Thyroid Disease Pathology Department, Zhejiang University School of Medicine, 马丽琴,maliqin198@zju.edu.cn
cartilage thyroidea thyroid
simple cuboidal epithelium colloid Normal thyroid seen microscopically consists of follicles lined by a an epithelium and filled with colloid.
This immunoperoxidase stain with antibody to calcitonin( 降血钙素 ) identifies the "C" cells
immunofluorescence test positive for antimicrosomal antibody( 抗微粒体抗体 )
immunofluorescence positivity for antithyroglobulin( 甲状腺球蛋白 )antibody
Thyroiditis Goiter Thyroid tumor
Thyroiditis
Type Acute, bacterial infection Subacute, viral infection Chronic,(chronic lymphocytic thyroiditis;clt), autoimmune disease
Subacute thyroiditis: viral infection Granulomatous inflammation, granulomatous thyroiditis/giant cell thyroiditis 20-50-year old female fever, thyromegaly, tenderness, Gross : gray, firm, adhesions, necrosis
foreign-body giant cell reaction
Chronic thyroiditis: Chronic lymphocytic thyroiditis;clt Fibrous thyroiditis
Chronic thyroiditis: Chronic lymphocytic thyroiditis (Hashimoto s thyroiditis 桥本病 ): autoimmune disease,antibody(+), Gross: thyromegaly, nodosity, grayish-white, hypofunction, Histologic: thyroid follice atrophy, destroy, lymphocyte, plasmocyte, fibroplasia
Chronic lymphocytic thyroiditis
thyroid follice atrophy,destroy,lymphocyte, eosinophils, plasmocyte, fibroplasia
Fibrous thyroiditis (Riedel goiter, chronic woody thyroiditis 慢性木样甲状腺炎 ): rare, hoarse voice, dysphagia, dyspneic respiration, wood-like thyroid follice atrophy, fibroplasia, hyalinosis,
Fibrous thyroiditis
Fibroplasia, hyalinos, lymphocyte
Goiter
Conception: Goiter is a group of diseases of thyroid hyperplasia, enlargement due to iodine deficiency or other factors. According to hyperthyroidism or not, goiter can be divided into nontoxic goiter and toxic goiter.
Diffuse nontoxic goiter
Conception Etiology Pathogenesis Pathological feature Clinico- pathological relationship
Conception
Conception Nontoxic goiter due to iodine deficiency to reduce thyroid hormone secretion, thyroid stimulating hormone (TSH) hypersecretion, follicular epithelial hyperplasia, follicular goiter glial accumulation. No hyperthyroidism, so also called simple goiter.
Type nontoxic goiter local distributed
The thyroid gland has a bi-lobe connected by a narrow isthmus.
Etiology
1. Iodine -deficiency 2.Causative agent(ca 2+, fluorine,diet, medicine, etc.) 3. Hyper-iodine 4. Heredity and immunization
Pathogenesis
Pathological feature
Stage of hyperplasia Diffuse hyperplastic goiter
Enlargement of thyroid
follicular hyperplasia
Stage of stored colloid Diffuse colloid goiter
Enlargement of thyroid
Follicle expansion, colloidal storage
Stage of nodule Nodular goiter
The red arrow points to an area of scarring. The blue arrow points to a large and the yellow to a small follicle
The follicular cells have round to oval nuclei with small visible nucleoli. The follicle cell cytoplasm is scant.
formation of nodus
Enlarged thyroid with more enlargement on left. Left lobe also shows multiple nodules
Cut surface of one lobe of thyroid gland showing ill defined nodules. Focus of cystic degeneration seen (blue arrow). Some hemorrhage (red arrow) and some scarring.
This diffusely enlarged thyroid gland is somewhat nodular. This patient was euthyroid
Clinio-pathological relationship
1 Thyromegaly 2 Compressional symptom 3 No thyroid hyperfunction
Diffuse toxic goiter
Function of thyroid hormones 1 To promote the metabolism 2 To elevate the nerval irritability 3 To promote the growth and development
Conception
Hyperthyroidism: Graves' disease Basedow ' disease ( 突眼性甲状腺肿 ) Excessive thyroxine in blood organs, tissues clinical syndrome Female: male=1:4-6,20-40
Etiology and Pathogenesis
1. Autoimmune disease 2. Antibody (+) 3. Heredity 4. Mental injury
Pathological feature
Diffusely enlarged red tan thyroid gland. Slight lobulation but no large cyst formed.
Microscopically 1. follicular epithelial proliferation--- stylolitic, mammillation 2. colloid substance rarefaction, uptake vacuole forming, 3. Mesenchymal vascular proliferation, congestion, lymphocyte infiltration, even folliculus lymphaticus emerging
A diffusely enlarged thyroid gland associated with hyperthyroidism is known as Grave's disease. At low power here, note the prominent infoldings of the hyperplastic epithelium.
At high power, the tall columnar thyroid epithelium with Grave's disease lines the hyperplastic infoldings into the colloid.
lymphocyte infiltration
uptake vacuole forming
Clinico-pathological relationship
1 T3.T4 分泌过多综合症 : 怕热多汗, 多食 善饥 消瘦, 疲乏无力, 神经过敏, 脉搏加快, 脉压差增大. 2 甲状腺肿 : 双侧对称性弥漫性肿大, 随吞咽上下移动, 左右叶上下极有震颤伴血管杂音. 3 眼征 : 良性突眼征, 恶性突眼征. 原因 : 眼球外肌水肿 球后结缔组织增生 淋巴细胞浸润 粘液水肿 其他器官增大 : 脾脏 胸腺 心脏等
Exorbitism Thyromegaly
Thyroid adenoma
Conception Thyroid adenoma is a common benign tumor in the thyroid caused by thyroid follicular epithelium. young and middle-aged female common involved, slow- growthing, no overt symptom, 1% hyperthyroidism.
Pathological feature
Gross : single, round or oval, millimeters to 3-5cm, firmly, smooth and glossy of the surface, perfect membrane, cystis degeneration, fibrosis, calcification in the tumor centre
Here is a surgical excision of a small mass from the thyroid gland that has been cut in half. The mass is well-circumscribed. Grossly it felt firm. This is a follicular adenoma.
Here is another follicular neoplasm (a follicular adenoma histologically) that is surrounded by a thin white capsule. It is sometimes difficult to tell a well-differentiated follicular carcinoma from a follicular adenoma.
normal tissue neoplasm
Type Follicle adenoma Simple adenoma Colloid adenoma Fetal adenoma Embryonal adenoma Eosinophilic adenoma Untypical adenoma
Simple adenoma The red arrow is located within the adenoma. Although composed of follicular cells, little colloid is seen. The blue arrow points to the capsule of the adenoma, a few strands of connective tissue. The yellow arrow points to colloid within a large normal follicle
Simple adenoma
Colloid adenoma
Fetal adenoma
Embryonal adenoma
Distinguish nodular goiter adenoma Number poly-nodus single membrane No complete membrane Size of Follicle larger complete membrane Smaller Periphery No effect Effect tissue Change + _
Thyroid cancer
Conception
Pathological feature
Papillary adenocarcinoma General : 40%--60%, young female, low potential malignancy, slow-moving, five year survival rate 75%. Characteristic : mamillae, invasing vessel, capsul Primal complaint : surrounding lymphatic metastasis
The thyroid is massively distorted by a multinodular growth. Shaggy external surface due to difficulty in dissecting organ from other structures, a feature which suggests malignancy.
The dark reddish brown tissue is characteristic of normal thyroid. The large tan nodules represent carcinoma. No large areas of hemorrhage and necrosis are seen.
Sectioning through a lobe of excised thyroid gland reveals papillary carcinoma.
This is the microscopic appearance of a papillary carcinoma of the thyroid. The fronds of tissue have thin fibrovascular cores. The fronds have an overal papillary pattern.
The center is fibrovascular; the cells covering it are epithelial.
This closeup shows that the cells range from low columnar to columnar. The red arrow shows a cell with an Orphan Annie eye nucleus.
Follicular adenocarcinoma General : 10%--15%, middle-aged female, low potential malignancy, slow-moving, five year survival rate 30%--40%. Characteristic : follicle structure Infiltration : capsul and blood vessel.
2.9cm minimally invasive follicular carcinoma of the thyroid
follicle structure
Medullary carcinoma caused by ultimobranchial cells( 滤泡旁细胞 ), APUD (amine precursor uptake and decarboxylation) tumor, 5%, 30-year-old, 90% secrete calcitonin( 降血钙素 ), Somatostati( 生长抑素 ), prostaglandin( 前列腺素 ), hormonelike materies
Single,non-capsul, soft, yellow brown.
At the center and to the right is a medullary carcinoma of thyroid. At the far right is pink hyaline material with the appearance of amyloid. These neoplasms are derived from the thyroid "C" cells and, therefore, have neuroendocrine features such as secretion of calcitonin.
Medullary Carcinoma of Thyroid 肿瘤细胞为圆形, 多角形或梭形的小细胞, 排列成簇状, 索状或小滤泡状. 间质较丰富, 常有淀粉样物质和钙盐沉着.
Undifferentiated carcinoma General: 15%, height-malignant, quick growth, infiltration and metastasis to surrounding tissues at early Type: small-cell carcinoma, giant cell carcinoma, spindle cell carcinoma, mixed cell carcinoma
Disease of Pancreatic Island
Type of cells A cell: 15-25%,secreting Glucagon B cell: 60-70%, secreting Insulin D cell: 5-10%, secreting Somatostatin PP cell: 2%, secreting pancreatic polypeptide G cell: secreting gastrin
Pancreatic island A cell B cell D cell
Diabetes mellitus
Reasons : Conception Deficient Insulin relatively or absolutely, Target cells low-sensitivity to Insulin, Defect structure of Insulin Result : a chronic disease involving the metabolic disorder of carbohydrate, fat, protein Major characteristic: hyperglycosemia, glucosuria; polydipsia, polyphagia, diuresis, weight loss -- 三多一少
Type Diabetes mellitus primary secondary IDDM (Ⅰ 型 ) NIDDM (Ⅱ 型 )
Pathological changes
Inflammatory cell infiltration, hyalinosis pancreatic island atrophy and reduction amyloidosis
Arterial changes: arteriole arteriosclerosis, artherosclerosis Renal lesions: Enlarged Retinopathy : nervous system: Others :
Islet cell adenoma
Type Insulinoma ( 胰岛素瘤 ) Glucagonoma ( 胰高血糖素瘤 ) Gastrinoma ( 胃泌素瘤 ) VIPoma ( 血管活性肠肽肿瘤 ) Somatostatinoma ( 生长抑素瘤 ) Pancreatic polypeptidoma ( 胰多肽瘤 )
Insulinoma ( 胰岛素瘤 )
Insulinoma ( 胰岛素瘤 )
Tumor case 病理诊断 : 胰腺间叶组织源性肿瘤溃破并发大出血, 腹腔内积血 2100 毫升
TUMOR case 入院前 2 小时进食, 餐后出现腹泻, 水样便, 次数多, 伴头晕 出汗 腹胀, 无发热, 伴有恶心 呕吐 自己未注意继续在工作, 入院前半小时许, 同事发现患者大小便失禁, 呼之难应, 全身湿冷, 四肢发凉, 面色发白, 呼 120 送至本院急诊 当时测血压 86/39mmHg, 血糖 27.3mmol/L( 正常空腹血糖为 3.15~ 6.19mmol/L, 餐后 2 小时血糖 11.1mmol/L 为糖尿病 ) 死者从小有头晕 史, 曾多次就诊杭州医院, 未查明原因 否认糖尿病 心脏病 肾疾病史, 否认哮喘史
TUMOR case 于重症监护, 吸氧 导尿 头孢米诺 洛美沙星针抗炎 补液 抗休克, 正规胰岛素降血糖治疗 死者于当天中午 11 45 分出现心跳呼吸骤停, 复苏无效死亡 双瞳孔散大, 大动脉搏动无, 血压 血氧饱和度为零 心电图示 : 直线 ; 四肢无活动, 呼吸无
TUMOR case 胰腺 :70g, 大小 17 4 2cm; 胰腺尾部可见一灰白色肿物, 大小约 4 3.5 2cm, 切面灰白, 致密 其表面有一破裂口, 直径 1cm, 可见血块突出表面 1cm 其余部位表面呈灰白色, 长叶状
TUMOR case 镜检 : 肿物由大量纤维组织构成 ( 包括少量胰岛细胞 ), 与周围正常胰腺组织界清, 但无包膜 在肿物内可见散在出血, 于一处见肿物表面溃破, 大片出血, 并见纤维蛋白及红细胞
TUMOR case 灰白色肿物
TUMOR case 灰白色肿物
肿物由大量纤维组织构成伴出血
肿物由大量纤维组织构成排列成束状 旋涡状, 并见少量炎细胞浸润
肿物由大量纤维组织构成