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Difference between revisions of "Thyroid gland"
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The '''thyroid gland''' is an important little endocrine organ in the anterior [[neck]]. It is not infrequently afflicted by cancer... but the common cancer has such a good prognosis there is debate about how aggressively it should be treated. The [[cytopathology]] of the thyroid gland is dealt with in the ''[[thyroid cytology]]'' article. It frustrates a significant number of pathologists, as the criteria for cancer are considered a bit wishy-washy. | The '''thyroid gland''' is an important little endocrine organ in the anterior [[neck]]. It is not infrequently afflicted by cancer... but the common cancer has such a good prognosis there is debate about how aggressively it should be treated. The [[cytopathology]] of the thyroid gland is dealt with in the ''[[thyroid cytology]]'' article. It frustrates a significant number of pathologists, as the criteria for cancer are considered a bit wishy-washy. | ||
=Thyroid specimens= | |||
They come in 3 common varieties: | They come in 3 common varieties: | ||
*Hemithyroid. | *Hemithyroid. | ||
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**Papillary thyroid carcinoma - may be calcified.<ref>BEC. 20 October 2009.</ref> | **Papillary thyroid carcinoma - may be calcified.<ref>BEC. 20 October 2009.</ref> | ||
=Common diagnoses= | |||
*Nodular hyperplasia. | *Nodular hyperplasia. | ||
*Lymphocytic thyroiditis. | *Lymphocytic thyroiditis. | ||
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*Parathyroid tissue. | *Parathyroid tissue. | ||
=Parathyroid tissue= | |||
General: | General: | ||
*Identification of normal can be tricky. | *Identification of normal can be tricky. | ||
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*[http://pathology.mc.duke.edu/research/PTH225.html Histology - several images. - pathology.mc.duke.edu]. | *[http://pathology.mc.duke.edu/research/PTH225.html Histology - several images. - pathology.mc.duke.edu]. | ||
==Parathyroid hyperplasia== | |||
*Parathyroid hyperplasia - classically assoc. with renal failure. | *Parathyroid hyperplasia - classically assoc. with renal failure. | ||
*Chief cell hyperplasia - associated with MEN I, MEN IIa.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2]. Accessed on: 29 July 2010.</ref> | *Chief cell hyperplasia - associated with MEN I, MEN IIa.<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2]. Accessed on: 29 July 2010.</ref> | ||
==Parathryoid adenoma== | |||
*One parathyroid is big... the others are small. | *One parathyroid is big... the others are small. | ||
*Associated with [[MEN I]] and [[MEN]] IIa/b (II/III). | *Associated with [[MEN I]] and [[MEN]] IIa/b (II/III). | ||
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Image: [http://library.med.utah.edu/WebPath/jpeg4/ENDO091.jpg Parathyroid adenoma (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 6 December 2010.</ref> | Image: [http://library.med.utah.edu/WebPath/jpeg4/ENDO091.jpg Parathyroid adenoma (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 6 December 2010.</ref> | ||
=Benign= | |||
==Nodular hyperplasia== | |||
*Very common benign diagnosis. | *Very common benign diagnosis. | ||
**If you've seen a handful of thyroids you've seen this. | **If you've seen a handful of thyroids you've seen this. | ||
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**Not cellular. | **Not cellular. | ||
==Follicular adenoma== | |||
*Most common neoplasm of thyroid<ref>{{Ref EP|51}}</ref> | *Most common neoplasm of thyroid<ref>{{Ref EP|51}}</ref> | ||
*Encapusled lesion (surrounded by fibrous capsule). | *Encapusled lesion (surrounded by fibrous capsule). | ||
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**No nuclear features suggestive of papillary carcinoma. | **No nuclear features suggestive of papillary carcinoma. | ||
==Graves disease== | |||
*Often misspelled "Grave's disease". | *Often misspelled "Grave's disease". | ||
*Hyperthyroidism. | *Hyperthyroidism. | ||
*Etiology: autoimmune. | *Etiology: autoimmune. | ||
===Gross=== | |||
Features:<ref>{{Ref EP|30}}</ref> | Features:<ref>{{Ref EP|30}}</ref> | ||
**Enlarged 50-150 g. | **Enlarged 50-150 g. | ||
**"Beefy-red" appearance, looks like raw beef. | **"Beefy-red" appearance, looks like raw beef. | ||
===Microscopic=== | |||
Features: | Features: | ||
*Papillae (may mimic papillary thyroid carcinoma in this respect). | *Papillae (may mimic papillary thyroid carcinoma in this respect). | ||
==Granulomatous thyoiditis== | |||
Features:<ref name=Ref_Sternberg4_559>{{Ref Sternberg4|559}}</ref> | Features:<ref name=Ref_Sternberg4_559>{{Ref Sternberg4|559}}</ref> | ||
*AKA ''de Quervain disease''. | *AKA ''de Quervain disease''. | ||
*Women > men. | *Women > men. | ||
==Ridel thyroiditis== | |||
*Fibrosis. | *Fibrosis. | ||
*Specimen often fragmented as it was difficult to remove. | *Specimen often fragmented as it was difficult to remove. | ||
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==Hashimoto's thyroiditis== | ==Hashimoto's thyroiditis== | ||
=== | ===General=== | ||
Presentation: | Presentation: | ||
*Hypothyroid | *Hypothyroid | ||
Associations:<ref name=pmid7813361 >{{cite journal |author=Poropatich C, Marcus D, Oertel YC | Associations:<ref name=pmid7813361 >{{cite journal |author=Poropatich C, Marcus D, Oertel YC |title=Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases |journal=Diagn. Cytopathol. |volume=11 |issue=2 |pages=141–5 |year=1994 |pmid=7813361 |doi= |url=http://www3.interscience.wiley.com/journal/112701408/abstract?CRETRY=1&SRETRY=0}}</ref> | ||
|title=Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases |journal=Diagn. Cytopathol. |volume=11 | |||
|issue=2 |pages=141–5 |year=1994 |pmid=7813361 |doi= | |||
|url=http://www3.interscience.wiley.com/journal/112701408/abstract?CRETRY=1&SRETRY=0}}</ref> | |||
*Antimicrosomal (antithyroid peroxidase) +ve. | *Antimicrosomal (antithyroid peroxidase) +ve. | ||
*Antithyroglobulin +ve. | *Antithyroglobulin +ve. | ||
*Increased risk of B-cell lymphoma. | *Increased risk of B-cell lymphoma. | ||
Etiology: | |||
*Autoimmune. | *Autoimmune. | ||
**Often genetic/part of a syndrome. | **Often genetic/part of a syndrome. | ||
=== | ===Microscopic=== | ||
Features: | |||
*Histologically often not possible to separate from "nonspecific" thyroiditis.<ref name=Ref_Sternberg4_560>{{Ref Sternberg4|560}}</ref> | *Histologically often not possible to separate from "nonspecific" thyroiditis.<ref name=Ref_Sternberg4_560>{{Ref Sternberg4|560}}</ref> | ||
*Nuclear clearing common - ergo may confuse with papillary carcinoma. | *Nuclear clearing common - ergo may confuse with papillary carcinoma. | ||
*Polymorphous lymphoplasmacytic infiltrate with germinal centres.<ref name=Ref_APBR672>{{Ref APBR|672}}</ref> | *Polymorphous lymphoplasmacytic infiltrate with germinal centres.<ref name=Ref_APBR672>{{Ref APBR|672}}</ref> | ||
=Malignant neoplasm= | |||
There are a bunch of 'em. The most common, by far, is papillary. | There are a bunch of 'em. The most common, by far, is papillary. | ||
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*Favourable prognosis. | *Favourable prognosis. | ||
=== | ===Microscopic=== | ||
*IMPOSSIBLE to differentiate from ''follicular adenoma'' on FNA (no cytologic differences). | Features: | ||
*'''IMPOSSIBLE''' to differentiate from ''follicular adenoma'' on FNA (no cytologic differences). | |||
*Defined by invasion through the capsule. | *Defined by invasion through the capsule. | ||
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*Abbreviated ''MTC''. | *Abbreviated ''MTC''. | ||
Medical school memory device - 3 M's: | |||
3 M's: | |||
*[[amyloid|aMyloid]]. | *[[amyloid|aMyloid]]. | ||
*Median node dissection done. | *Median node dissection done. | ||
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**[[Parathyroid adenoma]]. | **[[Parathyroid adenoma]]. | ||
Epidemiology: | |||
*Very rare. | *Very rare. | ||
*Poor prognosis. | *Poor prognosis. | ||
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*Arises from C cells (which produce calcitonin). | *Arises from C cells (which produce calcitonin). | ||
=== | ===Microscopic=== | ||
Features: | Features: | ||
*Nuclei with "neuroendocrine features". | *Nuclei with "neuroendocrine features". | ||
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*Horrible prognosis. | *Horrible prognosis. | ||
=== | ===Microscopic=== | ||
Features: | Features: | ||
*Cytologically malignant: | *Cytologically malignant: | ||
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Image: [http://commons.wikimedia.org/wiki/File:Anaplastic_thyroid_carcinoma_low_mag.jpg Anaplastic thyroid carcinoma with a component of papillary thyroid carcinoma (WC)]. | Image: [http://commons.wikimedia.org/wiki/File:Anaplastic_thyroid_carcinoma_low_mag.jpg Anaplastic thyroid carcinoma with a component of papillary thyroid carcinoma (WC)]. | ||
==IHC== | ===IHC=== | ||
*Keratin (AE1/AE3). | *Keratin (AE1/AE3). | ||
*Vimentin +ve, >90%.<ref name=pmid1712540>{{cite journal |author=Ordóñez NG, El-Naggar AK, Hickey RC, Samaan NA |title=Anaplastic thyroid carcinoma. Immunocytochemical study of 32 cases |journal=Am. J. Clin. Pathol. |volume=96 |issue=1 |pages=15–24 |year=1991 |month=July |pmid=1712540 |doi= |url=}}</ref> | *Vimentin +ve, >90%.<ref name=pmid1712540>{{cite journal |author=Ordóñez NG, El-Naggar AK, Hickey RC, Samaan NA |title=Anaplastic thyroid carcinoma. Immunocytochemical study of 32 cases |journal=Am. J. Clin. Pathol. |volume=96 |issue=1 |pages=15–24 |year=1991 |month=July |pmid=1712540 |doi= |url=}}</ref> | ||
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*HBME-1 thought to be positive in papillary lesions.<ref name=pmid15529186>{{Cite journal | last1 = Papotti | first1 = M. | last2 = Rodriguez | first2 = J. | last3 = De Pompa | first3 = R. | last4 = Bartolazzi | first4 = A. | last5 = Rosai | first5 = J. | title = Galectin-3 and HBME-1 expression in well-differentiated thyroid tumors with follicular architecture of uncertain malignant potential. | journal = Mod Pathol | volume = 18 | issue = 4 | pages = 541-6 | month = Apr | year = 2005 | doi = 10.1038/modpathol.3800321 | PMID = 15529186 }}</ref> | *HBME-1 thought to be positive in papillary lesions.<ref name=pmid15529186>{{Cite journal | last1 = Papotti | first1 = M. | last2 = Rodriguez | first2 = J. | last3 = De Pompa | first3 = R. | last4 = Bartolazzi | first4 = A. | last5 = Rosai | first5 = J. | title = Galectin-3 and HBME-1 expression in well-differentiated thyroid tumors with follicular architecture of uncertain malignant potential. | journal = Mod Pathol | volume = 18 | issue = 4 | pages = 541-6 | month = Apr | year = 2005 | doi = 10.1038/modpathol.3800321 | PMID = 15529186 }}</ref> | ||
=See also= | |||
*[[Thyroid cytopathology]]. | *[[Thyroid cytopathology]]. | ||
*[[Head and neck cytopathology]]. | *[[Head and neck cytopathology]]. | ||
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*[[Cytopathology]]. | *[[Cytopathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Endocrine pathology]] | [[Category:Endocrine pathology]] | ||