—  SHORT COURSE #41  — Pathology of the Thyroid Gland Zubair W. Baloch and Virginia A. LiVolsi Click on each case number below to display the text and references for that case Click on any thumbnail images for an enlarged view of that slide Case 1 - Text and References Diagnosis: Diffuse Toxic Goiter (Autoimmune Hyperthyroidism; Graves' Disease) Clinical Summary: A 28 year old woman presented with a goiter and symptoms ofthyrotoxicosis. Thyroid function tests supported the clinical findings: elevated T4, markedly suppressed TSH. She refused radioiodine treatment and was allergic to antithyroid drugs. After pretreatment with propanolol and potassium iodide, she underwent subtotal thyroidectomy. The gross specimen was a diffusely enlarged thyroid weighing 140 grams; no nodules were present. Case 1 - Figure 1 - Graves Disease Case 1 - Figure 2 - Graves Disease Case 1 - Figure 3 - Graves Disease Case 1 - Figure 4 - Graves Disease Case 2 - Text and References Diagnosis: Chronic Lymphocytic Thyroiditis (Hashimoto's Disease; Autoimmune Hypothyroidism) Clinical Summary: A 76 year old woman presented to her physician with weakness and feeling tired. On examination, a small goiter (estimated weight: 50 grams) was noted. Multiple nodules (up to 1 cm) were noted bilaterally. Thyroid function tests showed decreased T4, elevated TSH and presence of antithyroid antibodies (1: 600). FNA of two of the larger nodules showed thyroiditis and atypical nuclei were seen raising the possibility of neoplasm. Thyroid lobectomy (side with the two largest nodules) was undertaken. The gross specimen showed a lobulated tan tissue with indistinct nodularity. Case 2 - Figure 1 - Lymphocytic Thyroiditis Case 2 - Figure 2 - Lymphocytic Thyroiditis Case 2 - Figure 3 - Lymphocytic Thyroiditis Case 2 - Figure 4 - Lymphocytic Thyroiditis Case 3 - Text and References Diagnosis: Papillary Micro-carcinoma of Thyroid Clinical Summary: This 46 year old man presented with a 2.5 cm left thyroid nodule. He was clinically and biochemically euthyroid. Ultrasound guided FNA of the nodule showed "follicular neoplasm" and thyroid lobectomy was performed. Grossly, the lobe showed an encapsulated tan nodule; a small "gray area" about 3 mm in size was seen above the main lesion. Your slide is from the latter nodule. Case 3 - Figure 1 - Papillary Micro-carcinoma Case 3 - Figure 2 - Papillary Micro-carcinoma Case 3 - Figure 3 - Papillary Micro-carcinoma Case 3 - Figure 4 - Papillary Micro-carcinoma Case 4 - Text and References Diagnosis: Follicular Variant of Papillary Carcinoma Clinical Summary: A 24 year old woman was noted to have a 2 cm thyroid nodule during a prenatal physical examination. She was euthyroid clinically and by laboratory evaluation. FNA was performed and a diagnosis of "follicular neoplasm" was rendered. During the second trimester of her pregnancy, thyroid lobectomy was performed. Grossly the nodule was 2 cm and appeared circumscribed. Case 4 - Figure 1 - Follicular Variant of Papillary Thyroid Carcinoma Case 4 - Figure 2 - Follicular Variant of Papillary Thyroid Carcinoma Case 4 - Figure 3 - Follicular Variant of Papillary Thyroid Carcinoma Case 4 - Figure 4 - Follicular Variant of Papillary Thyroid Carcinoma Case 5 - Text and References Diagnosis: Tall Cell Variant of Papillary Thyroid Carcinoma Clinical Summary: This 69 year old woman presented with hoarseness and a right sided neck mass, measuring 5 cm. FNA was performed and a diagnosis of "papillary carcinoma" was rendered. Total thyroidectomy and neck node dissection were carried out. Case 5 - Figure 1 - Tall-cell Variant of Papillary Thyroid Carcinoma Case 5 - Figure 2 - Tall-cell Variant of Papillary Thyroid Carcinoma Case 5 - Figure 3 - Tall-cell Variant of Papillary Thyroid Carcinoma Case 5 - Figure 4 - Tall-cell Variant of Papillary Thyroid Carcinoma Case 6 - Text and References Diagnosis: Poorly Differentiated Carcinoma of Thyroid Clinical Summary: A 47 year old woman presented with a 7 cm left neck mass with associated cervical lymphadenopathy. After FNA diagnosis of "malignant neoplasm', thyroidectomy was performed. Grossly, the tumor was poorly circumscribed, appeared to extend beyond the thyroid itself and showed foci of necrosis. Case 6 - Figure 1 - Insular Carcinoma of Thyroid Case 6 - Figure 2 - Insular Carcinoma of Thyroid Case 6 - Figure 3 - Insular Carcinoma of Thyroid Case 6 - Figure 4 - Insular Carcinoma of Thyroid Case 7 - Text and References Diagnosis: Medullary Carcinoma of Thyroid, Sporadic Type. Clinical Summary: A 58 year old man complained of diarrhea. Evaluation of the GI tract was negative, but on examination of his neck a 2.5 cm thyroid mass was found. Thyroid function tests were normal, serum calcitonin was 28,000 units. Family history was negative for thyroid or other endocrine disease. After FNA confirmed the suspected clinical diagnosis, total thyroidectomy and node dissection including central node removal were performed. Grossly, the tumor was tan-yellow and circumscribed. The surrounding thyroid appeared normal. Case 7 - Figure 1 - Medullary Carcinoma of Thyroid Case 7 - Figure 2 - Medullary Carcinoma of Thyroid Case 7 - Figure 3 - Medullary Carcinoma of Thyroid Case 7 - Figure 4 - Medullary Carcinoma of Thyroid