Pathendo

Front 1

thyroglossal duct cyst

Back 1

Congenital.

GROSS: disappears w/ aspiration; fluid color not indicator of malignact potential.

HISTO: ciliated columnar epithelium, crystalline material, multinucleated giant cell.

Front 2

simple colloid goiter

Back 2

GROSS: enlarged w/ glistening/waxy surface

HISTO: huge colloid filled follicles.

CYTO: abundant colloid, scant uniform follicle cells.

Front 3

adenomatous multinoduloar goiter

Back 3

nontoxic

GROSS: multinodular (solid, cystic, hemorrhagic)

HISTO: pseudo papillations. no true capsule

CYTO: variable colloid, follicular cells numerous, honeycomb patterns. confused w/ follicular neoplasms.

Front 4

graves dz

Back 4

hyperthyroidism. dx via TFT and hx.

GROSS: red beefy

HISTO: hyperplasia of follicular cells, colloid thin, scalloping, pseudopolyps (polsters).

CYTO: fresh blood, thin colloid, lots of follicle cells, FLAME CELLS. pseudo-neoplastic: more follicle cells than colloid, nuclear overlap, anisonucleosis.

Front 5

subacute thyroiditis

Back 5

post viral (HLA B35)

-tender, nodularity may develop.

HISTO: giant cells, granulomas, fibrosis,

CYTO: scanty due to fibrosis, multinucleate giant cells, degenerating follicle cells, epithelioid histiocytes

Front 6

hashimotos thyroiditis

Back 6

autoimmune
-autoreactive CD4+ cells initiate process => CD8 cytotoxic death, cytokine mediated death, or antibody assisted death of thyrocytes.

GROSS: enlarged thyroid!!! fishy fleshy

HISTO: numerous lymphoid follicles w/ germinal centers, hurthle cells, overall loss of thyrocytes.

CYTO: small lymphos and scattered plasma cells.

increased incidence of malignant neoplasms

Front 7

thyroid neoplastic conditions

Back 7

-incr w/ age, women 4x more affected

-majority of solitary nodules are non neoplastic

-neoplastic nodules are mostly benign

-nodules in younger pts and males are more likely neoplastic

-radiation to head/neck => incr thyroid malignancy

-papillary more common in iodine rich and women.

-behavior of nodule based on histo and cyto.

Front 8

papillary carcinoma

Back 8

-RET protooncogene, prior ionizing radiation.

GROSS: solid or cystic, hemorrhagic, rarely a true capsule.

HISTO: true papillations w/ vascular core, PSAMMOBODIES, orphan annie eyes, nuclear irregularities.

CYTO: cellular smears w/ papillary clusters of cells.

MOLEC: RET or NTRK1, mutations in BRAF, RAS.

Front 9

papillary variants

Back 9

-follicular variants: same prog as papillary carcinoma but harder to dx.

-tall cell: 3x taller than wide, seen in hashimotos, very aggressive. lymphocytes.

columnar cell: secretory endometrium like cells, worse than papillary CA.

diffuse sclerosis: fibrosis, lymphocytic background, worse prognosis.

Front 10

follicular adenoma

Back 10

GROSS: solitary nodule, solid or cystic.

HISTO: complete encapsulation w/ thinner capsule than F-CA. microfollicles w/ scant thyroglobin

CYTO: cellular smear, equal sized clusters, cellular overlap, 3d groups, scanty colloid to no colloid.

MOLEC: TSH recep abnormalities, point mutation in RAS.

Front 11

follicular carcinoma

Back 11

GROSS: solitary nodule, thick capsule w/ necrosis, cystic change, or hemorrhage. Extension through capsule and adherence to nearby structures in neck.

HISTO: invasion through capsule or vessels otherwise identical to adenoma

CYTO: same as adenoma (cellular smear, microfollicular groups, scant collioid)

MOLEC: RAS mutation, PAX8-PPAR translocation.

Front 12

hurthle cells

Back 12

oncocytic cells, pink cytoplasm, round smooth nucleus, prominent nucleolus.

Front 13

clear cell

Back 13

clear or vacuolated cytoplasm, signet ring appearance

Front 14

medullary carcinoma

Back 14

-RET protoncogene

GROSS: spontaneous type = single lesion; MEN's syndrome = multiple lesions. Not encapsulated, rarely necrotic, cystic, or bloody. highest C-cell conc @ upper 2/3 lateral lobes.

HISTO: nests of plasmacytoid/spindle shaped cells, amyloid, granular cytoplasm, calcitonin positive, congo red positive.

CYTO: dispersed cell pattern, plasmacytoid or spindle cells, uniform hyperchromasia & stippled chromatin, multinucleated forms possible

MARKERS: serum calcitonin

MOLEC: RET oncogene germ line mutation => constitutive activation of receptor. Seen in 95% of familial types

Front 15

anaplastic carcinoma (giant cell)

Back 15

-worse prognosis of all!!!

GROSS: fleshy tumor, hemorrhagic and necrotic.

HISTO: Spindle and bizarre cells, numerous mitoses, multinucleated cell forms, necrosis

CYTO: bizarre multinucleate and/or spindle cells. numerous mitoses, hyperchromatic, macronucleoli, necrotic cell fragments

MOLEC: mutated p53.