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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
Medullary thyroid carcinoma | 🧬
``` Ret gene on chromosome 10: 1. Sporadic: Unilateral Adults Poor prognosis 2. Familial: Bilateral Multicentric MEN 2 syndrome ```
26
Medullary carcinoma of thyroid | Microscopy & tumour markers
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
Anaplastic carcinoma of thyroid | basic features
Least common Worst prognosis From follicular cells Both hematogenous and lymphatic metastasis 🧬 : p53 Usually, arises in the setting of papillary carcinoma
28
Anaplastic carcinoma of thyroid | microscopy
H&E: pleomorphic cells like 1. Spindle cells 2. Sarcomatoid cells 3. Giant cells
29
Malignant lymphoma of thyroid
Elderly female Cold nodule Risk factor: Hashimoto’s thyroiditis Eg. of MALToma
30
Water clear cells
Abundant glycogen deposition ➡️ produces clearing
31
Functions of parathyroid gland
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
Disorders of parathyroid
1. Hyperparathyroidism 2. Hypoparathyroidism 3. Mass lesion
33
Causes of primary hyperparathyroidism
``` 1. Parathyroid adenoma 85-90 % 2. Hyperplasia 5-10 % 3. Carcinoma <1 % Rare Criteria for diagnosis: metastasis ```
34
Primary hyperparathyroidism | pathology
1. Cyclin D1 🧬 inversion 2. 🔼 expression of cyclin D1 3. 🔼 cellular proliferation 4. Adenoma OR 1. Mutation in MEN I 🧬 2. 🔼 expression of menin
35
Difference between parathyroid adenoma and hyperplasia
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
Microscopic features of parathyroid adenoma and hyperplasia
1. Sheets/ cords of chief cells, central nuclei are round to polygonal 2. Sometimes 🔼 in oxyphil cells ➡️: Oxyphil adenoma/ Hurthle cell adenoma
37
Clinical features of hyperparathyroidism
1. Painful 😣 bones 🦴 2. Renal stones (➡️ pain) 3. Abdominal groans 4. Psychic moans: depression, anxiety, …
38
Bone manifestations of hyperparathyroidism
1. Osteoporosis 2. Osteitis fibrosa cystica 3. Brown’s tumour
39
Brown’s tumour
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
Secondary hyperparathyroidism
Due to prolonged hypocalcemia M/C cause chronic renal failure Other causes: vit D deficiency, malabsorption Reversible
41
Tertiary hyperparathyroidism
Parathyroid bd starts producing PTH even with hypocalcemia treatment autonomously ➡️ 🔼 PTH
42
Acidophils of pituitary
Somatotrophs | Lactotrophs
43
Basophils of pituitary
C. Corticotrophs B. Basophilic cells T. Thyrotrophs Gonadotrophs
44
Pituitary adenoma | basics
M/C pituitary tumour M/C type: prolactinemia (amenorrhea + galactorrhea) Distinguished from carcinoma via metastasis only
45
Classification of pituitary adenomas based on cells involved
``` 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
Pituitary adenoma classification: • radiologically • functionally
Microadenoma: <1 cm Macroadenoma: >1 cm Functional Non-functional
47
Microscopic and gross features of pituitary adenoma
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
Craniopharyngioma
``` Arises from Rathke’s pouch 3-4 cm encapsulated tumour Pressure effects on optic chiasma Gross: cyst with yellow/ brown oil ‘machine oil’ ```
49
Features of adenomatous craniopharyngioma absent in papillary craniopharyngioma
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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