1、亚 急 性 甲 状 腺 炎 Subacute thyroiditis,又称 Granulomatous thyroiditis 肉芽肿性甲状腺炎或巨细胞性甲状腺炎 病因发病：病毒感染有关。疼痛性结节。可自愈。 病理改变甲状腺不均匀性肿大，质硬，粘连 早期，滤泡内单核淋巴细胞浸润后期，滤泡破坏, 胶质外溢，形成肉芽肿（多核巨细胞、巨噬细胞、淋巴细胞等），无干酪样坏死,Subacute granulomatous thyroiditis (DeQuervains disease), which probably follows a viral infection and leads to a pa
2、inful enlarged thyroid. This disease is usually self-limited over weeks to months and the patients return to a euthyroid state. The foreign body giant cells with destruction of thyroid follicles.,慢性淋巴细胞性甲状腺炎 Chronic lymphocytic thyroiditis,又称 Hashimoto thyroiditis(桥本甲状腺炎) 病因发病：自身免疫性甲状腺炎。 大体：甲状腺呈对称性中
3、度增大，质地硬 包膜完整。 镜下：甲状腺滤泡明显萎缩大量淋巴及巨噬细胞增生，淋巴滤泡形成结缔组织增生。,Hashimotos thyroiditis demonstrates the pink Hurthle cells at the center and right. The lymphoid follicle is at the left. Hashimotos thyroiditis initially leads to painless enlargement of the thyroid, followed by atrophy years later. 018,甲状腺腺瘤 thyr
4、oid adenoma,甲状腺上皮发生的良性肿瘤，最常见大多为单发， 有完整的包膜，压迫周围组织组织结构比较一致,似不同分化阶段的甲状腺组织。胚胎性腺瘤、胎儿性腺瘤、单纯性腺瘤、胶性腺瘤、嗜酸性腺瘤、非典型腺瘤结节性甲状腺肿： 3个以上结节、无完整的包膜、不压迫周围组织,甲 状 腺 癌 carcinoma of thyroid,乳头状癌Papillary carcinoma 滤泡癌Follicular carcinoma 髓样癌Medullary carcinoma 未分化癌Undifferentiated carcinoma,占40%-60%，青少年女性多见。恶性度低，淋巴道转移为主，血道转
5、移率低，5年生存率80%以上。 肉眼特点：质硬的结节（孤立或多个），可见细小乳头 组织学特点： 癌细胞呈乳头状排列，乳头分支较多； 癌细胞立方形，核呈毛玻璃样，无核仁 间质中常见砂粒体。,乳 头 状 癌 papillary carcinoma,Thyroid gland reveals papillary carcinoma. This neoplasm can be multifocal,because of the propensity to invade lymphatics within thyroid, and lymph node metastases are common. Th
6、e most favorite site of metastasis is to local lymph nodes in the neck. Some papillary carcinomas may first present as nodal metastases. most often arise in middle-aged females.,Thyroid gland reveals papillary carcinoma. Note the small psammoma body in the center. The cells have clear nuclei.,滤 泡 癌
7、Follicular carcinoma,占10%-15%，多见于40岁以上女性。恶性度较高，早期血性转移 组织学特点： 肿瘤细胞构成滤泡，高分化者与腺瘤不易区分 肿瘤细胞侵犯包膜或血管,未 分 化 癌 Undifferentiated carcinoma,占15% 分化差，转移早，恶性度高，预后差（多在一年内死亡） 患者多在50岁以上。 组织学分型：小细胞癌巨细胞癌梭形细胞癌,021,髓 样 癌 Medullary carcinoma,起源于滤泡旁细胞(也称C细胞)的恶性肿瘤 占5%，恶性程度不一，无包膜但境界清晰 组织学特点： 肿瘤细胞为圆形、多角形或梭形的小细胞， 排列成簇状、索状或小滤
8、泡状 肿瘤间质血管丰富，常有淀粉样物质和钙盐沉着 EM：可见神经分泌颗粒 IM：降钙素 Calcitonin(+),嗜铬素(+),CEA(+),Medullary carcinoma of thyroid. These neoplasms are derived from the thyroid “C“ cells , have neuroendocrine features such as secretion of calcitonin. Medullary carcinomas can be sporadic or familial. The familial kind are associated with multiple endocrine neoplasia syndrome. Right: the amyloid stroma has been stained with Congo red.,
