anatomia patologica - tiroides

PATOLOGIA DE LA GLANDULA TIROIDES

Xavier Matias-GuiuHospital Universitari Arnau

de Vilanova, Lleida

• Inflamaciones• Hiperplasias (Bocios)• Tumores Benignos• Tumores Malignos

Patología del Tiroides

• Inflamaciones no específicas• Granulomatosa (Quervain)• Linfocítica (Hashimoto)• Fibrosa (Riedel)

Inflamaciones del Tiroides

• Hiperplasia (Bocio) Nodular • Hiperplasia (Bocio) Difusa

(Graves – Basedow)

Hiperplasias de Tiroides

Tumors de Tiroide (tipus històlogics)

• Adenoma fol.licular• Tumor (adenoma) trabecular

hialinitzant

Cancer de Tiroide (tipus històlogic)

• Carcinoma papil·lar• Carcinoma fol·licular• Carcinoma pobrement diferenciat• Carcinoma indiferenciat (anaplàsic)• Carcinoma medul·lar

Papillary Carcinoma(Definition)

A malignant epithelial tumour showing evidence of follicular cell differentiation and characterized by distinctive nuclear features

Carcinoma Papilar de Tiroides

• Cualquier edad• Poco agresivo• El más frecuente (especuialmente en

zonas no bociógenas• Diseminación por vía linfática

Carcinoma Papilar de Tiroides(Pronóstico)

• Edad• Tamaño• Invasión extratiroidea• Metástasis a distancia

Papillary Carcinoma(variants)

• Follicular variant• Macrofollicular variant• Oncocytic variant• Clear cell variant• Diffuse sclerosing variant• Tall cell variant• Columnar cell variant

Papillary Carcinoma(size variation)

• The term Microcarcinoma should be used for a papillary carcinoma , which is incidentally found, and measures 1 cm or less.

Papillary Carcinoma(Genetics)

• RET/PTC• TRK• RAS• BRAF

Papillary Carcinoma(Genetics)

• RET/PTC1 60-70%• RET/PTC2 < 10%• RET/PTC3-4 20-30%• RET/PTC5 rare• RET/PTC6 rare• RET/PTC7 rare• RET/ELKS rare• RET/KTN1 rare• RET/RFG8 rare• RET/PCM-1 rare

Follicular Carcinoma(Definition)

A malignant epithelial tumour showing evidence of follicular cell differentiation, lacking the diagnostic nuclear features of papillary carcinoma

Follicular Carcinoma(variants)

• Oncocytic variant (Hürthle cell Tumors)• Clear cell variant

Poorly differentiated Carcinoma(Definition)

Follicular-cell neoplasms that show limited evidence of structural follicular cell differentiation and occupy both morphologically and behaviourally an intermediate position between the well differentiated follicular and papillary carcinomas and the undifferentiated carcinomas

Poorly differentiated Carcinoma(Histopathology)

• Three patterns (insular, trabecular, solid)• Infiltrative pattern of growth, necrosis and

obvious vascular invasion• Prognostic significance of minor component

is unknown

Undifferentiated (Anaplastic) Carcinoma(Definition)

Highly malignant tumours that by standard light microscopy appear wholly or partially composed of undifferentiated cells that exhibit immunohistochemical or ultrastructural features indicating epithelial differentiation

Medullary Thyroid Carcinoma(Definition)

A malignant tumour of the thyroid gland showing C-cell differentiation and lacking follicular differentiation.

ESPORADICO

MEN 2A MEN 2 B

ASOCIADO NO ASOCIADO

FAMILIAR

CARCINOMA MEDULAR DE TIROIDES

CMT ESPORÁDICO CMT FAMILIAR

Medullary Thyroid Carcinoma

RET

RETT

CMT ESPORÁDICO CMT FAMILIAR

Limfoma de Tiroide

Metastatic Tumors