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Pathology MBBS > Thyroid, parathyroid, pituitary > Flashcards

Thyroid, parathyroid, pituitary Flashcards

1
Q

Causes of primary hyperthyroidism

A
  1. Diffuse enlargement of thyroid
  2. Toxic multinodular goitre
  3. Toxic adenoma
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2
Q

Grave’s disease

basics,, antibodies involved

A 
M/C cause of endogenous hyperthyroidism
👱🏽‍♀️ > 👨‍🦰
20-40 year olds 
Type II hypersensitivity reaction
Antibody mediated:
1. Anti-thyroid stimulating immunoglobulin 
2. LATS (long acting thyroid simulator)
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3
Q

Grave’s disease

Associated with genes

A 
Autoimmune etiology 
CTLA4
PTPN 22
HLA DR3
HLA B8
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4
Q

Grave’s disease

Clinical triad

A
  1. Hyperthyroidism
  2. Infiltrative ophthalmopathy
  3. Infiltrative dermopathy
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5
Q

Grave’s disease

Gross and microscopic features

A

Gross: symmetrically enlarged meaty/beefy red
H&E:
1. Hyperplastic follicles
2. Formation of papillae (absence of core)
3. Scalloping of colloid (whitish area along the cuboidal epithelium where it takes the shape of epithelium)

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6
Q

Multinodular goitre

A 
Gross: multiple nodules filled with colloid
HPE: 
1. Follicles of various sizes
2. Filled with colloid 
3. Degenerative changes:
• calcification 
• hemosiderin laden macrophages
• cystic changes
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7
Q

Hypothyroidism

Basics

A

Two types:
1. Primary
2. Secondary
M/C cause of hypothyroidism: iodine deficiency
M/C of hypothyroidism in iodine sufficient areas of the world: Hashimoto’s thyroiditis

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8
Q

Hashimoto’s thyroiditis

pathogenesis

A 
Autoimmune etiology 
Genetic:
• CTLA 4
• PTPN 22
Antibody mediated:
• anti TPO Ab
• anti microsomal Ab
• anti- thyroglobulin Ab
Clinically:
 Hashitoxicosis ➡️ hypothyroidism
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9
Q

Hashimoto’s thyroiditis

gross & microscopic features

A

Diffuse enlargement of thyroid gland
HPE:
1. Lymphoid follicles with terminal centers:
Struma lymphomatosum
2. Hurthle cell/ oncocytic change:
• Cells with abundant granular, eosinophilic cytoplasm
• Excess of mitochondria

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10
Q

Complications of Hashimoto’s disease

A

🔼 risk of developing:

  1. Papillary carcinoma of thyroid
  2. Extranodal marginal B cell lymphoma
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11
Q

Subacute lymphocytic thyroiditis

A 
Occurs in 🤰 
Self limiting
HPE:
1. Predominance of lymphocytes
2. Absence of Hurthle cell change
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12
Q

De Quervain’s thyroiditis
or
Granulomatous thyroiditis

A

Painful thyroid
Following viral infections
Self limiting
HPE: granulomas & lymphocytes

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13
Q

Reidel’s thyroiditis

A

Sony hard thyroid gland due to fibrosis

D/D for thyroid malignancy

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14
Q

Thyroid tumors

types

A 
1. Benign:
 Follicular adenoma 
2. Malignancy:
• papillary
• follicular
• medullary
• anaplastic
3. Lymphoma
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15
Q

Criteria to predict malignancy in a thyroid nodule

A
  1. Solitary
  2. Solid
  3. Young male
  4. Cold nodule
  5. Previous history of radiation ☢️ exposure
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16
Q

Follicular adenoma

A

Benign thyroid tumor

HPE: large no of follicles with scanty colloid

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17
Q

Papillary malignant thyroid carcinoma

basic features

A 
M/C thyroid malignancy
Best prognosis
From follicular cells
Metastasis: lymphatic
Genetics:
1. BRAF: M/C
2. RET-PTC
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18
Q

Risk factors for papillary thyroid carcinoma

A
  1. Radiation ☢️ exposure
  2. Thyroglossal cyst
  3. Hashimoto’s thyroiditis
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19
Q

Papillary carcinoma of thyroid

microscopic features

A
  1. Papillae with fibrovascular core
  2. Lined by cells with orphan Annie eye nucleus (optically clear nuclei)
  3. Nuclear pseudoinclusions
  4. Nuclear grooves: coffee ☕️ bean nuclei
  5. Psamomma bodies
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20
Q

Tumour that show nuclear grooves

A
  1. Papillary carcinoma of thyroid
  2. Granulosa cell tumour
  3. Brenner’s tumour
  4. Langerhan’s cell histiocytosis
21
Q

Variants of papillary carcinoma of thyroid

A 
1. Follicular variant:
 Cells arranged in follicles but nuclear features are those of papillary carcinoma
2. Tall cell variant
3. Columnar cell variant
4. Papillary microcarcinoma
5. Dense sclerosing variant
22
Q

Follicular carcinoma of thyroid

basics

A 
From follicular cells
Hematogenous metastasis
Genetics:
1. K-RAS
2. P13K
Risk factors:
1. Iodine deficiency
2. Multinodular goitre
23
Q

Follicular carcinoma of thyroid

microscopy

A

Cells arranged in follicles
📝: Capsular/ vascular invasion is useful in differentiating follicular adenoma from carcinoma ➡️
FNAC is not useful for diagnosis (capsule/ blood vessel specimen not taken)
H&E: gold standard for diagnosis

24
Q

Medullary carcinoma of thyroid

cells, metastasis

A

From para follicular cells/ C cells of thyroid

Both hematogenous & lymphatic metastasis

25
Q

Medullary thyroid carcinoma

🧬

A 
Ret gene on chromosome 10:
1. Sporadic:
 Unilateral
 Adults
 Poor prognosis 
2. Familial:
 Bilateral
 Multicentric
 MEN 2 syndrome
26
Q

Medullary carcinoma of thyroid

Microscopy & tumour markers

A

H&E:
• spindle cells
• A cal amyloid
Tumour marker: calcitonin
CEA carcinoembyronic antigen: marker for calcitonin negative medullary carcinoma
To confirm diagnosis: Congo red stain for amyloid shows 🍏 birefringence

27
Q

Anaplastic carcinoma of thyroid

basic features

A

Least common
Worst prognosis
From follicular cells
Both hematogenous and lymphatic metastasis
🧬 : p53
Usually, arises in the setting of papillary carcinoma

28
Q

Anaplastic carcinoma of thyroid

microscopy

A

H&E: pleomorphic cells like

  1. Spindle cells
  2. Sarcomatoid cells
  3. Giant cells
29
Q

Malignant lymphoma of thyroid

A

Elderly female
Cold nodule
Risk factor: Hashimoto’s thyroiditis
Eg. of MALToma

30
Q

Water clear cells

A

Abundant glycogen deposition ➡️ produces clearing

31
Q

Functions of parathyroid gland

A

Ca2+ homeostasis, 🔼

  1. Renal tubular reabsorption of Ca2+
  2. Conversion of vit D to active form in kidney
  3. Urinary PO4 excretion
  4. GIT Ca2+ abortion
32
Q

Disorders of parathyroid

A
  1. Hyperparathyroidism
  2. Hypoparathyroidism
  3. Mass lesion
33
Q

Causes of primary hyperparathyroidism

A 
1. Parathyroid adenoma
 85-90 %
2. Hyperplasia
 5-10 %
3. Carcinoma
 <1 %
 Rare 
 Criteria for diagnosis: metastasis
34
Q

Primary hyperparathyroidism

pathology

A
  1. Cyclin D1 🧬 inversion
  2. 🔼 expression of cyclin D1
  3. 🔼 cellular proliferation
  4. Adenoma
    OR
  5. Mutation in MEN I 🧬
  6. 🔼 expression of menin
35
Q

Difference between parathyroid adenoma and hyperplasia

A

Adenoma:
Solitary lesion involving single gland, but encapsulated
Hyperplasia:
Involves all 4 parathyroid glands, usually symmetrically.
Sometimes, 🔼 water clear cells
Microscopically, both are same

36
Q

Microscopic features of parathyroid adenoma and hyperplasia

A
  1. Sheets/ cords of chief cells, central nuclei are round to polygonal
  2. Sometimes 🔼 in oxyphil cells ➡️:
    Oxyphil adenoma/ Hurthle cell adenoma
37
Q

Clinical features of hyperparathyroidism

A
  1. Painful 😣 bones 🦴
  2. Renal stones (➡️ pain)
  3. Abdominal groans
  4. Psychic moans: depression, anxiety, …
38
Q

Bone manifestations of hyperparathyroidism

A
  1. Osteoporosis
  2. Osteitis fibrosa cystica
  3. Brown’s tumour
39
Q

Brown’s tumour

A

Cortical bone in parathyroid disorders ➡️
osteoclasts move through medullary cavity ➡️
Rail Road lesion/ dissecting osteitis
Accumulation of hemosiderin laden macrophages ➡️ some reparative lesions/ reactive bone formation ➡️ brown’s tumor

40
Q

Secondary hyperparathyroidism

A

Due to prolonged hypocalcemia
M/C cause chronic renal failure
Other causes: vit D deficiency, malabsorption
Reversible

41
Q

Tertiary hyperparathyroidism

A

Parathyroid bd starts producing PTH even with hypocalcemia treatment autonomously ➡️ 🔼 PTH

42
Q

Acidophils of pituitary

A

Somatotrophs

Lactotrophs

43
Q

Basophils of pituitary

A

C. Corticotrophs
B. Basophilic cells
T. Thyrotrophs
Gonadotrophs

44
Q

Pituitary adenoma

basics

A

M/C pituitary tumour
M/C type: prolactinemia (amenorrhea + galactorrhea)
Distinguished from carcinoma via metastasis only

45
Q

Classification of pituitary adenomas based on cells involved

A 
1. Corticotrophic:
 Cushing’s and Nelson’s syndrome
2. Somatotrophic: acromegaly, gigantism
3. Lactotrophic: prolactinemia
4. Mammosomatotrophic:
 acromegaly, gigantism, hyperprolactinemia 
5. Thyrotrophic: hypo & hyperthyroidism
6. Gonadotrophic: hypogonadism, mass effect
46
Q

Pituitary adenoma classification:
• radiologically
• functionally

A

Microadenoma: <1 cm
Macroadenoma: >1 cm
Functional
Non-functional

47
Q

Microscopic and gross features of pituitary adenoma

A
  1. Round to polygonal monomorphic cells
  2. Sparse supportive connective tissue
  3. Cellular monomorphism
  4. Absence of significant reticulin network
    Grossly: soft, well circumscribed
48
Q

Craniopharyngioma

A 
Arises from Rathke’s pouch
3-4 cm encapsulated tumour
Pressure effects on optic chiasma
Gross: cyst with yellow/ brown oil
 ‘machine oil’
49
Q

Features of adenomatous craniopharyngioma absent in papillary craniopharyngioma

A

Adenomatous craniopharyngioma is seen in children unlike papillary (adults)

  1. Stratified squamous epithelium
  2. Wet keratin
  3. Calcitonin
  4. Cysts
  5. Reticulin

Pathology MBBS (17 decks)

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