Wcs16 Endocrine Pathology i 2006

7/28/2019 Wcs16 Endocrine Pathology i 2006

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Endocrine

Dr. RG Inamdar, M.D.

Department of Pathology.

Thyroid


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Goals And ObjectivesAt The Conclusion Of This Exercise The Student Should Be Able To:

List The Clinical Features Of Hypo- And

Hyperthyroidism

Describe The Pathophysiology Of Autoimmune

Thyroiditis And Graves Disease

Know The Different Appearances And Clinical

Course Of The Major Types Of Thyroid Tumors


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Diseases Of The Thyroid

Goiter Thyroiditis

Hypothyroidism

Hyperplasia And Hyperthyroidism Tumors


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Causes Of A Thyroid Goiter

Nodular Hyperplasia Secondary To Iodine-deficient Diet

Dyshormonogenesis

Benign And Malignant Tumors


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Thyroid GoiterDefinition: any enlargement of the thyroid creating A neck

mass. Can be cysts, hyperplasia, benign adenoma or

carcinoma.


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Multinodular Thyroid Goiter

Massive Enlargement May BeDue To Iodine Deficient Diet

Resected Specimen WithMultiple Nodules With Cystic

Degeneration


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Types Of Thyroiditis

Acute Bacterial Thyroditis (Extension FromSuppurative Pharyngitis)

Autoimmune Thyroiditis (Hashimotos Disease)

Granulomatous Thyroiditis (Viral Thyroiditis)

Riedels Thyroditis (Fibrosis In The Neck Extends ToThe Thyroid)

Palpation Thyroiditis (Repeated Palpation Leads ToFocal Chronic Non-specific Inflammation)


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Autoimmune Thyroiditis

Hashimotos Disease

Anti-thyroid Antibodies In Circulation

Antibodies To Thyroglobulin; OTHER Ags

Hyperthyroid Then Euthyroid Then Hypothyroid

Far More Common In Women Of All Ages

Increased Risk Of Thyroid Non-Hodgkins

Lymphoma


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Hashimotos Thyroiditis

Gland Shows Nodular FibrosisFeatures

Autoimmune Basis

Antibodies To Thyroglobulin,

Other Antigens

Thyroid Function StatusVariable

Late Cases Become

Hypothyroid

May Develop Lymphoma


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Hashimotos Thyroiditis

Atrophic Follicles With Hurthle Cell Metaplasia And

Lymphocytic Infiltrate

Immunofluorescence Shows

Anti-thyroglobulin

Autoantibodies


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Firm , Fibrous Or

Nodular Consistency

Follicular Atrophy;

Lymphoid Follicles

Lymphoid

Follicles


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Follicular Atrophy Lymphocytic Infiltrate


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Granulomatous Thyroiditis

Dequervains Disease

Viral Etiology Likely

Giant Cell Thyroiditis


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Causes Of Hypothyroidism

Congenital Metabolic Defect (Cretinism) Iodine Deficient Diet


Post-thyroidectomy

Pituitary Insufficiency

Idiopathic/unknown


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Cogenital Hypothyroidism

Mental Retardation

Myxedema

Growth Retardation


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Acquired Hypothyroidism

Myxedema

Facies

Myxedema

Facies

Pretibial

Myxedema


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Features Of Hypothyroidism


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Types Of Hyperthyrodism

Diffuse Hyperplasia (Graves Disease) Hyperfunctioning Adenoma (Plummers

Syndrome)

TSH Producing Pituitary Or OtherNeuroendocrine Tumor

Iatrogenic (Over Treatment OfHypothyroidism)


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Features Of Graves Disease

L.A.T.S.

IgG

Low TSH

High T3

High T4

High BMR


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Graves Disease

Thyroid Enlargement With

Exopthalmos

Diffuse Thyroid Hyperplasia With Crowded

Follicles, Scalloping Of Colloid And

Lymphocytic Infiltrate


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Thyroid Tumors

Benign

Adenomas

Malignant

Papillary Carcinoma

Follicular Carcinoma

Medullary Carcinoma

Undifferentiated Carcinoma

Lymphomas


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Thyroid Tumor

Ad Of Th Th id


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Adenomas Of The Thyroid

Palpable Nodules

Vast Majority are Cold On Scan

FNA To Evaluate

Not Suspicious: Suppress With ExogenousHormone And Follow

Suspicious: Surgical Excision

Men, Rapid Growth, Fails Suppression: Higher RiskOf Malignancy


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Follicular Adenoma

Well-demarcated Cystic Degeneration


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Follicular Adenoma

Cystic Tumor Cold Nodule On Scan


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Thyroid Follicular Adenoma

Well-circumscribed Focally

Cystic NoduleMacro-follicular Type With Intac

Surrounding Capsule


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Thyroid Adenomas

Cystic Follicular

Adenoma

Features

Palpable Nodules Are 95% Benign

Cold Lesions On Scan More Likely

To Be Malignant

Hot Lesions May Be Toxic

Adenomas (Plummers Disease)

Nodules That Persist Or Grow

After TSH Suppression AreBiopsied By Fine Needle Aspiration

Most FNAs Are Benign

F lli l Ad


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Follicular Adenomas

Microfollicular Type Hurthle Cell Type

C i Of Th Th id


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Carcinomas Of The Thyroid

Tumor Type Features Metastases Prognosis

Papillary Ca Papillae Lymph Nodes Excellent

Follicular Ca Follicles Lung; Bone Good

Medullary Ca Amyloid Lung, Liver Guarded

Anaplastic Ca Giant Cells Disseminated Poor


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Papillary Carcinoma Of The Thyroid

Papillae Psammoma Bodies

Young Women Most Common

Lymph Node Metastases

Excellent Prognosis

Diagnosis By Fine Needle Aspiration

Followed By Thyroidectomy

Papillary Carcinoma


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Papillary Carcinoma

Solitary Multifocal


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Papillary Carcinoma: Psammoma Body


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Papillary Thyroid Cancer

Sclerotic Primary Lesion Tumor Papillae


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Papillary Thyroid Carcinoma

Solid Primary

Tumor

Tumor Papillae With

Fibro-vascular Stalks

Papillae With

Psamomma Body



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Papillary Fronds Sclerotic Appearance


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Follicular Carcinoma Of The Thyroid

Produces Follicles Rich In Thyroglobulin

Invades The Capsule Of The Tumor

Invades Blood Vessels

Metastasizes To Lung And Bone


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Solitary Nodule Bone Metastasis



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Medullary Carcinoma


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Medullary Carcinoma

Inherited Cases Associated With

Pheochromocytoma

RET Oncogene

C Cell Origin

Polygonal And Spindle Cell Types

Amyloid Stroma

Thyrocalcitonin Serum Tumor Marker

MEN II Sipples Syndrome


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MEN II Sipple s Syndrome

Medullary Thyroid

Cancer

Mucosal Neuroma of

the Tongue

Medullary Thyroid Cancer


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Medullary Thyroid Cancer

Solid Tumor With ExtensionThroughout The Thyroid

Infiltrating Tumor With AmyloidStroma

Medullary Carcinoma


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Medullary Carcinoma

Amyloid Stroma

Congo Red Stain With Apple

Green Birefringence


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Anaplastic (Undifferentiated) Carcinoma

Giant Cell; Spindle Cell (Sarcomatoid)

Types

Elderly Women

Rapidly Fatal

Small Cell Type: Usually Lymphoma

Anaplastic Thyroid Carcinoma


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Anaplastic Thyroid Carcinoma

Metastasis To Stomach EM Shows Primitive Cells

Th roid L mphoma


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Thyroid Lymphoma

Usually Well-differentiated B Cell

phenotype

Associated With Autoimmune Thyroiditis

Formerly Thought To Be a Small Cell

Carcinoma

Well differentiated Thyroid Lymphoma


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Well-differentiated Thyroid Lymphoma

Documents

Wcs16 Endocrine Pathology i 2006