Difference between revisions of "Thyroid"

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*'''Ink''' outer surface,<ref name=chicago/> at least if malignancy is suspected.<ref>{{Stora utskärningen}}</ref>
 
*'''Ink''' outer surface,<ref name=chicago/> at least if malignancy is suspected.<ref>{{Stora utskärningen}}</ref>
 
<gallery>
 
<gallery>
File:Grossing of hemithyroidectomy.svg|Hemithyroidecomy (lobe + isthmus) or lobectomy, including completion thyroidectomies: Use separate colors over the cut surface and the outer “capsular” surface.<ref group="notes" name="coloring">Separate coloring allows to distinguish the thyroid margin (continuous with the other lobe) from the peripheral margin (towards soft tissues).</ref>
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File:Grossing of hemithyroidectomy.svg|Hemithyroidecomy (lobe + isthmus) or lobectomy, including completion thyroidectomies: Use separate colors over the cut surface and the outer “capsular” or "peripheral" surface.
File:How to not gross hemithyroidectomy.svg|None of the outer “capsular” surface should be inked like the cut surface.<ref group="notes" name="coloring"/>
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File:How to not gross hemithyroidectomy.svg|None of the outer “capsular” surface should be inked like the cut surface.
 
File:Grossing of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Separate colors for each lobe and the isthmus.
 
File:Grossing of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Separate colors for each lobe and the isthmus.
 
File:Grossing of thyroidectomy without isthmus.svg|If no appreciable isthmus, Separate colors for each lobe.
 
File:Grossing of thyroidectomy without isthmus.svg|If no appreciable isthmus, Separate colors for each lobe.
 
</gallery>
 
</gallery>
 +
{{Comprehensive-begin}}In addition, use different ink colors on the anterior versus posterior “capsular” or "peripheral" surface.{{Comprehensive-end}}
 +
 
Serially '''section''' the specimen at 3-4mm intervals,<ref>{{cite web|url=https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual/Endocrine/Thyroid|title=THYROID|website=Royal College of pathologists of Australia|accessdate=2019-12-17}}</ref> such as follows:<ref name=chicago/>
 
Serially '''section''' the specimen at 3-4mm intervals,<ref>{{cite web|url=https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual/Endocrine/Thyroid|title=THYROID|website=Royal College of pathologists of Australia|accessdate=2019-12-17}}</ref> such as follows:<ref name=chicago/>
 
<gallery>
 
<gallery>
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==Microscopic examination==
 
==Microscopic examination==
[[File:Causes of hyperthyroidism.png|thumb|Most common causes of hyperthyroidism by age.<ref>{{cite journal|last1=Carlé|first1=Allan|last2=Pedersen|first2=Inge Bülow|last3=Knudsen|first3=Nils|last4=Perrild|first4=Hans|last5=Ovesen|first5=Lars|last6=Rasmussen|first6=Lone Banke|last7=Laurberg|first7=Peter|title=Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study|journal=European Journal of Endocrinology|volume=164|issue=5|year=2011|pages=801–809|issn=0804-4643|doi=10.1530/EJE-10-1155|pmid=21357288}}</ref>]]
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Look primarily for the most commons causes of the presentation at hand, such as hyperthyroidism. Otherwise, thyroid nodules can broadly be classified into benign versus malignant, where the risk of malignancy per nodule case is higher in younger people (approximately 23% in people aged 20-30 and approximately 13% in those aged >70 y).<ref name="KwongMedici2015">{{cite journal|last1=Kwong|first1=Norra|last2=Medici|first2=Marco|last3=Angell|first3=Trevor E.|last4=Liu|first4=Xiaoyun|last5=Marqusee|first5=Ellen|last6=Cibas|first6=Edmund S.|last7=Krane|first7=Jeffrey F.|last8=Barletta|first8=Justine A.|last9=Kim|first9=Matthew I.|last10=Larsen|first10=P. Reed|last11=Alexander|first11=Erik K.|title=The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk|journal=The Journal of Clinical Endocrinology & Metabolism|volume=100|issue=12|year=2015|pages=4434–4440|issn=0021-972X|doi=10.1210/jc.2015-3100}}</ref> Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).<ref name="MalithBombil2018">{{cite journal|last1=Malith|first1=V|last2=Bombil|first2=I|last3=Harran|first3=N|last4=Luvhengo|first4=TE|title=Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting|journal=South African Journal of Surgery|volume=56|issue=3|year=2018|pages=20–23|issn=00382361|doi=10.17159/2078-5151/2018/v56n3a2557}}</ref>
Look primarily for the most commons causes of the presentation at hand, such as hyperthyroidism (see image). Thyroid nodules can broadly be classified into benign versus malignant, where the risk of malignancy per nodule case is higher in younger people (approximately 23% in people aged 20-30 and approximately 13% in those aged >70 y).<ref name="KwongMedici2015">{{cite journal|last1=Kwong|first1=Norra|last2=Medici|first2=Marco|last3=Angell|first3=Trevor E.|last4=Liu|first4=Xiaoyun|last5=Marqusee|first5=Ellen|last6=Cibas|first6=Edmund S.|last7=Krane|first7=Jeffrey F.|last8=Barletta|first8=Justine A.|last9=Kim|first9=Matthew I.|last10=Larsen|first10=P. Reed|last11=Alexander|first11=Erik K.|title=The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk|journal=The Journal of Clinical Endocrinology & Metabolism|volume=100|issue=12|year=2015|pages=4434–4440|issn=0021-972X|doi=10.1210/jc.2015-3100}}</ref> Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).<ref name="MalithBombil2018">{{cite journal|last1=Malith|first1=V|last2=Bombil|first2=I|last3=Harran|first3=N|last4=Luvhengo|first4=TE|title=Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting|journal=South African Journal of Surgery|volume=56|issue=3|year=2018|pages=20–23|issn=00382361|doi=10.17159/2078-5151/2018/v56n3a2557}}</ref>
 
 
<gallery mode=packed heights=200px>
 
<gallery mode=packed heights=200px>
File:Histopathology of a Hürthle cell adenoma.jpg|thumb|'''Hürthle cell adenoma'''
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File:Causes of hyperthyroidism.png|Most common causes of hyperthyroidism by age.<ref>{{cite journal|last1=Carlé|first1=Allan|last2=Pedersen|first2=Inge Bülow|last3=Knudsen|first3=Nils|last4=Perrild|first4=Hans|last5=Ovesen|first5=Lars|last6=Rasmussen|first6=Lone Banke|last7=Laurberg|first7=Peter|title=Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study|journal=European Journal of Endocrinology|volume=164|issue=5|year=2011|pages=801–809|issn=0804-4643|doi=10.1530/EJE-10-1155|pmid=21357288}}</ref>
 +
File:Histopathology of nodular hyperplasia of the thyroid.png|'''Nodular hyperplasia''': Variable sized dilated follicles with flattened to hyperplastic epithelium, and without any significant capsule. Architecture resembles normal thyroid, but may be somewhat hypercellular.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid & parathyroid - Hyperplasia / goiter - Multinodular goiter|author=Swati Satturwar, M.D., F. Zahra Aly, M.D., Ph.D.|website=PathologyOutlines}} Last author update: 11 June 2021. Last staff update: 18 November 2021</ref>
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File:Histopathology of a Hürthle cell adenoma.jpg|thumb|'''Hürthle cell adenoma''', typically consisting of cells with large size, distinct cell borders, deeply eosinophilic and granular cytoplasm, large nucleus with prominent nucleolus, and complete loss of cell polarity.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthle.html|website=Pathology Outlines|author=Shuanzeng (Sam) Wei, M.D., Ph.D.|title=Thyroid & parathyroid - Other thyroid carcinoma - Main- Oncocytic (Hürthle cell) tumors}} Last author update: 1 October 2017. Last staff update: 21 July 2021</ref>
 +
File:Histopathology of hyperfunctioning and non-hyperfunctioning thyroid follicular adenoma.jpg|'''Thyroid follicular adenoma''', being architecturally and cytologically different from surrounding gland, and being completely enveloped by thin fibrous capsule (if not being encapsulated, mainly consider thyroid carcinoma if atypical cells, otherwise nodular hyperplasia with dominant nodule, the latter especially if there are hyperplastic changes elsewhere in gland).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicularadenoma.html|title=Thyroid & parathyroid Benign thyroid neoplasms. Follicular adenoma.|author=Sheren Younes, M.D.|website=Pathology Outlines}} Last author update: 1 November 2014. Last staff update: 8 March 2022</ref> Hyperfunctioning follicular adenoma typically shows follicles with papillary infoldings and bubbly, pale colloid with peripheral scalloping (a). Non-hyperfunctioning adenomas with papillary hyperplasia usually show a more predominantly papillary pattern without vacuolated cytoplasm and scalloping colloid (b).<ref name=Cameselle-Teijeiro2020>{{cite journal| author=Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M| title=Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. | journal=Endocr Pathol | year= 2020 | volume= 31 | issue= 3 | pages= 197-217 | pmid=32632840 | doi=10.1007/s12022-020-09638-x | pmc=7395918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32632840  }}<br>"This article is licensed under a Creative Commons Attribution 4.0 International License"</ref>
 
File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
 
File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
 
</gallery>
 
</gallery>
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*Chromatin with clearing, margination, glassy / ground glass texture
 
*Chromatin with clearing, margination, glassy / ground glass texture
 
*Nuclear membrane with irregular contour
 
*Nuclear membrane with irregular contour
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 +
===Other thyroid tumors===
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<gallery mode=packed heights=230px>
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File:Histopathology of follicular thyroid carcinoma.png|'''Follicular thyroid carcinoma''', resembling follicular cells, and typically do not display the nuclear features of papillary thyroid carcinoma mentioned above.
 +
</gallery>
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 +
===Reporting===
 +
{{CAP}}
 +
{{Reporting}}
  
 
==See also==
 
==See also==
 
*[[Parathyroid glands]]
 
*[[Parathyroid glands]]
 
{{Bottom}}
 
{{Bottom}}

Latest revision as of 16:10, 21 June 2022

Author: Mikael Häggström [note 1]

Presentations

Fixation

Generally 10% neutral buffered formalin. Fix all thyroids at least overnight to avoid artifactual nuclear atypia.[1]

  See also: General notes on fixation


Removal during autopsy

Parathyroid glands (white arrow), next to the thyroid gland.

Sharply dissect the thyroid from the cartilage, starting at the posterior end of each lobe & working forward. Do not cut the isthmus. Try to find parathyroids.

Gross processing of thyroidectomy

  • Weigh.[2] Up to 30 g versus over 30 g grams is an accepted cutoff between normal and increased weight of the thyroid gland.[3]
  • Measure each lobe and isthmus in 3 dimensions, respectively.[2]
  • Ink outer surface,[2] at least if malignancy is suspected.[4]

((In addition, use different ink colors on the anterior versus posterior “capsular” or "peripheral" surface.))

Serially section the specimen at 3-4mm intervals,[5] such as follows:[2]

  See also: General notes on gross processing


Thyroid cytology

Initially, check for adequacy of the sample. A minimum number of 6 clusters with 10 cells each has been arbitrary established to assume adequacy for a definitive diagnosis.[6] The presence of characteristic cells may still confer a definitive diagnosis, but otherwise, the report will simply state inadequate number of cells.

Microscopic examination

Look primarily for the most commons causes of the presentation at hand, such as hyperthyroidism. Otherwise, thyroid nodules can broadly be classified into benign versus malignant, where the risk of malignancy per nodule case is higher in younger people (approximately 23% in people aged 20-30 and approximately 13% in those aged >70 y).[7] Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).[8]

Papillary thyroid carcinoma

A papillary thyroid carcinoma is characterized by:

Also, it typically has nuclei with:[14]

  • Enlargement, elongation, overlapping
  • Chromatin with clearing, margination, glassy / ground glass texture
  • Nuclear membrane with irregular contour

Other thyroid tumors

Reporting

For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.

  See also: General notes on reporting


See also

Notes

  1. 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

  1. . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
  2. 2.0 2.1 2.2 2.3 . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
  3. Shamim, A; Monira, K; Manowara, B; Sabiha, M; Alim, A; Nurunnabi, ASM (1970). "Weight of the Human Thyroid Gland – A Postmortem Study ". Bangladesh Journal of Medical Science 9 (1): 44–48. doi:10.3329/bjms.v9i1.5230. ISSN 2076-0299. 
    - In turn citing: Langer P. Discussion about the limit between normal thyroid and goiter: mini review. Endocrine regulations. 1999 March; 33(1): 39-45.
  4. Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  5. . THYROID. Royal College of pathologists of Australia. Retrieved on 2019-12-17.
  6. Michael, Claire W.; Pang, Yijun; Pu, Robert T.; Hasteh, Farnaz; Griffith, Kent A. (2007). "Cellular adequacy for thyroid aspirates prepared by ThinPrep: How many cells are needed? ". Diagnostic Cytopathology 35 (12): 792–797. doi:10.1002/dc.20768. ISSN 87551039. 
  7. Kwong, Norra; Medici, Marco; Angell, Trevor E.; Liu, Xiaoyun; Marqusee, Ellen; Cibas, Edmund S.; Krane, Jeffrey F.; Barletta, Justine A.; et al. (2015). "The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk ". The Journal of Clinical Endocrinology & Metabolism 100 (12): 4434–4440. doi:10.1210/jc.2015-3100. ISSN 0021-972X. 
  8. Malith, V; Bombil, I; Harran, N; Luvhengo, TE (2018). "Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting ". South African Journal of Surgery 56 (3): 20–23. doi:10.17159/2078-5151/2018/v56n3a2557. ISSN 00382361. 
  9. Carlé, Allan; Pedersen, Inge Bülow; Knudsen, Nils; Perrild, Hans; Ovesen, Lars; Rasmussen, Lone Banke; Laurberg, Peter (2011). "Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study ". European Journal of Endocrinology 164 (5): 801–809. doi:10.1530/EJE-10-1155. ISSN 0804-4643. PMID 21357288. 
  10. Swati Satturwar, M.D., F. Zahra Aly, M.D., Ph.D.. Thyroid & parathyroid - Hyperplasia / goiter - Multinodular goiter. PathologyOutlines. Last author update: 11 June 2021. Last staff update: 18 November 2021
  11. Shuanzeng (Sam) Wei, M.D., Ph.D.. Thyroid & parathyroid - Other thyroid carcinoma - Main- Oncocytic (Hürthle cell) tumors. Pathology Outlines. Last author update: 1 October 2017. Last staff update: 21 July 2021
  12. Sheren Younes, M.D.. Thyroid & parathyroid Benign thyroid neoplasms. Follicular adenoma.. Pathology Outlines. Last author update: 1 November 2014. Last staff update: 8 March 2022
  13. Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M (2020). "Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. ". Endocr Pathol 31 (3): 197-217. doi:10.1007/s12022-020-09638-x. PMID 32632840. PMC: 7395918. Archived from the original. . 
    "This article is licensed under a Creative Commons Attribution 4.0 International License"
  14. Bin Xu, M.D., Ph.D.. Thyroid & parathyroid - Papillary thyroid carcinoma - Papillary thyroid carcinoma overview. Pathology Outlines. Topic Completed: 8 January 2020. Minor changes: 28 May 2021

Image sources