PATOLOGIA DE LA GLANDULA TIROIDES

Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Lleida

Patología del Tiroides

• Inflamaciones • Hiperplasias (Bocios) • Tumores Benignos • Tumores Malignos

Inflamaciones del Tiroides • Inflamaciones no específicas • Granulomatosa (Quervain) • Linfocítica (Hashimoto) • Fibrosa (Riedel)

Hiperplasias de Tiroides • Hiperplasia (Bocio) Nodular • Hiperplasia (Bocio) Difusa (Graves – Basedow)

Tumors de Tiroide (tipus històlogics)
• Adenoma fol.licular • Tumor (adenoma) trabecular hialinitzant

Cancer de Tiroide (tipus històlogic)
• • • • • Carcinoma papil·lar Carcinoma fol·licular Carcinoma pobrement diferenciat Carcinoma indiferenciat (anaplàsic) Carcinoma medul·lar

Papillary Carcinoma (Definition)
A malignant epithelial tumour showing evidence of follicular cell differentiation and characterized by distinctive nuclear features

Carcinoma Papilar de Tiroides
• Cualquier edad • Poco agresivo • El más frecuente (especuialmente en zonas no bociógenas • Diseminación por vía linfática

Carcinoma Papilar de Tiroides (Pronóstico)
• • • • Edad Tamaño Invasión extratiroidea Metástasis a distancia

Papillary Carcinoma (variants)
• • • • • • • Follicular variant Macrofollicular variant Oncocytic variant Clear cell variant Diffuse sclerosing variant Tall cell variant Columnar cell variant

Papillary Carcinoma (size variation)
• The term Microcarcinoma should be used for a papillary carcinoma , which is incidentally found, and measures 1 cm or less.

Papillary Carcinoma (Genetics)
• • • • RET/PTC TRK RAS BRAF

Papillary Carcinoma (Genetics)
• • • • • • • • • • RET/PTC1 RET/PTC2 RET/PTC3-4 RET/PTC5 RET/PTC6 RET/PTC7 RET/ELKS RET/KTN1 RET/RFG8 RET/PCM-1 60-70% < 10% 20-30% rare rare rare rare rare rare rare

Follicular Carcinoma (Definition)
A malignant epithelial tumour showing evidence of follicular cell differentiation, lacking the diagnostic nuclear features of papillary carcinoma

Follicular Carcinoma (variants)
• Oncocytic variant (Hürthle cell Tumors) • Clear cell variant

Poorly differentiated Carcinoma (Definition)
Follicular-cell neoplasms that show limited evidence of structural follicular cell differentiation and occupy both morphologically and behaviourally an intermediate position between the well differentiated follicular and papillary carcinomas and the undifferentiated carcinomas

Poorly differentiated Carcinoma (Histopathology)
• Three patterns (insular, trabecular, solid) • Infiltrative pattern of growth, necrosis and obvious vascular invasion • Prognostic significance of minor component is unknown

Undifferentiated (Anaplastic) Carcinoma (Definition)
Highly malignant tumours that by standard light microscopy appear wholly or partially composed of undifferentiated cells that exhibit immunohistochemical or ultrastructural features indicating epithelial differentiation

Medullary Thyroid Carcinoma (Definition)
A malignant tumour of the thyroid gland showing C-cell differentiation and lacking follicular differentiation.

CARCINOMA MEDULAR DE TIROIDES ESPORADICO FAMILIAR NO ASOCIADO

ASOCIADO MEN 2A MEN 2 B

CMT ESPORÁDICO

CMT FAMILIAR

Medullary Thyroid Carcinoma

RET

RET

T

CMT ESPORÁDICO

CMT FAMILIAR

Limfoma de Tiroide

Metastatic Tumors

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