Reprezinta cresterea de volum a glandei tiroide, prin prezenta unor noduli, unici sau multipli, pastrand un nivel normal de hormoni tiroidieni. Este un termen enspecific care defineste cresterea tiroidei in talie si in greutate de cause diverse, la persoanele eutiroidiene, hipotiroidiene sau hipertiroidiene.
Etiopatogenie: 1. Defectul genetic de sinteza de hormone tiroidieni, apare in gusa congenitala- hormonii tiroidieni fiind insuficienti, hipofiza stimuleaza sinteza de hormone tropi, cee ace implica proliferarea epiteliului follicular tiroidian cu hiperplazia secundara a acestuia.
Goatrogenii varza si conopida si unele medicamenete, interfera cu productia de hormone tiroidieni si aparitia gusei.
Diagnostic Pathology: Cytopathology
Gusa nodulara non toxica: este o crestere a tiroidei pe seama unei hiperplazii continute sau repretitive in raspunsul deficient de hormone secretati de glanda cancer ovarian metastasis. Clinic: Se observa masa cervicala ce comprima structurile din jur si determina simptome ca dispnee si disfagie; uneori poate fi prezent un nodul tiroidian hiperfunctional toxicsi se numeste sd.
Plummer, iar clinic pacientul prezinta hipertiroidism. Tiroida poate fi crescuta in talie, sa ajunga pana la de grame. Se poate extinde substernal sis a determine detresa respiratorie. Macroscopic: - gusa difuza: glanda marita uniform de volum mai mult de 40gsimetric, cu aspect cenusiu, translucid, sticlos din cauza prezentei coloidului; - gusa nodulara — marire de volum asimetrica, cu aspect multinodular pe sectiune; nodulii au aspect brun-galbui sau brun-roscat, gelatinos, in functie de cantitatea de coloid; nodulii sunt incapsulati; frecvent se observa zone hemoragice, chistice de scleroza si de calcificare.
Microscopic: Gusa difuza prezinta hiperplazie si hipertrofie difuza a epiteliului folicular, ocazional formand structuri papilare; pe masura ce afectiunea se cronicizeaza, cu episoade de stimulare si involutie administrare de iodaspectul coloid si nodular devind evident, cu foliculi dilatati chistic si epiteliu aplatizat sau cuboidal, nodulii au dimensiuni variabile si sunt separati prin septuri fibroase; frecvent se identifica zone de calcificare, scleroza, hemoragie si depozite de hemosiderina.
Two morphologic forms of goitre are distinguished: A. Diffuse goitre simple nontoxic goitre or colloid papillary thyroid carcinoma solid variant pathology. Nodular goitre papillary thyroid carcinoma solid variant pathology goitre or adenomatous goitre.
Pathogenesis of Goitre The pathogenetic mechanisms of both forms of goitre can be papillary thyroid carcinoma solid variant pathology together since nodular goitre is generally regarded as the end-stage of long-standing simple goitre Fig.
Sub Tiroida Sem 2
The fundamental defect is deficient production of thyroid hormones due to various etiologic factors described below, but most common is dietary lack of iodine. Deficient thyroid hormone production causes excessive TSH stimulation which leads to hyperplasia of follicular epithelium as well papillary thyroid carcinoma solid variant pathology formation of new thyroid follicles.
Cyclical hyperplastic stage followed by involution stage completes the picture of simple goitre. Repeated and prolonged changes of hyperplasia result in continued growth of thyroid tissue while involuted areas undergo fibrosis, thus completing the picture of nodular goitre. Diffuse Goitre Simple Non-toxic Goitre, Colloid Goitre Diffuse, nontoxic simple or colloid goitre is the name given to diffuse enlargement of the thyroid gland, unaccompanied by hyperthyroidism.
Most cases are in a state of euthyroid though they may have passed through preceding stage of hypothyroidism due to inadequate supply of iodine. TSH levels are invariably elevated. In general, goitre is more common in females. Simple goitre often appears at puberty or in adolescence, following which it may either regress or may progress to nodular goitre. Epidemiologically, goitre occurs in 2 forms: endemic, and non-endemic or sporadic.
Endemic goitre. Such endemic areas are several high mountainous regions far from the sea where iodine papillary thyroid carcinoma solid variant pathology of drinking water and food is low such as in the regions of the Himalayas, the Alps and the Paraziti intestinali synevo. Of late, however, the prevalence in these areas has declined due to prophylactic use of iodised salt. Though most endemic goitres are caused by dietary lack of iodine, some cases occur due to goitrogens and genetic factors.
Goitrogens are substances which interfere with the synthesis of thyroid hormones. These substances are drugs used in the treatment of hyperthyroidism and certain items of food such as cabbage, cauliflower, turnips and cassava roots.
Sporadic papillary thyroid carcinoma solid variant pathology endemic goitre.
Carcinom folicular vs adenomatos
Non-endemic or sporadic simple goitre is less common than the endemic variety. In most cases, the etiology of sporadic goitre is unknown.
A number of causal influences have been attributed. These include the following: Suboptimal iodine intake in conditions of increased demand as in puberty and pregnancy. Genetic factors. Dietary goitrogenes. Hereditary defect in thyroid hormone synthesis and transport dyshormonogenesis.
Best ultrasound images images in | Ultrasound, Radiology, Ultrasound sonography
Inborn errors of iodine metabolism. Grossly, the enlargement of the thyroid gland in simple goitre is moderate weighing up to gmsymmetric and diffuse. Cut surface is gelatinous and translucent brown Fig. Histologically, two stages are distinguished: 1. Hyperplastic stage is the early stage and is characterised by tall columnar follicular epithelium showing papillary infoldings and formation of small new follicles.
Involution stage generally follows hyperplastic stage after variable period of time. This stage is characterised by large follicles distended by colloid and lined by flattened follicular epithelium Fig.
Nodular Goitre Multinodular Goitre, Adenomatous Goitre As already stated, nodular goitre is regarded as the end-stage of long-standing simple goitre. It is characterised by most extreme degree of tumour-like enlargement of the thyroid gland and characteristic nodularity. The enlargement of the gland may be sufficient to not only cause cosmetic disfigurement, but in many cases may cause dsyphagia and choking due to compression of oesophagus and trachea.
Since nodular goitre is derived from simple goitre, it has the same female preponderance but hpv warts on the feet older individuals because it is a late complication of simple goitre. Etiologic factors implicated in endemic and nonendemic or sporadic variety of simple goitre are involved in the etiology of nodular goitre too. However, how nodular pattern is produced is papillary thyroid carcinoma solid variant pathology clearly understood.
Possibly, epithelial hyperplasia, generation of new follicles, and irregular accumulation of colloid in the follicles—all contribute to produce increased tension and stress in the thyroid gland causing rupture of follicles and vessels.
This is followed by haemorrhages, scarring and sometimes papillary thyroid carcinoma solid variant pathology, resulting in development of nodular pattern.
Grossly, the thyroid in nodular goitre shows asymmetric and extreme enlargement, weighing gm or even more. The five cardinal macroscopic features are as under Fig. Nodularity with poor encapsulation 2. Fibrous scarring 4. Focal calcification 5. Cystic degeneration. Papillary thyroid carcinoma solid variant pathology surface generally shows multinodularity but occasionally there may be only one or two nodules which are poorly- circumscribed unlike complete encapsulation of thyroid adenoma, described below.
Histologically, the same heterogenicity as seen on gross appearance is seen. Corresponding microscopic features are as follows Fig. Partial or incomplete encapsulation papillary thyroid carcinoma solid variant pathology nodules. The follicles varying from small to large and lined by flat to high epithelium. A few may show macropapillary formation. Areas of haemorrhages, haemosiderin-laden macrophages and cholesterol crystals.
Fibrous scarring with foci of calcification. Micro-macrocystic change.
Este cea mai frecventa cauza de hipertiroidism la persoanele sub 40 de ani, are incidenta maxima intre ani si un raport de in favoarea femeilor. Etiologie: factori genetici, mecanisme imune. Are porbabil, un mechanism immunologic si obisnuit este asosciata cu alte leziuni autoimmune. Clinic: semnele hipertiroidismului: bolnavii afectati sunt femei tinere cu manifestari enrvoase, tahicardie, transpiratii, pierdere in greutate si exoftalmie.
Histopathology Thyroid --Papillary carcinoma
Nivelul tireotropinei este scazut sau nesesizabil. Macroscopic: Tiroida este marita difuz de ori, bilateral; gusa are o consistenta ferma, aspect neted si o culoare rosu-brun pe suprafata de sectiune. Microscopic: Foliculii tiroidieni sunt hiperplazici, cu epiteliu cubic-cilindric si proeminente papilare fara ax conjunctiv in lumen; la polul apical al celulelor exista vacuole de resorbtie, sugestive pentru hiperfunctie metabolica a celulelor foliculare; Coloidul este redus, cu aspect crestat festonat marginal; interstitial se gaseste infiltrat inflamator si chiar agregate limfocitare nodulare fomate din limfocite T; administrarea preoperatorie de iod determina involutia si dilatarea foliculilor, cu aplatizarea epiteliului si fibroza interstiala; - tesutul periorbital prezinta initial edem apoi fibroza in infiltrare limfocitara.
Celulele foliculare sunt inalte, columnare, cu nuclei amrita. Stroma este intens vascularizata si infiltrate cu limfo monocyte. The disease is more frequent between the age of 30 and 40 years and has five-fold increased prevalence among females.
These are as follows: 1. Genetic factor association. A familial occurrence has been observed. Autoimmune disease association. Other factors. Depending upon its action as inhibitory or stimulatory to follicular epithelium, it may result in alternate episodes of hypo- and hyperthyroidism. The evidence in support is the intense lymphocytic infiltrate around the ocular muscles and detection of circulating autoantibodies against muscle antigen that cross-react with thyroid microsomes.
Grossly, the thyroid is moderately, diffusely and symmetrically enlarged and may weigh up to gm. On cut section, the thyroid parenchyma is typically homogeneous, red- brown and meaty and lacks the normal translucency.
Histologically, the following features are found Fig.
There is considerable epithelial hyperplasia and hypertrophy as seen by increased height of the follicular lining cells and formation of papillary infoldings of piled up epithelium into the lumina of follicles which are small.
The colloid is markedly diminished and is lightly staining, watery and finely vacuolated.
The stroma shows increased vascularity and accumulation of lymphoid cells. However, the pathologic changes in gross specimen as well as on histologic examination are considerably altered if preoperative medication has been administered.
Iodine administration results in accumulation of colloid in the follicles and decrease in vascularity and height of follicular cells, while antithyroid drugs such as thiouracil cause marked hyperplasia. Patients are usually young women who present with symmetric, moderate enlargement of the thyroid gland with features of thyrotoxicosis pageophthalmopathy and dermatopathy.
Ocular abnormalities are lid lag, upper lid retraction, stare, weakness of eye muscles and proptosis. In extreme cases, the lids can no longer close and may produce corneal papillary thyroid carcinoma solid variant pathology and ulcerations. Troidita Hashimoto Boala inflamatorie autoimuna a tiroidei caracterizata prin prezenta de anticorpi ce distrug treptat foliculii tiroidieni.
Frecvent se asociaza si alte leziuni de natura autoimuna, inclusive leziuni endocrine. Macroscopic: Glanda tiroida marita de volum de ori, difuz, simetric, bilateral; are o consistenta ferma greutate intre g, capsula intacta; pe suprafata de sectiune are aspect carnos, de culoare galben- cenusiu, palid, lobulatia este accentuate papillary thyroid carcinoma solid variant pathology lobii individuali proemina.
Much more than documents.
Microscopic: Interstitul tiroidian intre foliculi prezinta un bogat infiltrat inflamator limfo-mononuclear limfocite si plasmocitecu formare de foliculi limfoizi cu centru germinativ; - Foliculii tiroidieni sunt atrofici si redusi numeric si mici.
Infiltratul de limfoplasmocite cu formarea de centri clari asemeni unui limfom nodular este proeminent iar fibroza are grade variate de extindere. Diffuse goitrous enlargement of the thyroid. Lymphocytic infiltration of the thyroid gland.
В голосе у нее звучала едва ли не мольба, и Олвин отлично понимал, что она обращается не только к нему, но и к своему сыну.
Occurrence of thyroid autoantibodies. Though rare in children, about half the cases of adolescent goitre are owing to autoimmune thyroiditis. Hashimoto, a Japanese surgeon, described it in as the first auto immune disease of any organ. It appears that TSH-receptor antibody may act both to depress or stimulate the thyroid cells to produce hypo- or hyperthyroidism respectively. Thus, these patients may have alternate episodes of hypo- or hyperthyroidism. Genetic basis: The disease has higher incidence in firstdegree relatives of affected patients.
Grossly, the classic form is characterised by diffuse, symmetric, firm and rubbery enlargement of the thyroid which may weigh gm. Sectioned surface of the thyroid is fleshly with accentuation of normal lobulations but with retained normal shape of the gland. The fibrosing variant has a firm, enlarged thyroid with compression of the surrounding tissues. Histologically, the classic form shows the following features Fig. There is extensive infiltration of the gland by lymphocytes, plasma papillary thyroid carcinoma solid variant pathology, immunoblasts and macrophages, with formation of lymphoid follicles having germinal centres.
There is decreased number of thyroid follicles which are generally atrophic and are often devoid of colloid. The follicular epithelial cells are transformed into their degenerated state termed Hurthle cells also called Askanazy cells, or oxyphil cells, or oncocytes. Papillary thyroid carcinoma solid variant pathology cells have abundant oxyphilic or eosinophilic and granular cytoplasm due to large number of mitochondria and contain large bizarre nuclei.
Cancerul cu celule Hurthle este foarte rar și potențial cea mai agresivă formă de cancer tiroidian folicular. Carcinom papilar Carcinom folicular Carcinom slab difereniat Carcinom. Diferenţe între codurile morfologice din ediţiile a doua ºi a treia.
There is slight fibrous thickening of the septa separating the thyroid lobules. It can occur at all ages including children and young adults but the incidence is higher with advancing age. The tumour is found about three times more frequently in females than in males. Papillary carcinoma is typically a slow-growing malignant tumour, most often presenting papillary thyroid carcinoma solid variant pathology an asymptomatic solitary nodule.
Involvement of the regional lymph nodes is common but distant metastases to organs are rare. Some cases first come to attention by spread to regional lymph nodes and cause cervical lymphadenopathy.
Grossly, papillary carcinoma may range from microscopic foci to nodules upto 10 cm in diameter and is generally poorly delineated. Cut surface of the tumour is greyish-white, hard and scar-like Fig.