Thyroid برای بزرگنمایی عکسها کلیک را روی ان نگه دارید Figure 8.1 Immunoreactivity for calcitonin in thyroid C cells from a case of C-cell hyperplasia Figure 8.2 Solid cell rest. The irregular branching shape of the nodule is characteristic Figure 8.3 Black thyroid following minocycline therapy. (Courtesy of Dr. Maria Merino, Bethesda, Maryland.) Figure 8.4 Thyroglossal duct cyst. The content of the cyst is gelatinous Figure 8.5 Distribution of heterotopic thyroid tissue. (From Lemmon WT, Paschal GW Jr. Lingual thyroid. Am J Surg. 1941;52:82-85.) Figure 8.6 Branchial cleft cyst that has been partially opened to expose the inner surface, which is rendered irregular by the presence of innumer- able hyperplastic lymphoid follicles Figure 8.7 Granulomatous thyroiditis showing multiple granulomas centered in thyroid follicles Figure 8.8 So-called palpation thyroiditis is a common incidental finding Figure 8.9 Cut surface of thyroid involved by Hashimoto thyroiditis. The appearance is reminiscent of a hyperplastic lymph node Figure 8.10 Hashimoto thyroiditis showing lymphoid follicles with prominent germinal centers and oncocytic follicular epithelium Figure 8.11 Dilated lymphatic vessels in Hashimoto thyroiditis result in characteristic "cracking spaces." Figure 8.12 Hashimoto thyroiditis with extensive fibrosis, atrophy of follicular epithelium, and squamous metaplasia Figure 8.13 A and B, Hashimoto thyroiditis with branchial cleftlike cysts. In the high-power microphotograph(B) one can appreciate the infiltration by the lymphocytes of the lining epithelium Figure 8.14 Riedel thyroiditis showing sclerosis, chronic inflammation,and parenchymal atrophy Figure 8.15 Inflammation of a vein in Riedel thyroiditis Figure 8.16 Multifocal sclerosing thyroiditis, macroscopic appearance. Multiple fibrotic foci are scattered throughout the bisected thyroid lobe (arrows). (From Fellegara G, Rosai J. Gross appearance of multifocal fibrosing thyroiditis. Am J Surg Pathol. 2015;39(6):870.) Figure 8.17 Multifocal sclerosing thyroiditis, microscopic appearance.Reactive atypia of follicular cells and "nodular fasciitis-like" stroma. The inset shows the irregular starlike fibrotic focus at low power Figure 8.18 Dyshormonogenetic goiter. Gross appearance. Note the multinodular quality and the hemorrhagic changes in the larger nodules. (Courtesy of Dr. Michael Kashgarian, New Haven, Connecticut.) Figure 8.19 Dyshormonogenetic goiter. Microscopic appearance. The follicles are hyperplastic and lined by follicular cells with marked nuclear pleomorphism Figure 8.20 Outer aspect of diffuse thyroid hyperplasia in a patient with Graves disease. The gland is diffusely swollen and hyperemic Figure 8.21 Out surface of thyroid gland with diffuse hyperplasia, showing a hyperemic "juicy" appearance. Figure 8.22 Hyperplastic papillae protruding into dilated follicles in diffuse hyperplasia Figure 8.23 Lymphoid follicles with germinal centers and hyperplastic thyroid follicles in diffuse hyperplasia. Note the pale-staining quality of the colloid Figure 8.24 Nodular hyperplasia of thyroid gland, with secondary cystic and hemorrhagic areas. Figure 8.25 Low-power appearance of nodular hyperplasia. The hyperplastic nodules lack a capsule Figure 8.26 Nodular hyperplasia showing so-called Sanderson polster Figure 8.27 Nodular hyperplasia with benign papillary formations protrud- ing toward the center of a cystically dilated follicle. Note the basal position of the nuclei Figure 8.28 A and B, Gross appearance of two follicular adenomas. Both tumors show focal hemorrhagic areas Figure 8.29 Intact fibrous capsule around a follicular adenoma Figure 8.30 Microfollicular pattern of growth in a follicular adenoma Figure 8.31 Low-power (A) and high-power (B) views of follicular adenoma with bizarre nuclei. This feature is not a sign of malignancy and is analogous to that seen in many other endocrine tumors Figure 8.32 Low-power view of hyalinizing trabecular adenoma Figure 8.33 Hyalinizing trabecular adenoma. A wide trabecula is seen in the center of the picture, with the tumor cells arranged perpendicular to the longest axis Figure 8.34 Psammoma body formation in hyalinizing trabecular adenoma Figure 8.35 Typical hyalinizing trabecular adenoma pattern (right), and a lesion with the features of a papillary carcinoma (left) are seen side by side, in a cervical lymph node metastasis. (From Rosai J, DeLellis RA, Carcangiu ML, Frabel WJ, Tallini G. Tumors of the Thyroid and Parathyroid Glands. AFIP Atlas of Tumor Pathology. Fourth series, Fascicle 21. Silver Spring, MD: American Registry of Pathology; 2014.) Figure 8.36 Gross appearance of a papillary carcinoma Figure 8.37 Gross appearance of a papillary carcinoma. The tumor shown exhibits a central area of fibrosis Figure 8.38 Complex branching papillae in classic papillary carcinoma Figure 8.39 Nuclear features of papillary carcinoma: A, optically clear nuclei; B, nuclear pseudoinclusions Figure 8.40 Desmoplastic stromal reaction in papillary carcinoma Figure 8.41 Psammoma body formation in papillary carcinoma: A, within the stroma of the primary tumor; B, beneath the capsule of a cervical lymph node, without identifiable tumor cells Figure 8.42 Correlation of diagnostic categories (A) and molecular alterations (B) with the four basic morphologic features used to diagnose tumors of follicular cell derivation: papillary growth pattern, follicular growth pattern, presence of a tumor capsule (with or without invasion, of the capsule itself or of vessels), alterations of nuclear morphology of papillary carcinoma. PTC-Cl, classic papillary thyroid carcinoma; PTC-IFV, infiltrative follicular variant of papillary thyroid carcinoma (no tumor capsule); PTC-EFV, encapsulated follicular variant of papillary thyroid carcinoma (with or without invasion of capsule and vascular spaces); FA/FC, follicular adenoma/ follicular carcinoma. (From Tallini G, Tuttle RM, Ghossein RA. The history of the follicular variant of papillary thyroid carcinoma. J Clin Endocrinol Metab. 2017;102;15-22.) Figure 8.43 Papillary thyroid carcinoma with RET/PTC rearrangement visualized using fluorescent probes that cover the RET locus at 10q11.2. Split fluorescent in situ hybridization signals indicating RET rearrangement are highlighted and magnified in the square insets Figure 8.44 Typical stellate appearance of papillary microcarcinoma Figure 8.45 On high power, the appearance of papillary microcarcinoma is no different from that of its larger counterpart Figure 8.46 The benign papillary formations of nodular hyperplasia point toward the center of the cystically dilated follicles Figure 8.47 Benign papillary formations lined by columnar cells with basally located round normochromatic nuclei. The cytoplasm has a pale basophilic quality Figure 8.48 Follicular variant of papillary carcinoma. Note the clear overlapping nuclei Figure 8.49 Visual guide for scoring the nuclear features of papillary carcinoma using the three-point scoring scale. (From Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2(8):1023-1029.) Figure 8.50 Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This tumor has follicular growth pattern, the nuclear alterations of papillary carcinoma, and is well circumscribed and without invasion (inset) Figure 8.51 Solid variant of papillary carcinoma. The nests are separated by fibrohyaline strands Figure 8.52 So-called macrofollicular variant of papillary carcinoma. This lesion simulates nodular hyperplasia. The nuclear features that allow the diagnosis cannot be seen at this magnification Figure 8.53 Diffuse sclerosing variant of papillary carcinoma. Note the diffuse pattern of growth, the heavy lymphocytic infiltrate, and the sclerosis Figure 8.54 Prominent permeation of intrathyroid lymph vessels in diffuse sclerosing papillary carcinoma. Psammoma bodies are evident Figure 8.55 Tall cell variant of papillary carcinoma. Note the abundant granular acidophilic cytoplasm with oncocyte-like features Figure 8.56 Columnar cell variant of papillary carcinoma. The papillae are lined by a pseudostratified layer of spindle tumor cells Figure 8.57 A and B, Cribriform-morular variant of papillary carcinoma. The cribriform quality of the tumor is particularly well appreciated in B Figure 8.58 Hobnail variant of papillary carcinoma. Atypical nuclei with "hobnail" surface bulges, micropapillae, and discohesive cells (Courtesy of Drs. Asioli and Lloyd) Figure 8.59 Papillary thyroid carcinoma metastatic to cervical lymph node. The tumor has undergone cystic change, simulating on low power the appearance of a branchial cleft cyst; small papillary formations are present Figure 8.60 Capsular (A) and vascular (B) invasion in minimally invasive follicular carcinoma Figure 8.61 A and B, Reactive vascular proliferation in the capsule of a follicular neoplasm. On high power (B) the lesion has a papillary configuration Figure 8.62 Ultrastructural appearance of Hürthle cell (oncocytic) tumor of thyroid gland. A, The cytoplasm is packed with mitochondria. Secretory product is located toward the lumen, which is filled with colloid. B, Variably sized mitochondria with prominent cristae. (A, x3840; B, x11,230.) Figure 8.63 Gross appearance of Hürthle cell (oncocytic) carcinoma. The cut surface shows a tan color and a necrotic hemorrhagic center Figure 8.64 Hürthle cell (oncocytic) adenoma showing follicular pattern of growth and intact thin capsule Figure 8.65 Hürthle cell (oncocytic) carcinoma. A, The tumor has a predominantly solid pattern of growth. B, Extensive vascular invasion Figure 8.66 Hürthle cell (oncocytic) neoplasm with a papillary pattern of growth. The nuclear features of the papillary family of neoplasms are absent, and therefore this tumor should not be classified as a papillary carcinoma Figure 8.67 Follicular neoplasm with cytoplasmic clear change. The clearing has a finely granular quality Figure 8.68 Hürthle cell neoplasm with focal cytoplasmic clear change Figure 8.69 Hürthle cell neoplasm showing oncocytic features in the basal half of the tumor cells and clearing of the apical half Figure 8.70 So-called signet ring adenoma, resulting from intracytoplasmic accumulation of thyroglobulin Figure 8.71 A and B, Mucoepidermoid carcinoma of thyroid. (Courtesy of Dr. K. Franssila, Helsinki.) Figure 8.72 Sclerosing mucoepidermoid carcinoma with eosinophilia occurring in a thyroid gland affected by Hashimoto thyroiditis. The neoplasm, which almost entirely replaces a lobe, has a well-circumscribed quality. (Courtesy of Dr. Josie Zaroway, Edmonton, Canada.) Figure 8.73 Sclerosing mucoepidermoid carcinoma with eosinophilia. A, The pattern of growth is solid and squamoid and is associated with a massive eosinophilic infiltration. B, The formation of tissue spaces results in a pseudovascular appearance Figure 8.74 Diagnostic criteria for poorly differentiated thyroid carcinoma. HPF: high power field; random mitotic counts in areas with solid/trabecular/ insular (STI) growth pattern (From Volante M, Collini P, Nikiforov YE, et al. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol. 2007;31(8):1256-1264.) Figure 8.75 Low-power view of poorly differentiated thyroid carcinoma, showing a well-developed insular pattern Figure 8.76 On high power, the cells of insular carcinoma show round, medium-sized nuclei with a smooth contour and hyperchromasia Figure 8.77 Poorly differentiated (insular) carcinoma. The peritheliomatous pattern of growth results from necrosis associated with preservation of the tumor cells that are closer to nutrient vessels Figure 8.78 Poorly differentiated carcinoma showing trabecular pattern of growth rather than insular formations Figure 8.79 Poorly differentiated carcinoma of thyroid of insular type showing immunoreactivity for thyroglobulin Figure 8.80 Undifferentiated carcinoma of the thyroid entirely replacing the gland and extending into the surrounding skeletal muscle Figure 8.81 Undifferentiated carcinoma of the spindle cell type Figure 8.82 Undifferentiated carcinoma of giant cell type Figure 8.83 A and B, Combined poorly differentiated and undifferentiated thyroid carcinoma. Immunoreactivity for thyroglobulin is restricted to the poorly differentiated areas (B) Figure 8.84 Undifferentiated thyroid carcinoma showing residual papillary carcinoma Figure 8.85 Gross appearance of medullary carcinoma. Note its unencapsulated quality, solid appearance, and yellowish tan color Figure 8.86 Medullary carcinoma. Low-power microscopic view showing solid pattern of growth and deposition of amyloid Figure 8.87 Medullary carcinoma with pseudopapillary pattern of growth resulting from lack of cohesiveness of tumor cells Figure 8.88 Medullary carcinoma of oncocytic type. The appearance closely simulates that of Hürthle cell carcinoma. Clues to the diagnosis are represented by the amphophilic (rather than eosinophilic) staining quality of the cytoplasm and the prominent fibrous septation. This tumor was strongly immunoreactive for calcitonin Figure 8.89 Cytologic appearance of medullary carcinoma. The nuclei have clumped chromatin. An amorphous material compatible with amyloid is present Figure 8.90 Medullary carcinoma showing immunocytochemical positivity for calcitonin (A), chromogranin (B), and CEA (C) Figure 8.91 Ultrastructural appearance of medullary carcinoma. Portions of two tumor cells show multiple dense secretory granules in the cytoplasm. Each granule is surrounded by a single membrane, and the dense central portion is separated from it by a clear zone. Inset shows both oriented and randomly placed amyloid filaments and may be contrasted with larger banded collagen fibers. (Courtesy of Dr. J.S. Meyer, St Louis.) Figure 8.92 Thyroid paraganglioma showing well-formed Zellballen Figure 8.93 S-100 protein-positive sustentacular cells at the periphery of the "Zellballen" in paraganglioma of thyroid Figure 8.94 A and B, So-called sequestered (parasitic) thyroid nodule occurring in association with a gland involved by Hashimoto thyroiditis. The combination of oxyphilic change and germinal center formation in the sequestered nodule results in an appearance that can be confused with thyroid carcinoma metastatic to a lymph node Figure 8.95 Ectopic thyroid follicles in lymph node. The follicles are scanty, centered in the lymph node capsule, and devoid of structural and cytologic abnormalities Figure 8.96 Malignant lymphoma of thyroid. A, Low-power view showing a diffuse pattern of growth. B, Medium-power view showing tumor cells surrounding lymphoid follicles. One of the follicles shows "packing' of the lumen by lymphoid cells, a feature of diagnostic significance Figure 8.97 Hodgkin lymphoma involving the thyroid gland. A, Low-power view showing a nodular pattern of growth. B, High-power view showing a polymorphic infiltrate containing Reed-Sternberg cells. (Courtesy of Dr. Juan José Segura, San José, Costa Rica.) Figure 8.98 Langerhans cell histiocytosis involving the thyroid gland. A, Infiltrate composed of Langerhans cells and eosinophils. B, S-100 protein immunoreactivity of Langerhans cells Figure 8.99 Angiosarcoma of thyroid. The tumor is well differentiated and composed of anastomosing vascular channels lined by somewhat epithelioid endothelial cells Figure 8.100 Epithelioid angiosarcoma of thyroid. Note the prominent nucleoli Figure 8.101 Keratin immunoreactivity in thyroid angiosarcoma. There was also positivity for endothelial markers Figure 8.102 Lobular carcinoma of the breast with signet ring features metastatic to thyroid Figure 8.103 Renal cell carcinoma of clear cell type metastatic to thyroid. Note the blood-filled glands
