General Pathology Laboratory Exam #5 Study Guide Endocrine

There are 6 topics with a total of 10 slides, 2 questions per slide, 20 questions total. 5 slides will have Papillary Thyroid Carcinoma.
Question A usually asks for the diagnosis. NOTE: The topics listed below in BOLD are the acceptable answers.
Question B will ask something important, relevant, or unique to the diagnosis.
1. MULTINODULAR GOITER
Picture will be taken from the actual slide and will look like these.

Questions you should be able to answer:

i. What is the underlying cause of goiter?
ii. Why are they frequently mistaken for a neoplasm?
iii. What is the precursor of a multinodular goiter?
iv. Do goiters produce symmetrical or asymmetrical thyroid enlargement?
v. Are women or men affected more often?
vi. Can calcifications, scarring, and hemorrhage be seen?
vii. Is the pattern of enlargement predictable?
viii. What is the term for a goiter that grows behind the sternum or clavicles?
ix. What substance are the nodules filled with?
x. Is there a prominent capsule found between hyperplastic nodules and surrounding normal thyroid tissue?
xi. What are the main clinical features resulting from mass effect of the goiter?
xii. Are most patients clinically euthyroid, hypothyroid, or hyperthyroid?
xiii. What is the term for multinodular goiter with an autonomous nodule causing hyperthyroidism?
xiv. Does goiter with hyperthyroidism have the same clinical features as Graves disease?
xv. Is the risk of malignancy high in longstanding goiter?
xvi. What does a radioiodide scan usually demonstrate?
xvii. What procedure can be helpful to rule out a neoplasm?
 2. PAPILLARY THYROID CARCINOMA or PAPILLARY CARCINOMA
Pictures will be taken from the actual slide and will look like these.

Fine Needle
Aspiration of Neck or
Thyroid Masses

Papillary Structure composed of Tumor Cells Intranuclear Pseudoinclusion

Excision Biopsy or
Thyroidectomy High Power View: Fibrovascular Core lined by tumor cells with
Low Power View: Papillary Structures
with standard H&E Ground-glass or Orphan Annie eye nuclei
staining.

Tumor cells

Normal Lymph
Node area

Psammoma Body Lymph node with metastasis

 Questions you should be able to answer:
i. Is this the most common type of thyroid cancer?
ii. Does this arise from the thyroid follicular epithelium?
iii. Does ionizing radiation increase the risk of this tumor?
iv. Can it be solitary or multifocal or both?
v. What are the nuclear features of papillary carcinoma?
vi. Can the diagnosis be made based on nuclear features alone?
vii. What are psammoma bodies? Do they help support the diagnosis of papillary carcinoma?
viii. What is the typical route of metastasis?
ix. What organ does hematogenous metastasis typically go to?
x. How do most cases of papillary carcinoma present clinically?
xi. What symptoms suggest advanced disease?
xii. What tests can be done to assess if thyroid nodules are benign or malignant?
xiii. How does papillary carcinoma appear on radionuclide / scintiscan?
xiv. What is the prognosis?
xv. Does an isolated cervical node metastasis affect the prognosis significantly?
xvi. What factors influence the prognosis?
xvii. What age range has a worse prognosis?
3. HASHIMOTO THYROIDITIS
Pictures will be taken from the actual slide and will look like these.

Hrthle Cells that have

abundant eosinophilic,
granular cytoplasm

Questions you should be able to answer:

i. Is this considered to be an autoimmune disease?
ii. Can it cause hypothyroidism? What would the thyroid stimulating hormone (TSH), T3, and T4 levels be?
iii. Can it cause thyrotoxicosis?
iv. What age range does it affect most often?
v. Is it more common in males or females?
vi. Can it occur in children?
vii. What antibodies are usually found?
viii. Is there a strong genetic component?
ix. Can it cause thyroid enlargement?
x. What is Hrthle cell change / Hrthle cells?
xi. Is the thyroid gland capsule intact?
xii. Does fibrosis extend beyond the capsule?
xiii. Is there an increased risk of other autoimmune diseases?
xiv. What are the immunologic mechanisms that may contribute to thyroid cell death?
4. FOLLICULAR ADENOMA
Picture will be taken from the actual slide and will look like this.

Questions you should be able to answer:

i. Does this tumor arise from thyroid follicular epithelium?
ii. Are most adenomas functional?
iii. Is it usually solitary or multifocal or both?
iv. It is usually painless or painful?
v. What is hallmark feature required for diagnosis?
vi. What tests can be done to investigate thyroid nodules?
vii. What is the prognosis?
viii. Does this tumor recur?
ix. Does this tumor metastasize?
5. FOLLICULAR CARCINOMA
Picture will be taken from the actual slide and will look like this.

Questions you should be able to answer:

i. What are the significant differences between follicular adenoma and follicular carcinoma? Is there a special test to
distinguish them from each other?
ii. Can follicular carcinoma be widely infiltrative?
iii. What is found in areas with increased incidence of these tumors?
iv. Is this tumor more common in men or women?
v. What age range is usually affected?
vi. Are psammoma bodies usually present?
vii. Is there a cytologic difference between follicular adenoma and minimally invasive follicular carcinoma?
viii. Does the criterion for vascular invasion apply beyond the capsule or within the capsule?
ix. What is the prognostic significance of tumor cell plugs in blood vessels within the tumor?
x. Is lymphatic spread common?
xi. Are nodular tumors painful or painless?
xii. Are they usually hot or cold?
xiii. How does it usually metastasize?
xiv. What factors mainly influence the prognosis?
xv. What is the difference in prognosis between widely invasive and minimally invasive?
xvi. What is the treatment?
xvii. What should the serum thyroglobulin levels be?
6. ADRENOCORTICAL ADENOMA
Picture will be taken from the actual slide and will look like this.

Questions you should be able to answer:

i. Does this usually produce symptoms?
ii. What symptoms are functional adenomas most commonly associated with?
iii. Can these tumors produce non-steroidal hormones?
iv. Can the macroscopic and/or microscopic features demonstrate that the tumor is functional?
v. What are the methods used to tumor assess functionality?
vi. What is the cause in most cases?
vii. Why do these tumors typically have a yellow cut surface macroscopically?
viii. Why are these tumors vacuolated?
ix. Are mitotic figures frequently seen?