Thyroid Pathology Flashcards
Chronic lymphocytic thyroiditis / Hashimoto’s thyroiditis
Chronic lymphocytic thyroiditis / Hashimoto’s thyroiditis, magnified
What cell type is the top arrow pointing to? What about the bottom arrow?
Follicular cells
C cells
Graves disease
What cell type is the arrow pointing to?
Oncocytic cell / Hurthle cell
What are characteristic features of oncocytic / Hurthle cells?
- Eosinophilic / pink cytoplasm
- Round nucleus
- Prominent nucleolus
- Seen in both benign and malignant lesions
- Metaplastic follicular cell
What type of cell is the arrow pointing at?
Oncocytic cell
What are the arrows pointing to?
Oncocytic / Hurthle cell
What oncogene is commonly rearranged in endocrine tumors, specifically papillary thyroid carcinoma?
RET (rearranged during transfection)
What chromosome is Ret on? What does the gene do? How common is this chromosomal change?
- chromosome 10 INVERSION (rearrangement)
- tyrosine kinase domain gets overactivated
- 60-80% of papillary thyroid carcinomas occurring after irradiation
Which is Graves? Which is Papillary carcinoma? How do you know?
Papillary carcinoma is the one on the left - can tell because nuclei are empty-looking, enlarged, and have creases.
Which is Graves? Which is papillary carcinoma?
Graves is on the right, papillary carcinoma is on the left. Similar architecture but the nuclear cytology is very different!
What is this? What are some important features?
Papillary carcinoma. Papillary cores, blood vessel, and empty-looking nuclei.
Arrow?
Nuclear inclusion (seen in papillary carcinoma)
Nuclear groove seen in papillary carcinoma
Is the diagnosis of papillary carcinoma based on architecture or based on nucleus?
Nucleus - the architecture can vary quite a lot. (Papillae, follicles, tall cell variant).
Does follicular carcinoma metastasize by lymphatics or blood vessels? Where does it go?
Blood vessels - goes to distant organs like brain, lungs, or bone.
What are the empty spaces in this image? What is the thing in the middle? What is this?
The empty spaces are blood vessels. This tumor is sitting in the blood vessel. It is a follicular carcinoma.
How is a follicular carcinoma diagnosed? Contrast with papillary carcinoma?
Follicular carcinoma is diagnosed by invasion into the capsule and or the capsular vessels. Papillary carcinoma is diagnosed by nuclear features.
Can papillary carcinoma present as multiple tumors in the thyroid? What about follicular carcinoma?
Papillary carcinoma presents as multiple tumors; follicular carcinoma presents as a single tumor.
How does Ret involvement differ between papillary carcinoma (due to radiation) and medullary carcinoma (familial)?
For papillary carcinoma, we are thinking of Ret gene REARRANGEMENT.
For medullary carcinoma we are thinking of Ret gene MUTATION.
Can you treat C cell tumors with radioactive iodine?
No - they don’t use it
What stain is used to identify amyloid?
Congo red
Three ways to diagnose medullary carcinoma?
- Stain for calcitonin, 2. Look at cytology, 3. Measure calcitonin (should be high)
What is the most common thyroid carcinoma?
A. follicular carcinoma
B. papillary carcinoma
C. medullary carcinoma
D. anaplastic carcinoma
B, papillary carcinoma
What is this a histological image of (ignore the arrow)?
A. Papillary Carcinoma
B. Follicular Carcinoma
C. Medullary Carcinoma
D. Anaplastic Carcinoma
E. Graves Disease
D. Anaplastic carcinoma
Anaplastic carcinoma - note the necrotic areas
Histologic features of anaplastic carcinoma?
Pleiomorphic tumor cells - can show spindle cells and multinucleated giant cells
From what cell type are medullary carcinomas derived? How do they metastasize?
C cells. Via blood vessels and lymphatics.
What thyroid carcinoma is this?
Medullary carcinoma
This thyroid carcinoma is probably…
Medullary carcinoma
This thyroid carcinoma is probably…
Medullary carcinoma
Follicular carcinoma with invasion
Papillary Carcinoma, Follicular Variant
This is an example of:
A. Papillary Carcinoma, papillary variant
B. Follicular Carcinoma
C. Graves Disease
D. Papillary Carcinoma, follicular variant
D - you can tell because the nuclei are very characteristic, but the cells are not forming papillae (not sure I entirely see this).
Papillary Carcinoma Tall Cell Variant
Follicular Adenoma
