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PATOLOGIA DE LA GLANDULA

TIROIDES

Xavier Matias-Guiu
Hospital Universitari Arnau
de Vilanova, Lleida
Patología del Tiroides

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

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

• Hiperplasia (Bocio) Nodular


• Hiperplasia (Bocio) Difusa
(Graves – Basedow)
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.
CARCINOMA MEDULAR DE TIROIDES

ESPORADICO FAMILIAR

ASOCIADO NO ASOCIADO

MEN 2A MEN 2 B
CMT ESPORÁDICO CMT FAMILIAR
Medullary Thyroid Carcinoma

RET

RET
T
CMT ESPORÁDICO CMT FAMILIAR
Limfoma de Tiroide
Metastatic Tumors