FRCPath Part 2 Surgical Course Endocrine Pathology Dr Preetha Chengot
Case 1
Case No 1
Case 1
Clinical History F,19y. Adrenal mass. 30mm diameter yellow nodule.
Case 1
Histopathology Images
Case 1
What is your diagnosis?
Case 1
Diagnosis Pheochromocytoma
• MEN 2 • Von Hippel Lindau • Neurofibromatosis type 1 • Malignant phaeo more common in pts with SDHB mutation
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 1
Case 2
Case No 2
Case 2
Clinical History Female, 59y. Thyroid nodule.
Case 2
Histopathology Images
Case 2
What is your diagnosis?
Case 2
Diagnosis Medullary carcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 2
Case 3
Case No 3
Case 3
Clinical History Female, 43y.Neck mass.
Case 3
Histopathology Images
Case 3
What is your diagnosis?
Case 3
Diagnosis Metastatic dedifferentiated Hurthle cell carcinoma.
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 3
Case 4
Case No 4
Case 4
Clinical History 55 yr male. Large thyroid mass.
Case 4
Histopathology Images
Case 4
What is your diagnosis?
Case 4
Diagnosis Sarcomatous transformation in papillary thyroid carcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 4
Case 5
Case No 5
Case 5
Clinical History Female, 52y. Radiolucent lesion T3.
Case 5
Histopathology Images
Case 5
What is your diagnosis?
Case 5
Diagnosis Metastatic adrenal cortical carcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 5
Case 6
Case No 6
Case 6
Clinical History Female 42 y. Left level 4 lymph node.
Case 6
Histopathology Images
Case 6
What is your diagnosis?
Case 6
Diagnosis Metastatic diffuse sclerosing variant of papillary carcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 6
Case 7
Case No 7
Case 7
Clinical History Female, 53y. Right adrenal gland.
Case 7
What is your diagnosis?
Case 7
Diagnosis Collision tumour – adrenal cortical adenoma and ganglioneuroma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 7
Case 8
Case No 8
Case 8
Clinical History Female, 52y. Left thyroid lobectomy.
Case 8
Histopathology Images
Case 8
What is your diagnosis?
Case 8
Diagnosis Widely invasive follicular carcinoma.
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 8
Case 9
Case No 9
Case 9
Clinical History Male, 54y. Right adrenal gland.
Case 9
Histopathology Images
Case 9
What is your diagnosis?
Case 9
Diagnosis Composite pheochromocytoma-ganglioneuroma.
• MEN 2a Von Recklinghausen’s disease Neurofibromatosis Can be bilateral phaeo with ganglioneuroma, neuroblastoma or ganglioneuroblastoma. Bilateral phaeo- MPNST
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 9
Case 10
Case No 10
Case 10
Clinical History Male, 47y. Right adrenalectomy.
Case 10
Histopathology Images
Case 10
What is your diagnosis?
Case 10
Diagnosis Conn’s tumour
• Carney’s complex • MEN 1 • McCune- Albright syndrome • Familial hyperaldosteronism types 1 & 2 - congenital adrenal hyperplasia.
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 10
Case 11
Case No 11
Case 11
Clinical History Female, 60y.Left adrenalectomy
Case 11
Histopathology Images
Case 11
What is your diagnosis?
Case 11
Diagnosis Metastatic colorectal adenocarcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 11
Case 12
Case No 12
Case 12
Clinical History Female, 32y, Right thyroid lobectomy
Case 12
What is your diagnosis?
Case 12
Diagnosis Parathyroid carcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 12
• Hyperparathyroidism- jaw tumour syndrome • HRPT2 gene mutation • Fibroosseous lesions of jaws • Kidney cysts, hamartomas, carcinomas. • Late adolescence • Higher incidence of PTH carcinoma than MEN1 and 2a
Case 13
Case No 13
Case 13
Clinical History Male, 59y, Left thyroid lobectomy
Case 13
Histopathology Images
Case 13
What is your diagnosis?
Case 13
Diagnosis Papillary carcinoma with tall cell areas.
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 13
Case 14
Case No 14
Case 14
Clinical History Female, 52y. Large thyroid mass.
Case 14
Histopathology Images
Case 14
What is your diagnosis?
Case 14
Diagnosis Poorly differentiated (insular) carcinoma arising in papillary thyroid carcinoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 14
Case 15
Case No 15
Case 15
Clinical History Female, 59y. Adrenal mass.
Case 15
Histopathology Images
Case 15
What is your diagnosis?
Case 15
Diagnosis Metastatic malignant melanoma
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 15
Case 16 • Adrenal mass F 65
Diagnosis • Adrenal cortical carcinoma
• Li- Fraumeni Syndrome • Beckwith- Wiedemann syndrome • Weiss criteria • Reticulin algorithm
Marking Scheme 3.5
3.0
2.5
2.0 1.5 1.0
Case 15
Case 17 • Recurrent hyperparathyroidism 42 M
Diagnosis • Parathyromatosis
Criteria used for NIFTP diagnosis Major criteria
Minor criteria
Exclusion criteria
1. Encapsulation or clear demarcation 2. Follicular growth pattern (<1% papillae) 3. Nuclear Features of PTC (Score 2 or 3): Enlargement/crowding/ overlapping Elongation Irregular contours Grooves Pseudoinclusions Chromatin clearing
1. Dark/hypereosinophilic colloid 2. Irregularly-shaped follicles 3. Intratumoral acellular, eosinophilic fibrosis 4. “Sprinkling” sign (multifocal involvement within a single nodule) 5. Follicles cleft from stroma 6. Multinucleated giant cells within follicles
1. “True” papillae >1% 2. Psammoma bodies 3. Infiltrative border (capsular or lymphovascular invasion) 4. Tumor necrosis 5. High mitotic activity (>3/10 HPFs) 6. Cell/morphologic characteristics of other variants of PTC