Thyroid

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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]

  • Hemithyroidecomy (lobe + isthmus) or lobectomy, including completion thyroidectomies: Use separate colors over the cut surface and the outer “capsular” or "peripheral" surface.

  • None of the outer “capsular” surface should be inked like the cut surface.

  • Intact total thyroidectomy: Separate colors for each lobe and the isthmus.

  • If no appreciable isthmus, Separate colors for each lobe.

((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]

  • 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


Microscopic examination

Look primarily for the most commons causes of the presentation at hand. 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).[6] Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).[7] See hyperthyroidism article for such case presentations.

  • Thyroiditis, defined by a significant inflammatory infiltrate, usually lymphocytic.

  • Thyroid hyperplasia: Variable sized dilated follicles with flattened to hyperplastic epithelium. May form nodules, but without any significant capsule. Architecture resembles normal thyroid, but may be somewhat hypercellular.[8]

  • 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).[9] 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).[10]

  • NIFTP (noninvasive follicular thyroid neoplasm with papillary-like nuclear features): [11]

  • 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.[12]

  • Relative incidences of malignant thyroid tumors.

Papillary thyroid carcinoma

A papillary thyroid carcinoma is characterized by:

  • Pseudonuclear inclusions (representing cytoplasmic invaginations)

  • Nuclear grooves

Also, it typically has nuclei with:[13]

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

Other thyroid tumors

  • Follicular thyroid carcinoma, resembling follicular cells, and typically do not display the nuclear features of papillary thyroid carcinoma mentioned above. Distinction from adenoma requires invasion of adjacent thyroid parenchyma, capsule (complete penetration) and/or blood vessels (in or beyond the capsule).[14]

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. ↑ 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. 
  7. ↑ 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. 
  8. ↑ 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
  9. ↑ 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
  10. ↑ 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"
  11. ↑ Image by Mikael Häggström, MD. Reference for findings: Rachel Jug, M.B.B.Ch., B.A.O., David Poller, M.D., Xiaoyin "Sara" Jiang, M.D.. NIFTP. Pathology Outlines. Last author update: 10 May 2018
  12. ↑ 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
  13. ↑ 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
  14. ↑ Shuanzeng (Sam) Wei, M.D., Ph.D.. Thyroid & parathyroid - Other thyroid carcinoma - Follicular. Pathology Outlines. Last author update: 1 August 2017. Last staff update: 24 May 2022

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