PATHOLOGY LAB

VOL. 7

Parathyroid gland laying within the capsule of the thyroid gland

2016.4.7&8
Endocrine system (I) (II)

Micro teachingEndocrine system (I)

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2016/04/07/1,2

Introduction
Papillary Carcinoma

Outline

Thyroid

4015 (169) Nodular goiter, thyroid

3323 (54) Granulomatous thyroiditis

3156 (30) Hashimoto thyroiditis, thyroid

3803 (101) Graves' disease, thyroid

4057 (103) Papillary carcinoma, thyroid

4171 (82) Medullary carcinoma, thyroid

Thyroid
. follicle

4015 (169) Nodular goiter, thyroid

. Gross

() Multilobulated, asymmetrically enlarged glands

() Irregular nodules containing variable amounts of brown, gelatinous colloid
() nodular goiter nodule
() Thyroid capsule nodule colloidnodule
fibrosis follicular adenoma tumor
() Cystic changedegeneration
. Micro
() nodules TSH
hemorrhage

() Secondary change
1.

cystic change follicle

2.

hemorrhage

3.

fibrosis follicle fibrosis

4.

calcification

Fibrosis
fibrosis
() lining epithelium inactive
() Papillary infolding Graves' resorption vacuoles
follicle Graves'

() hemosiderin

.
() Multinodular / irregular nodules
() Variable-sized follicles lined by flattened, inactive follicular epithelia
() Hemorrhage, fibrosis, calcification, and cystic change

3323 (54) Granulomatous thyroiditis

. Gross
() firm and yellow-white cancer
() Unilateral or bilateral enlarged, intact capsule

. Micro

() chronic inflammatory infiltrate with multinucleate giant cells

() thyroid gland follicle colloid giant
cell giant cell

()

1.

fibrotic tissue
thyroid follicle thyroid follicle atrophy

) granulomatous thyroiditis diffuse change

Hashimoto thyroiditis & Graves' disease

2.

germinal center

()

1.

Thyroid follicle epithelioid histiocyte

granuloma folliculocentric granuloma
follicle folliculocentric granuloma
granulomatous thyroiditis

2.

multinucleated giant cell Langhans giant cell

colloid

3.

Follicle Hashimoto disease

lymphocyte germinal center

4.

granuloma PMN microabscess

granulomatous inflammation
fibrosis

multinucleated giant cell granulomatous

thyroditis fibrosis capsule

5.

Colloid giant cell

.
() Collapsed and damaged follicles
() Neutrophils and microabscess (early stage)
() Folliculocentric granuloma
() Multinucleated giant cells enclose colloids
() Fibrosis (late stage)

3156 (30) Hashimoto thyroiditis, thyroid

.
() diffuse involvement
() Mononuclear inflammatory infiltrate
1.

lymphoplasma cells infiltration Graves' disease

germinal center

() Hrthle cell change

1.

thyroid follicles are atrophic and are lined in many areas by epithelial
cells with abundant eosinophilic, granular cytoplasm

2.

Thyroid mitochondria

oncocytic change

. Micro
()

10

1.

atrophic follicle

2.

Atrophic thyroid follicleThyroid follicle colloid

reabsorption droplet atrophic folliclefollicle

3.

Lymphoid infiltrationfollicle lymphocyte or plasma cell

lymphoid follicle germinal center
germinal center polarity mantle zone
reactive germinal center

11

()
1.

Hrthle cell changeoncocytic change

(1) thyroid follicles are atrophic and are lined in many areas by
epithelial cells with abundant eosinophilic, granular cytoplasm
(2) round regular nuclei with prominent nucleoli
(3) Thyroid mitochondria

oncocytic
change

2.

96 Hashimoto thyroiditis Hrthle cell change

Hrthle cell change

.
() Diffuse involvement
() Extensive mononuclear inflammatory infiltration (lymphocytes and plasma
cells)
() Well-developed germinal centers
() Hrthle cells

12

3803 (101) Graves' disease

Graves' disease Diffuse toxic goiter Diffuse hyperplasia, thyroid
. Gross
() Diffusely bilateral symmetric enlargement of the gland and a beefy deep red
color resembling muscle, soft

. Micro
() Crowded epithelial cells
overlappingcolloid nodular goiter
Graves' disease follicle follicle

13

() columnar

14

() Papillary projections

() Pale colloid with scalloped marginsColloid

scalloped
nodule
goiter
thyroid colloid
Graves' disease

15

() Lymphoid infiltration and lymphoid follicles

Hashimoto disease

() colloid colloids Papillary projections

Papillary projections

.
() Diffuse hypertrophy and hyperplasia
() Tall and crowded epithelial cells with papillary projections
() Colloidpale with scalloped margins
() Lymphoid infiltrate and lymphoid follicles

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4057 (103) Papillary carcinoma, thyroid

.
() papillary
() Solitary / multiplewell circumscribed / encapsulatedfibrosis / calcification
/ cystic change
follicular ca

cyst well-defined tumor

() Branching papillaea fibrovascular stalk covered by a single to multiple
layers of cuboidal epithelial cells (found in gross or microscopic)

() Chromatin
Orphan-Annie eye nuclei

ground-glass nuclei
() cytoplasm invagination
1.

pseudo-inclusion

2.

Nuclear grooving

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() pseudo-inclusion ground-glass nuclei

. Micro
()
1.

Non-tumor part thyroid follicle Inflammatory reaction

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2.

follicle papillary invasion

Desmoplastic change sclerotic change

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3.

()
1.

Nuclear 2 3

20

2.

Nuclear grooving

orphan Annie eye pseudo-inclusion

21

3.

concentric calcification Psammoma body

fibrosis

.
() Optically clear or empty nuclei (ground-glass or Orphan Annie eye nuclei)
1.

Nuclear crowding

2.

Nuclear enlargement2-3x larger than nonneoplastic epithelium

() Invagination of cytoplasm
1.

Nuclear pseudoinclusion

2.

Nuclear grooving

() Nuclear feature is sufficient for diagnosis of papillary thyroid carcinoma

(even no papillary structure)
() Psammoma body (calcification)

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4171 (82) Medullary carcinoma

. Gross
() a solid pattern of growth and do not have connective tissue capsules
well-defined capsule

() C cell tumor neuroendocrine tumor mass

componentC cell calcitonin amyloid
()
1.

papillary carcinoma

2.

Neuroendocrine tumor uniform nucleus with salt-and-pepper

chromatin
cell polygonal or spindle shape

3.

Amorphous amyloid deposit

23

. Micro

() pattern tumor papillary pattern

() nest

24

() trabeculae ribbon-like

() polygonal cell spindle-shaped cell

25

() Amyloid cleft

collagen
Amyloid calcitonin polypeptide
fibrosis collagen fiber

26

() Neuroendocrine featurechromatin salt and pepper

.
() Neuroendocrine tumorsalt-and-pepper chromatin
() Polygonal to spindle-shaped cells, which may form nests, trabeculae, and
even follicles
() Amorphous amyloid deposits, derived from altered calcitonin polypeptides

. 4015 (169) Nodular goiter, thyroid

() Multinodular / irregular nodules
() Variable-sized follicles lined by flattened, inactive follicular epithelia
() Hemorrhage, fibrosis, calcification, and cystic change
. 3323 (54) Granulomatous thyroiditis
() Collapsed and damaged follicles
() Neutrophils and microabscess (early stage)
() Folliculocentric granuloma
27

() Multinucleated giant cells enclose colloids

() Fibrosis (late stage)
. 3156 (30) Hashimoto thyroiditis, thyroid
() Diffuse involvement
() Extensive mononuclear inflammatory infiltration (lymphocytes and plasma
cells)
() Well-developed germinal centers
() Hrthle cells
. 3803 (101) Graves' disease, thyroid
() Diffuse hypertrophy and hyperplasia
() Tall and crowded epithelial cells with papillary projections
() Colloidpale with scalloped margins
() Lymphoid infiltrate and lymphoid follicles
. 4057 (103) Papillary carcinoma, thyroid
() Optically clear or empty nuclei (ground-glass or Orphan Annie eye nuclei)
1.

Nuclear crowding

2.

Nuclear enlargement2-3x larger than nonneoplastic epithelium

() Invagination of cytoplasm
1.

Nuclear pseudoinclusion

2.

Nuclear grooving

() Nuclear feature is sufficient for diagnosis of papillary thyroid carcinoma

(even no papillary structure)
() Psammoma body (calcification)
. 4171 (82) Medullary carcinoma, thyroid
() Neuroendocrine tumorsalt-and-pepper chromatin
() Polygonal to spindle-shaped cells, which may form nests, trabeculae, and
even follicles
() Amorphous amyloid deposits, derived from altered calcitonin polypeptides

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 finding

1.

2.

29

3.

Ans.
1. Papillary carcinoma
fibrosis
2. Hashimoto thyroiditis
Lymphocytic infiltration
Hrthle cell
3. Medullary carcinoma
polygonal uniform + salt-and-pepper chromatin + amyloid

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Micro teachingEndocrine system (II)

///

2016/04/08/12

Introduction
neuroendocrine tumor

Outline

Neuroendocrine tumor

4172 (85) Pituitary adenoma

2903 (10) Parathyroid adenoma

4100 (107) Pancreatic neuroendocrine tumor

3735(93) Adrenocortical adenoma

3971(144) Pheochromocytoma, adrenal

Neuroendocrine tumor
. Tumor cell salt and pepper chromatin, uniform cell
. location organ
neuroendocrine tumor thyroid metastatic insulinoma
medullary

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4172 (85) Pituitary adenoma

. Pituitary gland
() Silver stain
Cell Reticular network
() HE stain
cytoplasm
acidophil basophil chromophobe

. Pituitary adenoma
() Silver stainDisruption of reticular network
() HE stainUniform / monotonous cell population

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. neuroendocrine tumor pattern

Diffuse / solid

Pseudorosettingtumor cell

Papillary

nonspecific endocrine

pseudo-Zellballen formation

glandular

33

. Micro
() Tumor cellsalt and pepper chromatin, uniform cell

() Morphologyglandular, solid, pseudorosetting pattern

34

2903(10) Parathyroid adenoma

. Gross
() solitary hyperplasia
() well-circumscribed (fibrous capsule), soft, reddish-brown nodule
. Parathyroid gland
() chief cell
oxyphil cell
() adipose tissue
. Micro
() Tumor cell (chief cells) uniform, polygonal small, centrally placed
nuclei
() adipose tissue adenoma

() Adenoma Parathyroid gland adipose

tissue oxyphil cell

35

() infiltrative border

() Morphologysolidacinar

4100(107) Pancreatic neuroendocrine tumor

. WHO pancreatic neuroendocrine tumor= pancreatic NET
Robbins islet cell tumor
. Non-functional
. Functional
() Hyperinsulinism (insulinoma)functional amyloid deposition
() Zollinger-Ellison syndrome
() Multiple endocrine neoplasia (MEN)

36

amyloid deposition
. Micro
() Organ duodenum

pancreas and duodenum

Brunner's glands

pancreas

lobule

Islet of Langerhans

Fibular septa lobule acini ductular system

37

() Pancreas tumor ductular system ductular

carcinomaislet pancreatic NET

() Well-defined nesting

() Tumor cellUniform cells with granular cytoplasm and centrally located round
nuclei Pancreatic NET salt and pepper
chromatin

() Patternsnesting, trabecular, glandular, pseudorosette, ribbon-like

trabecular

Ribbon-like

38

3735(93) Adrenocortical adenoma

. adrenal gland
Cortex
() zona glomerulosa 2~3
cytoplasm zona fasciculata
() zona fasciculata cytoplasm
lipid/fat droplet
() zona reticularis cytoplasm
eosinophilic granule
cytoplasm pigment lipofuscin pigment

Medullachromaffin cellsustentacular cell

39

. Gross nodule
() Usually solitary
() Less than 50 grams
() Well-defined
() hemorrhage, necrosis
() Conn syndromegolden-yellow or bright-yellow
() Cushing syndromebright-yellow

. Micro
() Tumor cell
1.

zone fasciculata aldosterone tumor

zone fasciculata zone glomerulosa

2.

Large cellabundant, clear cytoplasm with lipid droplets

3.

Nucleismall, round and regular, may be pleomorphic (endocrine atypia

malignant)

40

() Lipomatous metaplasia myelocytomatosis

myelolipoma

3971(144) Pheochromocytoma, adrenal

. Gross
() Variable-sized and weight 20-10 cm
() Round to oval
() Sharply circumscribed
() Red-brown color hemorrhage
() 10% tumor
1.

10% at exadrenal paraglangioma

2.

10% bilateral, 10%malignant,

41

. Micro
() Tumor cell (chromaffin cell)
1.

Polygonal to spindle-shaped

2.

Round nuclei with prominent nucleoli

3.

pleomorphism NET mitosis

bizarre nuclei
malignantParaglanglioma
Pheochromocytoma malignant metastasis

4.

Granular basophilic cytoplasm Adrenocortical

adenoma

() Zellballen appearancewell-defined nests sustentacular cells

NET sustentacular cells
Paraglanglioma Pheochromocytoma thin strands of fibrovascular
stroma

42

. 4172 (85) Pituitary adenoma

() Tumor cellsalt and pepper chromatin, uniform cell
() Patternglandular, solid, pseudorosetting
. 2903 (10) Parathyroid adenoma
() well-circumscribed (fibrous capsule)
() Tumor cell (chief cells)salt and pepper chromatin, uniform cells
() No adipose tissue
. 4100 (107) Pancreatic neuroendocrine tumor
() Tumor cellsalt and pepper chromatin, uniform cell
() Patternsnesting, trabecular, glandular, pseudorosette, ribbon-like
. 3735(93) Adrenocortical adenoma
() Well-defined
() Tumor cell
1.

Large

2.

abundant, clear cytoplasm with lipid droplets

3.

Nucleismall, round and regular, mild pleomorphic

() Lipomatous metaplasia
. 3971(144) Pheochromocytoma, adrenal
() Tumor cell(chromaffin cell)
1.

Polygonal to spindle-shaped

2.

Round nuclei with prominent nucleoli, mild pleomorphism

3.

Abundant intracytoplasmic lipid droplets, basophilic cytoplasm

() Zellballen appearancewell-defined nestssurrounded by sustentacular cells

and fibrovascular stroma

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1.

20
1
104-1

(A)adenocarcinoma (B)hemangioma
(C)insulinoma (D)pseudocyst
2.

finding

1. (C), salt and pepper chromatin cell

2. pheochromocytoma, Zellballen appearance: well-defined nestssurrounded by
sustentacular cells and fibrovascular stromacompress medulla
44