Difference between revisions of "Thyroid"

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{{Fixation - standard}} Fix all thyroids at least overnight to avoid artifactual nuclear atypia.<ref name=chicago>{{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>
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==Presentations==
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*[[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 - general notes}}
 
{{Fixation - general notes}}
==Gross processing==
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===Selection and trimming===
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==Removal during autopsy==
{{Selection and trimming}}
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[[File:Gross pathology of parathyroid gland, annotated.jpg|thumb|210px|'''[[Parathyroid glands]]''' (white arrow), next to the thyroid gland.]]
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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.
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==Gross processing of thyroidectomy==
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*'''Weigh'''.<ref name=chicago>{{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> Up to 30 g versus over 30 g grams is an accepted cutoff between normal and increased weight of the thyroid gland.<ref name="ShamimMonira1970">{{cite journal|last1=Shamim|first1=A|last2=Monira|first2=K|last3=Manowara|first3=B|last4=Sabiha|first4=M|last5=Alim|first5=A|last6=Nurunnabi|first6=ASM|title=Weight of the Human Thyroid Gland – A Postmortem Study|journal=Bangladesh Journal of Medical Science|volume=9|issue=1|year=1970|pages=44–48|issn=2076-0299|doi=10.3329/bjms.v9i1.5230}}<br>- In turn citing: Langer P. Discussion about the limit between normal thyroid and goiter: mini review. Endocrine regulations. 1999 March; 33(1): 39-45.</ref>
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*'''Measure''' each lobe and isthmus in 3 dimensions, respectively.<ref name=chicago/>
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*'''Ink''' outer surface,<ref name=chicago/> at least if malignancy is suspected.<ref>{{Stora utskärningen}}</ref>
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<gallery>
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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” 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: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:Grossing of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Separate colors for each lobe and the isthmus.
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File:Grossing of thyroidectomy without isthmus.svg|If no appreciable isthmus, Separate colors for each lobe.
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</gallery>
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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/>
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<gallery>
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File:Sectioning of hemithyroidectomy.svg|Hemithyroidecomy (lobe + isthmus) or lobectomy: Include isthmic orange margins in your transverse sections.
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File:Sectioning of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Transverse lobe sections and sagittal isthmus sections
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File:Sectioning of thyroidectomy without isthmus.svg|Short/inconspicious isthmus: The isthmus can be included in the transverse sections.
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</gallery>
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{{Gross processing}}<noinclude>
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==Thyroid cytology==
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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.<ref name="MichaelPang2007">{{cite journal|last1=Michael|first1=Claire W.|last2=Pang|first2=Yijun|last3=Pu|first3=Robert T.|last4=Hasteh|first4=Farnaz|last5=Griffith|first5=Kent A.|title=Cellular adequacy for thyroid aspirates prepared by ThinPrep: How many cells are needed?|journal=Diagnostic Cytopathology|volume=35|issue=12|year=2007|pages=792–797|issn=87551039|doi=10.1002/dc.20768}}</ref> The presence of characteristic cells may still confer a definitive diagnosis, but otherwise, the report will simply state inadequate number of cells.
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 +
==Microscopic examination==
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[[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 (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>
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<gallery mode=packed heights=200px>
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File:Histopathology of a Hürthle cell adenoma.jpg|thumb|'''Hürthle cell adenoma'''
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File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
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</gallery>
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===Papillary thyroid carcinoma===
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A '''papillary thyroid carcinoma''' is characterized by:
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<gallery mode=packed heights=200px>
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File:Histopathology of papillary thyroid cancer in a thyroglossal cyst, high magnification, annotated.jpg|'''Pseudonuclear inclusions''' (representing cytoplasmic invaginations)
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File:Nuclear grooves.jpg|'''Nuclear grooves'''
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</gallery>
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Also, it typically has nuclei with:<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidpapillary.html|title=Thyroid & parathyroid - Papillary thyroid carcinoma - Papillary thyroid carcinoma overview|website=Pathology Outlines|author=Bin Xu, M.D., Ph.D.}} Topic Completed: 8 January 2020. Minor changes: 28 May 2021</ref>
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*Enlargement, elongation, overlapping
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*Chromatin with clearing, margination, glassy / ground glass texture
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*Nuclear membrane with irregular contour
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==Reporting==
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{{CAP}}
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{{Reporting}}
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==See also==
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*[[Parathyroid glands]]
 
{{Bottom}}
 
{{Bottom}}

Latest revision as of 08:14, 9 September 2021

Author: Mikael Häggström [notes 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]

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

Most common causes of hyperthyroidism by age.[7]

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).[8] Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).[9]

Papillary thyroid carcinoma

A papillary thyroid carcinoma is characterized by:

Also, it typically has nuclei with:[10]

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

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.
  2. 2.0 2.1 Separate coloring allows to distinguish the thyroid margin (continuous with the other lobe) from the peripheral margin (towards soft tissues).

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. 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. 
  8. 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. 
  9. 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. 
  10. 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