Thyroid Neoplasms :part 1
Associate Professor Dr Kishore G Banerjee
MBBS ; MD (Doctor of Medicine) in Pathology (AIIMS, New Delhi);
Member of USCAP
Associate Professor, Pathology Unit, Faculty of Medicine, MUCM
Learning Objectives : will be covered in 02
parts of this lecture-topic
• Explain the clinicopathological features of the following thyroid
neoplasms (C2)
• a. Follicular adenoma
• b. Follicular adenocarcinoma
• c. Papillary adenocarcinoma
• d. Medullary carcinoma
• Neoplasms originating of the thyroid are
generally benign.
Neoplasms • Malignant neoplasms are usually
carcinomas and lymphomas are rarely seen.
of thyroid • Those tumours that are malignant have a
:Introduction variable behaviour that dictates the clinical
management. Histological classification is,
therefore of vital importance.
Benign neoplasm
Follicular adenoma
Follicular adenomas
• Adenomas of the thyroid are typically discrete, solitary masses,
derived from follicle epithelium, and hence they are also known as
follicular adenomas.
• The typical thyroid adenoma is a solitary, spherical, encapsulated
lesion that is demarcated by a well-defined, intact capsule.
Follicular adenoma
Follicular adenoma is a common cause of a solitary
thyroid nodule.
It usually consists of a solid mass within a fibrous capsule,
compressing the adjacent gland.
But,the centre may show areas of haemorrhage and
cystic changes.
Follicular adenoma :well encapsulated
Histology :
Follicular adenoma
: the
photomicrograph
shows well-
differentiated
follicles
resembling normal
thyroid
parenchyma
Malignant neoplasm
• Approximately 95% of all thyroid
malignancies are carcinomas
• Lymphomas of thyroid comprise less
Thyroid than 5% of thyroid cancers
cancer/Thyroid • Sarcomas of thyroid are extremely
rare
malignancy
• Metastasis in thyroid could be seen
from melanoma, renal cell carcinoma
and bronchiogenic carcinoma
03-12-2022 DR KISHORE G BANERJEE
Comprise 95% of thyroid malignancies
4 major histologic types
CARCINOMAS Papillary carcinoma, Thyroid
OF THYROID Follicular carcinoma, Thyroid
Medullary carcinoma, Thyroid
Anaplastic carcinoma, Thyroid
03-12-2022 DR KISHORE G BANERJEE
Papillary carcinoma,
thyroid/
Papillary adenocarcinoma,
thyroid
• Papillary carcinomas are the most common
form of thyroid cancer
Papillary • They occur throughout life but most often
carcinoma, between 25 and 50 years of age
thyroid • Account for the majority of thyroid
carcinomas associated with previous
exposure to ionizing radiation
Papillary
carcinoma of
thyroid :Gross
specimen
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PTC :Histopathology :normal architecture of
thyroid completely effaced by papillary structures
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Histological
appearance
:Papillary Thyroid
Carcinoma(PTC)
PTC :Microscopic
appearance
:Psammoma body
seen at the centre
DR KISHORE G BANERJEE
12/3/2022
DR KISHORE G BANERJEE
“True” papillae
formation with
fibrovascular core
in PTC
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What are the characteristic
nuclear features of PAPILLARY
THYROID CARCINOMA (PTC)?
Key Concept
03-12-2022 DR KISHORE G BANERJEE
• Finely dispersed chromatin ;often
described as powdery chromatin
Characteristic • Optically clear nuclei / “Orphan
nuclear Annie eye” nuclei/ Ground-glass
nuclei
features in • Eosinophilic pseudo-inclusions
PTC (which represent invaginations of
the cytoplasm into the nucleus)
• Nuclear grooves
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Nuclear
features :PTC
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Nuclear grooves :PTC
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FNAC(Cytopathology) appearance of PTC
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Clinical presentation : Papillary carcinoma,
thyroid
• Most conventional papillary carcinomas present as asymptomatic
thyroid nodules, but the first manifestation may be a mass in a
cervical lymph node.
• Interestingly, the presence of isolated cervical nodal metastases does
not have a significant impact on prognosis, which is generally good.
• In a minority of patients, hematogenous metastases are present at
the time of diagnosis, most commonly in the lung.
Most PTC present as asymptomatic thyroid
nodules
Clinical 1st manifestation may be a mass in cervical
lymph node
presentation
& Diagnosis FNAC (Fine Needle Aspiration Cytology)
plays a key role in diagnosis before surgery
:PTC
The nuclear features of PTC are often nicely
demonstrated by FNAC
03-12-2022 DR KISHORE G BANERJEE
• Papillary thyroid cancers have an excellent
prognosis, with a 10-year survival rate in
Clinical excess of 95%.
• The prognosis is dependent on several
course & factors including age (in general, being less
prognosis favorable among patients older than 40
years), presence of extrathyroidal extension,
and presence of distant metastases .
Will be continued
in part 02 of the
lecture..
Thank you : Dr
Kishore
