PathologieProf. Dr. med. Katharina Glatz

Thyroid benign

March 16, 2020

• Normal thyroid gland

• Thyroiditis

• Thyroid hyperplasia

• Benign tumors

Agenda

• Adult: 15-25g

• Follicular cells:– Endodermal

thyroid anlage

– PAX8, TTF1 +

• C-cells:– Neural-crest

– TTF1, CEA, CGA, Calcitonin +

– PAX8, Thyreoglobulin -

Normal Thyroid Gland

birefringentcrystals

• In the course of the ductus thyreoglossus• Base of the tongue

• Before/behind hyoid bone

• Infrahyoidal

• Caudal to normal thyroid• Pericardium, Heart muscle

• Inguinal region

• Liver hilus

• Vagina

Ectopic Thyroid Tissue

• In the course of the ductus thyreoglossus• Base of the tongue

• Before/behind hyoid bone

• Infrahyoidal

• Caudal to normal thyroid• Pericardium, Heart muscle

• Inguinal region

• Liver hilus

• Vagina

Ectopic Thyroid Tissue

THYROIDITIS

Hashimoto Thyroiditis

Most common cause of hypothyroidismFemale:male 7:1Goitrous or atrophic autoimmune thyroiditisLymphocytic infiltration & follicular destructionTPO and TG AntibodiesThyroid-specific B and T cellsGradual (irreversible) thyroid failure

Subacute Thyroiditis De Quervain

Subacute Thyroiditis De Quervain

THYROID HYPERPLASIA

Colloid Goiter

• Diffuse → nodular hyperplasia

• Euthyreosis

• Nodules at autopsy up to 50%

• Females 8x

Colloid Goiter

• Pathogenesis:

– Familial predisposition

– Intrathyreoidal iodine deficiency

– Growth stimulation by immunoglobulins

• Organ specific autoimmune disease

– Anti TSH-receptor antibody

– Anti thyreoglobulin antibody

– Anti thyroid peroxidase antibody

• 70-90% diffuse goiter and hyperthyroidism

• Endocrine orbitopathy

Grave’s Disease

Grave’s Disease

Hyperplastic Nodule or Adenoma

Macropapilla in hyperplasia:Follicles within stromaNormal nuclei

BENIGN TUMORS

WHO 2017

Follicular Adenoma

Usually solitary nodulewith thin to moderatelythick capsule.

By definition: No capsular or vascularinvasion.

Architecture andmorphology differentfrom surroundingparenchyma.

Follicular Adenoma Variants

Toxic adenoma

Signet-ring cell adenoma

• Hyperfunctioning (toxic/hot) adenoma• Follicular adenoma with papillary hyperplasia• Lipoadenoma• Follicular adenoma with bizarre nuclei• Signet-ring cell follicular adenoma• Clear cell follicular adenoma• Spindle cell follicular adenoma (TG, Calcitonin)• Black follicular adenoma

Spindle cell follicular adenomaSpindle cell follicular adenoma

• WHO 2017 «fetal», «oncocytic», «atypicaladenoma» were omitted

• Hürthle cell adenoma in the chapter «Hürthle(oncocytic) cell tumors»

• New subtypes «spindle cell variant», «blackadenoma» (Minocyclin)

Follicular Adenoma

• Higher rate of malignancy (30-40% vs. 2-3%)

• Criteria of malignancy as FTC

• Frequent intraoperative rupture. Margin??

• Poorer prognosis (less avidity for radiojodine)

Hürthle-Zell (oncocytic) Tumors

Hürthle-Zell (onkozytäre) Tumoren

Hürthle-Zell (oncocytic) Tumors

Definition:Complete≥ 75% Hürthle cells

Hürthle cell adenomaHürthle cell carcinoma

DD:PTC variants:• Tall cell• Oncocytic• Warthin-like

Medullary carcinomaOncocytic variant

Encapuslated Follicular Tumors

Int J Surg Oncol. 2017 Apr 13 published online; Golding A et al.

Invasive?

Nuclear featuresof papillaryCarcinoma?

NIFTP

Assessment guidelinefor nuclear criteria

Adenoma

UMPTumor of unknownmalignant potential

Carcinomayes

?

no

ja

nein

?

Eur J Surg Oncol. 2017 May 18. in pressXu B, Ghossein R.

Encapuslated Follicular Tumors

Nuclear features of

PTC

Invasion (C/V)

present

Invasion

questionable

Invasion

missing

present Encapsulated variant

of papillary

carcinoma

WDT-UMP Well differentiated tumor

with unceartain malignant

potential

NIFTP Non invasive

follicular thyroid neoplasm

with papillary-like nuclear

features

questionable Well differentiated

carcinoma NOS

missing Follicular thyroid

carcinoma

FT-UMPFollicular tumor ofunknownmalignant potential

Follicular adenoma

Encapuslated Follicular Tumors

Nuclear features of

PTC

Invasion (C/V)

present

Invasion

questionable

Invasion

missing

present Encapsulated variant

of papillary

carcinoma

WDT-UMP Well differentiated tumor

with unceartain malignant

potential

NIFTP Non invasive

follicular thyroid neoplasm

with papillary-like nuclear

features

questionable Well differentiated

carcinoma NOS

missing Follicular thyroid

carcinoma

FT-UMPFollicular tumor ofunknownmalignant potential

Follicular adenoma

NIFTPnoninvasive follicular tumor with papillary-like nuclear features

The term «noninvasive follicular tumor with papillary-like nuclear features» is actually incorrect: it should have been «noninvasive follicular tumor with papillary CARCINOMA-like nuclear features»

The NIFT-P acronym has essentially been imposed by the clinicians in the panelThat did not want the word «carcinoma» or «malignancy» in the new name

G. Tallini, Bologna

NIFTPnoninvasive follicular tumor with papillary-like nuclear features

The term «noninvasive follicular tumor with papillary-like nuclear features» is actually incorrect: it should have been «noninvasive follicular tumor with papillary CARCINOMA-like nuclear features»

The NIFT-P acronym has essentially been imposed by the clinicians in the panelThat did not want the word «carcinoma» or «malignancy» in the new name

G. Tallini, Bologna

Revised criteria 2018

JAMA Oncol. 2016; 2:1023-1029.JAMA Oncol. 2018; 4:1125-1126Nikiforov YE et al

<3 mitoses/10 HPF

Helpful but not required for NIFTP diagnosis

NIFTP

Int J Surg Oncol. 2017 Apr 13 published online; Golding et al.

But:13/37 patients with NIFTP had a synchronousmalignant tumor of the thyroid (35%)

noninvasive follicular tumor with papillary-like nuclear features

Was ist Gesundheit?

?Human Pathology 2008, 39:1080-1087 HyperplasiaPathologe 2003, 24:348-356 HyperplasiaPathologe 2006, 27:13-18 Treatment effectsPathologe 2019, 40:220-226 NIFTP

Pathologe 2006, 27:13-18 Treatment effects