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ENDOCRINE PATHO > L2 Pathology of Thyroid > Flashcards

L2 Pathology of Thyroid Flashcards

1
Q

What are some effects of thyroid hormones ?

A
  1. Stimulate the contraction of heart
  2. Increase oxygen consumption and heat production in all tissue
  3. Stimulate gut motility
  4. Important of CNS development
  5. Stimulate production of structural proteins
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2
Q

What are the disorders of thyroid ?

A
  1. Hyper
  2. Hypo
  3. Diffuse/nodular/multi-nodular goiter
  4. Thyroid cancer (adenoma/ carcinoma )
  5. Thyroiditis
  6. Congenital > thyroglossal duct cyst
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3
Q

What is thyroglossal duct cyst ?

A

It is a fluid-filled cyst occurs anywhere along the thyroglossal duct in the midline
Most commonly near hyoid bone or attached to soft tissue

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4
Q

What is the structure of the cyst ?

A
  1. Made of squamous or respiratory type epithelium

2. Variable amount of thyroid tissue

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5
Q

What type of tumor can develop in these cyst ?

A

Papillary carcinoma

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6
Q

What are the main causes of hyper?

A
  1. Abnormal stimulator of the thyroid ( grave disease )
  2. Intrinsic disease of thyroid ( toxic multi-nodular goiter / functional thyroid adenoma )
  3. Abnormal secretion of TSH ( pituitary adenoma)
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7
Q

What are the triad for people with grave disease ?

A
  1. Hyperthyroidism
  2. Exophthalmus
  3. Peri-tibial myxedema / clubbing
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8
Q

What are the gross and microscopic features of thyroid in grave disease ?

A

GROSS :

  • moderately enlarged
  • firm and beefy red ( due to increased vascularity )

MICROSCOPIC :

  • lymphoid infiltrate
  • glands show hyperplasia of :
  • acinar epithelium
  • tall columnar cells
  • papillary folds
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9
Q

What is the cause of exophthalmus and peri-tibial myxedema ?

A
  1. Lymphocytic infiltrate

2. Glycosaminoglycans ( hyaluronic acid ) deposition

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10
Q

What are the causes of hypothyroidism (myxedema ) ?

A
  1. Iodine deficiency
  2. Hashimoto disease
  3. Drugs
  4. Radiation / surgery
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11
Q

What are the types of thyroiditis ?

A
  1. Acute thyroiditis ( bacterial or fungal infection )
  2. Chronic autoimmune thyroiditis ( Hashimoto disease )
  3. Granulomatous thyroiditis ( viral infection ):
    - de queen
    - giant cell thyroiditis
  4. Subacute lymphocytic thyroiditis ( post-partum )
  5. Riedel thyroiditis ( IgG-4 related - thyroid fibrosis )
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12
Q

What is the underlying cause of Hashimoto disease ?

A

It is an autoimmune disease caused by ab against :

  1. ER
  2. Thyroglobulin
  3. Thyroperoxidase

Due to HLA B8 / DR5

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13
Q

What are the gross and microscopic features of Hashimoto disease?

A

Gross :
- firm diffuse goiter

Microscopic:

  • follicle atrophy with lymphocyte
  • hurthle cells ( eosinophilic epithelial cells )
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14
Q

What is the pathological mechanisms in Hashimoto disease ?

A
  1. CD8+ cytotoxic T cell mediated killing
  2. Cytokine mediated cell death ( interferon will activate more cells / Macrophages )
  3. Binding of antithyroid antibodies then ADCC
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15
Q

What is the genetic cause of granulomatous thyroiditis?

A

HLA B35

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16
Q

What is the microscopic features of granulomatous thyroiditis ?

A
  1. Patchy Micro abscess

2. Granulomas with giant cells

17
Q

What is happening in the iodine deficiency goiter ?

A

Hyperplasia of the epithelium of the gland and appearance of less active areas that will be compressed by the hyper-plastic areas

18
Q

What will lead to multi-modular goiter in iodine deficiency goiter ?

A

The tracts of fibrosis that will separate areas

19
Q

What are the features of thyroid neoplasms ?

A
  1. Most are solitary and benign
  2. Low mortality rate
  3. May be functional ( hot )
20
Q

What are the main types of thyroid cancer ?

A
  1. Papillary carcinoma ( most common )
  2. Follicular adenoma
  3. Follicular carcinoma
  4. Anaplastic carcinoma
  5. Medullary carcinoma ( least )
21
Q

What is the gross and microscopic features of follicular adenoma ?

A

GROSS:

  • solid mass with fibrous capsule that is not breached
  • centre may contain areas of hemorrhage and cystic changes

MICROSCOPIC :

  • compacted follicles
  • lined with epithelial cells that show hyperchromtism
  • little collied
  • rarely, it can produce T3 and T4 so considered as hot
22
Q

Which age is usually affected by each type of thyroid cancer ? What is the prognosis ?

A
  1. Papillary carcinoma ( young adults >45 ) ( only 5% is familial )
  2. Follicular ( young middle < 45 )
  3. Anaplastic ( elderly / very poor prognosis )
  4. Medullary ( elderly / can be familial which will be more aggressive )
23
Q

What are the possible risk factors of papillary carcinoma ?

A
  1. High iodine intake
  2. Radiation
  3. Genetic factors
  4. Somatic mutations
24
Q

What are the different somatic mutations that increase the risk of papillary carcinoma?

A
  1. Familial granulomatous polyposis
  2. Somatic rearrangement of RET proto-oncogenes on chromosome 10
  3. Chromosomal rearrangement of RET or NTRK1
  4. Mutations in BRAF
25
Q

What is the gross and microscopic features of papillary carcinoma ?

A

GROSS :

  1. Non-encapsulated infiltrative mass
  2. Firm and whitish due to fibrosis

MICROSCOPIC:

  1. Epithelial papillary projections
  2. Psammoma bodies
  3. Characteristic nuclei with central clear mass ( orphan Annie nuclei )
26
Q

Through what does the papillary and follicular carcinoma metastasize ?

A
  1. Papillary > lymphatics to cervical lymph node

1. Follicular > blood vessels to bones and lungs

27
Q

Why follicular carcinoma has god prognosis ?

A

As many tumors retain their ability to uptake the I311 ( radiotherapy )

28
Q

What are the possible genetic causes underlying follicular carcinoma?

A

Either
- RAS mutations
Or
- PAX8-PPAR gamma 1 rearrangement

29
Q

What are anaplastic carcinoma ? and what is the microscopic features ?

A
  • It is poorly differentiated adenocarcinoma from thyroid epithelium
  • It has many histological appearances but the commonest is :
  • giant cell
  • spindle cell
30
Q

Why anaplastic carcinoma has very poor prognosis ?

A

Due to rapid local invasion

31
Q

What is medullary carcinoma ?

A

Derived from C cells

32
Q

What does medullary carcinoma secrete ?

A
  1. Calcitonin
  2. Serotonin
  3. ACTH
  4. somatostatin
33
Q

What are the features of the tumor in medullary carcinoma?

A
  1. Solid mass
  2. Sheets of neoplastic cells
  3. Hyaline stroma
  4. Amyloid reactions

ENDOCRINE PATHO (4 decks)

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