Endocrine pathology lab
This presentation is the property of its rightful owner.
Sponsored Links
1 / 48

Endocrine Pathology Lab PowerPoint PPT Presentation


  • 55 Views
  • Uploaded on
  • Presentation posted in: General

Endocrine Pathology Lab. April 3, 2014. Case 1: Q1: Please describe the following gross and microscopic thyroid. Case 2. CHIEF COMPLAINT : “I have a lump in my neck”

Download Presentation

Endocrine Pathology Lab

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Endocrine pathology lab

Endocrine Pathology Lab

April 3, 2014


Case 1 q1 please describe the following gross and microscopic thyroid

Case 1: Q1: Please describe the following gross and microscopic thyroid


Case 2

Case 2

CHIEF COMPLAINT: “I have a lump in my neck”

HISTORY: The patient is a 42-year-old female who noticed a painless lump in her neck about a month ago. It has not seemed to increase or decrease in size.

She has no chronic medical problems and has had no surgeries.

She takes no medications.

Her father and mother are alive and well. She is an only child.

She has no diarrhea or constipation, no heat or cold intolerance, stable weight, no change in skin or hair texture.


Endocrine pathology lab

PHYSICAL EXAMINATION:

A painless 3cm mass is palpated in the left neck. The mass moves when the patient swallows and seems contiguous with the thyroid gland. The remainder of the thyroid gland is normal. There is no cervical or supraclavicular lymphadenopathy. The remainder of the physical exam is unremarkable.


Q1 what is the main clinical problem and differential diagnosis

Q1: What is the main clinical problem and differential diagnosis?


Q2 based on the given data is the patient clinically euthyroid hyperthyroid or hypothyroid

Q2: Based on the given data, is the patient clinically euthyroid, hyperthyroid, or hypothyroid?


Lab data

Lab Data

  • TSH 1.2 (0.4-4.4 uu/mL)


Iodine uptake scan

Iodine uptake scan

Most benign and virtually all malignant thyroid

nodules concentrate iodine radioisotopes less

avidly than adjacent normal thyroid tissue

These nodules appear “cold” and generally

require further evaluation by FNA

Cold nodule left upper thyroid gland

Remainder of thyroid uptake is normal.


Fine needle aspiration

Fine Needle Aspiration

  • “Follicular Neoplasm”


Q4 discuss the term follicular neoplasm differential and distinguishing features

Q4: Discuss the term Follicular Neoplasm, differential, and distinguishing features


Q5 describe gross findings

Q5: Describe gross findings


Q6 describe the histopathology

Q6: Describe the histopathology


Q7 compare and contrast the histopathology seen here

Q7: Compare and contrast the histopathology seen here

Normal Thyroid

Follicular Adenoma of the thyroid


Q8 what is your diagnosis

Q8: What is your diagnosis?


Q9 correlate the clinical findings with the pathology

Q9: Correlate the clinical findings with the pathology


Q10 discuss the term toxic follicular adenomas

Q10: Discuss the term“Toxic” Follicular adenomas


Case 3

Case 3

CHIEF COMPLAINT: Routine physical.

HISTORY: 55-year-old woman presents for an annual physical exam. She feels well and has no concerns except that perhaps her cholesterol might be high due to dietary indiscretion.

She has no chronic medical problems and has had no surgeries.

She takes no medications.

She is adopted and does not know of her family history.


Endocrine pathology lab

PHYSICAL EXAMINATION:

A painless 2.5 cm nodule is palpated in the left thyroid gland. There is an enlarged, nontender 2cm left cervical lymph node. Exam is otherwise unremarkable.


Q1 what is the main clinical problem and differential diagnosis1

Q1: What is the main clinical problem and differential diagnosis?


Diagnostic work up

Diagnostic work-up

  • Normal TSH

  • “Cold” thyroid nodule on iodine uptake scan

  • FNA

  • Results of above lead to Thyroidectomy


Q2 identify organ and describe gross findings

Q2: Identify organ and describe gross findings


Q3 describe the histopathology findings

Q3: Describe the histopathology findings


What is your diagnosis

What is your diagnosis?

  • Papillary carcinoma

  • The most common thyroid carcinoma

  • About half of cases will have metastasis to cervical lymph nodes at the time of a diagnosis


Q4 what is gene is involved in the pathogenesis of this condition

Q4: What is gene is involved in the pathogenesis of this condition?


Other genes

Other genes

  • BRAF

    • Encodes a signaling intermediary in MAP kinase pathway

    • 33-50% papillary thyroid cancers have activating mutation in BRAF gene


Q5 what are the clinical implications of gene mutations in carcinoma

Q5: What are the clinical implications of gene mutations in carcinoma?


Case 4

Case 4

CHIEF COMPLAINT: “I’ve been feeling tired and cold all the time”

HISTORY: 60-year-old previously healthy woman presents with fatigue and cold intolerance. She has had about 10 pound weight gain over the past 6 months which she attributes to inactivity. She is being treated for hypertriglyceridema with gemfibrozil. She started taking laxatives about 3 months ago for constipation. She does not smoke or drink alcohol.


Endocrine pathology lab

PHYSICAL EXAMINATION:

Alert and oriented female

Pulse 61, BP 150/90

Thyroid gland is diffusely enlarged. No nodules are palpated. No cervical LAD is present.

Lung, heart, and abdominal exams are unremarkable.


Q1 what are the main clinical problems and differential diagnosis

Q1: What are the main clinical problems and differential diagnosis?


Diagnostic evaluation

Diagnostic evaluation

TSH 21.2 (0.4-4.4 uu/mL)

Free T4 0.4 (0.8-1.7 ng/dL)


Q2 etiologies of primary hypothyroidism

Q2: Etiologies of Primary Hypothyroidism?


Q3 identify organ which one is normal

Q3: Identify organ, which one is normal?


Q4 please describe the histopathology

Q4: Please describe the histopathology


Q5 what is your diagnosis

Q5: What is your diagnosis?


Q6 what is the primary immunologic defect in this entity

Q6: What is the primary immunologic defect in this entity?


Q7 clinical course

Q7: Clinical Course?


Case 5

Case 5

HISTORY 55-year-old female presents for physical exam. She has not seen a physician in many years. She feels well except for some mild dyspnea on exertion. She has no chest pain, no leg edema, no weight loss or weight gain, no heat or cold intolerance, no palpitations, no difficulty swallowing. She has no known chronic medical problems. She had an appendectomy at age 15. She takes no medications.


Endocrine pathology lab

PHYSICAL EXAMINATION:

Well-developed, pulse 72, BP 112/64. Both lobes of the thyroid gland are enlarged. Several small, bilateral nontender thyroid nodules are palpated. Exam is otherwise unremarkable.


Q1 what is the main clinical problem and differential diagnosis2

Q1: What is the main clinical problem and differential diagnosis?


Q2 based on history and physical what do you expect serum tsh to be

Q2: Based on history and physical, what do you expect serum TSH to be?


Endocrine pathology lab

Thyroid Ultrasound


Q3 identify the organ and describe pathologic changes

Q3: Identify the organ and describe pathologic changes


Q4 describe the histopathology

Q4: Describe the histopathology


Q5 what is your diagnosis1

Q5: What is your diagnosis?


Q6 clinical manifestations of this condition

Q6: Clinical Manifestations of this condition?


Endocrine pathology lab

Goiter Causing

Tracheal

compression


  • Login