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Endo II > Pathology of the Thyroid II > Flashcards

Pathology of the Thyroid II Flashcards

1
Q

goiter

A

enlargement of thyroid

impaired synthesis of thyroid hormon

most often - dietary iodine deficiency

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2
Q

diffuse nontoxic goiter

A

simple**

enlargement of entire gland without nodularity

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3
Q

endemic goiter

A

areas with low iodine

can lead to diffuse nontoxic simple goiter

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4
Q

sporadic goiter

A

less frequent than endemic

-more in female around puberty or young adult life

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5
Q

increased TSH levels

A

lead to hypertrophy and hyperplasia of thyroid follicular cells

with simple goiter

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6
Q

phases of nontoxic goiter formation

A

hyperplastic phase
-diffuse and symmetric enlargement

colloid involution
-if increased dietary iodine or demand for thyroid hormone decreases - stimulated follicular epithelium involutes - resulting in enlarged colloid rich gland

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7
Q

simple goiter clinical

A

typically euthyroid

clinical problems - mass effects

normal T3 and T4 with elevated TSH

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8
Q

multinodular goiter

A

over time - recurrent episodes of hyperplasia and involution

irregular enlargement of thyroid

often mistaken for neoplasms

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9
Q

female with tickle in throat, solid lesion near thyroid

A

multinodular goiter

but need to see if is neoplasm

male - more likely to be noeplastic

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10
Q

plunging goiter

A

multinodular goiter growing behind sternum and clavicles

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11
Q

multinodular goiter morph

A

asymmetrically enalrged

colloid rich follicles lined by flattened inactive epithelium and areas of follicular hyperplasia

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12
Q

follicular neoplasm of thyroid

A

prominent capsule between hyperplastic nodule and residual compressed thyroid parenchyma

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13
Q

multinodular goiter clinical

A

often see mass effects

airway obstruction, dysphagia, superior vena cava syndrome**

most patients euthyroid

small number of patients - toxic multinodular goiter (hyperthyroidism)

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14
Q

plummer syndrome

A

toxic multinodular goiter

has NO dermopathy or ophthalmopathy - as in graves

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15
Q

uneven iodine uptake

A

solitary thyroid nodule

dominant nodule in multinodular goiter

can mimic a thyroid noeplasm

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16
Q

solitary thyroid nodule

A

more common in women

majority are localized and non-neoplastic

benign neoplasms outnumber thyroid carcinomas 10:1

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17
Q

clinical criteria for thyroid nodule

A

solitary - more likely neoplastic

younger patient - more likely neoplastic

males - more likely neoplastic

radiation history - more likely thyroid malignancy

functional - take up radioiodine - hot nodule - tend to be benign

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18
Q

52yo M, lump in neck, solitary thyroid nodule, TSH and T4 normal

cold nodule radioiodine
fusion scan shows vascularity

A

male, solitary, cold nodule - worried about neoplasm

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19
Q

fusion scan

A

shows vasculature

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20
Q

follicular adenoma

A

adenoma of thyroid

discrete solitary mass derived from epithelium

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21
Q

toxic adenoma

A

produce thyroid hormone

independent of TSH stimulation

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22
Q

solitary spherical lesion in thyroid with capsule

A

thyroid adenoma

multinodular goiter - no capsule

23
Q

follicular adenoma vs. carcinoma

A

evaluation for invasion of capsule is critical**

24
Q

hurthle cell change

A

implies aggressiveness

25
Q

cold nodule

A

does not take up radioiodine
-10% are malignant**

need to evaluate capsular integrity

26
Q

majority of thyroid carcinoma

A

papillary carcinoma

85% of cases

5-15% follicular
5% anaplastic
5% medullary

27
Q

papillary carcinoma of thyroid

A

good prognosis

28
Q

follicular carcinoma of thyroid

A

worse prognosis

29
Q

most common form of thyroid carcinoma

A

papillary carcinoma

30
Q

white tumor of thyroid

A

papillary carcinoma

31
Q

optically clear nuclei

A

in papillary carcinoma of thyroid

good prognosis

32
Q

orphan annie eye nuclei

A

optically clear nuclei

papillary carcinoma

33
Q

lymph node mets in papillary carcinoma

A

still good prognosis**

34
Q

35yo cuts neck shaving, feels lump in neck

surgeon removes metastatic papillary carcinoma

prognosis?

A

good**

mets don’t change prognosis

papillary thyroid carcinoma - has excellent prognosis - 10 yr survival 95%

35
Q

hemorrhagic red lesion in thyroid

A

follicular carcinoma

36
Q

follicular carcinoma

A

areas with dietary iodine deficiency

women age 40-60yo

spread is hematogenous - to lung and bone

37
Q

scintigram

A

radioactive tracer distribution in organ

38
Q

follicular carcinoma

A

often cold nodule
-may be warm

hematogenous spread common - mets to bone, lung, and liver

39
Q

prognosis of follicular carcinoma of thyroid

A

widely invasive - systemic mets - bad

minimally invasive - not as bad - 10yr survival 90%

40
Q

monitor recurrence of follicular thyroid carcinoma

A

thyroglobulin levels

41
Q

mutations of RAS or PI-3K/AKT pathways

A

follicular carcinomas

42
Q

anaplastic carcinoma of thyroid

A

undifferentiated

  • less than 5%
  • bad prognosis - 100% mortality

age 65yo

1/4 patients have history of well-differentiated thyroid carcinoma

43
Q

pleomorphic giant cells and spindle cells

A

anaplastic carcinoma of thyroid

44
Q

rapidly enlarging neck mass, dyspnea, dysphagia, hoarseness, cough

A

anaplastic carcinoma of thyroid

death less than 1 year

45
Q

medullary carcinoma of thyroid

A

neuroendocrine neoplasm of parafollicular C cells**

46
Q

C cells

A

secrete calcitonin from thyroid

cells in medullary carcinoma

47
Q

diagnosis of medullary carcinoma of thyroid

A

calcitonin levels

also important for post-op follow up

48
Q

medullary carcinoma

A

70% arise sporadically

remainder from MEN 2a and 2b or FMTC

49
Q

bilateral and multicentric medullary carcinoma

A

familial cases

50
Q

amyloid

A

in medullary carcinoma of thyroid

51
Q

carcinoembryonic antigen

A

biomarker for medullary carcinoma

useful in presurgical tumor assessment of tumor load and calcitonin negative tumors

52
Q

more aggressive medullary carcinomas

A

context of MEN-2B

more frequent mets and more aggressive

53
Q

RET mutation

A

offered prophylactic thyroidectomy

asymptomatic MEN-2 patients

because 100% get medullary carcinoma of thyroid

Endo II (12 decks)

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