28. Thyroid cancer Flashcards Preview

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Flashcards in 28. Thyroid cancer Deck (48):
1

thyroid cancer - types

1. papillary Ca
2. follicular Ca
3. medullary Ca
4, anaplastic / undiffererentiated Ca
5. lymphoma

2

thyroid lymphoma is associated with

Hashimoto thyroiditid

3

thyroid carcinoma related to Hashimoto thyroiditis

thyroid lymphoma

4

thyroid cancer with the worst prognosis

anaplastic ( undiffrentiated carcinoma)

5

anaplastic ( undiffrentiated carcinoma) - age

older patients

6

anaplastic ( undiffrentiated carcinoma) - characteristic / age

invade local structures leading to dysphagia or respiratory compromise --> poor prognosis
older age

7

Medullary carcinoma is associated with

RET mutations ( MEN 2A and MEN 2B )

8

Medullary carcinoma - arises from

parafollicular C cells

9

Medullary carcinoma produces

calcitonin

10

parafollicular C cells - types / function / origin

neuroendocrine cells that secrete calcitonin
origin : neural crest

11

Medullary carcinoma - histology

solid sheellary carcinoma ts of cells with amyloid deposition ( calcitonin ) --> stains with congo Red

12

MC thyroid cancer

Papillary carcinoma

13

Papillary carcinoma - prognosis

excellent

14

Papillary carcinoma - risk factors

1. RET mutation
2. BRAF mutation
3. Childhood irradiation

15

Papillary carcinoma - histology

1. nuclear grooves
2. psammoma bodies
3. Orphan Annie eyes
4. Lymphatic invasion (common)

16

Orphan Annie eyes - ? and where

empty appearing nuclei with central clearing
Papillary carcinoma

17

follicular carcinoma - prognosis

good prognosis

18

follicular carcinoma - histology ?

- malignant proliferation of follicles surrounded by fibrous capsule with invasion of the capsule ( uniform follicles)

19

follicular carcinoma vs adenoma

follicular carcinoma incades the capsule ( unlike adenoma)

20

follicular carcinoma / adenoma - FNA

FNA only examines cells and not the capsule, hence a distinction between follicular adenoma and carcinoma cannot be made by FNA . ENTIRE CAPSULE MUST BE EXAMINED MICROSCOPICALLY

21

thyroidectomy - complication

1. hoarsenesss
2. hypocalcemia
3. transection of recurrent and superior laryngeal nerve
4. compressing hematoma

22

thyroidectomy - hoarseness ?

due to recurrent laryngeal nerve damage

23

thyroidectomy - hypocalcemia ?

due to removal of parathyroid glands

24

thyroidectomy - transection of recurrent and superior laryngeal nerve during

ligation of inferior thyroid artery and superior laryngeal artery respecively

25

thyroid cancer with BRAF mutation

Papillary carcinoma

26

thyroid cancer with lymphatic invasion

Papillary carcinoma

27

thyroid cancer - childhood irradatiation

Papillary carcinoma

28

thyroid cancer with psammoma bodies

Papillary carcinoma

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thyroid cancer with fibrous capsule

follicular

30

thyroid cancer in older patients

anaplastic

31

thyroid cancer hematogenous metastasis

follicular

32

thyroid cancer associated with MEN

medullary

33

thyroid cancer associated with RET mutation

medullary
papillary

34

thyroid cancer with orphan Annie sign

papillary

35

thyroid ademoma - definiton

benign solitary growth of the thyroid

36

thyroid ademoma- histology

MC histology is follicular ( absence of capsular or vascular invasion ( unlike carcinoma)

37

thyroid ademoma- thyroid hormones ??

- Most are nonfunctional ( cold)
- can cause hyperthyroidism via autonomous thyroid hormones production ( hot or toxic)

38

follicular cancer - genetics

is asssociated with RAS mutation

39

thyroid cancer with RAS mutation

follicular

40

• You diagnose thyroid cancer in a patient. What is the prognosis of the most common type of thyroid cancer?

Papillary carcinoma, the most common type of thyroid cancer, has an excellent prognosis

41

• Place the following thyroid cancers in order from best to worst prognosis: follicular, undifferentiated/anaplastic, and papillary.

Papillary, follicular, undifferentiated/anaplastic

42

• A biopsy of a thyroid nodule shows sheets of cells with amyloid. Where does the cancer originate, and how does it usually spread?

Parafollicular C cells that produce calcitonin; spreads hematogenously (this is medullary thyroid cancer)

43

• A man has episodic headaches, palpitations, an adrenal mass, and a thyroid nodule. What type of thyroid cancer could he have?

Medullary carcinoma; symptoms and mass suggest pheochromocytoma (pheochromocytoma and medullary cancer are associated with MEN 2A/2B)

44

• A 50-y/o woman with thyroid cancer opts for thyroidectomy. Weeks later, paresthesias and hyperreflexia develop. What happened?

Inadvertent removal of the parathyroid glands with the thyroid, with resulting hypocalcemia (paresthesias, hyperactive reflexes)

45

A surgeon injures a nerve during ligation of the inferior thyroid artery in a thyroidectomy. What nerve is affected, and what is the result?

Recurrent laryngeal nerve; hoarseness

46

A patient has paralysis of the cricothyroid muscle after a thyroidectomy. Which nerve was affected?

Superior laryngeal nerve (injured during ligation of the superior laryngeal artery)

47

A patient discovers a thyroid mass. Biopsy shows uniform follicles. How does the pathologist know whether this mass is benign or malignant?

Invasion of the thyroid capsule suggests a more malignant follicular carcinoma; no invasion suggests a more benign thyroid adenoma

48

FNA of thyroid nodule shows cells with large empty-appearing nuclei and intranuclear inclusion bodies. Three risk factors for this finding?

Papillary carcinoma of the thyroid; risk factors include childhood irradiation and RET and BRAF mutations.