Index

A tumor size and weight , 174 ACC. See Adrenal cortical carcinoma (ACC) unilateral tumors , 165 ACTH. See Adrenocorticotropic hormone (ACTH) Adrenal cortical hyperplasia Acute thyroiditis , 14 autosomal dominant disorder , 159 Adenomatoid tumor description , 159 asymptomatic and identifi ed , 204 diffuse cortical cells and focal lipomatous ectopic ACTH production , 160 metaplasia, 205 enlargement , 161 spaces, small glandular , 205 pancreatic neuroendocrine tumor , 160 Adrenal cortical carcinoma (ACC) secondary hyperplasia , 160 aldosteronism , 168 zona fasciculata , 160 alveolar pattern , 169 nodular cellular and nuclear pleomorphism , 167 defi nition , 161 cystic degeneration , 171 endocrine atypia , 162 cytotoxic chemotherapy , 173 macro- and micronodules , 161, 162 description , 173 PPNAD (see Primary pigmented nodular adrenocortical eosinophilic cells , 167, 168 disease (PPNAD)) eosinophilic cytoplasm , 170, 172, 179, 180 PRKAR1A gene , 159 feminizing/virilizing tumors , 165 Adrenal cysts histologic features , 173 CD31-immunostained sample , 156 insulin-like growth factor 2 , 173 endothelial-lined adrenal cysts , 156 keratin , 181 fi brous-walled adrenal pseudocyst , 156 lipid-rich adrenal cortical adenoma cells , 168 , 155 lipofuscin , 171 pseudocysts , 155, 156 lipomatous/myelolipomatous , 167 vague symptoms , 155 lymphoma , 177 Adrenal gland mitotic fi gures , 175 abnormalities and pathogenic processes , 147 multivariate analysis , 165 adipocytes and lymphocytes , 151 myxoid change central adrenal vein , 150 and epithelioid cells , 170 chromaffi n cells , 150 and spindle cells , 170 encapsulated cortical extrusions , 151 necrosis , 175 formalin , 148 nuclear-to-cytoplasmic ratios heterotopia (see Heterotopia) and cellular monotony , 174 medullary hyperplasia , 147 monotonous cells , 176 pheochromocytomas , 147 mucin , 178 right and left adrenal glands , 148 pleomorphism , 176 scattered adipocyte , 150 oncocytic adenomas , 171 zona pale lipid-rich cell , 166 fasciculata , 149 pale-staining cells , 167 glomerulosa , 148 pediatric tumors , 173 reticularis , 149 polymorphous cells , 176 Adrenal gland tumors primary hyperaldosteronism , 168 adenomatoid , 204–205 pseudoglandular growth pattern , 169 angiosarcoma , 202 pseudoglandular pattern , 177 leiomyosarcoma , 203 punctate microscopic foci , 175 , 204 small cell cytomorphology , 178 Adrenal medullary hyperplasia spindle cell change , 179 description , 187 spironolactone bodies , 169 MEN2A, MEN2B and cystic subclinical Cushing syndrome , 166 fi brosis , 188 trabecular growth pattern , 176 , 188 tumor behavior , 170 trabecular growth pattern , 188

L.A. Erickson, Atlas of Endocrine Pathology, Atlas of Anatomic Pathology, 211 DOI 10.1007/978-1-4939-0443-3, © Springer Science+Business Media New York 2014 212 Index

Adrenal colloid , 34 adjacent adrenal cortical tissue , 184 cystic-appearing lymph node metastasis , 36 bilateral , 183 growth patterns , 34 cortical tissue , 184 intranuclear holes , 34 description , 183 invasive , 32 hematopoietic elements , 184 low-power photomicrograph , 35 hypersecretion , 183 multiple ill-defi ned fi rm masses , 32 trilineage hematopoietic cells , 185 “Orphan Annie” nuclei , 32 yellow adipose tissue , 184 papillae with fi brovascular cores and cystic change , 32, 33 Adrenal tumors, metastatic prominent papillae with fi brovascular cores , 32, 33 breast cancer , 209 psammoma bodies , 33 cortical , 207 Columnar variant of PTC , 47 medullary , 207 Composite pheochromocytoma melanoma , 208 composition , 194 neuroendocrine , 207 ganglioneuroma , 194 primary , 207 Cowden syndrome , 25 renal cell carcinoma , 208 Cribriform-morular variant of PTC Adrenocorticotropic hormone (ACTH) aberrant nuclear and cytoplasmic staining, β-catenin, 41 in congenital adrenal hyperplasia , 159 arches and anastomosing bars , 40 cortical hyperplasia , 159 autosomal dominant syndrome , 40 neuroendocrine tumor , 160 morules , 41 Amiodarone thyroid , 5–6 nuclear staining, TTF1 , 41 Amyloid goiter , 25, 28–29 spindle/oval tumor cells , 41 Anaplastic thyroid carcinoma adjacent structures, invasion , 72 atypical spindle cells , 73 D composition , 71, 73 de Quervain thyroiditis. See Granulomatous distant metastases , 71 (de Quervain) thyroiditis hemorrhage and necrosis areas , 72 Diffuse hyperplasia. See Graves disease Hurthle cell carcinoma, dedifferentiation , 74 Diffuse sclerosing variant of PTC , 43 papillary thyroid carcinoma (PTC) , 74–75 Dyshormonogenetic goiter , 27–28 Rhabdoid features , 74 Riedel (fi brous) thyroiditis , 71, 73 TTF1 , 71 F vascular invasion , 72 Familial isolated (FIH) , 131 Angiosarcoma , 92, 202 Fibrous (Riedel) thyroiditis , 13, 16, 71, 73 Atypical FIH. See Familial isolated hyperparathyroidism (FIH) composition , 128 Focal lymphocytic thyroiditis , 13, 18 hypercellular and fi brosis , 128 Follicular adenoma indolent behavior , 128 adipocytes , 57 irregular growth and fi brous bands , 129 clear cell change , 56, 57 Ki67 labeling index , 129 degenerative feature and hyalinization , 59 monotonous growth , 129 description , 55 parathyroid carcinoma , 128 extensive signet ring cell change , 58 immunoperoxidase markers , 56 medium-power view , 59 B metaplastic bone/ossifi cation , 59 Breast cancer , 209 microfollicular and macrofollicular architectural Brown tumor of bone , 113 pattern, 56 mucin , 57 prominent spindle cell change , 58 C signet ring cell change , 58 Calcifi cations , 81 thyroid , 56 Carcinoembryonic antigen (CEA) , 84 Follicular carcinoma Carcinoma showing thymus-like differentiation (CASTLE) , 94–95 capsular invasion , 60 CASTLE. See Carcinoma showing thymus-like clear cell change , 61, 62 differentiation (CASTLE) description , 60 C cells, tumors mushroom-like area , 60 hyperplasia , 78 signet ring cell change , 62 medullary thyroid microcarcinoma , 78–79 spindle cell change , 62 MTC ( see Medullary thyroid carcinoma (MTC)) thrombus , 61 CEA. See Carcinoembryonic antigen (CEA) vascular invasion , 60, 61 Chief cells, parathyroid histology , 103–104 Follicular thyroid neoplasms Classic PTC adenomas (see Follicular adenoma) cervical and ipsilateral lymph nodes , 35 carcinomas (see Follicular carcinoma) characteristic cytologic features , 33 cytologic specimens , 55 Index 213

histologic patterns , 55 extracellular eosinophilic hyaline fi brosis , 52 malignancy , 55 prominent eosinophilic intranuclear tumors with extensive vascular invasion , 55 inclusions , 52 Follicular variant of papillary thyroid RET/PTC rearrangements , 51 carcinoma (FVPTC) tumor cells , 52 characteristic features , 38 Hyperparathyroidism–jaw tumor syndrome classic PTC , 37, 39 (HP-JT), 131 cumulative diagnosis , 37 elongated follicles , 38 encapsulated tumors , 37 L HBME-1 immunostain , 40 Langerhans cell histiocytosis , 91 low-power photomicrograph , 39 Leiomyosarcoma , 203 numerous patterns , 38 Lipoadenomatous hyperplasia , 114 photomicrograph shows , 38 Lipohyperplasia , 109 thyroid parenchyma , 39 Low-grade fi bromyxoid sarcoma , 93 Lymphoma , 90

G Ganglioneuroma M adrenal gland , 198 Medullary thyroid carcinoma (MTC) needle core biopsy , 198 acinar growth pattern , 82 recognizable tumor , 197 amyloid , 79 spindled Schwann cells , 199 calcifi cations , 81 stroma-rich , 198 , 83 Granulomatous (de Quervain) thyroiditis CEA , 84 multinucleated giant cells , 15 composition , 81 noncaseating granulomas , 15 epithelioid cells , 80 patchy areas, neutrophils and microabscesses , 14 growth patterns , 80 patients , 13, 14 intranuclear pink holes , 80 Graves disease neuroendocrine markers , 83 complications , 21 oxyphilic , 82 cut section , 22 papillary architectural pattern , 83 diffuse hyperplasia , 23 recognization , 82 diffusely enlarged thyroid , 22 solid growth, necrosis , 81 follicular epithelium , 24 spindle cells , 80 hyperthyroidism , 21 syndromic , 79 low-power photomicrograph , 22 TTF1 , 83, 84 papillae , 22, 23 Metastases to parathyroid patients treatment with iodine , 24 carcinoma , 144 thyroid carcinomas , 21 medullary thyroid carcinoma , 144 thyroid parenchyma , 22 primary thyroid tumors , 143 thyroid tumors , 144 Metastases to thyroid H breast cancer metastatic , 100 Hashimoto thyroiditis melanoma metastatic , 101 fi brous variant , 18 primary tumors , 99 prominent lymphoid follicles , 17 renal cell carcinoma metastatic , 100 solid cell nests , 18 resection , 99 thyroid , 13 Minocycline thyroid , 5–6 H&E. See Hematoxylin and eosin (H&E) MTC. See Medullary thyroid Hematoxylin and eosin (H&E) , 1, 4 carcinoma (MTC) Heterotopia Multinodular goiter , 26–27 adipocytes and foci, lymphocytes , 152 Multiple endocrine neoplasia (MEN) types cortical nodule , 152 1 and 2A, 109 embryologic path , 152 subcapsular space , 152 Hobnail variant of PTC , 48 N HP-JT. See Hyperparathyroidism–jaw tumor Nephrolithiasis , 121 syndrome (HP-JT) Hurthle cell adenoma , 63, 64 children , 197 Hurthle cell carcinoma , 65 classifi cation , 197, 199 Hurthle cell thyroid neoplasms , 63–65 ganglion and Schwann cells , 197 Hyalinizing trabecular tumor malignant , 197 Carney’s group , 51 nests , 200 description , 51 primordial neural crest cells , 199 encapsulation and separation , 52 sporadic , 197 214 Index

Normal thyroid glandular growth pattern , 135 central lumen containing colloid , 3 hemosiderin deposition , 134 chromogranin immunostain , 4 HRPT2 tumor suppressor gene , 131 cut section , 2 hyperplasia and , 133 fat cells , 4 intrathyroidal , 133 follicles , 3 invasive growth , 132 gross image , 2 monotonous growth pattern , 134 immunopositivity, TTF1 , 3 multiple mitotic fi gures , 134 thyroglobulin, immunopositivity , 3 nuclear atypia and mitotic activity , 137 oxyphilic , 135–136 palisading , 136–137 O perithyroidal soft tissue , 132 Oncocytic/Hurthle cell , 44 postoperative radiation , 131 Oxyphilic cells , 104 prognostic factors , 131 PTH , 131 skeletal muscle, neck , 132–133 P trabecular growth pattern , 136 Palpation thyroiditis , 7 vascular thrombus , 133 Papillary thyroid carcinoma (PTC) Parathyroid histology BRAF mutations , 31 chief cells , 103–104 classic (see Classic PTC) clear cytoplasm and pyknotic nuclei , 105 columnar variant , 47 cysts and infl ammation , 103, 105–106 cribriform-morular variant (see Cribriform-morular normal , 104 variant of PTC) in older patients , 105 diffuse sclerosing variant , 43 oxyphilic cells , 104 and FVPTC (see Follicular variant of papillary thyroid parathyroiditis , 106–107 carcinoma (FVPTC)) Parathyroid hormone (PTH) , 109, 131 histologic variants , 31 Parathyroid hyperplasia hobnail variant , 48 asymmetric enlargement , 109 microcarcinoma , 36, 37 brown tumor of bone , 113 oxyphilic variant , 44 lipoadenomatous hyperplasia , 114 patients , 31 lipohyperplasia , 109 radioactive iodine , 31 multiple endocrine neoplasia (MEN) types 1 and 2A , 109 solid variant , 45 primary tall cell variant , 46 adipocytes , 110 warthin-like variant , 42 chief and clear cells , 111 Papillary thyroid microcarcinoma glandular growth pattern , 112 benign thyroid disease , 37 nodular enlargement , 110 gross photograph , 36 nodular grow , 111 , 96 nuclear palisading , 112 Parathyroid adenoma oxyphilic cells , 111 atypical parathyroid adenoma , 128–129 parenchymal mass , 110 chief cell primary clear cell hyperplasia , 113–114 composition , 123 PTH , 109 cystic change , 124 secondary degenerative edema , 123 chief cells , 116 diffuse cellularity , 122 diffuse hyperplasia , 117 edematous change , 123 fi brosis and fi brous bands , 117 features , 122 foci of amyloid , 118 fi brous connective tissue capsule , 122 hemosiderin deposition , 117 glandular growth , 124 nodular growth , 115 hyalinization and metaplastic bone , 123 nodular hyperplasia , 115 large dilated follicular-like spaces , 125 oxyphilic cells , 116 parenchyma cells and adipocytes , 122 parathyroid tissue, implant , 118 signet ring cell change , 124 parenchymal mass , 115 spindle cell change , 125 tertiary parathyroid hyperplasia , 118 stromal fat , 123 Parathyroiditis , 106–107 clear cell , 126 Parathyroid lipoadenoma , 127 molecular basis , 121 Parathyromatosis nephrolithiasis , 121 calcimimetic agents , 139 oxyphil cell , 125–126 features , 140 parathyroid lipoadenoma , 127 hypercellular parathyroid tissue, nodules , 140 screening calcium , 121 serum calcium level , 140 Parathyroid carcinoma Pendred syndrome , 25 clear cell , 137 Pheochromocytoma dilated follicular structures , 135 adrenal cortical adenoma , 193 features , 132 alveolar and trabecular growth patterns , 191 FIH , 131 composite , 194 Index 215

degenerative features, hyalinization Thyroid goiter and fi brosis , 192 amyloid , 25, 28–29 description , 187 Cowden syndrome , 25 epithelioid cells , 190 dyshormonogenetic goiter , 27–28 histologic features , 190 endemic , 25 macroscopically cystic lesions , 192 malignancy , 25 metastasis, skull , 193 medications , 25 mitotic fi gure , 192 meta-analysis , 25 neuroendocrine tumors , 190 multinodular goiter , 26–27 nuclear nontoxic , 25 pleomorphism , 191 Pendred syndrome , 25 pseudoinclusions , 191 toxic multinodular , 25 paraganglioma , 193 Thyroid histology pseudocyst , 193 calcitonin mRNA , 1 syndrome-associated tumors , 189 C cells , 1 yellow adrenal cortical tissue , 189 colloid , 1 “zellballen” growth pattern , 190 ectopic thyroid tissue , 8 Poorly differentiated thyroid carcinoma immunohistochemical stains , 1 external-beam radiotherapy , 67 minocycline and amiodarone , 5–6 insular growth pattern , 68 normal thyroid (see Normal thyroid) necrosis , 68 palpation thyroiditis , 7 operational pathologic defi nition , 67 radiation changes , 5 relapse-free and cause-specifi c survival solid cell nests (see Solid cell nests) rates , 67 , 9–10 TP53 mutations , 68 thyroglossal duct cyst , 9 Turin criteria , 67 thyroid needle-biopsy site , 7 uniform tumor cells , 68 TTF1 , 1 PPNAD. See Primary pigmented nodular adrenocortical Thyroiditis disease (PPNAD) acute infl ammation , 13, 14 Primary pigmented nodular adrenocortical de Quervain granulomatous , 13, 14–15 disease (PPNAD) fi brous (Riedel) , 13, 16 affected adrenal glands , 162 focal lymphocytic , 18 bilateral micronodular hyperplasia , 162 Hashimoto , 13, 17–18 corticomedullary junction , 163 Thyroid needle-biopsy site , 7 description , 159 Thyroid-stimulating hormone (TSH) , 3 lipofuscin , 163 Thyroid transcription factor 1 (TTF1) , 1, 3, 83, 84 zona reticularis–type , 163 Thyroid tumors angiosarcoma , 92 CASTLE , 94–95 R langerhans cell histiocytosis , 91 Renal cell carcinoma , 208 low-grade fi bromyxoid sarcoma , 93 Rhabdomyosarcoma , 94 lymphoma , 90 Riedel thyroiditis. See Fibrous (Riedel) thyroiditis paraganglioma , 96 rhabdomyosarcoma , 94 sclerosing mucoepidermoid carcinoma , S 87–88 Schwannoma , 203 solitary fi brous tumor , 91 Sclerosing mucoepidermoid carcinoma squamous cell carcinoma , 89 in adult women , 87 synovial sarcoma , 93 invasive growth recognization , 88 teratoma , 95 mucous cells , 88 TSH. See Thyroid-stimulating hormone (TSH) Solid cell nests TTF1. See Thyroid transcription factor 1 (TTF1) oval cells with fi ne chromatin , 4 PTCs , 4 Solid variant of PTC , 45 U Solitary fi brous tumor , 91 Unusual adrenal tumors Squamous cell carcinoma adenomatoid , 201, 204–205 adolescent, Hashimoto thyroiditis , 89 angiosarcoma (see Angiosarcoma) keratinization , 89 leiomyosarcoma , 203 pure squamous differentiation , 89 malignant melanoma , 201 Struma ovarii , 9–10 primary lymphoma , 201 Synovial sarcoma , 93 schwannoma , 203 teratoma , 204

T Tall cell variant of PTC , 46 W Teratoma , 95, 204 Warthin-like variant of PTC , 42 Thyroglossal duct cyst , 9