内分泌系统疾病_.ppt

Figure 20-18 Electron micrograph of medullary thyroid carcinoma. These cells contain membrane-bound secretory granules that are the sites of storage of calcitonin and other peptides (original magnification ×30,000). * Behavior: Middle grade malignant 5-year survival rate:50% 30%的病人由于肿瘤合成血管活性肠肽（VIP）和或前列腺素而出现腹泻。虽然降钙素水平高，但绝大部分血钙水平正常。 绝大部分散发，其余家族性大多呈常染色体显性遗传。 * Grossly: Tumors are massive, ill-circumscribed nodules without capsules, invaded surrounding tissues.肿块较大，边界不清，无包膜，浸润性生长 The cut surface is gray-white.切面灰白 Hemorrhage and necrosis often occur 有出血坏死 * Nodular stage Pathologic changes Multinodular, bilaterally, asymmetrically enlarged May more than 2000 gram. Nodules are not uniform in size and are well-circumscribed, without capsules or with incomplete capsules. Hemorrhage, fibrosis, calcification, and cystic change in cut section * 结节性甲状腺肿 Nodular goiter * Figure 20-10 Multinodular goiter. The gland is coarsely nodular and contains areas of fibrosis and cystic change. Note the brown gelatinous colloid characteristic of this condition (colloid goiter). * Pathologic changes Microscopy Follicles are not uniform in size. Partial follicles are highly enlarged and colloid-rich, and the epithelial cells involute and become flattened. Partial follicular cells proliferate and become columnar or form fake papillae or small follicles. The hyperplastic connective tissue divide and enclose thyroid tissue to result in the formation of irregular nodules * Clinical symptom * Results Malignant change * 与21三体综合症鉴别：面部黏液性水肿，T3T4低TSH高，染色体核型分析。早期长期终身甲状腺激素替代治疗。 * 与抑郁症鉴别：激素水平测定。 * * 2003-09-22 07:45　 * Benigh tumor derived from thyroid follicular epithelium Grossly Solitary, spherical nodule with intact capsule 3 ~ 5 cm in diameter The nodule may compress adjacent thyroid tissue * Figure 20-11 Follicular adenoma of the thyroid. A solitary, well-circumscribed nodule is seen Here is a surgical excision of a small mass from the thyroid gland that has been c