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Endocrine > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

1
Q

What is a development abnormality of the thyroid?

What about from inflammation?

A
  • Developmental abnormalities - Thyroglossal duct cyst
  • Inflammation - Autoimmune thyroiditis (Hashimoto) - Subacute thyroiditis (de Quervain) - Chronic fibrosing thyroiditis (Riedel)
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2
Q

Hyperplasia in the thyroid is d/t

A
  • Iodine deficiency (diffuse or nodular goiter)
  • Autoimmune (Graves’ disease
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3
Q

What neoplasias do we see in the thryoid gland?

A

Neoplasia - Benign tumors (follicular adenoma)

  • Malignant tumors (carcinoma, sarcoma, lymphoma, etc)
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4
Q

Hashimoto Thyroiditis is an autoimmune disorder, what antibodies do we see in this disease?

A

Anti-TPO, anti-Tg

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5
Q

Gross appereance of hashimotos

A

diffuse enlargement and very nodular looking

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6
Q

Lymphocytic inflammation

– Germinal centers

– Hurthle cell change

All microscopic findings in:

A

Hashimoto thyroiditis

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7
Q
A
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8
Q

What type of cell is in the pictuer that is seen in Hashimotos?

A

Hurthle cells; have more cytoplasm; its more pink and is dt inflammation

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9
Q

Suppurative (neutrophils)

Granulomatous (giant cells)

seen in what thyroid disease?

A

Subacute Thyroiditis (de Quervain)

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10
Q

Causes of Subacute Thyroiditis (de Quervain)

A

Viral or postviral response • Painful, self-limited disease

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11
Q

Describe Riedel or Fibrous Thyroiditis

A
  • Hard and fixed thyroid
  • Painless
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12
Q

– Dense fibrosis • Collagen fibers

– Fibrosis can extend outside of thyroid

seen in what type of thyroiditis?

A

Fibrious or Riedel Thyroiditis

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13
Q

Autoimmune disease causing thyroid hyperplasia, most common cause of endogenous hyperthryroidism

A

Graves

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14
Q

Describe the apperance of Graves thryoid on microscopy

A

See irregular follicles and scalloped colloid

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15
Q

Histology of a Goiter

  • Follicles lined by crowded_____ cells
  • ____ sized follicles
  • _____ colloid
A

columnar

Variably

Abundant

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16
Q

What happens overtime in pt with recurrent episodes of goiter?

A

Recurrent episodes lead to a multinodular gland (i.e., “multinodular goiter”) • With time will develop degenerative changes (cysts, fibrosis, calcification, hemorrhage)

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17
Q

Describe the histology seen from goiter below

A

variable sized colloid filled follicles and see nodule throuhgout

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18
Q

How common are solitary thyroid nodules?

are they often benign or maligant?

A

Incidence in US is between 1 and 10%

  • Four times more common in women
  • Majority are non-neoplastic (focal hyperplasia, simple cysts) or benign (adenomas)
  • Carcinoma is relatively uncommon (<1% of all solitary thyroid nodules)
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19
Q

When would a FNA be useful?

A
  • Useful initial approach of solitary nodule
  • Quick, inexpensive, minimal complications •

Can be diagnostic in papillary carcinoma, medullary carcinoma, lymphoma and metastatic tumors

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20
Q

What is a limitiation of FNA?

A

Cannot differentiate follicular adenoma from follicular carcinoma or from hyperplastic nodules

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21
Q

Benign neoplasm with various morphologic appearances (follicular, microfollicular, trabecular, Hurthle cell, etc.); however, this is not clinically significant

• Most are nonfunctional

A

Follicular Adenoma

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22
Q

Are we concerend about follicular adenomas progressing to cancer? What if they are funcitonal?

A

nope

functional = toxic adenomas and cause thyrotoxicosis

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23
Q
  • Solitary
  • Completely surrounded by a fibrous capsule – No capsular or vascular invasion
  • Different growth pattern from adjacent normal gland
A

key findings of Follicular Adenoma

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24
Q
A
25
Q

Below is an image of a mass in someones thyroid.What is it and how can you tell

A

Follicula adenoma

there are some normal thyroid follices seperated by a fibrous capsule and then tons of small follicles and there is NO invasion

26
Q

Etiology of Thyroid cancer

A
  • Thyroid cancer is uncommon – 1.5% of all cancers
  • Mortality is low – 0.4% of all cancer deaths
  • More common in women than in men
  • Occurs in all ages including children
  • Most significant proven risk factor for development of thyroid cancer is exposure to ionizing radiation
27
Q

What is the most common type of thyroid caner?

A
  • Papillary CA – 85% to 95% of cases
  • Follicular CA – 5% of cases
  • Medullary CA – 5% of cases
  • Anaplastic CA – <1% of cases
28
Q

What is the genetic abnormality seen in papillary CA?

A

BRAF oncogene: inv 10

RAS: t:(10:17)

29
Q

What is the gentic mutation in follicular CA?

A
30
Q

What is teh genetic mutation seen in Medullary CA?

A

RET germinline mutation

31
Q

Age pts get Papillary carcinoma

mode of metastatisis

A

Most occur in younger age group (20s – 40s) •

Preferentially metastasize by way of lymphatics to regional lymph nodes

• Cervical nodes involved in up to 50% of cases

32
Q

Prognosis of Papillary thyroid carcionma

A
  • Excellent prognosis (>95% survival at 20 years)
  • Adverse prognostic factors include: age > 40, tumor > 5 cm, extrathyroidal extension, and osseous metastasis
33
Q

What is the gross appereance of a papillary thyroid carcinoma? Is this enough to make a Dx?

A

Very bulbous and fleshy appereaning but dx made based on nuclear study, IE, fine needle aspiration

34
Q
  • “Chewing gum” colloid
  • Psammoma bodies
  • Multinucleated giant cells
A

Papillary CA

35
Q

What are the three nuclear features we see w/ Papillary CA?

A

– Clear nuclei “Orphan Annie eyes”

– Intranuclear cytoplasmic inclusions

– Intranuclear grooves

36
Q

Key feature below is orphan annie eyes seen in:

A

Papillary Carcinoma of thyroid

37
Q

What type of architecture do you see in papillary carcioma of thryoid

A

papillary, but can vary

38
Q

What is shown in the image below?

A

– Intranuclear cytoplasmic inclusions

KEY diagnostic feature of papillary carcinoma

39
Q

what do we see in the histo below? when do we see this?

A

longitudinal nuclear grooves seen in papillary CA

40
Q

See image with overlapping nuclei and lots of clear cells. what is teh Dx

A

Papillary Thyroid carcinoma

41
Q
  • Second most common thyroid cancer
  • Present at older age than papillary (40s to 50s)
  • Slowly enlarging painless nodule
A

Follicular Carcinoma of thyroid

42
Q

What is the pattern of spread in follicular CA?

A

Vascular spread to bone, lungs, liver, etc

(papillary is via lymphatics)

43
Q

PRognosis of follicular thyroid CA

A

Prognosis depends on stage at presentation (generally a worse prognosis than papillary thyroid carcinoma) and extent of invasion

44
Q

What is teh key feature to distinguish follicular adenoma from carcinoma?

A
45
Q

What is a challenge when dx follicular thyroid CA?

A

No cytologic features of malignancy (i.e., no atypia, mitoses, nuclear pleomorphism, etc)

• Most tumors are “well-differentiated”

Minimally invasive carcinomas are difficult to distinguish from follicular adenomas and extensive sampling of the capsule is required

46
Q

Origin of MEdullary CA and what do they secreate?

A

Neuroendocrine tumors derived from the parafollicular (C-cells) of the thyroid

• Tumor cells secrete calcitonin

47
Q

Cause of Medullary CA?

A
  • 80% are sporadic
  • 20% occur within families especially as part of the MEN-2 syndrome
48
Q

Peak incidence and prognosis in Medullary CA

A
  • Peak incidence in the 40s and 50s except in MEN-2 (can occur in childhood)
  • 40% - 60% survival at 10 years
49
Q

The histologist describes a section to you as full of neuroendocrine nests and points out pink amyloid stroma. What is the likely suspect for this?

A

MEdullary CA

amlyoid will also have apple green birefringence

50
Q

What stains do we see in Medullary CA?

A

• Calcitonin + • Chromogranin + • Synaptophysin + • CEA + • Keratin + • Thyroglobulin -

51
Q
  • Undifferentiated tumors of follicular epithelium – Do not stain with thyroid specific immunostains
  • Mean age at presentation is 65 years
  • May have a history of long-standing goiter, differentiated thyroid carcinoma or concurrent papillary carcinoma
A

Anaplastic CA

52
Q

Prognosis of pts with Anaplastic CA

A

• Most have extrathyroidal spread or distant metastasis at presentation – Hoarseness and neck pain • Mortality rate is virtually 100% • Mean survival is 6 months

53
Q

Microscopic appereance of anaplatic CA

A

Spindle cells, epithelioid cells, giant cells – All cells are pleomorphic

54
Q

lymphocytic thyroiditis with germinal centers

A

Hashimoto thyroiditis –

55
Q

Irregular follicular contours and scalloped colloid

A

Graves’ disease –

56
Q

is most common thyroid cancer and is diagnosed based on nuclear features: pseudoinclusions, grooves, clearing

A

Papillary carcinoma

57
Q

_______carcinoma is diagnosed by demonstrating capsular or vascular invasion

A

Follicular

58
Q

Medullary carcinoma secretes

A

calcitonin and is associated with amyloid

Endocrine (20 decks)

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