What is seen here?

A

Medullary carcinoma

  • Relatively small cells
  • Not forming follicles or papilla
  • Background pink amyloid (beta-pleated sheet pattern) due to hormones (Calcitonin)
49
Q

What is seen here?

A

Ultrastructural analysis of medullary carcinoma

  • Dense core neurosecretory granules; characteristic of tumors that drive neuroectoderm
50
Q

What is seen here?

A

Anaplastic carcinoma

  • Rare; 1-2% of thyroid cancers
  • Poor prognosis; essentially incurable
  • Older individuals
51
Q

What is seen here?

A

Anaplastic carcinoma

  • Tumor encased espohagus/epiglottis area
52
Q

What is seen here?

A

Low grade papillary carcinoma

  • Developed rapidly growing cancer within this (on the right)
  • Cells on the right are much more anaplastic (huge nucleolus, many mitotic figures)…
53
Q

Embryologic development of the thyroid?

A
  • Derives from foramen cecum, midline base of tongue (not degraded by GIT; can take orally)
  • Descends in the midline neck, may result in lingual throid, thryoglossal duct cyst or pyramidal lobe
54
Q

What are the main cell types of the thyroid? Origin?

A
  • Follicular cells (endoderm)
  • C-cells (neural crest)
55
Q

What is seen here?

A

Thyroglossal duct cyst

  • Cells lining cystic space proliferate, die, produce necrotic material that accumulates in this cystic space -> enlargement
56
Q

Parathyroid glands originate from what embryological structure(s)

A

3rd and 4th pharyngeal pouch

57
Q

How many parathyroids are there?

A

Typically 4

58
Q

What is seen here?

A

Adipose tissue and chief cells, oxolytic cells, etc. all in parathyroid gland

59
Q

What are causes of primary hyperparathyroidism?

A
  • Parathyroid adenoma (85%)
  • More common in women (40s/50s)
  • Parathryoid hyperplasia (15%)
  • Parathryoid carcinoma (under 1%)
60
Q

What are some causes of hypercalcemia?

A

Malignancy

  • Osteolytic metastases
  • PTH-like hormone production

Hyperparathyroidism

Other

61
Q

What is seen here?

A

Parathyroid adenoma

62
Q

What is seen here?

A

Parathyroid adenoma

  • Diffuse population of relatively benign appearing cells (just too many of them)
63
Q

What is seen here?

A

Parathyroid carcinoma

64
Q

What is seen here?

A

Parathyroid carcinoma

  • Cells don’t look benign
  • Nuclear irregularity
65
Q

What is seen here?

A

Parathyroid adenoma

66
Q

What is seen here?

A

Parathyroid carcinoma

MS2 Endocrine (25 decks)

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