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Thyroid

Lab 1 Young woman Lab 4 49 year old w/ fatigue

TSH and T4 TSH and T4


o diff dx = problem w/ ant pit or o 1 hypothyroidism
above or ectopic TSH secreting Diff dx = Hashimotos
tumor Order Antithyroglobulin and antithyroid
TSH and T4 peroxidase antibodies
o Graves, neoplasm of thyroid Histo Lots of lymphocytes w/ germinal
gland, toxic multinodular goiter, centers and Hurthle Cells (pink granules
thyroiditis, Struma ovarii, in cytoplasm)
exogenous thyroid hormone Complication Marginal B cell
Order lymphoma, other autoimmune dzs
o IgG that stimulates TSH receptor
o Anti thyroid antibodies Lab 5 36 year old w/ sore throat
Diffuse radioactive uptake
o Diffusely synthesizing more Papillary thyroid carcinoma
thyroid hormone throughout the Histo = Papillary configuration ,
gland Psammoma bodies, Orphan Annie Eye
Histo nuclei
o Very cellular but only few colloid RF = exposure to ionizing radiation
o Lymphoid aggregates w/ germinal Mets to cervical lymph nodes
centers Prog is good
What else do you see in the thyroid
Lab 6 50 year old Unilat neck mass w/ mild
tissue
o Lymphocytes dysphagia
Dx
Medullary carcinoma
o Graves
o Histo Sheets of Salt and pepper
o Exopthalmos
o Pretibial myxedema chromatin
o Lots of amyloid do congo stain
o Lab test Calcitonin, CEA
o Assoc w/ mutation in RET
Lab 2 40 year old woman w/ nodule on 1 side oncogene

Diff dx follicular adenoma, or papillary,


follicular or medullary carcinoma, or
dominant nodule of a multinodular goiter
Order FNA
Histo normal thyroid in periphery
o Does not invade capsule
Dx = Benign follicular adenoma

Lab 3

Diff dx Multinodular goiter w/ dominant


nodule
Histo no capsule seen
o Scarring
o Hemosiderin laden Macs indicating
previous hemorrhage
Breast

Lab 1 36 year old F w/ intermittent breast


tenderness before her menses

Biopsy Blue dome cyst = fibrocystic


Lab 4 56 year old woman for routine follow up
change
Histo excess connective tissue w/ for her HTN
dilated cysts lined by apocrine Lobular carcinoma in situ = small cells
metaplasia
filling up lobule
Lab 2 24 year old F w/ a painless lump in left Lobular Invasive = single file pattern of
breast, well delineated, mobile, rubbery carcinoma cells w/ a Bulls-eye pattern
where tumor cells are arranged
Dx = Fibroadenoma concentrically around residual ducts and
Histo lots of connective tissue and lobules
squished ducts but still have LCIS is systemically treated w/ tamoxifen
myoepithelial cells so still benign b/c it is multifocal and bilateral
Phyllodes tumor if They are just as likely to get invasive
o Stroma that overgrows, not epith lobular carcinoma
o Older people
o Can be malignant

Lab 3 routine annual mammogram on 52 year


old

Cluster of microcalcifications on
mammography (no mass can by
physically felt)
Dx Ductal Carcinoma In Situ, Comedo
type
Myoepithelial cells present
Necrosis and dystrophic calcifications
Have not invaded Basement membrane
Tx Without tx, it will prog to invasive
ductal carcinoma
Stellate scar image on radiograph
o Invade basement membrane
o No myoepithelial cells seen
o Can palpate b/c lots of
desmoplastic stroma and
retraction of nipple
o Upper outer quadrant
o Mets to axillary nodes then to
blood
o Besides grade and stage what else
is a Px factor = molecular markers
such as ER, PR, and HER2/neu
amplify
Lower female genital tract Lab 3

Intro Post menopausal ovary would have more


scars than ovary from woman of
Ecto = non keratinized stratif squamous reproductive age
epithelium Ovarian neoplasm presents as subtle
Endo = simple columnar mucinous vague abdominal pain
glandular epithelium 1 ovarian neoplasm come from surface
epithelium, germ cells, sex cord stromal
Lab 1 18 year old sexually active comes for
tumors
pap smear
Surface epithelial tumor subtpyes
Koilocytic change - N:C, o Serous (if diff to fallopian tube)
o Mucinous (if diff to endocervix)
hyperchromatic, surrounding halo
o Endometriooid (if diff to
HPV infxn
Comes back 8 year for coloscopy endometrium)
o Koilocytes on top Surface epithelial tumor malignant
o CIN 3 or CIS seen features
HPV 16, 18, 31, 33 o Gross = Solid, multilocular,
Not surprised that she had no Sx b/c she Bilateral
o Micro
only has in situ
benign = very minimal
Lab 2 22 year old primigravid woman to ER in epithelial prolif single row
labor

Painful vesicles Lab 3 = 32 year old w/ vague feeling of


Dx = HSV 2 abdominal discomfort
o Stratified squamous epithelium
single row of mucin secreting cells =
o Blistering lesion w/ multinucleated
benign mucinous cystadenoma
squamous cells that coalesce w/
Mullerian duct epith recapitulated =
ground glass chromatin
Do C section for baby and tx w/ acyclovir endocervix

Lab 4 = 54 year old woman for annual exam

Cysts lined w/ a thick shaggy lining piling


up on top of each other
Papillary serous cystadenocarcinoma
Mullerian duct Fallopian tube
Most common ovarian malignancy
CA-125 cell marker
Cause ascites seeding of cancer into
peritoneum
Poor Px
Endometrial hyperplasia indicates long
standing estrogen even 15 post
menopausal
Can be granulosa tumor or thecoma
Histo = Call-exner bodies
o Granulosa cell tumor
o Malignant but Indolent
Cell marker = inhibin

What types of malig freq mets to ovaries?

Endometrial carcinoma, breast cancer, GI tract

Lab 5 Germ cell tumor

20s and younger age group


Most are benign mature teratomas
Primordial germ cells come via midline of
yolk sac up midline of retroperitoneum.
Can see them midline

Lab 5 25 year old

Mature squamous epithelium lining


Tissue resembles skin
Derived from ectoderm
Benign Lab 7 47 F w/ early satiety and abdominal
If malig discomfort
o More solid
o Composed of embryonic immature Krukenberg tumor from diffuse gastric
cells carcinoma w/ signet ring cells

Sex cord stromal tumors

Granulosa , theca, and fibroblasts


Sometimes sertoli-leydif cells
Whats unique? They can make
hormones

Lab 6 66 year old w/ vaginal bleed