قسم الـعملي "LAB Section"_الدفعة السادسة
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🌸 Hurthle cells (metaplasia cell)

Is large cell with pink (eosinophilic) cytoplasm and round nucleus with prominent nucleolus , lined follicles
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#Microscopic 

#Diagnosis 👉🏻  Riedel thyroiditis


#The_black_arrows
Dense fibrosis

#The_blue_arrows
Chronic inflammatory cell infiltrate

#The_yellow_arrow
Atrophied Follicles

#The_features
In the gross
- Stony hard due to fibrosis
- Tan or gray, woody
- avascular, no lobules apparent (adherant)
- Painless

In the Microscopic
- No normal lobular pattern
- Atrophied Follicles due to compression of dense fibrous tissue( pink color), which also infiltrates adjacent skeletal muscle
- Patchy lymphocytes
اي مش منظمة على شكل follicles ، منتشره فقط .
- No hurthle cells, no giant cells


NOTE
Cause Dysphagia and dyspnea
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#Microscopic

#Diagnosis 👉🏻 Subacute Granulomatous thyroiditis ( Dequervain diseases)



#The_black_arrows
Gaint cell

#The_features
- Inflammatory infiltrate composed of multinucleated giant cells(enclose fragmentof colloid) , neutrophils, macrophage, lymphocytes, plasma cells
- Variable background of fibrosis
- a painful enlarged thyroid
- usually self-limited
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#Microscopic

#Diagnosis 👉🏻 Subacute Granulomatous thyroiditis ( Dequervain diseases)


#The_black_area
Gaint cell 
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#Gross  

#Diagnosis 👉🏻  Multinodular goiters (simple goiter)


#The_white_arrows
Colloid ( reddish brown )

#The_black_arrow
Fibrosis septa

#The_features
- Nodular enlargement
- Asymetrical
- Firm
- Show multinodular are variable in size and shape , and are separate by septa

NOTE
Cause Pressure symptoms due to compression of trachea and esophagus
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#Gross  

#Diagnosis 👉🏻  Multinodular goiters


#The_white_area
Nodules

#The_black_arrow
Fibrosis Septa

#The_blue_stars
colloid

#The_yellow_arrows
Hemorrhage

#The_features
cut surface shows multinodular separated by fibrosis septa , hemorrhagic , brown colloid with focal calcification
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#Microscopic

#Diagnosis 👉🏻  Multinodular goiters


#The_blue_arrows 
Colloid

#The_black_area
Fibrosis septa 
و Nodule هي يلي محوطه ب septa كامل

#The_features
- Multinodular are variable in size and shape , separate by septa
- The single nodule composed of multiple thyroid follicles that are Dilated by Colloid with flattened to hyperplastic epithelium cells

✓ The follicles are variable in size , separated by fibrous stroma
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#Microscopic

#Diagnosis 👉🏻  Multinodular goiters


#The_white_area
Follicles

#The_black_area
Fibrosis septa 

#The_blue_arrows
Hemorrhage
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#Gross  

#Diagnosis 👉🏻  Colloid goiter -thyroid with colloid cysts-
( simple goiter/diffuse nontoxic goiter)


#The_white_arrow
Large colloid cyst

#The_black_arrow
Small colloid cyst

#The_features
Diffuse enlargement gland with brownish cysts, cut surface is brown (colloid)
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#Microscopic

#Diagnosis 👉🏻 Colloid goiter ( simple goiter/diffuse nontoxic goiter)


#The_black_area
Follicle 

#The_features
The follicles enlarged and filled by abundant colloid , with Flattened follicular epithelial lining
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#Microscopic

#Diagnosis 👉🏻 graves diseases


#The_black_area
 lymphoid follicle

#The_blue_arrows
papillary infoldings

#The_features
- Tall follicular cells (tall columnar epithelium cells) with papillae usually lacking fibrovascular cores
بسبب انه الخلايا حصل لها hyperplasia
- Nuclei are round, often basally located, rarely overlap
- Scalloping of colloid , or vacuoles due to follicular cells eat colloid for the production of hormones
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#Microscopic

#Diagnosis 👉🏻 graves diseases


#The_black_area
 lymphoid follicle

#The_blue_arrows
papillary infoldings

#The_brown_arrows
follicular cells appear columnar

#The_yellow_arrows
Scalloping or vacuoles
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#Gross

#Diagnosis 👉🏻 follicular thyroid neoplasm (follicular adenoma)


#The_white_arrow
Normal thyroid

#The_black_arrow
Capsule

#The_blue_star
Neoplasm (adenoma)

#The_features
- an encapsulated round
neoplasm with a uniform (solitary) nodule.
- bright brown appearance, surrounded by a rim of normal thyroid

NOTES
• Cause pressure symptoms
• Painless
• Cause hyperthyroidism
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#Gross

#Diagnosis 👉🏻 follicular thyroid neoplasm ( follicular adenoma )
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#Microscopic

#Diagnosis 👉🏻 follicular thyroid neoplasm


#The_black_arrow
Normal follicles

#The_red_area
Capsule

#The_white_arrow
Neoplasm (adenoma)

#The_features
- well differentiation
- an encapsulated round
neoplasm
- The tumor is composed of cloclosely packed follicles
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#Microscopic

#Diagnosis 👉🏻 follicular thyroid neoplasm


#The_black_arrow
Normal follicles

#The_red_area
Capsule

#The_white_arrow
Neoplasm (adenoma)
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#Gross

#Diagnosis 👉🏻  Papillary carcinoma


#The_blue_arrows
Normal thyroid

#The_black_arrows
Tumor tissue

#The_red_arrow
Calcification (Psammoma body)

#The_yellow_arrows
Tumor tissue
هنا عامله infiltrative

#The_features
- The tumor is usually solid
- grey white in color
- papillary projections
- sometimes it can be multifocal
- encapsulated or infiltrative
- calcification (appear white in color)
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#Gross

#Diagnosis 👉🏻  Papillary carcinoma


#The_blue_arrow
Colloid

#The_black_arrow
Normal thyroid

#The_white_arrow
papillary projections of the tumor

#The_white_star
Tumor tissue
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#Gross

#Diagnosis 👉🏻  Papillary carcinoma


#The_black_arrow
papillary projections of the tumor

#The_white_arrows
Tumor tissue

#The_blue_arrow
Calcification

#The_green_arrow
Normal thyroid
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#Microscopic

#Diagnosis 👉🏻  Papillary carcinoma


#The_white_arrow
Psammoma body

#The_green_arrows
Optical clear nuclei ( ground glass nuclei)

#The_blue_arrows
Papillae

#The_black_arrows
Papillae by transfert section

#The_features
Nuclear features
- Change of nuclear size and shape
• nuclear enlargement, elongation
Nuclear overlapping the nuclei are so crowded that they look like they are sitting on one another
Ground glass nuclei : it means the chromatin is finely dispersed and optically clear. This appearance is also known as “Orphan Annie Eye” 
groove nuclei are formed due to folding of  the unessential nuclear membrane
nuclear inclusions
Vascular Nuclei
- Nuclear membrane irregular

Other features
- randomly oriented papillae with fibrovascular cores
- Psammoma body in the fibrovascular cores
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