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1、内分泌系统疾病基础医学院病理学教研室goiterthyroid tumorAPUDomaDiffuse nontoxic goiter、Conception由于甲状腺素分泌不足、促甲状腺激素分泌增多，甲状腺滤泡上皮增生，胶质堆积而引起的甲状腺肿大。也称单纯性甲状腺肿，1、概念2、分类散发性甲状腺肿地方性甲状腺肿弥漫性非毒性甲状腺肿3、正常解剖组织学复习甲状软骨甲状腺The thyroid gland has a right lobe and a left lobe connected by a narrow isthmus. 单层立方上皮胶质Normal thyroid seen micros
2、copically consists of follicles lined by a an epithelium and filled with colloid.This immunoperoxidase stain with antibody to calcitonin identifies the “C“ cells immunofluorescence test positive for anti- microsomal antibodyimmunofluorescence positivity for anti- thyroglobulin antibody、Etiology氨基酸合
3、成贮存碘化重吸收分解释放T3、T4I-1、缺碘2、致甲状腺肿因子3、遗传与免疫、Pathogenesis、Pathological feature1、Stage of hyperplasiaDiffuse hyperplastic goiter小滤泡大量增生，胶质少2、 Stage of stored colloid Diffuse colloid goiter滤泡扩张，大量胶质贮积弥漫性胶样甲状腺肿3、Stage of noduleNodular goiter The red arrow points to an area of scarring. The blue arrow points
4、 to a large and the yellow to a small follicleThe follicular cells have round to oval nuclei with small visible nucleoli. The follicle cell cytoplasm is scant 可见结节形成，部分滤泡显著扩张，部分滤泡增生、萎缩。 Enlarged thyroid with more enlargement on left. Left lobe also shows multiple nodules Cut surface of one lobe of t
5、hyroid gland showing ill defined nodules. Focus of cystic degeneration seen (blue arrow). Some hemorrhage (red arrow) and some scarring. This diffusely enlarged thyroid gland is somewhat nodular. This patient was euthyroid甲状腺显著肿大，有结节形成。、Clinio- pathological relationship1、甲状腺肿大2、压迫症状3、一般不伴有甲状腺功能亢进Dif
6、fuse toxic goiter、Conception1、 定义：指血中甲状腺素过多，作用于全身 各组织所引起的临床综合症，临床上统称 为甲状腺功能亢进症，简称“甲亢”，又称 突眼性甲状腺肿。多见于女性, 男/女=1/4- 6，以20-40岁最多见。2、甲状腺激素的功能 促进机体的新陈代谢； 提高神经的兴奋性； 促进机体的生长发育。、Etiology and Pathogenesis自身免疫性疾病、Pathological feature Diffusely enlarged red tan thyroid gland. Slight lobulation but no large cyst
7、 formed. 光镜 ：滤泡上皮增生呈高柱状,常有乳头形成 ； 滤泡腔内胶质稀薄, 在紧靠上皮的胶质 内出现很多吸收空泡; 间质血管增生,明显充血,大量淋巴细胞 浸润,并形成淋巴滤泡。A diffusely enlarged thyroid gland associated with hyperthyroidism is known as Graves disease. At low power here, note the prominent infoldings of the hyperplastic epithelium.At high power, the tall columnar
8、 thyroid epithelium with Graves disease lines the hyperplastic infoldings into the colloid. 、Clinico-pathological relationship 眼征:良性突眼征,恶性突眼征. T3.T4分泌过多综合症:怕热多汗,多食善饥消 瘦,疲乏无力,神经过敏,脉搏加快, 脉压差增大. 甲状腺肿:双侧对称性弥漫性肿大,随吞咽上 下移动,左右叶上下极有震颤伴血管杂音.Thyroid adenoma、Conception甲状腺腺瘤是甲状腺滤泡上皮 发生的最常见的甲状腺良性肿瘤,多 见于青中年妇女.腺瘤生
9、长缓慢,大部 分病人无明显症状,约1%的患者可出 现甲亢。 、Pathological feature肉眼:多为单发,呈圆形或椭圆形, 大 小从直径数毫米到3-5cm,局限在一侧腺 体内,质地稍硬,表面光滑,无压痛,能随吞咽 上下移动,有完整包膜,肿瘤中心有时可见 囊性变,纤维化或钙化.Here is a surgical excision of a small mass from the thyroid gland that has been cut in half. The mass is well-circumscribed. Grossly it felt firm. By scint
10、igraphic scan it was “cold.“ This is a follicular adenoma.Here is another follicular neoplasm (a follicular adenoma histologically) that is surrounded by a thin white capsule. It is sometimes difficult to tell a well-differentiated follicular carcinoma from a follicular adenoma. 病理组织学分型:滤泡型腺瘤单纯型腺瘤胶样
11、型腺瘤胎儿型腺瘤胚胎型腺瘤嗜酸性细胞腺瘤 The red arrow points to the predominantly small follicles contained in the adenoma. The blue arrows point to compressed normal thyroid. The yellow arros points to normal thyroid with much larger follicles than most of those within the adenoma. The red arrow is located within the
12、 adenoma. Although composed of follicular cells, little colloid is seen. The blue arrow points to the capsule of the adenoma, a few strands of connective tissue. The yellow arrow points to colloid within a large normal follicle Simple adenomaColloid adenomaFetal adenomaEmbryonal adenoma前者周围甲状腺组织无压迫现
13、象，临近甲 状腺内与结节内有相似病变；后者周围有压 迫现象，周围与远处甲状腺组织均正常。 鉴别：结节性甲状腺肿常为多个结节，无完整包 膜；腺瘤多单发,有完整包膜；前者滤泡大小不一致，一般比正常大；后 者则相反；Thyroid cancer、Conception甲状腺癌是由甲状腺滤泡上皮或滤 泡旁细胞发生的恶性肿瘤,女性明显多于 男性.一般来说,甲状腺癌比其它器官的癌 发展相对缓慢,病程相对较长.值得注意的 是,有的原发灶很小,临床上常首先发现转 移灶.、Pathological feature 乳头状癌:最多见,占甲状腺癌的 40%-60%,青少年女性多见,恶性程度较 低, 生长较缓慢,预后较
14、好,五年存活率达 75%.以具有乳头状结构为特征,临床上往 往以颈部甲状腺旁淋巴结转移为首发症 状. The thyroid is massively distorted by a multinodular growth. Shaggy external surface due to difficulty in dissecting organ from other structures, a feature which suggests malignancy. The dark reddish brown tissue is characteristic of normal thyroid.
15、 The large tan nodules represent carcinoma. No large areas of hemorrhage and necrosis are seen. Sectioning through a lobe of excised thyroid gland reveals papillary carcinoma. This is the microscopic appearance of a papillary carcinoma of the thyroid. The fronds of tissue have thin fibrovascular cor
16、es. The fronds have an overal papillary pattern. The blue arrow points to a papillary structure. The center is fibrovascular; the cells covering it are epithelial. The red arrow shows a similar papillary structure in cross section. This closeup shows that the cells range from low columnar to columnar. The red arrow sh
