This document discusses the gross examination and sampling of thyroid specimens. It describes: 1. The normal anatomy of the thyroid gland and types of thyroid surgery including lobectomy, subtotal thyroidectomy, and total thyroidectomy. 2. The steps for gross examination including orientation, measurement, inspection of posterior aspect, palpation, slicing, and sequential layout of slices. 3. Features to note for diffuse versus isolated lesions and guidelines for sampling different types of thyroid specimens, including solitary nodules and multinodular glands.

1. Presented by – Dr. Monika Nema
Monika Nema

2.  The normal adult thyroid gland is composed
of two lobes joined by the isthmus, which
lies across the trachea anteriorly, below the
level of the cricoid cartilage.
Monika Nema

3.  Nodulectomy - (a procedure largely
abandoned that consists of enucleation of a
thyroid nodule)
 Lobectomy
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4. Subtotal thyroidectomy –in which the
posterior capsule and a small portion of
thyroid tissue – 1–2 g – are left on the side
opposite to the lesion
Total thyroidectomy -in which the entire
gland – including the posterior capsule – is
removed.
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5.  Type of specimen received.
 Orient the specimen.
The isthmus can be used to identify the inferior
and medial aspects of the gland, the lobes taper
superiorly and the posterior surfaces of the
lateral lobes have a concave shape caused by the
trachea.
• Measure the specimen.
• Inspect the posterior aspect of the specimen
for parathyroid glands and lymph nodes
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6.  Palpate the specimen to assess the
consistency of the thyroid and to localize any
focal lesions before cutting the specimen.
 Cut parallel longitudinal slices 5 mm each.
 Capsule is best demonstrated by cutting
perpendicular to the long axis of each
individual lobe.
 Once the thyroid is sectioned, sequentially
lay out the individual slices in such a way as
to maintain the proper orientation of the
specimen.
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7.  smooth or nodular?
 If an isolated lesion is identified, record its
size and location, and determine if it is
surrounded by a capsule.
 If nodular:
Mention number, size, and appearance of
nodules (cystic? calcified? hemorrhagic?
necrotic?)
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8. For diffuse lesions:
 Is the gland symmetrically or asymmetrically
involved?
 Is the lesion confined to the thyroid, or does
it extend beyond the capsule of the thyroid
into the surrounding soft tissues?
 Is the lesion cystic or solid, soft or hard, well
demarcated or poorly defined?
Monika Nema

9. Sections for histology should be taken to
demonstrate the following:
 (1) all components of a lesion (e.g., solid areas
and cystic areas);
 (2) the interface of the tumor (and its
surrounding capsule) with the adjacent non-
neoplastic thyroid parenchyma;
 (3) the relationship of the tumor to the thyroid
capsule and extrathyroidal soft tissues; and
 (4) the presence of parathyroids, lymph nodes,
and normal-appearing thyroid parenchyma.
Monika Nema

10.  1 For diffuse and/or inflammatory lesions:
three sections from each lobe and one from
isthmus.
 2 For a solitary encapsulated nodule
measuring up to 5 cm: entire circumference
is taken.
Take one additional section for each
additional centimeter in diameter. Most of
these sections should include the tumor
capsule and adjacent thyroid tissue, if
present
Monika Nema

11.  Primary task in encapsulated nodule is to
make sure that areas of transcapsular or
vascular invasion are not missed. Since these
areas usually cannot be seen by the naked
eye, they can easily be missed unless the
peripheral portion of the nodule is
extensively sampled.
 The more capsule sampled, the greater
chance of finding invasive foci. Therefore,
the tumor–capsule–thyroid interface of any
encapsulated nodule should be submitted in
its entirety for histologic evaluation.
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12.  Tangential sections through a round nodule
may give the artifactual microscopic
impression that the tumor infiltrates the
capsule.
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13. Decapitate the rounded ends from the tumor nodule
To minimize tangential sectioning
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14. place the flat surface of each end on the cutting board, and then direct each
cut perpendicular to the tumor capsule
To minimize tangential sectioning
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15. 3 For multinodular thyroid glands: one section of
each nodule (up to five nodules), including rim
and adjacent normal gland; more than one
section for larger nodules.
4 For papillary carcinoma: block entire thyroid
gland and (separately) line of resection
5 For grossly invasive carcinoma other than
papillary: three sections of tumor, three of non-
neoplastic gland, and one from line of resection
6 For all cases: submit parathyroid glands if
found on gross inspection
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16.  Thyroids removed from patients with one of
the multiple endocrine neoplasia (MEN)
syndromes should be extensively sampled for
histology.
 In gross report, note those sections taken
from the middle third of each lobe, as this
area is where C-cell hyperplasia and small
medullary carcinomas are most likely to be
detected.
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17. Gross appearance of follicular
adenomas.Tumor show focal
hemorrhagic areas
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18. Diffuse and symmetrical enlargement of the gland.
The consistency is firm but not stony hard as in Riedel thyroiditis.
There is no extension of the process outside the gland. The cut surface is
dstinctly nodular, yellowish gray, and greatly resembles a hyperplastic lymph
node
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19. The gland is enlarged and multinodular
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20. The gland is diffusely swollen and hyperemic.
Cut surface of thyroid gland with diffuse hyperplasia, showing a
hyperemic ‘juicy’ appearance.
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21. Grossly, gland is enlarged,solid,firm.Sometimes the papillary
formations are evident to the naked eye.
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22. Grossly, the tumors are solid, tan, and well vascularized Most are well
encapsulated throughout.
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23. Grossly, the typical tumor is solid,
firm, and nonencapsulated but
relatively well circumscribed and
has a gray to yellowish cut surface
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24. Presentation by- Dr. Monika Nema
Monika Nema