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Book - Molavi > Chapter 23 - Thyroid > Flashcards

Chapter 23 - Thyroid Flashcards

1
Q

What are the two cells types in the thyroid, and for what do they stain?

A

Follicular epithelium (TTF-1, thyroglobulin)

Parafollicular C cells (TTF-1, neuroendocrine markers, calcitonin)

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2
Q

Recall five forms of thyroiditis.

A

Acute thyroiditis (with necrosis)

Subacute / De Quervain’s (giant cells, painless)

Palpation thyroiditis (histiocytes, giant cells)

Lymphocytic thyroiditis

Riedel’s (dense fibrosis, chronic inflammation)

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3
Q

What are the morphologic features of Hashimoto’s thyroiditis?

A

Prominent lymphoplasmacytic infiltrate with germinal center formation.

Small, atrophic follicles with Hurthle cell change.

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4
Q

What are the morphologic features of Graves disease? Denote treated vs untreated.

A

Untreated: Highly cellular thyroid with minimal colloid.

Treated: Large follicles with prominent papillary infoldings and scalloped colloid.

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5
Q

What is the difference between endemic and sporadic goiter?

A

Endemic: Iodine deficiency

Sporadic: Enzyme defects

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6
Q

What cancers form the category of follicular-type carcinomas?

Which form papillary carcinomas?

Which form neuroendocrine carcinomas?

A

Follicular: Colloid nodule, adenomatoid nodule, follicular adenoma, hurtle cell adenoma, follicular carcinoma, insular carcinoma.

Papillary: Many subtypes including follicular, diffuse sclerosing, tall cell, columnar cell, trabecular, cribriform, and cystic.

Neuroendocrine: Medullary carcinoma

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7
Q

What is a colloid nodule?

What is a follicular adenoma?

A

A hyperplastic nodule of large distended follicles in which the ratio of colloid to cells is high.

An encapsulated nodule composed of small microfollicles with scant colloid.

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8
Q

How are follicular adenoma and carcinoma distinguished?

A

By vascular invasion or invasion of the capsule. They cannot be distinguished by cytology / FNA!

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9
Q

How is the diagnosis of Hurtle cell adenoma handled?

A

Same as with follicular adenoma; must evaluate for capsular / vascular invasion. Cytology is different, that’s all.

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10
Q

What are the two “strengths” of follicular carcinoma?

To where does it spread?

A

Minimally invasive & widely invasive.

Spreads hematogenously to lung and bone.

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11
Q

What is an insular carcinoma? How does it appear?

A

A rare, poorly differentiated thyroid carcinoma. Its cells grow in sheets and cords. Cytology resembles follicular carcinoma. Pleomorphism is uncommon, but mitoses, necrosis, vascular invasion, and infiltration are common.

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12
Q

By what features is PTC truly diagnosed? Describe them

A

By cytologic features.

Cleared out chromatin (Orphan Annie eyes), overlapping & crowding, nuclear grooves & pseudoinclusions.

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13
Q

Where are the following features found in PTC?

Prominent nucleoli

Psammoma bodies

A

Prominent nucleoli are not a feature of PTC.

Psammoma bodies are seen in the interstitium (not follicles!)

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14
Q

What defines a papillary microcarcinoma? What is its significance?

A

Microcarcinomas are < 1 cm, are usually incidentally discovered, and if solid are considered benign.

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15
Q

Describe the follicular variant of PTC.

A

Has nuclei of PTC, but with follicular architecture with no papillae. Nuclear changes can be patchy, making distinguishing it from follicular carcinoma difficult.

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16
Q

Describe the diffuse sclerosing variant of PTC.

A

Rare, with a worse prognosis. Widely infiltrative and more aggressive, with a desmoplastic stroma, suamous metaplasia, psammoma bodies, dense lymphocytic infiltrate, and vascular invasion.

17
Q

Name 5-8 variants of PTC.

A

Classical type

Follicular type

Diffuse sclerosing variant

Tall cell

Columnar cell

Trabecular

Cribriform

Cystic

18
Q

Describe the morphologic features of anaplastic carcinoma.

From what background does it arise?

A

Tumor cells may appear as sheets of pleomorphic cells (truly undifferentiated), as squamous cell carcinoam (squamoid differentiation), or sarcomatoid.

Usually papillary thyroid carcinoma, but sometimes other forms of carcinoma.

19
Q

What is significant about diagnosing PTC in a background of Hashimoto’s thyroiditis?

A

Hashimoto’s can have areas of nuclear clearing and pleomorphism that mimic PTC. Have a high index of suspicion; true carcinoma should stand out sharply.

20
Q

What is the most important prognostic factor in papillary thyroid cancer?

To where does it metastasize?

A

Age (younger is better).

Cervical lymph nodes, lung, bone

21
Q

Describe the morphologic appearance of medullary carcinoma/

A

Like most neuroendocrine tumors; nested or trabecular growth with epithelioid to spindled cells. Uniform, finely speckled nuclei.

22
Q

Distinguish thyroglossal duct cysts and branchial cleft cysts.

A

Thyroglossal duct cyst: A midline cyst lined by ciliated epithelium and thyroid follicles.

Branchial cleft cyst: An anterolateral structure that looks tonsillar.

23
Q
A

Hashimoto’s Thyroiditis

Arrow: Germinal center in lymphoid aggregate

24
Q
A

Grave’s Disease

Arrow: Papillary infoldings of follicular epithelium

25
Q
A

Follicular adenoma (microfollicular adenomatoid nodule).

Arrow: Tightly packed small follicle

26
Q
A

Hurtle cell (Oncocyte) adenoma

Arrow: Surrounding capsule

27
Q
A

Papillary thyroid carcinoma

Arrow: Vessel (lymphatic?) invasion

Arrowhead: Epithelialization of tumor plug

28
Q
A

Insular thyroid carcinoma

29
Q
A

Papillary thyroid carcinoma (arrow) arising in a background of Hashimoto’s thyroiditis (arrowhead)

30
Q
A

Papillary thyroid carcinoma

31
Q
A

Psammoma body (arrow) in PTC with shear artifact from sectioning (arrowheads)

32
Q
A

Follicular variant of papillary thyroid carcinoma.

Arrow: PTC cytology

33
Q
A

Anaplastic carcinoma

Arrow: Focus of squamoid appearance

34
Q
A

Medullary thyroid carcinoma

Book - Molavi (29 decks)

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