Flashcards in 28. Thyroid cancer Deck (48):
thyroid cancer - types
1. papillary Ca
2. follicular Ca
3. medullary Ca
4, anaplastic / undiffererentiated Ca
thyroid lymphoma is associated with
thyroid carcinoma related to Hashimoto thyroiditis
thyroid cancer with the worst prognosis
anaplastic ( undiffrentiated carcinoma)
anaplastic ( undiffrentiated carcinoma) - age
anaplastic ( undiffrentiated carcinoma) - characteristic / age
invade local structures leading to dysphagia or respiratory compromise --> poor prognosis
Medullary carcinoma is associated with
RET mutations ( MEN 2A and MEN 2B )
Medullary carcinoma - arises from
parafollicular C cells
Medullary carcinoma produces
parafollicular C cells - types / function / origin
neuroendocrine cells that secrete calcitonin
origin : neural crest
Medullary carcinoma - histology
solid sheellary carcinoma ts of cells with amyloid deposition ( calcitonin ) --> stains with congo Red
MC thyroid cancer
Papillary carcinoma - prognosis
Papillary carcinoma - risk factors
1. RET mutation
2. BRAF mutation
3. Childhood irradiation
Papillary carcinoma - histology
1. nuclear grooves
2. psammoma bodies
3. Orphan Annie eyes
4. Lymphatic invasion (common)
Orphan Annie eyes - ? and where
empty appearing nuclei with central clearing
follicular carcinoma - prognosis
follicular carcinoma - histology ?
- malignant proliferation of follicles surrounded by fibrous capsule with invasion of the capsule ( uniform follicles)
follicular carcinoma vs adenoma
follicular carcinoma incades the capsule ( unlike adenoma)
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
thyroidectomy - complication
3. transection of recurrent and superior laryngeal nerve
4. compressing hematoma
thyroidectomy - hoarseness ?
due to recurrent laryngeal nerve damage
thyroidectomy - hypocalcemia ?
due to removal of parathyroid glands
thyroidectomy - transection of recurrent and superior laryngeal nerve during
ligation of inferior thyroid artery and superior laryngeal artery respecively
thyroid cancer with BRAF mutation
thyroid cancer with lymphatic invasion
thyroid cancer - childhood irradatiation
thyroid cancer with psammoma bodies
thyroid cancer with fibrous capsule
thyroid cancer in older patients
thyroid cancer hematogenous metastasis
thyroid cancer associated with MEN
thyroid cancer associated with RET mutation
thyroid cancer with orphan Annie sign
thyroid ademoma - definiton
benign solitary growth of the thyroid
thyroid ademoma- histology
MC histology is follicular ( absence of capsular or vascular invasion ( unlike carcinoma)
thyroid ademoma- thyroid hormones ??
- Most are nonfunctional ( cold)
- can cause hyperthyroidism via autonomous thyroid hormones production ( hot or toxic)
follicular cancer - genetics
is asssociated with RAS mutation
thyroid cancer with RAS mutation
• 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
• Place the following thyroid cancers in order from best to worst prognosis: follicular, undifferentiated/anaplastic, and papillary.
Papillary, follicular, undifferentiated/anaplastic
• 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)
• 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)
• 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)
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
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)
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