Thyroid Neoplasia and Diseases of Parathyroid

Question 1

Solitary thyroid nodules are more likely to be neoplastic than multiple nodules are

Answer 1

truth

Question 2

What age, sex, health history, is associated with increased thyroid malignancy risk?

Answer 2

younger pts, males, history of radiation in the head/neck.

Question 3

What characteristics of radionucleotide imaging predispose to a neoplasm

Answer 3

“cold” nodules 10% malignancy

“hot” nodules almost always benign

Question 4

Who do you call if you do a fine needle aspiration and the result is a follicular lesion?

Answer 4

Surgeon. It could be a follicular adenoma (benign) or a follicular carcinoma (malignant), but you can’t tell the difference between the two so you’ve got to remove it either way. KNOW

Question 5

Who do you call if it comes back a papillary lesion?

Answer 5

surgeon…papillary lesions in the thyroid are always malignant

Question 6

What are the three types of benign thyroid nodules

Answer 6

colloid nodules (80% of the time)
cysts
follicular adenoma

Question 7

What are the different types of malignant thyroid nodules?

Answer 7

Papillary carcinoma- most common malignant
Follicular carcinoma
medullary carcinoma
anaplastic carcinoma
rare malignancy

Question 8

How do you tell the difference between a follicular adenoma and carcinoma

Answer 8

Follicular carcinoma will feature capsular and/or vascular invasion

Question 9

Thyroid carcinomas account for about what percentage of human malignancies?

Answer 9

about 1%

Question 10

Thyroid carcinomas in autopsy specimens

Answer 10

about 10%

Question 11

Medullary and anaplastic tumors commonly arise at what age range?

Answer 11

After 40 years

Question 12

Papillary and follicular carcinomas frequently arise at what age range?

Answer 12

Before 40 years

Question 13

What is a psammoma body?

Answer 13

associated with papillary carcinoma, papillary calcium in thyroid tends to produce these calcified structures

Seen in many different neoplasms but mainly associated with papillary cancers (remember that papillary carcinomas can arise in organs besides the thyroid)

Question 14

Carcinomas demonstrate vascular invasion

Answer 14

Adenomas do not

Question 15

Medullary carcinoma is by definition what?

Answer 15

Tumor of the parafollicular C cells which produce calcitonin…get too much calcitonin release so pts present with hypocalcemia

Question 16

What percentage of medullary carcinomas are sporadic?

Answer 16

80%

Question 17

Of the non-sporadic medullary carcinoma, what are some major mutations?

Answer 17

MEN-IIA, MEN-IIB, non-MEN

Question 18

Major clinical finding in medullary carcinoma?

Answer 18

hypocalcemia,,,,severe (may kill them)

Question 19

Amyloid deposits associated with…

Answer 19

medullary carcinoma

Question 20

Anaplastic carcinoma

Answer 20

RARE but TERRIBLE, invade locally and metastasize widely, usually affect older folks (mean age = 65)
- most pts have a history of some sort of thyroid disease

Question 21

Lymphoma in the thyroid is almost always from what cell lineage?

Answer 21

B cell

Question 22

What is the only known risk factor for thyroid lymphoma?

Answer 22

Hashimoto’s Thyroiditis

Question 23

How many parathyroid glands are there?

Answer 23

4

Question 24

What do they develop from?

Answer 24

third and fourth brachial pouches

Question 25

Parathyroid adenoma

Answer 25

most are benign.

• Inc in PTH and hypercalcemia
• Most are asymptomatic
• Moans, bones, stones

Question 26

Parathyroid hyperplasia

Answer 26

absolute increase in the mass of the parenchymal cells of the parathyroid gland. All or most of the glands are enlarged as opposed to one solitary gland in adenoma.