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SEC TION III

Endocrine
endocrinePathology
131-I radioactive uptake studies:
uptake seen in Graves or nodular goiter;
uptake seen in adenoma and carcinoma (warrants FNA biopsy don't take regular biopsy because it will bleed like crazy)

Thyroid cancer

Thyroidectomy is an option for thyroid cancers and hyperthyroidism. Complications of surgery

include hoarseness (due to recurrent laryngeal nerve damage), hypocalcemia (due to removal of
parathyroid glands), and transection of recurrent and superior laryngeal nerves (during ligation of
inferior thyroid artery and superior laryngeal artery, respectively).

Papillary carcinoma

Most common, excellent prognosis. Empty-appearing nuclei with central clearing (Orphan
Annie eyes) A , psammoma bodies, nuclear grooves. Lymphatic invasion common. risk with
Esp. cervical nodes. Even with
RET and BRAF mutations, childhood irradiation. e.g., old treatment for severe acne
spread, prognosis is excellent

80% of thyroid carcinomas

Classically forms papillary "finger-like"
projections, but nuclear features define
papillary carcinoma

Follicular carcinoma

Good prognosis, invades thyroid capsule (unlike follicular adenoma), uniform follicles.

Medullary carcinoma

From parafollicular C cells; produces calcitonin, sheets of cells in an amyloid stroma

hematogenous spread common. Associated with MEN 2A and 2B (RET mutations).

Undifferentiated/
anaplastic carcinoma

Older patients; invades local structures, very poor prognosis.

Lymphoma

Associated with Hashimoto thyroiditis.

Detection of RET mutation warrants

prophylactic thyroidectomy

Nuclear grooves in thyroid papillary carcinoma

Often leading to dysphagia or respiratory compromise

Thyroid papillary carcinoma.Note classic empty-appearing

nucleus (Orphan Annie eye, arrow).

Usually nonfunctional; rarely

may secrete thyroid hormone
B , Calcitonin deposits
within tumor as amyloid

C cells normally make calcitonin, which at physiologic

levels is inactive. At high enough levels though, it renal
excretion of Ca2+ and can lead to hypocalcemia

Medullary carcinoma. Solid sheets of cells with amyloid

deposition (arrow).

Note that FNA cannot distinguish between follicular adenoma (left) vs.
carcinoma (right). It will just show follicular cells either way. The only
way to distinguish them is to see the capsule, either on gross specimen
or under microscope to see if there is microscopic invasion.
Although the general rule is that carcinoma
likes to spread to lymph node, this likes to
spread hematogenously (other "rule
violators" = renal cell carcinoma [via renal
v.], hepatocellular carcinoma [via hepatic
v.], choriocarcinoma [placenta/uterus])

Psamomma bodies in thyroid papillary carcinoma.

Because you classically get papillary architecture,
you can see calcification of this architecture
resulting in a psamomma body, which is a
concentric, layered calcification.
Note the layering.

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