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Patho Lec 2 Thyroid 2

هوهتوختوخن٩

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33 views23 pages

Patho Lec 2 Thyroid 2

هوهتوختوخن٩

Uploaded by

asdmohtt222
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Lecture 2

Pathology of Thyroid Gland


part 2

Assistant Prof.Marwa Shakweer


Department of Pathology ASU/BUC
ILO’S
• Explain causes, pathogenesis , pathologic features of thyroiditis
• Classify tumors of thyroid gland
• Describe pathological features and clinical presentations of thyroid
tumors
• List methods used for diagnosis of thyroid neoplasm

MM.shakweer
Thyroiditis
• Hashimoto thyroiditis
• Subacute thyroiditis
• Riedle’s thryoiditis

MM.shakweer
1- Hashimoto thyroiditis
• Hashimoto thyroiditis is a chronic autoimmune disease characterized by
immune destruction of the thyroid gland and hypothyroidism.
• females more than males, with peak age 40–65.
• Hashimoto thyroiditis is the most common cause of hypothyroidism (due to
destruction of thyroid tissue),
• though the initial inflammation may cause transient hyperthyroidism
(hashitoxicosis).
• Hashimoto may be associated with other autoimmune diseases (SLE,
rheumatoid arthritis, Sjögren syndrome, etc.),
• It has an increased risk of non-Hodgkin B-cell lymphoma.
MM.shakweer
Pathologic features
• Grossly: Hashimoto
produces a pale, enlarged
thyroid gland;
• Microscopically: it shows
lymphocytic inflammation
with germinal centers and
epithelial “Hürthle cell”
changes, and atrophy of
thyroid follicles

MM.shakweer
MM.shakweer
2- Subacute thyroiditis (de Quervain
thyroiditis / Granulomatous thyroiditis)

• is the second most common form of thyroiditis;


• it affects females more than males, with peak age
30–50.
• Patients may complain of odynophagia (pain on
swallowing).
• Typically preceded by a viral illness
• Produces a tender, firm, enlarged thyroid gland
• May be accompanied by transient hyperthyroidism
• Microscopy shows granulomatous thyroiditis.
• The disease typically follows a self-limited course.
MM.shakweer
3- Riedle’s thyroiditis
• Riedel thyroiditis is a rare disease of unknown
etiology, characterized by destruction of the thyroid
gland by dense fibrosis and fibrosis of surrounding
structures (trachea and esophagus).
• It affects females more than males, and most
patients are middle-aged.
• Causes an irregular, hard thyroid that is adherent to
adjacent structures
• May clinically mimic carcinoma and present with
stridor, dyspnea, or dysphagia
• Microscopic exam shows dense fibrous replacement
of the thyroid gland with chronic inflammation.
• Reidel thyroiditis is associated with retroperitoneal
and mediastinal fibrosis.

MM.shakweer
Thyroid tumors
• Benign: Thyroid adenoma
• Malignant:
1- Papillary carcinoma
2- Follicular carcinoma
3- Medullary carcinoma
4- Anaplastic carcinoma

MM.shakweer
Follicular adenoma of thyroid gland

• Clinically, adenomas are usually painless,


solitary, encapsulated nodules that appear
“cold” on thyroid scans.
• They may be functional and cause
hyperthyroidism (toxic adenoma).

MM.shakweer
Microscopic
• Completely enveloped by thin
fibrous capsule
• Architecturally and
cytologically different from
surrounding gland;
• surrounding thyroid tissue
shows signs of compression
• Closely packed follicles,
trabeculae or solid sheets

MM.shakweer
MM.shakweer
Papillary carcinoma of thyroid
• Papillary carcinoma accounts for 80% of
malignant thyroid tumors.
• It affects females more than males, with peak age
20–50.
• PF: Radiation exposure is a risk factor.. There are
chromosomal rearrangements of the RET
oncogene.
• Microscopically, the tumor typically exhibits a
papillary pattern.
• Occasional psammoma bodies may be seen.
MM.shakweer
Papillary carcinoma
• Characteristic nuclear features include
a) Clear “Orphan Annie eye” nuclei,
b) nuclear grooves,
c) intranuclear cytoplasmic inclusions.
• Lymphatic spread to cervical nodes is
common

MM.shakweer
MM.shakweer
Papillary carcinoma of thyroid
• Resection is curative in most cases.
• Radiotherapy with iodine 131 is effective for
metastases.
• The prognosis is excellent, with 20-year survival 90%
due to slow growth and metastasis to regional
cervical lymph nodes.

MM.shakweer
Follicular carcinoma of thyroid
• Follicular carcinoma accounts for 15%
of malignant thyroid tumors. It affects
females more than males, with peak age
40–60.
• Hematogenous metastasis to the bones
or lungs is common.
• These cancers are microscopically
distinguished from follicular adenoma by
the presence of capsular invasion.

MM.shakweer
MM.shakweer
Medullary carcinoma
• Medullary carcinoma accounts for 5% of malignant thyroid tumors.
• It arises from C cells (parafollicular cells) and secretes calcitonin.
• Microscopic exam shows nests of polygonal cells in an amyloid
stroma.
• A minority of cases (25%) is associated with MEN 2 and MEN 3
syndromes, and those cases tend to be multicentric.
• Activating RET mutations are present in familial and sporadic types.
• What is the immunohistochemical marker that you would use to
diagnose medullary carcinoma of thyroid?
MM.shakweer
MM.shakweer
Anaplastic carcinoma of thyroid
• Anaplastic carcinoma affects females more
than males, with peak age >60. It can
• present with a firm, enlarging, and bulky
mass, or with dyspnea and dysphagia.
• The tumor has a tendency for early
widespread metastasis and invasion of the
trachea and esophagus.
• Microscopically, the tumor is composed of
undifferentiated, anaplastic, and
pleomorphic cells.
• This very aggressive tumor is often rapidly
fatal.
MM.shakweer
Case study
• A 40 years old female was presented by thyroid enlargement which
moves up and down with deglutition. She was adviced to make neck
US which revealed solitary thryoid nodule measuring 2.5 cm in
diameter. Thyroid scan showed the nodule to be hot nodule. Answer
the following questions and discuss them with your tutor
a) What is the next diagnostic procedure that you would suggest for
the patient?
b) What is your differential diagnosis
c) What is the role of fine needle aspiration cytology in this case
d) What is the best surgical decision for this case and why

MM.shakweer
Thank you

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