Difference between revisions of "Thyroid gland"

Jump to navigation Jump to search

Thyroid gland (view source)

Revision as of 03:43, 20 March 2018

14,417 bytes removed ,  03:43, 20 March 2018
→‎See also
 
(16 intermediate revisions by the same user not shown)
Line 127: Line 127:
*p63 +ve.
*p63 +ve.
**-ve in clear cells.
**-ve in clear cells.
*CEA +ve (polyconal).<ref name=pmid7509563>{{cite journal |author=Mizukami Y, Nonomura A, Michigishi T, ''et al.'' |title=Solid cell nests of the thyroid. A histologic and immunohistochemical study |journal=Am. J. Clin. Pathol. |volume=101 |issue=2 |pages=186–91 |year=1994 |month=February |pmid=7509563 |doi= |url=}}</ref>
*[[CEA]] +ve (polyconal).<ref name=pmid7509563>{{cite journal |author=Mizukami Y, Nonomura A, Michigishi T, ''et al.'' |title=Solid cell nests of the thyroid. A histologic and immunohistochemical study |journal=Am. J. Clin. Pathol. |volume=101 |issue=2 |pages=186–91 |year=1994 |month=February |pmid=7509563 |doi= |url=}}</ref>
**+ve also in clear cells.
**+ve also in clear cells.
*Chromogranin A +ve ~45% of cases.<ref name=pmid7509563/>
*Chromogranin A +ve ~45% of cases.<ref name=pmid7509563/>
Line 137: Line 137:
*[[AKA]] ''[[nodular hyperplasia]]''.
*[[AKA]] ''[[nodular hyperplasia]]''.
*[[AKA]] ''adenomatoid nodule''.
*[[AKA]] ''adenomatoid nodule''.
 
{{Main|Thyroid gland nodular hyperplasia}}
===General===
*Clinical diagnosis: ''goitre'', [[AKA]] ''sporadic goitre'', AKA ''multinodular goitre'' (MNG).
*Most common diagnosis in the thyroid.
**If you've seen a handful of thyroids you've seen this.
 
Notes:
*Large lesions may be clonal; however, this is clinically irrelevant.
 
===Gross===
Features:
*Enlarge thyroid gland.
*+/-Distinct (well-circumscribed) nodules.
 
===Microscopic===
Features:
*Follicles of variable size - '''key feature'''.
**Should be obvious at low power, i.e. with the 2.5x objective.
*+/-Nodules.
**Do not have a thick fibrous capsule.
**May have a high cellularity.
**Architecture: solid or microfollicular.<ref name=Ref_EP36>{{Ref EP|36}}</ref>
 
Negatives:
*No nuclear features suggestive of malignancy (at lower power).
**One should not look at high power.
*Not cellular.
 
DDx:
*[[Papillary thyroid carcinoma]] - esp. [[papillary thyroid carcinoma follicular variant]].
*[[Follicular thyroid adenoma]] - contained in a fibrous capsule.
*[[Follicular thyroid carcinoma]] - has fibrous capsule and invasion through it.
 
===Sign out===
<pre>
HEMITHYROID, RIGHT, HEMITHYROIDECTOMY:
- NODULAR HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
HEMITHYROID, RIGHT, HEMITHYROIDECTOMY:
- CELLULAR ADENOMATOID NODULE ON A BACKGROUND OF NODULAR HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
RIGHT THYROID, RIGHT HEMITHYROIDECTOMY:
- BENIGN NODULE WITH MICROFOLLICLES IN A BACKGROUND OF NODULAR HYPERPLASIA.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Micro====
The sections show thyroid gland with follicles of variable size and marked enlargement.
A lymphocytic infiltrate is present. Focal germinal centre formation is present.  Oncocytic changes and reactive changes are seen focally. No significant nuclear atypia is identified.
 
=====Alternate=====
The sections show thyroid gland with follicles of variable size and marked enlargement. A large nodule is present with microfollicles that are densely packed around the edge and few in the centre.  The nuclei of the microfollicles are round. No significant nuclear membrane irregularities there are apparent.  Very rare enlarged nuclei are present. Occasional nucleoli are seen. No nuclear overlap is readily apparent.


==Follicular thyroid adenoma==
==Follicular thyroid adenoma==
Line 201: Line 144:


==Graves disease==
==Graves disease==
===General===
{{Main|Graves' disease}}
*Often misspelled "Grave's disease".
*Autoimmune disease leading to hyperthyroidism.
*Eye problems not resolved with thyroid removal.{{fact}}
*Higher risk of [[papillary thyroid carcinoma]].
 
Clinical:
*TSH-receptor antibody +ve.<ref name=pmid19576193>{{Cite journal  | last1 = Massart | first1 = C. | last2 = Gibassier | first2 = J. | last3 = d'Herbomez | first3 = M. | title = Clinical value of M22-based assays for TSH-receptor antibody (TRAb) in the follow-up of antithyroid drug treated Graves' disease: comparison with the second generation human TRAb assay. | journal = Clin Chim Acta | volume = 407 | issue = 1-2 | pages = 62-6 | month = Sep | year = 2009 | doi = 10.1016/j.cca.2009.06.033 | PMID = 19576193 }}</ref>
 
===Gross===
Features:<ref>{{Ref EP|30}}</ref>
*Enlarged 50-150 g.
*"Beefy-red" appearance, looks like raw beef.
 
===Microscopic===
Features:
*Classic:
**Hypercellular
**Patchy lymphocytes.
**Little colloid.
*Scalloping of colloid; colloid has undulating border.
**Non-specific finding.
*+/-Nuclear clearing.
*+/-Papillae (may mimic papillary thyroid carcinoma in this respect).
 
Notes:
*Usually has an unimpressive appearance... as it is treated, i.e. history is important.
*Nuclear clearing and papillae are usu. diffuse in Graves disease - unlike in papillary thyroid carcinoma.
 
Image:
*[http://library.med.utah.edu/WebPath/jpeg4/ENDO022.jpg Graves disease (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: 4 December 2011.</ref>


==Idiopathic granulomatous thyroiditis==
==Idiopathic granulomatous thyroiditis==
Line 294: Line 207:
==Riedel thyroiditis==
==Riedel thyroiditis==
*[[AKA]] ''invasive fibrous thyroiditis''.<ref name=pmid21568724>{{Cite journal  | last1 = Fatourechi | first1 = MM. | last2 = Hay | first2 = ID. | last3 = McIver | first3 = B. | last4 = Sebo | first4 = TJ. | last5 = Fatourechi | first5 = V. | title = Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008. | journal = Thyroid | volume = 21 | issue = 7 | pages = 765-72 | month = Jul | year = 2011 | doi = 10.1089/thy.2010.0453 | PMID = 21568724 }}</ref>
*[[AKA]] ''invasive fibrous thyroiditis''.<ref name=pmid21568724>{{Cite journal  | last1 = Fatourechi | first1 = MM. | last2 = Hay | first2 = ID. | last3 = McIver | first3 = B. | last4 = Sebo | first4 = TJ. | last5 = Fatourechi | first5 = V. | title = Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976-2008. | journal = Thyroid | volume = 21 | issue = 7 | pages = 765-72 | month = Jul | year = 2011 | doi = 10.1089/thy.2010.0453 | PMID = 21568724 }}</ref>
===General===
{{Main|Riedel thyroiditis}}
Clinical features:<ref name=pmid21568724/>
*Extremely rare.
*Women > men.
*Usually smokers.
*May be associated with ''[[retroperitoneal fibrosis]]''.
*May be hypothyroid.
*+/-Obstructive symptoms.
 
===Microscopic===
Features:
*Fibrosis.
*Specimen often fragmented as it was difficult to remove.
 
DDx:
*[[Anaplastic thyroid carcinoma|Anaplastic carcinoma]], spindle cell variant.


==Hashimoto thyroiditis==
==Hashimoto thyroiditis==
===General===
{{Main|Hashimoto's thyroiditis}}
*'''This is a clinical diagnosis'''.
**The histomorphologic findings, generally, are '''not''' diagnostic.
 
Etiology:
*Autoimmune disease leading to hypothyroidism.
**Often genetic/part of a syndrome.
 
====Clinical====
Serology:<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>
*Antimicrosomal (antithyroid peroxidase) +ve.
*Antithyroglobulin +ve.
 
Associated pathology:<ref name=pmid7813361/>
*Increased risk of B-cell lymphoma; these are classically:<ref name=pmid18018576 >{{Cite journal  | last1 = Ohye | first1 = H. | last2 = Fukata | first2 = S. | last3 = Hirokawa | first3 = M. | title = [Malignant lymphoma of the thyroid]. | journal = Nihon Rinsho | volume = 65 | issue = 11 | pages = 2092-8 | month = Nov | year = 2007 | doi =  | PMID = 18018576 }}</ref>
**[[MALT lymphoma]].
**[[Diffuse large B cell lymphoma]] (DLBCL).
 
===Microscopic===
Features:
*Lymphocytic infiltrate - '''key feature'''.
*Nuclear clearing common.
**May confuse with [[papillary thyroid carcinoma]].
*Polymorphous lymphoplasmacytic infiltrate with germinal centres.<ref name=Ref_APBR672>{{Ref APBR|672}}</ref>
*+/-Oncocytic metaplasia.
 
Notes:
*Histologically often '''not''' possible to separate from "non-specific" thyroiditis.<ref name=Ref_Sternberg4_560>{{Ref Sternberg4|560}}</ref>
 
DDx:
*[[Lymphocytic thyroiditis]].
*[[Papillary thyroid carcinoma]].
*[[MALT lymphoma]].
*[[Diffuse large B cell lymphoma]].
 
===IHC===
*Panel to exclude lymphoma may be required, e.g. CD3, CD20, CD10, BCL6, BCL2, kappa, lambda.
 
===Molecular===
*Occasionally done to exclude lymphoma - see ''[[MALT lymphoma]]'' and ''[[DLBCL]]''.


==C-cell hyperplasia==
==C-cell hyperplasia==
*Abbreviated ''CCH''.
*Abbreviated ''CCH''.
===General===
{{Main|C-cell hyperplasia}}
*Screening for C-cell hyperplasia/[[medullary thyroid carcinoma]] done with ''serum calcitonin level''.<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
 
===Gross===
*Not visible.
 
===Microscopic===
Features:
*Location:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/Thyroid_11protocol.pdf]. Accessed on: 7 April 2012.</ref>
**Mid portion of lobe to upper third of lobe.
***Not at the poles.
***Not in the isthmus.
 
*Definitions vary.<ref>SR. 17 January 2011.</ref>
 
One definition - either of the following:<ref name=pmid19726541>{{cite journal |author=Machens A, Hoffmann F, Sekulla C, Dralle H |title=Importance of gender-specific calcitonin thresholds in screening for occult sporadic medullary thyroid cancer |journal=Endocr. Relat. Cancer |volume=16 |issue=4 |pages=1291–8 |year=2009 |month=December |pmid=19726541 |doi=10.1677/ERC-09-0136 |url=http://erc.endocrinology-journals.org/cgi/content/full/16/4/1291}}</ref>
#>50 C-cells per low-power field (x100).
#*This part of the definition suffers from [[LPFitis]]. The paper should have been rejected.
#Confined to the thyroid gland and no larger than 10 mm in greatest dimension.


Another definition:
==Adenolipoma of the thyroid==
*Invasion of the basement membrane with stromal reaction.
{{Main|Adenolipoma of the thyroid}}
 
A third definition:
*"Several clusters" of more than six C cells.
 
====Images====
*[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f2.html CCH - crappy B&W image (nature.com)].<ref>{{Cite journal  | last1 = Guyétant | first1 = S. | last2 = Josselin | first2 = N. | last3 = Savagner | first3 = F. | last4 = Rohmer | first4 = V. | last5 = Michalak | first5 = S. | last6 = Saint-André | first6 = JP. | title = C-cell hyperplasia and medullary thyroid carcinoma: clinicopathological and genetic correlations in 66 consecutive patients. | journal = Mod Pathol | volume = 16 | issue = 8 | pages = 756-63 | month = Aug | year = 2003 | doi = 10.1097/01.MP.0000081727.75778.0C | PMID = 12920219 }}</ref>
*[http://www.nature.com/modpathol/journal/v16/n8/fig_tab/3880836f3.htm CCH - crappy B&W image (nature.com)].
*[http://www.forpath.org/workshops/0201/photos/fullsize/cas7c.jpg CCH (forpath.org)].<ref>URL: [http://www.forpath.org/workshops/0201/html/case_7.asp http://www.forpath.org/workshops/0201/html/case_7.asp]. Accessed on: 21 May 2013.</ref>
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=4849 CCH (unibas.ch)].
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=10739 Nodular CCH (unibas.ch)].


=Malignant neoplasm=
=Malignant neoplasm=
Line 400: Line 231:
==Follicular thyroid carcinoma==
==Follicular thyroid carcinoma==
*[[AKA]] ''follicular carcinoma''.
*[[AKA]] ''follicular carcinoma''.
===Clinical===
{{Main|Follicular thyroid carcinoma}}
Medical school memory device ''4 Fs'':
*FNA NOT diagnosable.
*Far away mets (sometimes).
*Female predominant.
*Favourable prognosis.
 
Notes:
*Usu. has a hematologic spread.
**PTC usu. spread via lymphatics.
 
===Microscopic===
Features:
*Defined by either:
*#Invasion through the capsule:
*#*Should be all the way through.<ref>SR. 17 January 2011.</ref>
*#**1/2 does not count.
*#**Fibrous reaction does not count.
*#**"Above the contour" does not count.
*#Vascular invasion (all of the following):
*##In a small vein (not a capillary), that is outside of the tumour mass.
*##Tumour adherent to the side of the vessel.
*##Tumour must be re-endothelialized.
 
Notes:
*'''Impossible''' to differentiate from ''[[follicular thyroid adenoma|follicular adenoma]]'' on FNA (no cytologic differences).
*Described as "over-diagnosed" ... misdiagnoses: PTC follicular variant, follicular adenoma, multinodular goitre with a thick capsule.
 
Images:
*[http://path.upmc.edu/cases/case653.html Follicular thyroid carcinoma - several images (upmc.edu)].


==Medullary thyroid carcinoma==
==Medullary thyroid carcinoma==
Line 458: Line 260:
*[[AKA]] ''hyalinizing trabecular adenoma''.
*[[AKA]] ''hyalinizing trabecular adenoma''.
*Abbreviated ''HTT''.
*Abbreviated ''HTT''.
===General===
{{Main|Hyalinizing trabecular tumour}}
*Considered by some (e.g. Silvia Asa) to be a variant of [[papillary thyroid carcinoma]].<ref name=pmid11117782>{{cite journal |author=Cheung CC, Boerner SL, MacMillan CM, Ramyar L, Asa SL |title=Hyalinizing trabecular tumor of the thyroid: a variant of papillary carcinoma proved by molecular genetics |journal=Am. J. Surg. Pathol. |volume=24 |issue=12 |pages=1622–6 |year=2000 |month=December |pmid=11117782 |doi= |url=}}</ref>
*Behaviour similar to papillary thyroid carcinoma - indolent.
 
===Microscopic===
Features:
*Trabecular arrangement of cells.
**May have "curved" trabeculae.
*Extracellular space has hyaline material - '''key feature'''.
*Cytoplasm mimics hyaline material in the extracellular space.
 
DDx:
*[[Papillary thyroid carcinoma]] (if one believes this is a separate entity).
*[[Medullary thyroid carcinoma]] - not trabecular, nuclei not [[PTC]]-like.
*[[Paraganglioma]].<ref>URL: [http://path.upmc.edu/cases/case465/dx.html http://path.upmc.edu/cases/case465/dx.html]. Accessed on: 17 January 2011.</ref>
 
====Images====
<gallery>
Image: Hyalinized trabecular tumour - low mag.jpg | HHT - low mag. (WC)
Image: Hyalinized trabecular tumour - intermed mag.jpg | HHT - intermed. mag. (WC)
Image: Hyalinized trabecular tumour - high mag.jpg | HHT - high mag. (WC)
Image: Thyroid gland - high mag.jpg | Thyroid gland - high mag. (WC)
 
Image: Hyalinized trabecular tumour - 2 - intermed mag.jpg | HHT - intermed. mag. (WC)
Image: Hyalinized trabecular tumour - 2 - high mag.jpg | HHT - high mag. (WC)
 
Image: Hyalinized trabecular tumour - 3 - intermed mag.jpg | HHT - intermed. mag. (WC)
Image: Hyalinized trabecular tumour - 3 - high mag.jpg | HHT - high mag. (WC)
Image: Hyalinized trabecular tumour - 3 - very high mag.jpg | HHT - very high mag. (WC)
</gallery>
www:
*[http://archive.biomedcentral.com/1742-6413/3/17/figure/F2?highres=y HTT (biomedcentral.com)].<ref name=pmid16867191>{{Cite journal  | last1 = Baloch | first1 = ZW. | last2 = Puttaswamy | first2 = K. | last3 = Brose | first3 = M. | last4 = LiVolsi | first4 = VA. | title = Lack of BRAF mutations in hyalinizing trabecular neoplasm. | journal = Cytojournal | volume = 3 | issue =  | pages = 17 | month =  | year = 2006 | doi = 10.1186/1742-6413-3-17 | PMID = 16867191 }}</ref>
*[http://www.ispub.com/journal/the-internet-journal-of-endocrinology/volume-2-number-1/hyalinizing-trabecular-neoplasm-of-the-thyroid-controversies-in-management.article-g01.fs.jpg HTT (ispub.com)].<ref>URL: [http://www.ispub.com/journal/the-internet-journal-of-endocrinology/volume-2-number-1/hyalinizing-trabecular-neoplasm-of-the-thyroid-controversies-in-management.html http://www.ispub.com/journal/the-internet-journal-of-endocrinology/volume-2-number-1/hyalinizing-trabecular-neoplasm-of-the-thyroid-controversies-in-management.html]. Accessed on: 1 January 2012.</ref>
 
===IHC===
*Thyroglobulin +ve.
*NSE +ve.


==Hürthle cell neoplasm==
==Hürthle cell neoplasm==
*[[AKA]] ''oncocytic neoplasm''.
*[[AKA]] ''oncocytic neoplasm''.
*Also spelled ''Hurthle cell neoplasm''.
*Also spelled ''Hurthle cell neoplasm''.
 
{{Main|Hürthle cell neoplasm}}
===General===
*Incidence: uncommon.
*This is a general category - includes:
**Hürthle cell adenoma.
**Hürthle cell carcinoma.
 
*Some advocate ''total thyroidectomy'' for all Hürthle cell neoplasms, as it is difficult to reliably differentiate adenomas and carcinomas.<ref name=pmid9697901>{{Cite journal  | last1 = Wasvary | first1 = H. | last2 = Czako | first2 = P. | last3 = Poulik | first3 = J. | last4 = Lucas | first4 = R. | title = Unilateral lobectomy for Hurthle cell adenoma. | journal = Am Surg | volume = 64 | issue = 8 | pages = 729-32; discussion 732-3 | month = Aug | year = 1998 | doi =  | PMID = 9697901 }}</ref>
*It can be understood as a special type of ''follicular neoplasm'' (including ''[[follicular thyroid adenoma]]'' and ''[[follicular thyroid carcinoma]]'').<ref name=Ref_EP104>{{Ref EP|104}}</ref>
 
====Adenoma vs. carcinoma====
Suggestive for carcinoma:<ref name=pmid9697901/>
*Male.
*>4 cm
**Adenomas usu. <3 cm.
Definite for carcinoma:<ref name=pmid9697901/>
*Lymphovascular invasion.
*Capsular invasion.
 
===Gross===
*Yellow.
*Encapsulated.
 
===Microscopic===
Features:<ref name=Ref_EP104>{{Ref EP|104}}</ref>
*Oncocytes >= 75% of cells:
**Abundant granular, eosinophilic cytoplasm.
**Round regular nucleus +/- prominent nucleolus.
*+/-Degenerative changes.
 
Negatives:
*Lack nuclear features of [[papillary thyroid carcinoma]].
*Lack features of [[medullary thyroid carcinoma]].
 
DDx:<ref name=pmid18684023>{{cite journal |author=Montone KT, Baloch ZW, LiVolsi VA |title=The thyroid Hürthle (oncocytic) cell and its associated pathologic conditions: a surgical pathology and cytopathology review |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=8 |pages=1241–50 |year=2008 |month=August |pmid=18684023 |doi= |url=}}</ref>
*Papillary thyroid carcinoma oncocytic variant.
*Medullary thyroid carcinoma oncocytic variant.
*Others.


==Minocycline associated thyroid pigmentation==
==Minocycline associated thyroid pigmentation==
Line 568: Line 297:
===Stains===
===Stains===
*[[Fontana-Masson stain]] +ve.<ref name=pmid10615019>{{Cite journal  | last1 = Sant'Ambrogio | first1 = S. | last2 = Connelly | first2 = J. | last3 = DiMaio | first3 = D. | title = Minocycline pigmentation of heart valves. | journal = Cardiovasc Pathol | volume = 8 | issue = 6 | pages = 329-32 | month =  | year =  | doi =  | PMID = 10615019 }}</ref>
*[[Fontana-Masson stain]] +ve.<ref name=pmid10615019>{{Cite journal  | last1 = Sant'Ambrogio | first1 = S. | last2 = Connelly | first2 = J. | last3 = DiMaio | first3 = D. | title = Minocycline pigmentation of heart valves. | journal = Cardiovasc Pathol | volume = 8 | issue = 6 | pages = 329-32 | month =  | year =  | doi =  | PMID = 10615019 }}</ref>
==Sclerosing mucoepidermoid carcinoma with eosinophilia==
{{Main|Sclerosing mucoepidermoid carcinoma with eosinophilia}}


=See also=
=See also=
Michael
48,466

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/36548...48823"

Navigation menu