Thyroid Nodules and Neoplasms. Emad Raddaoui , MD, FCAP, FASC Associate Professor; Consultant Histopathology & Cytopathology. Solitary thyroid nodule. Palpably discrete swelling within an otherwise apparently normal thyroid gland. - PowerPoint PPT Presentation
Thyroid Nodules and NeoplasmsEmad Raddaoui, MD, FCAP, FASCAssociate Professor; ConsultantHistopathology & Cytopathology1Solitary thyroid nodulePalpably discrete swelling within an otherwise apparently normal thyroid gland. The estimated incidence of solitary palpable nodules in the adult population of the United States varies between 1% and 10%. Single nodules are about four times more common in women than in men. The incidence of thyroid nodules increases throughout life.
Majority of solitary nodules of the thyroid prove to be localized, non-neoplastic conditions or benign neoplasms such as follicular adenomas. Benign neoplasms outnumber thyroid carcinomas by a ratio of nearly 10 : 122Thyroid NeoplsmsClues to the nature of a given thyroid nodule:
Solitary nodules : neoplasticNodules in younger patients : neoplasticNodules in males : neoplasticA history of radiation : neoplasticNodules uptakeing radioactive iodine (hot nodules) : benign 33Adenomas Adenomas of the thyroid are typically discrete, solitary masses. (follicular adenomas)
Degree of follicle formation and the colloid content of the follicles:Simple colloid adenomas (macrofollicular adenomas)A common form recapitulate stages in the embryogenesis of the normal thyroid (fetal or microfollicular, embryonal or trabecular). 4Adenomas of the thyroid are typically discrete, solitary masses. With rare exception, they are derived from follicular epithelium and so might all be called follicular adenomas. A variety of terms have been proposed for classifying adenomas on the basis of degree of follicle formation and the colloid content of the follicles. Simple colloid adenomas (macrofollicular adenomas), a common form, resemble normal thyroid tissue; others recapitulate stages in the embryogenesis of the normal thyroid (fetal or microfollicular, embryonal or trabecular). There is limited utility in these classifications because mixed patterns are common, and most of these benign tumors are nonfunctional. Although the vast majority of adenomas are nonfunctional, a small proportion produce thyroid hormones and cause clinically apparent thyrotoxicosis. Hormone production in functional adenomas ("toxic adenomas") occurs independent of TSH stimulation and represents another example of thyroid autonomy, analogous to toxic multinodular goiters.4AdenomasPresent as painless nodules. Larger masses may produce local symptoms such as difficulty in swallowing.Adenomas appear as "cold" nodules relative to the adjacent normal thyroid gland. Toxic adenomas, however, will appear as "warm" or "hot" nodules in the scan. As many as 10% of "cold" nodules eventually prove to be malignant. Definitive diagnosis of thyroid adenoma can only be made after careful histologic examination of the resected specimen Thyroid adenomas have an excellent prognosis and do not recur or metastasize55Adenomas Clinically, follicular adenomas can be difficult to distinguish from dominant nodules of follicular hyperplasia or from the less common follicular carcinomas.
Careful evaluation of the integrity of the capsule is critical in distinguishing follicular adenomas from follicular carcinomas, which demonstrate capsular and/or vascular invasion66
7Follicular adenoma of the thyroid. A solitary, well-circumscribed nodule is seen.Morphology. The typical thyroid adenoma is a solitary, spherical, encapsulated lesion that is well demarcated from the surrounding thyroid parenchyma Follicular adenomas average about 3 cm in diameter, but some are smaller and others are much larger (up to 10 cm in diameter). In freshly resected specimens, the adenoma bulges from the cut surface and compresses the adjacent thyroid. The color ranges from gray-white to red-brown, depending on the cellularity of the adenoma and its colloid content. The neoplastic cells are demarcated from the adjacent parenchyma by a well-defined, intact capsule. These features are important in making the distinction from multinodular goiters, which contain multiple nodules on their cut surface (even though the patient may present clinically with a solitary dominant nodule), produce less compression of the adjacent thyroid parenchyma, and lack a well-formed capsule. Areas of hemorrhage, fibrosis, calcification, and cystic change, similar to those encountered in multinodular goiters, are common in follicular adenomas, particularly within larger lesions.
The major subtypes of thyroid carcinoma and their relative frequencies are as follows :Papillary carcinoma (> 85% of cases)Follicular carcinoma (05% to 15% of cases)Medullary carcinoma (5% of cases)Anaplastic carcinoma ( 65 year2727Anaplastic CarcinomasHighly anaplastic cells:(1) large, pleomorphicgiant cells, including occasional osteoclast-like multinucleate giant cells(2) spindle cells with a sarcomatous appearance (3) mixed spindle and giant cells(4) small cells28Microscopically, these neoplasms are composed of highly anaplastic cells, which may take one of several histologic patterns: (1) large, pleomorphicgiant cells, including occasional osteoclast-like multinucleate giant cells; (2) spindle cells with a sarcomatous appearance; (3) mixed spindle and giant cells; and (4) small cells resembling those seen in small cell carcinomas arising at other sites. It is unlikely that a true small cell carcinoma exists in the thyroid, and a significant number of such "small cell" tumors have ultimately proven to be medullary carcinomas (discussed previously) or malignant lymphomas, which may also occur in the thyroid but have a much better prognosis. Foci of papillary or follicular differentiation may be present in some tumors, suggesting origin from a better differentiated carcinoma.