PRAKTIKUM

PATOLOGI ANATOMI
BLOK 2.5
SESI 1

ASISTEN PATOLOGI ANATOMI 2010

Yogi Miki Kevin Michael Thahra Dika Radit Reza
Bagas Gubi Henny Valen Ado Tenny Galih Keket
THYROID
NORMAL HISTOLOGY
COLLOID GOITER
 Overview
 Goiter  Enlargement of the thyroid gland.
 A compensation mechanism
 Have an endemic and sporadic distribution.
 Endemic : present >10 % on that area. the cause : 
intake iodine.
 Sporadic : less common. In most cases, the cause is
not apparent. Etiology : Ingestion of Goitrogen,
enzymatic defect.
 Toxic vs Non-Toxic Type
 Nodular vs Multinodular Type
 The Disease Progression

1. Hyperplasion phase: High stimulation from TSH →

hypertrophy & hyperplasia of Follicular cell → epitel
columnar

2. Involution Phase : adequate intake of iodine → needs

of thyroid hormone is declining → the follicle cell
back to normal.
 m e n t
p l a c e e )
e R e i o d i n
rm o n c k o f
H o
 h e r a py (i f l a io n
i st ra t
T d m i n
ro i d a n t o f
n t it y h a m o u
 f excess one)
A i v e

Thera
(i h o r m
y r oi d
th to m y
o i d e c
r

p
h y
T

y
  Caus
ed by
the en the m
large ass ef
airwa d gla fect o

es
y n d f
comp obstructi . (ex :
eatur
ressio on, d
on ne n of l yspha
ck, co arge gia,
 some smeti
c effe
vesse
ls
times ct )
cal F
neop m imic
lasm
thyro that a the
id gla rise f
clinic nd, th ro m t
at’s w he
Cli n i

ally s
 Radio ignifi
cant
hy it’
s
activ
show e
n as H iodine sc
ot No an
dul
 Macroscopic Features
Thyroid gland enlargement, Encapsulated, consist
of nodules, browny, , cystic and have a black serous
fluid.
 Microscopic Features

 Specimen of thyroid gland consist of follicles which

vary on their size

 Macrofollicle is a large follicle, have abundant colloid

mass with flattened epithelium

 Microfollicle is a small follicle, have a little colloid

mass and the epithelium that lining the follicle is
simplex columnar.
Microfollicle

Macrofollicle
Colloid Mass

Microfollicle

Macrofollicle
PAPILLARY CARCINOMA OF
THE THYROID
  Malig
ition
nant
show e p it h
ing e elial
follic viden tumo
Defin
u l ar c ce o f ur ,
and c ell di
harac fferen
distin terize tiatio
ctive d by n
nucle
ar fea
tures
.
 Thyroid Carcinoma Subtype

 Papillary carcinoma (75% to 85% of cases)

 Follicular carcinoma (10% to 20% of cases)
 Medullary carcinoma (5% of cases)
 Anaplastic carcinomas (<5% of cases)
 a n c e r
a n c
ll h u m
r o m a

Epide
1 % f o n
 < m m r i n e

Thyr
o s t c o n d o c
h e m s o f e
 a l ig n a n c
T i e

miolo
m

oid C
m g i n is
syste C e l ls o r i
e C -
u la r a n t h
o l l i c o n t h
 F ore comm

gy of
ance r
m r i g in
o
Cells
 Etiology
• Hormonal, Environmental and Genetic.
• GENETIC : Chromosomal rearrangements involving
the tyrosine kinase receptor gene RET (located on
chromosome 10q11) and BRAF proto-oncogen
mutation. RET protein is a receptor tyrosine kinase that
plays essential roles in the development of
neuroendocrine cells.
• ENVIRONMENTAL : Exposure of ionizing radiation
on the first 2 decades of life.
  Expo

r
s u re o

Facto
 Fema f radi
atio
les pr n.
adult edom
life, b inanc
sexes u t eq e in
on ch ual fo
Ris k
adult ildho r both
life. od an
 Histo d late
ry of
and f thyro
amili id dis
al his ease,
tory.
 > 9 0 %
v a l i s e l ow
s u r vi i e n t b

Progn
e r a l r p a t r
v
 rticularl And 10-
O y f o y e a
pa r s o ld .
5 % .
y e a i s > 9
45 t e

o
v a l r a
i

sis
su rv
 Staging
Using TNM Classification (by WHO)
T = Primary N : Regional M : distant
Tumour Lymph Nodes metastasis
T1 : < 2 cm N1 : regional lymph M1 : Distant
T2 : 2 – 4 cm node metastasis Metastasis

T3 : >4 cm, minimal

extrathyroid
extension
T4 : anysize,
extending beyond
thyroid capsule
  Radio
activ
a cold e iod
nodu ine sc
 A pal le. an sh
ows

es
pable
surro n
undin odule fix
eatur with
enlar
norm
g tiss
al thy
ue, so
ed on
metim
geme roid g es
 Painl n t) l and (
cal F

ess m no
 Mass ass.
effec
 The m t.
Cli n i

route ost comm

is lym on m
cervi ph o etasta
cal ly g en to tic
mph
node the
.
 e r a p y
d i o th t a l
 Ra o rT o
o m y

Thera
o b e c t y
 hyroidec
L to m
T ra p y
o t he
em

p
 C h

y
 Macroscopic Features

 Variety in gross pattern, most common is grey-white

firm mass.
 A cystic change
 Irregular border and infiltration to surrounding tissue
 Calcification , fibrosis and hemorragic area
 Microscopic Features
• The thyroid specimen consist of epithelial cell tumor with
papillary pattern and thick fibrovascular core.
• Nucleus of tumor cells is clear because of dispersed chromatin
(Ground Glass nuclei/Orphan Annie Eye nuclei), and some
cells have a intranucleus inclusion/pseudoinclusion
• There’s a focus of calcification called psamomma’s body
• Tumor cells are atypical, polymorph, with mitotic activity
 Pappilary Pattern

Fibrovascular Core
Ground Glass
Nuclei / Orphan
Annie’s Eye
Pseudoinclusion
Psamomma’s
Body
LEIOMYOMA OF THE
LEOMYOMA UTERI
CORPUS UTERI
a) Shows the basal layer of endometrium and myometrium
b) Basal layer endometrium consist of glands and arteries
c) Shows the surface epithelium of the endometrium and the
stroma.
 Definition

 A benign neoplasm composed of smooth

muscle cells with a variable amount of fibrous
stroma
 Because the its firm, sometimes it’s called
fibroid
 This lesion is estrogen sensitive.
 r
Facto  Using
contr hormonal
acept
Ris k
 Repro ive
ducti
ve ag
e
 m a t i c
m p t o
l y a sy
e n t i re ia a re
b e h a g

Clini
a n o r r
 C
t i m e s m e n
it h o u t
o m e o r w
 S esent, wit h

cal F
pr h a g i a
et r o rr
m r e a
p a in l v i c a
c u t e n p e


e
A a s s o
m

ature
l p a b le a t i n g
 P a n u r in
u l t y o
i ff i c
D

s
 Macroscopic Features
• sharply circumscribed, firm gray-white masses
with a characteristic whorled cut surface.
• Usually multiple
• Foci of fibrosis, calcification, ischemic necrosis,
cystic degeneration, and hemorrhage may be
present.
 Microscopic Features
• On the uterus specimen, there’s a mesenchymal tumor, consist
of smooth muscle that similar to normal myometrium
structures.
• The tumor cell are uniform and monomorf, spindle shaped,
with oval and elongated nucleus, without any sign of
malignancies.
• Some areas show hyalin degeneration.
Oval/elongated nucleus
Hyalin degeneration
MUCINOUSLEOMYOMA
CYSTADENOCARCINOMA
UTERI OF
THE OVARY
HISTOLOGI OVARIUM
 Ovarian
Tumors

Germ
Epithelial Sex-cord- Metastatic
Cell
stromal tumors

Serous Mucinous Endo- Brenner Clear Teratoma

metrioid Tumor Cell Fibroma

Cystadeno- Dysgerminoma
Cystadeno- ma Thecoma
ma
Yolk Sac
Borderline Tumor
Granulosa
Borderline Cystadenocarci- cell Tumor
noma Choriocarcinoma

Cystadeno- Sertoli cell Monodermal

carcinoma tumors

Leydig cell tumors

WHO Classification-simplified
Mucinous cystadenocarcinoma of ovary

• Tumor epithelial ovarium malignant, sel

epithelialnya mengandung musin intrasitoplasmik
• Karakteristik tumor multilokus yang di dalamnya
berisi cairan lengket gelatinosa kaya glikoprotein
• Jarang terjadi bilateral
• Dapat menghasilkan massa kistik besar mencapai
>25 kg
Etiologi dan patogenesis

• Masih kurang diketahui

• Ditemukan mutasi KRAS proto-oncogene

Faktor resiko

• Diduga terkait dengan merokok

Epidemiologi

• Terutama pada middle adult life, jarang sebelum pubertas

dan setelah menopause
• Tumor musinosa kejadiannya 30% dari seluruh
neoplasma pada ovarium
• Dari seluruh tumor musinosa 80% benign atau
borderline, 15% malignant
 Manifestasi Klinis

• Jarang ada gejala untuk deteksi dini

• Massa pada abdomen
• Lower abdominal pain
• Massa pelvic pada pemeriksaan
• Nyeri area genital
• Nyeri adnexal
• Perdarahan vaginal
• Back pain
• Kista yang ruptur dpt menyebabkan
pseudomyxoma peritonei.
A

B
 DESKRIPSI MAKROSKOPIS

• Tumor berukuran besar, lebih sering unilateral

• Dinding kista luar membentuk gambaran
papilar, sebagian lagi solid
• Permukaan halus
• Masa kistik unilocular atau multilocular, yang
berisi material mucoid cair atau kental
• Pada beberapa tumor dapat didominasi oleh
pola solid
Apical
Mucin

Tumor Cells
invading stroma
 DESKRIPSI MIKROSKOPIS

• Sel epithelial atypia,polimorfi, terdapat stratifikasi, mitosis

patologis, inti hiperkromasi, musin intrasitoplasmik
• Stroma diInfiltarasi oleh sel tumor malignant dan
mengikuti pola pertumbuhan papiler
• Terdapat area pola pertumbuhan tumor solid, papiler
• Hilangnya struktur glandular
• Terdapat area nekrosis dan perdarahan
Diagnosis
• Klinis, USG, pengangkatan tumor

Terapi
• Surgical
• Adjuvant therapy (radiation therapy and/or chemotherapy)
--particularly important for high-grade stage I tumors

Prognosis
• 10-year survival rates stage I, noninvasive “intraepithelial
carcinomas,” sekitar 95%, dan invasive malignant tumors 90%
• Overall prognosis dari ovarian carcinoma masih buruk karena
cepatnya pertumbuhan dan sedikitnya gejala awal. Overall
survival rate 35% at 5 years, 28% at 10 years, dan 15% at 25
years
DERMOID CYST OF THE OVARY
LEOMYOMA UTERI
Mature (Benign) Teratomas
Mature cystic teratoma
Dermoid cyst of the ovary

• Tumor yang bersifat kistik, terkadang solid yang

tersusun atas jaringan dewasa matur
• Benign teratomas bersifat bilateral pada 10% -15%
kasus. Biasanya berupa kista unilokular yang
utamanya mengandung rambut dan material sebaseus
seperti keju
Etiologi dan patogenesis

• Hampir seluruh teratoma jinak ovarian memiliki karyotype

46,XX dan ditemukan barr bodies (nuclear sex chromatin)
• Diduga tumor ini muncul dari ovum setelah pembelahan
meiotic yang pertama

Faktor resiko

• Wanita usia reproductive

Epidemiologi

• Kebanyakan ditemukan pada wanita usia reproductive, rata-

rata 32 tahun, 5% pada wanita post menopause
• Insidensi mature cystic teratoma adalah 27-44% semua tumor
ovarium dan 58% dari semua tumor jinak ovarium.
 Manifestasi klinis
• Temuan massa (25-60% ditemukan tidak sengaja)
• 90% unilateral
• Massa dan nyeri pada pelvis (lebih sering pada massa yang
solid)
• Komplikasi :
• -1. torsi ovary yg menimbulkan nyeri, perforasi dan
perdarahan intraabdomen
• -2. ruptur tumor, isi tercecer ke peritoneum menyebabkan
chemical peritonitis
• -3. infeksi dari tumor
A B

C
 DESKRIPSI MAKROSKOPIS

• Dermoid cyst berbentuk ovoid, bilateral pada 8-15%

kasus, massa kistik 0,5-40 cm (mean 15) dengan
permukaan eksternal halus dan terisi berbagai material
terutama sebaseus dan rambut.
• Elemen lain yang sering ditemukan yaitu gigi, jaringan
thyroid, intestinal dan tulang rawan.
• Nodule yang tersusun atas jaringan lemak dengan gigi
atau tulang yg menonjol ke dalam kista disebut
protuberantia Rokitansky
Kelenjar

Folikel rambut

Adiposa
Colloid thyroid
 DESKRIPSI MIKROSKOPIS

• Tumor membentuk kista yg terdiri atas 2 atau 3 komponen

lapisan embrionik : ectoderm, mesoderm, endoderm
• Dinding kista tersusun atas epithelium stratifikatum
squamosum dan jaringan di bawahnya terisi oleh glandula
sebasea, rambut, strutur adnexal kulit lainnya.
• Dapat ditemukan pula struktur dari lapisan germinal
lainnya seperti kartilago, tulang , thyroid dan jaringan
neural.
Diagnosis
• Klinis, USG, pengangkatan tumor

Terapi
• Surgery

Prognosis
• Biasanya terus bersifat jinak kecuali epitel squamous
yang berpotensi menjadi squamous cell carcinoma
• Rekurensi lebih tinggi pada tumor yang bersifat
bilateral atau multiple dan telah rupture