Difference between revisions of "Hyperthyroidism"
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{{Fixation - standard}} Fix all thyroids at least overnight to avoid artifactual nuclear atypia.<ref name=chicago2>{{cite web|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref> | {{Fixation - standard}} Fix all thyroids at least overnight to avoid artifactual nuclear atypia.<ref name=chicago2>{{cite web|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref> | ||
{{Fixation - general notes}} | {{Fixation - general notes}} | ||
| − | + | ==Gross processing== | |
| + | As per standard for '''[[thyroid]]'''. | ||
| + | |||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
The most common cause of hyperthyroidism is Grave's disease (50-80% worldwide). Its typical features are:<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/thyroidgraves.html|title=Thyroid gland - Hyperplasia / goiter - Graves disease|author=F. Zahra Aly, M.D., Ph.D., Swati Satturwar, M.B.B.S.|website=PathologyOutlines}} Topic Completed: 1 November 2017, Minor changes: 14 March 2019</ref> | The most common cause of hyperthyroidism is Grave's disease (50-80% worldwide). Its typical features are:<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/thyroidgraves.html|title=Thyroid gland - Hyperplasia / goiter - Graves disease|author=F. Zahra Aly, M.D., Ph.D., Swati Satturwar, M.B.B.S.|website=PathologyOutlines}} Topic Completed: 1 November 2017, Minor changes: 14 March 2019</ref> | ||
| − | *Hyperplastic thyroid follicles with papillary infoldings | + | *'''Hyperplastic''' thyroid follicles with papillary infoldings. |
| − | *Diffuse hyperplasia and hypertrophy of follicular cells with retention of lobular architecture | + | *Diffuse '''hyperplasia and hypertrophy''' of follicular cells with retention of lobular architecture. |
| − | *Prominent vascular congestion | + | *Prominent vascular '''congestion'''. |
| − | *Tall follicular cells with papillae that usually lack fibrovascular cores | + | *'''Tall follicular cells''' with papillae that usually lack fibrovascular cores. |
| − | *Nuclei are round, often basally located, and rarely overlap | + | *'''Nuclei are round''', often basally located, and rarely overlap. |
| − | * | + | *Typically '''decreased colloid''' amount, and when present it typically has peripheral scalloping. |
| − | *Variable patchy lymphoid stromal infiltrate | + | *Variable patchy lymphoid stromal '''infiltrate'''. |
| − | <gallery mode=packed> | + | <gallery mode=packed heights=200> |
File:Histopathology of Graves' disease - low mag.jpg|'''Graves' disease''' - low magnification: exuberant papillary hyperplasia. | File:Histopathology of Graves' disease - low mag.jpg|'''Graves' disease''' - low magnification: exuberant papillary hyperplasia. | ||
File:Histopathology of Graves' disease - medium mag.jpg|'''Graves' disease''' - medium magnification: cells with round nuclei and even chromatin pattern lining the papillae. | File:Histopathology of Graves' disease - medium mag.jpg|'''Graves' disease''' - medium magnification: cells with round nuclei and even chromatin pattern lining the papillae. | ||
| − | File:Histopathology of multinodular toxic goiter.jpg|'''Toxic multinodular goiter''', whose typical findings are:<br>- Variably dilated follicles with flattened hyperplastic epithelium.<ref name=POMultinodular>{{cite web|url=http://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid gland - Hyperplasia / goiter - Multinodular goiter|website=PathologyOutlines|author=Swati Satturwar, M.B.B.S., F. Zahra Aly, M.D., Ph.D.}} Topic Completed: 1 February 2018. Minor changes: 14 December 2019</ref><br>- Nodules may be present (but lack thick capsule in contrast to adenomas).<br>- Potentially focal fresh or old hemorrhages, rupture of follicles with granulomatous inflammation, fibrosis, calcification and even osseous metaplasia.<ref name=POMultinodular/>< | + | File:Histopathology of multinodular toxic goiter.jpg|'''Toxic multinodular goiter''', whose typical findings are:<br>- Variably dilated follicles with flattened hyperplastic epithelium.<ref name=POMultinodular>{{cite web|url=http://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid gland - Hyperplasia / goiter - Multinodular goiter|website=PathologyOutlines|author=Swati Satturwar, M.B.B.S., F. Zahra Aly, M.D., Ph.D.}} Topic Completed: 1 February 2018. Minor changes: 14 December 2019</ref><br>- Nodules may be present<ref name=POMultinodular/> (but lack thick capsule in contrast to adenomas).<br>- Potentially focal fresh or old hemorrhages, rupture of follicles with granulomatous inflammation, fibrosis, calcification and even osseous metaplasia.<ref name=POMultinodular/><br>- Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.<ref name=POMultinodular/> |
File:Histopathology of amiodarone associated follicular cell damage - high mag.jpg|'''Amiodarone associated follicular cell damage''' - high magnification: large thyroid follicles filled with colloid and numerous histiocytes | File:Histopathology of amiodarone associated follicular cell damage - high mag.jpg|'''Amiodarone associated follicular cell damage''' - high magnification: large thyroid follicles filled with colloid and numerous histiocytes | ||
File:Histopathology of amiodarone associated follicular cell damage - low mag.jpg|'''Amiodarone associated follicular cell damage''' - low magnification: large thyroid follicles filled with colloid and numerous histiocytes (arrow heads) | File:Histopathology of amiodarone associated follicular cell damage - low mag.jpg|'''Amiodarone associated follicular cell damage''' - low magnification: large thyroid follicles filled with colloid and numerous histiocytes (arrow heads) | ||
Revision as of 18:45, 14 June 2021
Author:
Mikael Häggström [note 1]
Contents
Fixation
Generally 10% neutral buffered formalin. Fix all thyroids at least overnight to avoid artifactual nuclear atypia.[1]
See also: General notes on fixation
Gross processing
As per standard for thyroid.
Microscopic evaluation
The most common cause of hyperthyroidism is Grave's disease (50-80% worldwide). Its typical features are:[2]
- Hyperplastic thyroid follicles with papillary infoldings.
- Diffuse hyperplasia and hypertrophy of follicular cells with retention of lobular architecture.
- Prominent vascular congestion.
- Tall follicular cells with papillae that usually lack fibrovascular cores.
- Nuclei are round, often basally located, and rarely overlap.
- Typically decreased colloid amount, and when present it typically has peripheral scalloping.
- Variable patchy lymphoid stromal infiltrate.
Graves' disease - low magnification: exuberant papillary hyperplasia.
Graves' disease - medium magnification: cells with round nuclei and even chromatin pattern lining the papillae.
Toxic multinodular goiter, whose typical findings are:
- Variably dilated follicles with flattened hyperplastic epithelium.[3]
- Nodules may be present[3] (but lack thick capsule in contrast to adenomas).
- Potentially focal fresh or old hemorrhages, rupture of follicles with granulomatous inflammation, fibrosis, calcification and even osseous metaplasia.[3]
- Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.[3]
Amiodarone associated follicular cell damage - high magnification: large thyroid follicles filled with colloid and numerous histiocytes
Amiodarone associated follicular cell damage - low magnification: large thyroid follicles filled with colloid and numerous histiocytes (arrow heads)
Papillary hyperplastic nodule - high magnification: oncocytic cells lining the papillary structures (arrow)
Papillary hyperplastic nodule - low magnification: cystic nodule with papillary architecture (arrow)
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
- ↑ F. Zahra Aly, M.D., Ph.D., Swati Satturwar, M.B.B.S.. Thyroid gland - Hyperplasia / goiter - Graves disease. PathologyOutlines. Topic Completed: 1 November 2017, Minor changes: 14 March 2019
- ↑ 3.0 3.1 3.2 3.3 Swati Satturwar, M.B.B.S., F. Zahra Aly, M.D., Ph.D.. Thyroid gland - Hyperplasia / goiter - Multinodular goiter. PathologyOutlines. Topic Completed: 1 February 2018. Minor changes: 14 December 2019
Image sources
