gross of thyroid gland
TRANSCRIPT
Monika Nema
GROSS OF THYROID GLAND
Presented by – Dr. Monika Nema
Monika Nema
ANATOMY The normal adult thyroid gland is
composed of two lobes joined by the isthmus, which lies across the trachea anteriorly, below the level of the cricoid cartilage.
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OPERATIONS ON THE THYROID GLAND Nodulectomy - (a procedure largely
abandoned that consists of enucleation of a thyroid nodule)
Lobectomy
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OPERATIONS ON THE THYROID GLAND Subtotal thyroidectomy –in which the
posterior capsule and a small portion of thyroid tissue – 1–2 g – are left on the side opposite to the lesion
Total thyroidectomy -in which the entire gland – including the posterior capsule – is removed.
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GROSSING PROCEDURE Type of specimen received. Orient the specimen. The isthmus can be used to identify the
inferior and medial aspects of the gland, the lobes taper superiorly and the posterior surfaces of the lateral lobes have a concave shape caused by the trachea.
• Measure the specimen.• Inspect the posterior aspect of the
specimen for parathyroid glands and lymph nodes
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Palpate the specimen to assess the consistency of the thyroid and to localize any focal lesions before cutting the specimen.
Cut parallel longitudinal slices 5 mm each.
Capsule is best demonstrated by cutting perpendicular to the long axis of each individual lobe.
Once the thyroid is sectioned, sequentially lay out the individual slices in such a way as to maintain the proper orientation of the specimen.
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OBSERVE THE CUT SURFACE: smooth or nodular? If an isolated lesion is identified, record
its size and location, and determine if it is surrounded by a capsule.
If nodular: Mention number, size, and appearance
of nodules (cystic? calcified? hemorrhagic? necrotic?)
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OBSERVE THE CUT SURFACE: For diffuse lesions: Is the gland symmetrically or
asymmetrically involved? Is the lesion confined to the thyroid, or
does it extend beyond the capsule of the thyroid into the surrounding soft tissues?
Is the lesion cystic or solid, soft or hard, well demarcated or poorly defined?
SECTIONS FOR HISTOLOGY Sections for histology should be taken to
demonstrate the following: (1) all components of a lesion (e.g., solid
areas and cystic areas); (2) the interface of the tumor (and its
surrounding capsule) with the adjacent non-neoplastic thyroid parenchyma;
(3) the relationship of the tumor to the thyroid capsule and extrathyroidal soft tissues; and
(4) the presence of parathyroids, lymph nodes, and normal-appearing thyroid parenchyma.
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Monika Nema
SECTIONS FOR HISTOLOGY 1 For diffuse and/or inflammatory
lesions: three sections from each lobe and one from isthmus.
2 For a solitary encapsulated nodule measuring up to 5 cm: entire circumference is taken.
Take one additional section for each additional centimeter in diameter. Most of these sections should include the tumor capsule and adjacent thyroid tissue, if present
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Primary task in encapsulated nodule is to make sure that areas of transcapsular or vascular invasion are not missed. Since these areas usually cannot be seen by the naked eye, they can easily be missed unless the peripheral portion of the nodule is extensively sampled.
The more capsule sampled, the greater chance of finding invasive foci. Therefore, the tumor–capsule–thyroid interface of any encapsulated nodule should be submitted in its entirety for histologic evaluation.
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Tangential sections through a round nodule may give the artifactual microscopic impression that the tumor infiltrates the capsule.
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Decapitate the rounded ends from the tumor nodule
To minimize tangential sectioning
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place the flat surface of each end on the cutting board, and then direct each cut perpendicular to the tumor capsule
To minimize tangential sectioning
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SECTIONS FOR HISTOLOGY
3 For multinodular thyroid glands: one section of each nodule (up to five nodules), including rim and adjacent normal gland; more than one section for larger nodules.
4 For papillary carcinoma: block entire thyroid gland and (separately) line of resection
5 For grossly invasive carcinoma other than papillary: three sections of tumor, three of non-neoplastic gland, and one from line of resection
6 For all cases: submit parathyroid glands if found on gross inspection
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Thyroids removed from patients with one of the multiple endocrine neoplasia (MEN) syndromes should be extensively sampled for histology.
In gross report, note those sections taken from the middle third of each lobe, as this area is where C-cell hyperplasia and small medullary carcinomas are most likely to be detected.
FOLLICULAR ADENOMA
Gross appearance of follicular adenomas.Tumor show focal hemorrhagic areas
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Monika Nema
HASHIMOTO THYROIDITIS
Diffuse and symmetrical enlargement of the gland. The consistency is firm but not stony hard as in Riedel thyroiditis. There is no extension of the process outside the gland. The cut surface is dstinctly nodular, yellowish gray, and greatly resembles a hyperplastic lymph node
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DYSHORMONOGENETIC GOITER
The gland is enlarged and multinodular
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GRAVES DISEASE (DIFFUSE TOXIC GOITER)
The gland is diffusely swollen and hyperemic.
Cut surface of thyroid gland with diffuse hyperplasia, showing a hyperemic ‘juicy’ appearance.
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PAPILLARY CARCINOMA
Grossly, gland is enlarged,solid,firm.Sometimes the papillary formations are evident to the naked eye.
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HÜRTHLE CELL (ONCOCYTIC) TUMORS
Grossly, the tumors are solid, tan, and well vascularized Most are well encapsulated throughout.
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MEDULLARY CARCINOMA
Grossly, the typical tumor is solid, firm, and nonencapsulated but relatively well circumscribed and has a gray to yellowish cut surface
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THANK YOU
Presentation by- Dr. Monika Nema