THYROID TUMORS

 NODULES
 USUALLY BENIGN
 MALIGNANCY VERY RARE
SO LIT A RY T U M O RS

30% 5% REST
BEN IG N M A LIG N A N T N O N N EO PLA ST IC
FO LLICU LA R A D EN O M A LES IO N S
 CLASSIFICATION
 WHO CLASSIFICATION
 HISTOLOGICAL CLASSIFICATION
BY ROSAI & HIS MEMBERS
 WHO CLASSIFICATION
(2004)
 THYROID CARCINOMA
 THYROID ADENOMA & RELATED
TUMORS
 OTHER THYROID TUMORS
 THYROID CARCINOMA
 Papillary carcinoma
 Follicular carcinoma
 Poorly differentiated carcinoma
 Undifferentiated (anaplastic) carcinoma
 Squamous cell carcinoma
 Mucoepidermoid carcinoma
 Sclerosing mucoepidermoid carcinoma
with eosinophilia
 Mucinous carcinoma
 Medullary thyroid carcinoma
 Mixed medullary and follicular cell
carcinoma
 Spindle cell tumor with thymus-like
differentiation (SETTLE)
 Carcinoma showing thymus-like
differentiation (CASTLE)
 THYROID ADENOMA &
RELATED TUMORS
 Follicular adenoma
 Hyalinizing trabecular tumor
 OTHER THYROID
TUMORS
 Teratoma
 Primary lymphoma and plasmacytoma
 Ectopic thymoma
 Angiosarcoma
 Smooth muscle tumors
 Peripheral nerve sheath tumors
 Paraganglioma
 Solitary fibrous tumor
 Follicular dendritic cell tumor
 Langerhans cell histiocytosis
 Secondary tumors of the thyroid
 ROSAI’S
HISTOLOGICAL
CLASSIFICATION
OF THYROID
TUMORS
 T HYRO ID
TU M O RS

PRIM A RY SECON DARY

TUM ORS TUM O RS

T .O F F O L L I C U L A R M A LIGN A N T U N D IFFEREN T IA T ED 1) T . W IT H O N CO CYT IC FEA T U RE

CELLS CA RCIN O M A TUM ORS 2) T . W IT H CLEA R CELL FEA T U RE
3) T . W IT H S Q U A M O U S FEA T U RE
4) T . W IT H M U CIN O U S FEA T U RE

B .F .A D CO N VEN T IO N A L T .O F .C - C E L L & R E L A T E D T .O F .F O L L I C U L A R &

W ELL D IFFEREN T IA T ED PO O RLY D IFFEREN T IA T ED
EN D O CRIN E CELLS C-CELL
M ED U LLA RY CA

V A RIEN T SA RCO M A M A LIG N A N T LYM PH O M A

TUM ORS FO LLICU LA R PA PILLA RY IN S U LA R OTHERS

M IS CELLA N EO U S
N EO PLA S M S
 ADENOMAS OF THYROID
GLAND
 DISCRETE, SOLITARY MASSES.
 TYPES: FOLLICULAR,PAPILLARY,
MIXED
 MOST COMMON TYPE :
FOLLICULAR ADENOMA.
 FOLLICULAR ADENOMA
 Benign encapsulated thyroid tumor
 Derived from follicular epithelium
 Euthyroid except in toxic adenoma.
 Solitary
 multiple associated - genetic
syndromes.
 AGE: any age.
 MALE:FEMALE – 1:4
 Cytogenetics: clonal;
 occasionally tetraploid or aneuploid.
25% are aneuploid.
 PATHOGENESIS

 TSH receptor mutation

 Genetic defect: abnormality in
terminal region of long arm of chr 19.
 Associated with cowden’s disease.
 20% - point mutation in RAS family of
oncogene
 GROSS MORPHOLOGY
 solitary, spherical ,firm
 3-10 cm.
 Gray-white to red-brown nodule.
 Encapsulated by thin complete
capsule.
 bulges when fresh, compresses
adjacent thyroid.
 secondary degenerative changes such as:
 Hemorrhage
 edema
 fibrosis
 calcification
 bone formation
 cystic degeneration
 No vascular invasion into capsule.
 MICROSCOPY
 Uniformly appearing follicles that contain
colloid.
 A variety of patterns, singly or in
combination:
 normofollicular (simple)
 macrofollicular (colloid)
 microfollicular (fetal)
 trabecular/solid (embryonal)
 Mitoses: rare or absent
 muscular cushions
 papillary or pseudopapillary structures -
follicular adenoma with papillary
architecture.
 SCAN APPEARANCE
hyperfunctioning (hot) adenomas -more
cellular and the cells have more abundant
cytoplasm than nonfunctioning (cold)
tumors
 HOT NODULES ALWAYS BENIGN.
 FOLLICULAR MULTINODULAR
ADENOMA GOITER

 SOLITARY NODULE  MULTIPLE NODULES

 MORE COMPRESSION OF  LESS COMPRESSION OF
ADJACENT THYROID ADJACENT THYROID
PARENCHYMA PARENCHYMA
WELL ENCAPSULATED  LACK OF WELL FORMED
CAPSULE
FOLLICULAR GROWTH IN NODULAR AND
ADENOMA DISTINCT FROM UNINVOLVED THYOIR
OTHER NON NEOPLASTIC PARENCHYMA HAVE
THYROID. SIMILAR GROWTH
PATTEN.
 VARIENT FORMS
 HURTHLE CELL ADENOMA-
neoplastic cells acquire brightly
eosinophilic granular cytoplasm.
 Follicular adenoma with oxyphilia
 HYALINIZING TRABECULAR
ADENOMA
 neoplasm with prominent trabecular
pattern and hyalinization
 yellow-tan, circumscribed
 Gross images:
lobular configuration with white, shi
ny, cartilaginous elements
 MICROSCOPY
 thin capsule
 prominent trabeculae of follicular epithelium
in abundant hyalinized or sclerotic stroma,
 cells are polygonal or spindled with
elongated nuclei with chromatin clearing,
intranuclear grooves and inclusions
 psammoma bodies
 Cytoplasmic Yellow body
 no vascular or capsular invasion
 ATYPICAL ADENOMA
 pronounced cellular proliferation
 More extensive variation in cellular size
and nuclear morphology.
 Increased mitotic activity.
 no capsular or blood vessel invasion
 ADENOMA WITH BIZARRE
NUCELI
 huge hyperchromatic nuclei, usually in
clusters
 no malignancy
 DD: parathyroid adenomas
 TOXIC ADENOMA
 Some adenomas produce thyroid hormones
 Produce clinically thyrotoxicosis.
 Functional adenomas
 Independent of TSH stimulation
 THYROID AUTONOMY
 OTHER VARIENTS
 clear cell changes- signet ring, mucin-
producing, and lipid-rich types
 adipose metaplasia of the stroma -adenolipoma
 cartilaginous metaplasia -adenochondroma
 massive deposition of cytoplasmic black pigment
following minocycline therapy-black adenoma
CLEAR CELL ADENOMA
MUCIN PRODUCING
ADENOMA
ADENOLIPOMA
ADENOCHONDROMA
BLACK ADENOMA
 CLINICAL FEATURES
 Unilateral painless mass
 Difficulty in swallowing.
 Euthyroid state except in toxic adenoma
 No recurrance
 No metastasis.
 INVESTIGATIONS
 RADIONUCLIDE SCAN: cricumscribed cold
nodule.
 Normal T3,T4, TSH levels except in toxic
adenoma
 FNAC:cellular smear with microfollicles
 Ultrasonography
 Positive stains: low molecular weight
keratin, thyroglobulin
 Negative stains: CK19
COLD NODULE
TOXIC ADENOMA
FNAC
 DD
 Dominant nodule of nodular hyperplasia
 Minimally invasive follicular carcinoma
 Follicular variant of papillary carcinoma
 Vascular tumors:
some follicular adenomas are highly
vascularized
 TREATMENT:  PROGNOSIS:

 lobectomy  Excellent prognosis

 No Enucleation including for atypical
 suppression with adenoma
levothyroxine
 toxic adenoma -131 I