内分泌系统疾病2009

内分泌系统疾病基础医学院病理学教研室goiterthyroidtumorAPUDomaDiffusenontoxicgoiterⅠ、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Thethyroidglandhasarightlobeandaleftlobeconnectedbyanarrowisthmus.

单层立方上皮胶质Normalthyroidseenmicroscopicallyconsistsoffollicleslinedbyaanepitheliumandfilledwithcolloid.Thisimmunoperoxidasestainwithantibodytocalcitoninidentifiesthe"C"cells

immunofluorescencetestpositiveforanti-microsomalantibodyimmunofluorescencepositivityforanti-thyroglobulinantibodyⅡ、Etiology氨基酸合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Ⅲ、PathogenesisⅣ、Pathologicalfeature1、StageofhyperplasiaDiffusehyperplasticgoiter小滤泡大量增生，胶质少2、StageofstoredcolloidDiffusecolloidgoiter滤泡扩张，大量胶质贮积弥漫性胶样甲状腺肿3、StageofnoduleNodulargoiter•Theredarrowpointstoanareaofscarring.•ThebluearrowpointstoalargeandtheyellowtoasmallfollicleThefollicularcellshaveroundtoovalnucleiwithsmallvisiblenucleoli.•Thefolliclecellcytoplasmisscant

可见结节形成，部分滤泡显著扩张，部分滤泡增生、萎缩。•Enlargedthyroidwithmoreenlargementonleft.

•Leftlobealsoshowsmultiplenodules

•Cutsurfaceofonelobeofthyroidglandshowingilldefinednodules.

•Focusofcysticdegenerationseen(bluearrow).

•Somehemorrhage(redarrow)andsomescarring.

Thisdiffuselyenlargedthyroidglandissomewhatnodular.Thispatientwaseuthyroid

甲状腺显著肿大，有结节形成。Ⅴ、Clinio-pathologicalrelationship1、甲状腺肿大2、压迫症状3、一般不伴有甲状腺功能亢进DiffusetoxicgoiterⅠ、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①促进机体的新陈代谢；②提高神经的兴奋性；③促进机体的生长发育。Ⅱ、EtiologyandPathogenesis

自身免疫性疾病Ⅲ、Pathologicalfeature•

Diffuselyenlargedredtanthyroidgland.

•Slightlobulationbutnolargecystformed.

光镜：①滤泡上皮增生呈高柱状,常有乳头形成；

②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;

③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。AdiffuselyenlargedthyroidglandassociatedwithhyperthyroidismisknownasGrave'sdisease.Atlowpowerhere,notetheprominentinfoldingsofthehyperplasticepithelium.Athighpower,thetallcolumnarthyroidepitheliumwithGrave'sdiseaselinesthehyperplasticinfoldingsintothecolloid.Ⅳ、Clinico-pathologicalrelationship③眼征:良性突眼征,恶性突眼征.

①T3.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.②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.ThyroidadenomaⅠ、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.腺瘤生长缓慢,大部分病人无明显症状,约1%的患者可出现甲亢。Ⅱ、Pathologicalfeature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.Hereisasurgicalexcisionofasmallmassfromthethyroidglandthathasbeencutinhalf.Themassiswell-circumscribed.Grosslyitfeltfirm.Byscintigraphicscanitwas"cold."Thisisafollicularadenoma.Hereisanotherfollicularneoplasm(afollicularadenomahistologically)thatissurroundedbyathinwhitecapsule.Itissometimesdifficulttotellawell-differentiatedfollicularcarcinomafromafollicularadenoma.病理组织学分型:滤泡型腺瘤单纯型腺瘤胶样型腺瘤胎儿型腺瘤胚胎型腺瘤嗜酸性细胞腺瘤•

Theredarrowpointstothepredominantlysmallfolliclescontainedintheadenoma.

•Thebluearrowspointtocompressednormalthyroid.

•Theyellowarrospointstonormalthyroidwithmuchlargerfolliclesthanmostofthosewithintheadenoma.

•

Theredarrowislocatedwithintheadenoma.

•Althoughcomposedoffollicularcells,littlecolloidisseen.

•Thebluearrowpointstothecapsuleoftheadenoma,afewstrandsofconnectivetissue.

•Theyellowarrowpointstocolloidwithinalargenormalfollicle

SimpleadenomaColloidadenomaFetaladenomaEmbryonaladenoma③前者周围甲状腺组织无压迫现象，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：①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；②前者滤泡大小不一致，一般比正常大；后者则相反；ThyroidcancerⅠ、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.

Ⅱ、Pathologicalfeature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.•

Thethyroidismassivelydistortedbyamultinodulargrowth.

•Shaggyexternalsurfaceduetodifficultyindissectingorganfromotherstructures,afeaturewhichsuggestsmalignancy.

•

Thedarkreddishbrowntissueischaracteristicofnormalthyroid.

•Thelargetannodulesrepresentcarcinoma.

•Nolargeareasofhemorrhageandnecrosisareseen.

Sectioningthroughalobeofexcisedthyroidglandrevealspapillarycarcinoma.Thisisthemicroscopicappearanceofapapillarycarcinomaofthethyroid.Thefrondsoftissuehavethinfibrovascularcores.Thefrondshaveanoveralpapillarypattern.•Thebluearrowpointstoapapillarystructure.•Thecenterisfibrovascular;thecellscoveringitareepithelial.•Theredarrowshowsasimilarpapillarystructureincrosssection.

•Thiscloseupshowsthatthecellsrangefromlowcolumnartocolumnar.•TheredarrowshowsacellwithanOrphanAnnieeyenucleus.

滤泡性癌:占甲状腺癌的10%--15%,多见于50岁以上的女性,以具有滤泡结构为特征.分化良好者与滤泡性腺瘤不易区别,可根据包膜或血管是否浸润来确定.分化差者早期出现血道转移,五年存活率为30%--40%.A2.9cmminimallyinvasivefollicularcarcinomaofthethyroid髓样癌:从滤泡旁细胞发生的癌,占甲状腺癌的5%,有家族发病倾向性,发病年龄多在30岁左右,恶性程度不一,平均存活6.6年.90%肿瘤分泌降钙素,有的还同时分泌生长抑素,前列腺素及其它多种激素样物质.Thisimmunoperoxidasestainwithantibodytocalcitoninidentifiesthe"C"cells

肉眼:多为单个肿块,无包膜,但境界清楚,较软,呈黄褐色.Atthecenterandtotherightisamedullarycarcinomaofthyroid.Atthefarrightispinkhyalinematerialwiththeappearanceofamyloid.Theseneoplasmsarederivedfromthethyroid"C"cellsand,therefore,haveneuroendocrinefeaturessuchassecretionofcalcitonin.光镜:肿瘤细胞为圆形,多角形或梭形的小细胞,排列成簇状,索状或小滤泡状.间质较丰富,常有淀粉样物质和钙盐沉着.MedullaryCarcinomaofThyroidThyrocalcitoninmarkersinMedullaryCa