Thyroid

Lab 1 Young woman Lab 4 49 year old w/ fatigue

TSH and T4 TSH and T4

o diff dx = problem w/ ant pit or
above or ectopic TSH secreting
tumor
TSH and T4
o Graves, neoplasm of thyroid
gland, toxic multinodular goiter,
thyroiditis, Struma ovarii,
exogenous thyroid hormone
Order
o IgG that stimulates TSH receptor
o Anti thyroid antibodies
Diffuse radioactive uptake
o Diffusely synthesizing more
thyroid hormone throughout the
gland
Histo
o Very cellular but only few colloid
o Lymphoid aggregates w/ germinal
centers
What else do you see in the thyroid
tissue
o Lymphocytes
Dx
o Graves
o Exopthalmos
o Pretibial myxedema
Lab 2 40 year old woman w/ nodule on 1 side
o 1 hypothyroidism
Diff dx = Hashimotos
Order Antithyroglobulin and antithyroid
peroxidase antibodies
Histo Lots of lymphocytes w/ germinal
centers and Hurthle Cells (pink granules
in cytoplasm)
Complication Marginal B cell
lymphoma, other autoimmune dzs
Lab 5 36 year old w/ sore throat
Papillary thyroid carcinoma
Histo = Papillary configuration ,
Psammoma bodies, Orphan Annie Eye
nuclei
RF = exposure to ionizing radiation
Mets to cervical lymph nodes
Prog is good
Lab 6 50 year old Unilat neck mass w/ mild
dysphagia
Medullary carcinoma
o Histo Sheets of Salt and pepper
chromatin
o Lots of amyloid do congo stain
o Lab test Calcitonin, CEA
o Assoc w/ mutation in RET
oncogene

Diff dx follicular adenoma, or papillary,

follicular or medullary carcinoma, or
dominant nodule of a multinodular goiter
Order FNA
Histo normal thyroid in periphery
o Does not invade capsule
Dx = Benign follicular adenoma

Lab 3

Diff dx Multinodular goiter w/ dominant

nodule
Histo no capsule seen
o Scarring
o Hemosiderin laden Macs indicating
previous hemorrhage
Breast

Lab 1 36 year old F w/ intermittent breast

tenderness before her menses

Biopsy Blue dome cyst = fibrocystic

change
Histo excess connective tissue w/
dilated cysts lined by apocrine
metaplasia
Lab 2 24 year old F w/ a painless lump in left
breast, well delineated, mobile, rubbery
Dx = Fibroadenoma
Histo lots of connective tissue and
squished ducts but still have
myoepithelial cells so still benign
Phyllodes tumor if
o Stroma that overgrows, not epith
o Older people
o Can be malignant
Lab 4 56 year old woman for routine follow up
for her HTN
Lobular carcinoma in situ = small cells
filling up lobule
Lobular Invasive = single file pattern of
carcinoma cells w/ a Bulls-eye pattern
where tumor cells are arranged
concentrically around residual ducts and
lobules
LCIS is systemically treated w/ tamoxifen
b/c it is multifocal and bilateral
They are just as likely to get invasive
lobular carcinoma

Lab 3 routine annual mammogram on 52 year

old

Cluster of microcalcifications on
mammography (no mass can by
physically felt)
Dx Ductal Carcinoma In Situ, Comedo
type
Myoepithelial cells present
Necrosis and dystrophic calcifications
Have not invaded Basement membrane
Tx Without tx, it will prog to invasive
ductal carcinoma
Stellate scar image on radiograph
o Invade basement membrane
o No myoepithelial cells seen
o Can palpate b/c lots of
desmoplastic stroma and
retraction of nipple
o Upper outer quadrant
o Mets to axillary nodes then to
blood
o Besides grade and stage what else
is a Px factor = molecular markers
such as ER, PR, and HER2/neu
amplify
Lower female genital tract Lab 3

Intro Post menopausal ovary would have more

scars than ovary from woman of
Ecto = non keratinized stratif squamous reproductive age
epithelium Ovarian neoplasm presents as subtle
Endo = simple columnar mucinous vague abdominal pain
glandular epithelium 1 ovarian neoplasm come from surface
epithelium, germ cells, sex cord stromal
Lab 1 18 year old sexually active comes for
tumors
pap smear
Surface epithelial tumor subtpyes
Koilocytic change - N:C, o Serous (if diff to fallopian tube)
o Mucinous (if diff to endocervix)
hyperchromatic, surrounding halo
o Endometriooid (if diff to
HPV infxn
Comes back 8 year for coloscopy endometrium)
o Koilocytes on top Surface epithelial tumor malignant
o CIN 3 or CIS seen features
HPV 16, 18, 31, 33 o Gross = Solid, multilocular,
Not surprised that she had no Sx b/c she Bilateral
o Micro
only has in situ
benign = very minimal
Lab 2 22 year old primigravid woman to ER in epithelial prolif single row
labor

Painful vesicles Lab 3 = 32 year old w/ vague feeling of

Dx = HSV 2 abdominal discomfort
o Stratified squamous epithelium
single row of mucin secreting cells =
o Blistering lesion w/ multinucleated
benign mucinous cystadenoma
squamous cells that coalesce w/
Mullerian duct epith recapitulated =
ground glass chromatin
Do C section for baby and tx w/ acyclovir endocervix

Lab 4 = 54 year old woman for annual exam

Cysts lined w/ a thick shaggy lining piling

up on top of each other
Papillary serous cystadenocarcinoma
Mullerian duct Fallopian tube
Most common ovarian malignancy
CA-125 cell marker
Cause ascites seeding of cancer into
peritoneum
Poor Px
 Endometrial hyperplasia indicates long
standing estrogen even 15 post
menopausal
Can be granulosa tumor or thecoma
Histo = Call-exner bodies
o Granulosa cell tumor
o Malignant but Indolent
Cell marker = inhibin

What types of malig freq mets to ovaries?

Endometrial carcinoma, breast cancer, GI tract

Lab 5 Germ cell tumor

20s and younger age group

Most are benign mature teratomas
Primordial germ cells come via midline of
yolk sac up midline of retroperitoneum.
Can see them midline

Lab 5 25 year old

Mature squamous epithelium lining

Tissue resembles skin
Derived from ectoderm
Benign Lab 7 47 F w/ early satiety and abdominal
If malig discomfort
o More solid
o Composed of embryonic immature Krukenberg tumor from diffuse gastric
cells carcinoma w/ signet ring cells

Sex cord stromal tumors

Granulosa , theca, and fibroblasts

Sometimes sertoli-leydif cells
Whats unique? They can make
hormones

Lab 6 66 year old w/ vaginal bleed