1. Atrophy of thyroid….Hashimoto thyroiditis
In general, the dimensions are decreased
*Hashimoto is more common to end
with atrophy than the other 2 thyroiditis
types.
*The destruction here is more
progressive than the other 2 thyroiditis
types (Others are usually self-limited).
*Hashimoto causes hypothyroidism
more than Hashitoxicosis
*The other 2 types are more common
than Hashimoto to present with
thyrotoxicosis

2. Hashimoto thyroiditis
Lymphoid follicles…also
with germinal centers
Hashimoto thyroiditis
The residual thyroid
tissue…note the
eosinophilia on low
power…this is because
that individual cells
contain bulky
eosinophilic cytoplasm
(Hurthle cell change)

3. Lymphocytes Hashimoto thyroiditis…high power
The follicular epithelial cells
contain abundant finely granular
eosinophilic cytoplasm…this is
Because of abundant
mitochondria
= Hurthle cell change
= Oxyphilic change
= Oncocytic change
Lymphocytes

4. Subacute granulomatous (Painful) thyroiditis
Multinucleated giant cells
Epithelioid
histiocytes
The remaining thyroid tissue
is not shown here
Mixed inflammatory cells

5. Multinodular goiter 2 nodules. Others will appear with sectioning
I can not guarantee
that these nodules are
benign on gross
examination alone

6. A section from colloid nodule
When the effect of ACTH on a certain area in
goiter in a case of iodine deficiency for example
disappears, this area will not become hyperplastic
and the cells will become flattened and most of this
area will be colloid more than cells “= colloid nodule”.
The presence of such areas with other areas that
are still hyperplastic will cause the goiter to be
“multinodular/irregular” after it was previously diffuse
A dilated follicle
Another
follicle
Flattened follicular epithelial cells

7. Graves disease Pseudopapillary hyperplasia
Scalloped (moth-eaten) colloid
No true papillae are seen
(no fibrovascular cores)

8. Follicular adenoma Capsule…but I cannot guarantee
if it is intact on gross alone
Well-circumscribed
A follicular adenoma
mainly composed of
Hurthle cells
(= Hurthle cell adenoma)
…note the finely granular
abundant eosinophilic
cytoplasm of the tumor cells
Follicular
adenoma
Follicles are like normal…may be of variable sizes and may be
solid growth of follicular epithelial cells with an accepted
degree of endocrine atypia
…the capsule is not shown in this image to assess for
invasion but I am telling you it’s a follicular adenoma

9. Papillary thyroid carcinoma
Please read all the description below

10. Follicular carcinoma

11. Anaplastic thyroid carcinoma
Anaplasia…severe pleomorphism, bizarre nuclei, too many mitoses, abnormal mitoses

12. Medullary carcinoma
Amyloid deposition…appears as amorphous pink material
is characteristic
The images here are of H&E-stained slides
…amyloid will show apple green color
on polarized light microscopy if stained
with congo-red
…Immunohistochemical staining of the tumor cells
and amyloid will be positive for calcitonin

13. Parathyroid adenoma
Compressed normal parathyroid rim (containing scattered adipocytes)
Most commonly
chief cells
The tumor cells resemble
normal cells and may be
arranged as solid sheets or
follicles
…endocrine atypia is accepted
& the most important to say “malignant” is tumor behavior
The neoplasm

14. Parathyroid adenoma The neoplasm
Compressed normal parathyroid rim (containing scattered adipocytes)

15. Normal pituitary Acidophils Basophils Chromophobes Reticulin network
(supportive
connective tissue)
..mainly collagen III

16. Pituitary adenoma Monomorphous proliferation with
accepted degree of endocrine atypia

17. Craniopharyngioma Wet keratin
All information mentioned here about this tumor will be in the practical
exam, not the theory exam
Craniopharyngioma
Peripheral palisading
*from Rathke pouch remnants
*Bimodal age distribution: in children and those
older than 60
*Suprasellar mass…mainly presents with visual
disturbances…growth retardation in children is common
(low GH and hypopituitarism)
*2 main types:
-Adamantinomatous (in children)
…calcification common (seen in imaging)
…cysts containing cholesterol-rich yellowish material
resembling machine oil
-Papillary (in adults)
…calcification uncommon
…lacks keratin
**Craniopharyngioma is benign even if large and invasive
**malignant transformation (to squamous cell carcinoma)
is very rare…associated with irradiation
Wet keratin
Squamous
cells