甲状腺结节的评估与管理课件.ppt

1、Wu XiaohongWu XiaohongEndocrinology Department,Endocrinology Department,First Affiliated of Nanjing Medical First Affiliated of Nanjing Medical UniversityUniversityl lColloid(adenomatoid)noduleColloid(adenomatoid)nodulelThyroid adenomaThyroid adenoma Follicular adenoma Follicular adenoma Hurthle cel

2、l Hurthle celllThyroid cancerThyroid cancer Primary-Primary-Papillary,Follicular,Medullary,Anaplastic Papillary,Follicular,Medullary,Anaplastic Meetastatic/direct invasionMeetastatic/direct invasion Renal cell,Breast,Lung,Melanoma,Colon Renal cell,Breast,Lung,Melanoma,Colon cancer,Gastric carcinoma,

3、Pancreatic cancer,Gastric carcinoma,Pancreatic carcinoma,Head and neck tumors,carcinoma,Head and neck tumors,Hodgkins disease;Hodgkins disease;Thyroid lymphoma Thyroid lymphomalThyroid cyst-pure,complexThyroid cyst-pure,complexlThyroiditis-Acute,Subacute,Hashimotos;Thyroiditis-Acute,Subacute,Hashimo

4、tos;lRiedels diseaseRiedels diseaselGravesdiseaseGravesdiseaselInfectious-Abscess,Tuberculosis;Infectious-Abscess,Tuberculosis;lInfiltrative/granulomatous diseaseInfiltrative/granulomatous disease Sarcoidosis,Amyloidosis Sarcoidosis,AmyloidosislDevelopmental abnormalitiesDevelopmental abnormalities

5、Thyroid hemiagenesis Thyroid hemiagenesis Thyroglossal duct cyst Thyroglossal duct cyst Teratoma TeratomalNeck structures simulating thyroid nodulesNeck structures simulating thyroid nodules Aberrant subclavian artery and vein Aberrant subclavian artery and vein Lipomas Lipomas Extrathyroidal hemato

6、ma Extrathyroidal hematoma Esophageal diverticulum Esophageal diverticulum Parathyroid adenoma,cyst,or carcinoma Parathyroid adenoma,cyst,or carcinomalPrimary epithelial tumorsPrimary epithelial tumors Tumor of Tumor of follicularfollicular cells cells Benign:follicular adenoma Benign:follicular ade

7、noma Malignant:carcinoma Malignant:carcinoma Differentiated-papillary,folllicular Differentiated-papillary,folllicular Poorly differentiated-insular,others Poorly differentiated-insular,others Undifferentiated(anaplastic)Undifferentiated(anaplastic)Tumor of Tumor of C C cells-Medullary carcinoma cel

8、ls-Medullary carcinoma Tumor of Tumor of follicular and Cfollicular and C cells cells Mixed medullary-follicular carcinoma Mixed medullary-follicular carcinomalPrimary non epithelial tumorsPrimary non epithelial tumors Malignant lymphomas Malignant lymphomas Sarcomas Sarcomas Others OtherslSecondary

9、 tumorsSecondary tumorslConventionalConventional Trabecular/Trabecular/solidsolid(embryonal)adenoma(embryonal)adenoma Microfollicular(fetal)adenoma Microfollicular(fetal)adenoma Normofollicular(simple)adenoma Normofollicular(simple)adenoma Macrofollicular(Macrofollicular(colloidcolloid)adenoma)adeno

10、malVariantsVariants Hyalinizing trabecular adenoma Hyalinizing trabecular adenoma Oncocytic(oxyphilic or Hurthle cell)tumor Oncocytic(oxyphilic or Hurthle cell)tumor Adenomas with papillary hyperplasia Adenomas with papillary hyperplasia Hyperfunctioning(Hyperfunctioning(toxictoxic)adenoma)adenoma A

11、typical(hypercellular)adenoma Atypical(hypercellular)adenoma lA family history of HT,benign thyroid A family history of HT,benign thyroid nodule,or goiter;nodule,or goiter;lSymptoms of hypothyroidism or Symptoms of hypothyroidism or hyperthyroidism;hyperthyroidism;lPain or tenderness associated with

12、 the Pain or tenderness associated with the nodule.nodule.lYoung(70 years old)Young(70 years old)patient age;patient age;lMale sex;Male sex;lHistory of external neck radiation during History of external neck radiation during childhood or adolescence;childhood or adolescence;lPrevious history of thyr

13、oid cancer;Previous history of thyroid cancer;lRecent changes in speaking,breathing,or Recent changes in speaking,breathing,or swallowing;swallowing;lA family history of thyroid cancer or type 2 A family history of thyroid cancer or type 2 MEN.MEN.lfirst described in 1948 and pioneered by first desc

14、ribed in 1948 and pioneered by Scandinavian;Scandinavian;lnow gained wide acceptance as the most now gained wide acceptance as the most accurate diagnostic procedure for distinguishing accurate diagnostic procedure for distinguishing benign from malignant thyroid nodules benign from malignant thyroi

15、d nodules l it gives limited information in approximately 25 it gives limited information in approximately 25%of cases because of insufficient cellular yield or%of cases because of insufficient cellular yield or indeterminate diagnoses.indeterminate diagnoses.lThis in part is due to difficulty in di

16、stinguishing This in part is due to difficulty in distinguishing benign adenomas from malignant follicular benign adenomas from malignant follicular neoplasms;surgical excision of all such lesions neoplasms;surgical excision of all such lesions is therefore required is therefore required l The cytop

17、athologist can report that an The cytopathologist can report that an adequate smear contains normal cells only,adequate smear contains normal cells only,cells from benign non-tumorous conditions cells from benign non-tumorous conditions such as lymphocytic thyroiditis,or suspicious such as lymphocytic thyroiditis,or suspicious(indeterminate)or frankly malignant cells.(indeterminate)or frankly malignant cells.