DEPT PATOLOGI ANATOMI
FK UMI
THYROID GLAND
Dr.Sanggam B Hutagalung,M.BioMed,SpPA
KELAINAN PADA
THYROID GLAND
Congenital
Infection
Neoplasma
Others (Grave’s Disease)
KELAINAN PADA
THYROID GLAND
Congenital
Infection
Neoplasma
Others (Grave’s Disease)
Thyroid gland
The thyroid gland (N):
on the anterior trachea
of the neck.
Has a right lobe & a left
lobe connected by a
narrow isthmus.
Weight: 10-30 gr.
Normal thyroid (microscopic)
Consists of follicles lined by a an epithelium and filled with
colloid.
The interstitium, which may contain "C" cells
Normal Thyroid
THYROIDITIS
Hashimoto Thyroiditis
(Chonic Lymphocytic Thyroiditis)
Subacute Granulomatous Thyroiditis
(De Quervain Thyrooiditis)
Subacute Lymphocytic Thyroiditis
Riedel Thyroiditis
Hashimoto's Thyroiditis
Thyroid failure because of autoimmune destruction
Microscopis :
extensive infiltration of the parenchym by a
mononuclear inflammtory infiltrat (germinal
centers)
Atrophic follicles thyroid
Hurtle cell (+) metaplastic respon of the
normally low cuboidal follicular epithelium to
ongoing injury
Thyroid gland (atrophy)
• This patient was hypothyroid.
• The end result of
Hashimoto's thyroiditis.
• Hashimoto's thyroiditis
results from abnormal T cell
activation & subsequent B
cell stimulation to secrete a
variety of autoantibodies.
Hashimoto's thyroiditis
(low power microscopic)
Lymphocytic infiltrate in
the thyroid, with
lymphoid follicle
formation and fibrosis.
Hashimoto's thyroiditis
(High power microscopic)
• Demonstrates the pink Hürthle cells at the center and right.
• Initially leads to painless enlargement of the thyroid, followed
by atrophy years later
Sub-acute granulomatous thyroiditis
(DeQuervain's disease)
Caused by viral infection or postviral
inflammatory process
Granulomatous
Multinucleated giant cell
Early stage : microabscess follicles
Sub-acute granulomatous thyroiditis
(DeQuervain's disease)
Note: the foreign body giant cells with destruction of
thyroid follicles.
RIEDEL THYROIDITIS
Unknown etiology
Characterized by extensive fibrosis involving the
thyroid and contiguous neck structur
May be associated with idiopathic fibrosis in
other sites in the body
This thyroid gland is about normal in size, but there is a larger
colloid cyst at the left lower pole and a smaller colloid cyst at
the right lower pole.
smaller colloid cyst larger colloid cyst
Diffuse and Multinodular Goiters
Enlargement of the thyroid or goiter
Reflect impaired synthesis of the thyroid hormon,
most often caused by dietary iodine deficiency
This diffusely enlarged thyroid gland is
somewhat nodular.
This represents the most common cause for an enlarged thyroid gland and
the most common disease of the thyroid--a nodular goiter.
Multinodular goiter
(Low power microscopic)
Grave's Disease
An autoimmune disorder
Diffusely hyperplastic thyroid
The follicles are lined by tall columnar
epithelium
The crowded, enlarged epithelial cells project
into the lumens of the follicles
The active cells resorb the colloid in the centers
of the follicles scalloped
appearance of the edges of the colloid
Grave's disease
(low power-autoimmune disease the action of TSI's)
Grave's disease
(high power, the tall columnar thyroid epithelium)
Follicular adenoma
• The mass is well
circumscribed.
• Gross : felt firm.
• By scintigraphic scan
"cold."
FOLLICULAR ADENOMA
Typically a solitary, spherical, encapsulated lesion that
is well demarcated from the surrounding thyroid
parenchyma
Follicular Adenoma
This adenoma is a well- differentiated neoplasm
because it closely resemble normal tissue.
Classification & Incidence of Thyroid Cancer
Follicular cell origin
Differentiated
Papillary 80%
Follicular 10%
Hurthle cell 3-5%
Undifferentiated
Anaplastic 1-2%
Parafollicular cell origin
– Medullary 5%
Thyroid Cancers*
Papillary 80%
Follicular 11%
Hürthle 3%
Medullary 4%
Anaplastic 2%
*National Cancer Data Base
31,513 patients (1985-1995)
Papillary Carcinoma
Accounts for 90% radiation induced cancer
Classified as microcarcinoma, intrathyroidal, and
extrathyroidal
Histologic variants: tall-cell, clear-cell, columnar, diffuse
sclerosing
Multicentric in 30-50% of tumors
Spreads via lymphatics with propensity for mid-
and lower-anterior cervical chain (Level VI)
20-50% patients have involvement of cervical LN
Sectioning through a lobe of excised thyroid
gland reveals papillary carcinoma
Multifocal
Because of the propensity
to invade lymphatics
within thyroid, and
lymph node metastases
are common.
The larger mass is cystic
and contains papillary
excresences.
Most often arise in
middle-aged females
Papillary Carcinoma
(Microscopic)
The fronds of tissue have thin fibrovascular cores. The fronds have an
overal papillary pattern.
Papillary Carcinoma
(Microscopic)
Note the small psammoma body in the center. The cells of the
neoplasm have clear nuclei.
PAPILLARY CARCINOMA
can contain branching papillae having a fibrovascular
stalk covered by a single to multiple layers of cuboidal
epithelial cells
NUCLEI of papillary carcinoma cells contain finely
dispersed chromatin, which imparts an optically clear or
empty appearance, giving rise to the designation ground
glass or Orphan Annie eye nuclei
invaginations of the cytoplasm may in cross-sections give
the appearance of intranuclear inclusions ("pseudo-
inclusions") or intranuclear grooves
Follicular Carcinoma
Only 10% of thyroid cancers in developed
countries, although more prevalent in regions with
iodine deficiency
Diagnosis depends on demonstration of vascular
or capsular invasion
Classified as minimally or widely invasive
Vascular invasion tends to have a more aggressive course
than capsular invasion
Uncommon to have multicentric disease
Hematogenous spread
2nd most common thyroid cancer
10% to 20% of all thyroid cancers
tend to present in women, and at an older age than do
papillary carcinomas
peak incidence in the forties and fifties
incidence increased in areas of dietary iodine deficiency,
suggesting that in some cases, nodular goiter may
predispose to the development of the neoplasm
high frequency of RAS mutations in follicular adenomas
and carcinomas suggests that the two may be related
tumors
Con’td
Where does follicular carcinoma tend to metastasize?
Bone
lung
FOLLICULAR CA THYROID
Anaplastic Carcinoma
Increasingly rare
Arise within differentiated cancers
Pts > 60 years old with rapidly expanding neck
mass
Local invasion very common at time of dx
(FNA)
Surgery plays limited role given advanced stage
at dx
Radiation and chemotherapy have not
demonstrated any significant improvement in
survival
Median survival ~ 4 - 6 months
Medullary Thyroid Carcinoma
Originates from the parafollicular C cells
Elevation in calcitonin and CEA (50%)
80% have sporadic MTC (unifocal), remainder have
genetic component
75% patients have LN metastasis at time of dx, 20%
distant mets
Medullary Carcinoma
These neoplasms are derived from the thyroid "C" cells and, therefore,
have neuroendocrine features such as secretion of calcitonin
Amyloid stroma
