Thyroid Tumor Classification & Adenoma by-c.subathra

8/8/2019 Thyroid Tumor Classification & Adenoma by-c.subathra

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THYROID TUMORS

NODULES

USUALLY BENIGN MALIGNANCY VERY RARE

30%

BENIGN

FOLLICULAR ADENOMA

5%

MALIGNANT

REST

NONNEOPLASTIC

LESIONS

SOLITARY TUMORS



CLASSIFICATION

WHO CLASSIFICATION

HISTOLOGICAL CLASSIFICATION

BY ROSAI & HIS MEMBERS



WHO CLASSIFICATION

(2004) THYROID CARCINOMA

THYROID ADENOMA & RELATED

TUMORS

OTHER THYROID TUMORS



THYROID CARCINOMA Papillary carcinoma

Follicular carcinoma

Poorly differentiated carcinoma Undifferentiated (anaplastic) carcinoma

Squamous cell carcinoma

Mucoepidermoid carcinoma

Sclerosing mucoepidermoid carcinomawith eosinophilia

Mucinous carcinoma



Medullary thyroid carcinoma

Mixed medullary and follicular cell

carcinoma Spindle cell tumor with thymus-like

differentiation (SETTLE)

Carcinoma showing thymus-like

differentiation (CASTLE)



THYROID ADENOMA &

RELATED TUMORS

Follicular adenoma

Hyalinizing trabecular tumor



OTHER THYROID

TUMORS Teratoma

Primary lymphoma and plasmacytoma

Ectopic thymoma

Angiosarcoma

Smooth muscle tumors

Peripheral nerve sheath tumors Paraganglioma



Solitary fibrous tumor Follicular dendritic cell tumor

Langerhans cell histiocytosis

Secondary tumors of the thyroid



ROSAI¶SROSAI¶S

HISTOLOGICALHISTOLOGICALCLASSIFICATIONCLASSIFICATION

OF THYROIDOF THYROID

TUMORSTUMORS



B.F.AD CONVENTIONAL

VARIENT

TUMORS

T.OF FOLLICULAR

CELLS

FOLLICULAR PAPILLARY

WELL DIFFERENTIATED

INSULAR OTHERS

POORLY DIFFERENTIATED

MALIGNANT

CARCINOMA

T.OF.C-CELL& RELATED

ENDOCRINE CELLS

MEDULLARY CA

T.OF.FOLLICULAR &

C-CELL

SARCOMA MALIGNANT LYMPHOMA

MISCELLANEOUS

NEOPLASMS

UNDIFFERENTIATED

TUMORS

PRIMARY

TUMORS

1) T. WITHONCOCYTIC FEATURE

2) T. WITHCLEAR CELL FEATURE

3) T. WITHSQUAMOUS FEATURE

4) T. WITHMUCINOUS FEATURE

SECONDARY

TUMORS

THYROID

TUMORS







FOLLICULAR ADENOMA

Benign encapsulated thyroid tumor

Derived f rom follicular epithelium

Euthyroid except in toxic adenoma.

Solitary

multiple associated - geneticsyndromes.



AGE: any age.

MALE:FEMALE ± 1:4 Cytogenetics: clonal;

occasionally tetraploid or aneuploid.

25% are aneuploid.



PATHOGENESIS

TSH receptor mutation

Genetic defect: abnormality in

terminal region of long arm of chr 19. Associated with cowden¶s disease.

20% - point mutation in RAS family of

oncogene



GROSS MORPHOLOGY

solitary, spherical ,firm

3-10 cm.

Gray-white to red-brown nodule.

Encapsulated by thin complete

capsule.

bulges when fresh, compresses

adjacent thyroid.



secondary degenerative changes such as:

Hemorrhage

edema

f ibrosis

calcif ication

bone f ormation

cystic degener ation

No vascular invasion into capsule.





MICROSCOPY

Unif ormly appearing f ollicles that contain

colloid.

A variety of patterns

,s

ingly or in combination:

normofollicular (simple)

macrofollicular (colloid) microfollicular (fetal)

trabecular/solid (embryonal)











Mitoses: r ar e or a bsent

muscular cushions

papillary or pseudo papillary structur es -follicular adenoma with papillaryarchitecture.

SCAN APPEARANCEhyperfunctioning (hot) adenomas -mor ecellular and the cells have mor e a bundant cyto plasm than nonfunctioning (cold)tumor s

HOT NODULES ALWAYS BENIGN.



FOLLICULAR

ADENOMA

MULTINODULAR

GOITER SOLITARY NODULE MULTIPLE NODULES

MORE COMPRESSION OF

ADJACENT THYROID

PARENCHYMA

LESS COMPRESSION OF

ADJACENT THYROID

PARENCHYMA

WELL ENCAPSULATED LACK OF WELL FORMED

CAPSULE

FOLLICULAR GROWTH IN

ADENOMA DISTINCT FROMOTHER NON NEOPLASTIC

THYROID.

NODULAR AND

UNINVOLVED THYOIR PARENCHYMAHAVE

SIMILAR GROWTH PATTEN.



VARIENT FORMS

HURTHLE CELL ADENOMA-

neo plastic cells acquir e brightly

eosino philic gr anular cyto plasm.

Follicular adenoma with oxy philia







HYALINIZING TRABECULAR

ADENOMA

neoplasm with prominent trabecular

pattern and hyalinization

yellow-tan, circumscribed

Gross images: lobular configuration

with white, shiny, cartilaginous

elements



MICROSCOPY

thin capsule

prominent trabeculae of follicular epithelium

in abundant hyalinized or sclerotic stroma, cells are polygonal or spindled with

elongated nuclei with chromatin clearing,intranuclear grooves and inclusions

psammoma bodies Cytoplasmic Yellow body

no vascular or capsular invasion







ATYPICAL ADENOMA

pronounced cellular prolifer ation

Mor e extensive variation in cellular size

and nuclear mor phology.

Incr eased mitotic activity.

no capsular or blood vessel invasion





ADENOMA WITH BIZARRE

NUCELI

huge hy per chromatic nuclei, usually in

cluster s

no malignancy

DD: par athyroid adenomas





TOXIC ADENOMA

Some adenomas produce thyroid hormones

Produce clinically thyrotoxicosis.

Functional adenomas

Independent of TSH stimulation

THYROID AUTONOMY





OTHER VARIENTS

clear cell changes- signet ring, mucin-

producing, and lipid-rich ty pes

adi pose metaplasia of the stroma -adenolipoma

cartilaginous metaplasia -adenochondroma

massive deposition of cyto plasmic black pigment

f ollowing minocycline ther apy-black adenoma



CLEAR CELL ADENOMA



MUCIN PRODUCING

ADENOMA



ADENOLIPOMA



ADENOCHONDROMA



BLACK ADENOMA



CLINICAL FEATURES

Unilater al painless mass

Diff iculty in swallowing.

Euthyroid state except in toxic adenoma

No r ecurr ance

No metastasis.



INVESTIGATIONS

RADIONUCLIDE SCAN: cricumscribed cold nodule.

Normal T3,T4, TSH levels

except in toxicadenoma

FNAC:cellular smear with microf ollicles

Ultrasonography

Positive stains: low molecular weightkeratin, thyroglobulin

Negative stains: CK19



COLD NODULE



TOXIC ADENOMA



FNAC



DD

Dominant nodule of nodular hy per plasia

Minimally invasive f ollicular car cinoma

Follicular variant of papillary car cinoma

Vascular tumor s:

some f ollicular adenomas ar e highly

vascularized



TREATMENT:

lobectomy

No Enucleation

su ppr ession with

levothyroxine

toxic adenoma -131 I

PROGNOSIS:

Excellent prognosis

including f or aty pical

adenoma



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Thyroid Tumor Classification & Adenoma by-c.subathra