Cook R.A., Stewart B. Colour Atlas of Anatomical Pathology

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ENDOCRINE

SYSTEM

Fig. 9.49

Multifocal

papillary

carcinoma

of the

thyroid.

F/21. Tumour

present throughout

the

enlarged gland.

Fig. 9.50

Solitary

papillary

carcinoma

the

thyroid.

F/43. This presented

as a

localized lump

in the

left

lateral lobe

of the

thyroid.

Figures. 9.48

9.50 demonstrate

the

three main ways

which papillary

carcinoma

of the

thyroid presents.

When

the

presentation

because

cervical

lymphadenopathy,

the

thyroid

may not be

palpable.

It is

necessary

remove

the

whole gland, because

the

primary tumour

may

multifocal

and

only identifiable

microscopic

examination.

Fig. 9.51

Medullary

carcinoma

of the

thyroid.

F/40. Tumour involved both lobes

the

gland, causing considerable

enlargement,

shown

this operative

photograph.

Fig. 9.49

cm Fig.

9.50

Fig. 9.51

201

ENDOCRINE

SYSTEM

Fig.

9.52

0 cm 1

Fig. 9.53

Fig. 9.52

Medullary

carcinoma

of the

thyroid.

Cut

surface

of the

tumour from

Figure

9.51.

It is

fleshy

and

yellowish

colour.

One

would need

examine

the

microscopic sections

to see the

anaplastic

tumour with amyloid stroma before making

confident diagnosis

this case.

Fig. 9.53

Multiple

neurofibromas

the tip of the

tongue

of the

patient

Figure

9.51. During life

she had

mild

dysphagia

and

diarrhoea. Postmortem

examination,

years after

her

first

diagnosis, revealed

the

presence

ganglioneuromatosis

of the

oesophagus

and

small intestine.

202

ENDOCRINE

SYSTEM

Fig. 9.54

Phaeochromocytoma.

One of the

bilateral

phaeochromocytomas removed from

the

patient

Figure 9.51.

There

appear

to be two

larger,

fairly discrete areas

tumour

(one

them being partially cystic)

and two

smaller, discrete

areas

tumour within this adrenal gland.

The

patient exhibited

the

features

multiple

endocrine

adenopathy

syndrome

type

2B. Two of her

siblings were tested

and

they

did not

have

it, but her

mother probably died from secondary medullary

carcinoma

of the

thyroid.

Fig. 9.55 Secondary

medullary

carcinoma

of the

thyroid

in the

liver.

F/55. This woman

had had a

medullary carcinoma

the

thyroid removed

years before

she

presented with

Cushing's syndrome,

months before

her

death. This

demonstrates

two of the

other features

medullary carcinoma:

(1)

that

grows slowly

and

metastases

may not

appear until

many

years after removal

of the

primary;

(2)

that

it is one of the

tumours that produces ACTH,

and the

clinical presentation

may

occur

because

of the

effects

this.

Fig. 9.54

Fig.

9.55

203

ENDOCRINE

SYSTEM

Fig. 9.56

Fig.

9.57

Fig.

9.58

Fig. 9.56

Amyloid

goitre.

F/12 from Papua

New

Guinea.

The

thyroid

has

been almost completely replaced

firm,

homogeneous pale tissue which microscopically

was

amyloid.

Amyloid

goitre

relatively common

Papua

New

Guinea,

where

occurs

part

of a

primary amyloidosis syndrome,

the

other

main feature

which

normotensive renal failure.

Fig. 9.57 Thyroglossal cyst. F/40. Situated

in the

midline,

just above

the

thyroid cartilage.

Fig. 9.58 Thyroglossal

cyst.

Surgical specimen showing

the

cyst filled with glistening

colloid.

204

BONES, JOINTS

AND

CONNECTIVE

TISSUE

BONES,

JOINTS

AND

CONNECTIVE

TISSUE

Fig.

10.3

0 cm 1

Fig. 10.1

Osteogenesis

imperfecta.

Patients with this

condition have abnormally fragile bones

and

suffer

multiple

repeated fractures. They usually have blue-coloured sclerotics,

shown

this

eye

from

child

who

died from this condition.

Fig. 10.2

Achondroplasia.

M/6.

The

patient demonstrates

the

short arms

and

legs

this inherited abnormality

endochondral ossification.

Fig. 10.3

Multiple

enchondromata

(Ollier's

disease).

M/28.

The

head

of the

humerus

greatly expanded

by the

intramedullary chondromas.

206

Fig.

10.1

Fig.

10.2

BONES,

JOINTS

AND

CONNECTIVE

TISSUE

Fig. 10.4

Acute

osteomyelitis.

F/21.

There

is a

large collection

of pus in the

medullary cavity

of the

shaft

of the

femur.

This patient died from acute

leukaemia,

and the

infection resulted

from

her

immune deficiency state.

Fig. 10.5

Chronic

osteomyelitis.

This

specimen shows death

of the

bone

the

shaft

of the

tibia. This

has

separated completely

as a

sequestrum.

New

bone

- an

involucrum

has

formed

around

the

dead bone. Lacunae

open

through

the

involucrum

and

result

discharging

sinuses

on the

skin

surface.

This

specimen

was

prepared

in the

1770s

John Hunter

and is

displayed

the

Museum

of the

Royal

College

Surgeons

London.

demonstrates

the

long-term complications

acute

osteomyelitis

before

the

days

antibiotics.

The

pressure

of the pus

causes

death

of the

bone.

Pus

then

forms

abscess, which ruptures

through

the

skin, producing chronic

discharging sinuses.

Then,

progressively,

new

bone forms

on the

scaffolding

of the

dead bone. Progressively, some

or all of

the

dead

bone (sequestrum) discharges

through

the

sinuses.

The

Museum

catalogue does

not

record

an age or sex

for

this specimen.

Fig. 10.4

Fig. 10.5

207

BONES,

JOINTS

AND

CONNECTIVE

TISSUE

Fig.

10.6

Fig.

10.7

Fig. 10.6

Tuberculosis

of the

spine.

F/4. This

child

from

Papua

New

Guinea

grossly emaciated from

the

disseminated

infection.

The

deformity

in the

lumbar region

characteristic

involvement

of the

lumbar vertebrae

tuberculous infection.

The

diseased vertebrae 'collapsed'.

208

Fig. 10.7

Tuberculosis

of the

spine.

F/4.

X-ray

of the

child

shown

Figure 10.6.

The

collapsed lumbar vertebrae

are

easily

seen.

BONES, JOINTS

AND

CONNECTIVE

TISSUE

Fig. 10.8

Fig. 10.8 Tuberculosis

in the

spine

of a

young

boy

(Pott's

fracture

of the

vertebrae). This

is a

specimen from

one of

Percival

Pott's original cases from about 1770.

It is

housed

in the

Pathology Museum

of St

Bartholomew's Hospital, London.

Fig. 10.9

Tuberculous

psoas abscess.

Two

lumbar

vertebrae

involved

tuberculosis with extension

of the

caseation into

the

psoas muscle. When such infection spreads

along

the

psoas,

the

abscess

may

'point'

in the

groin.

Fig. 10.10 Secondary carcinoma

in the

lumbar

vertebrae.

M/68. Cream-coloured homogeneous deposits

can

seen

each vertebral body,

the

biggest being

in the

lower

one.

The

primary tumour

was a

bronchogenic carcinoma

of the

lung.

Fig. 10.10

209

Fig.

10.9

BONES,

JOINTS

AND

CONNECTIVE

TISSUE

Fig.

10.14

Fig.

10.15

210

Fig.

10.11

Fig.

10.12

Fig.

10.13