Difference between revisions of "Thyroid"
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[[File:Gross pathology of parathyroid gland, annotated.jpg|thumb|210px|Parathyroid gland (white arrow), next to the thyroid gland.]] | [[File:Gross pathology of parathyroid gland, annotated.jpg|thumb|210px|Parathyroid gland (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. | 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 thyroid}} | + | |
| + | ==Gross processing of thyroidectomy== | ||
| + | *'''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> | ||
| + | *'''Measure''' each lobe and isthmus in 3 dimensions, respectively.<ref name=chicago/> | ||
| + | *'''Ink''' outer surface,<ref name=chicago/> at least if malignancy is suspected.<ref>{{Stora utskärningen}}</ref> | ||
| + | <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> | ||
| + | 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"/> | ||
| + | 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. | ||
| + | </gallery> | ||
| + | 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> | ||
| + | File:Sectioning of hemithyroidectomy.svg|Hemithyroidecomy (lobe + isthmus) or lobectomy: Include isthmic orange margins in your transverse sections. | ||
| + | File:Sectioning of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Transverse lobe sections and sagittal isthmus sections | ||
| + | File:Sectioning of thyroidectomy without isthmus.svg|Short/inconspicious isthmus: The isthmus can be included in the transverse sections. | ||
| + | </gallery> | ||
| + | {{Gross processing}}<noinclude> | ||
| + | |||
| + | ==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.<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. | ||
==See also== | ==See also== | ||
*[[Parathyroid glands]] | *[[Parathyroid glands]] | ||
{{Bottom}} | {{Bottom}} | ||
Revision as of 18:44, 14 June 2021
Author:
Mikael Häggström [note 1]
Contents
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
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]
Hemithyroidecomy (lobe + isthmus) or lobectomy, including completion thyroidectomies: Use separate colors over the cut surface and the outer “capsular” surface.[notes 1]
None of the outer “capsular” surface should be inked like the cut surface.[notes 1]
Intact total thyroidectomy: Separate colors for each lobe and the isthmus.
If no appreciable isthmus, Separate colors for each lobe.
Serially section the specimen at 3-4mm intervals,[5] such as follows:[2]
Hemithyroidecomy (lobe + isthmus) or lobectomy: Include isthmic orange margins in your transverse sections.
Intact total thyroidectomy: Transverse lobe sections and sagittal isthmus sections
Short/inconspicious isthmus: The isthmus can be included in the transverse sections.
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.
See also
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.
- ↑ 2.0 2.1 2.2 2.3 . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
- ↑ 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:. 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. - ↑ Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
- ↑ . THYROID. Royal College of pathologists of Australia. Retrieved on 2019-12-17.
- ↑ 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:. ISSN 87551039.
Image sources
