View source for IPLab:Lab 7:Adenoma

== Clinical Summary == 
This 80-year-old white female's death came as the result of cardiopulmonary disease -- hypertension, coronary artery disease, pulmonary emphysema and cardiac hypertrophy.

During a routine postmortem examination, this patient's thyroid gland was found to be nodular. The right lobe contained several colloid nodules. Located in the left lobe was a 2-cm well-circumscribed mass.

== Images ==
<gallery heights="250px" widths="250px">
File:IPLab7Adenoma1b.jpg|This is a low-power photomicrograph of a nodule found in the thyroid of this case. Note that the mass is well-circumscribed and there is a sharp line of demarcation between the mass and the adjacent thyroid tissue (arrows).
File:IPLab7Adenoma2b.jpg|This is a higher-power view of the border between the tumor mass and the adjacent thyroid tissue. Note that the mass has a  capsule (arrow). Also note the different morphology between the adenoma on the bottom (very cellular, dense follicles) and the adjacent normal thyroid (larger follicles, colloid). 
File:IPLab7Adenoma3b.jpg|This is another higher-power photomicrograph of the adenoma (bottom) and the adjacent thyroid tissue (top). Note the capsule(*) separating the adenoma from the adjacent normal thyroid tissue.
File:IPLab7Adenoma4b.jpg|This is a photomicrograph of the adenoma. Note that the follicular architecture is well developed throughout this section. 
</gallery>

== Virtual Microscopy ==
<peir-vm>IPLab7Adenoma</peir-vm>

== Study Questions ==
* <spoiler text="What is the likelihood that this tumor would have been 'hot' or would have taken up radioactive iodine?">Benign tumors are more likely to take up radioactive iodine than malignant tumors.</spoiler>
* <spoiler text="What are the differential diagnoses for thyroid masses?">Goiter, adenomas, neoplastic tumors of the thyroid.</spoiler>
* <spoiler text="Although usually asymptomatic, what important clinical problems can occur in patients with benign thyroid adenomas?">They may:
# increase in size and cause pressure symptoms in the neck,
# achieve a certain size and then plateau,
# suddenly enlarge and become painful owing to intralesional hemorrhage, and
# rarely synthesize T3 or T4 and cause hyperthyroidism that is usually mild and unassociated with ophthalmopathy.</spoiler>
* <spoiler text="Is someone with a thyroid adenoma at risk for thyroid carcinoma?">No. The risk of malignant transformation is almost negligible.</spoiler>

== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/850823-overview eMedicine Medical Library: Evaluation of Solitary Thyroid Nodule]
* [http://emedicine.medscape.com/article/127491-overview eMedicine Medical Library: Thyroid Nodule]

=== Journal Articles ===
* Tonacchera M, Vitti P, Agretti P, Ceccarini G, Perri A, Cavaliere R, Mazzi B, Naccarato AG, Viacava P, Miccoli P, Pinchera A, Chiovato L.  [http://www.ncbi.nlm.nih.gov/pubmed/10566665 Functioning and nonfunctioning thyroid adenomas involve different molecular pathogenetic mechanisms].  ''J Clin Endocrinol Metab'' 1999 Nov;84(11):4155-8.

=== Images ===
* [{{SERVER}}/library/index.php?/tags/140-thyroid PEIR Digital Library: Thyroid Images]
* [http://library.med.utah.edu/WebPath/ENDOHTML/ENDOIDX.html WebPath: Endocrine Pathology]

== Related IPLab Cases ==
* [[IPLab:Lab 6:Graves Disease|Lab 6: Thyroid: Graves Disease]]

{{IPLab 7}}

[[Category: IPLab:Lab 7]]