Thyroid Nodules: Clinical, Pathologic and Pathophysiologic Correlates

Question 1

1. Recognize the pathological disorders that can lead to the appearance of a solitary or multiple thyroid nodules.

Answer 1

Benign
-Adenoma

Malignant

• Papillary (85-90%) multifocal, LN
• Follicular/Hurthle (5%) vascular spread
• Anaplastic (

Question 2

2. Describe the tests that are helpful to evaluate a thyroid nodule.

Answer 2

Do TSH first

Do Diagniostic ultrasound

Do fine needle aspirate

if biopsy suspicious–> do a scan–> increased uptake is likely not cancer

Question 3

4. Outline the general principles of treatment of benign and malignant thyroid tumors.

Answer 3

benign- clinical follow up

malignant- thyroidectomy

Question 4

What is most common gene mutated in thyroid cancer?

Answer 4

BRAF

Question 5

Papillary carcinoma

Answer 5

most common, excellent prognosis, orphan annie eyes, psammoma bodies, nuclear grooves, lymphatic invasion common, RET and BRAF mutations

Question 6

follicular carcinoma

Answer 6

good prognosis, invades thyroid capsule

Question 7

medullary carcinoma

Answer 7

from parafollicular C cells, produces calcitonin, hematogenous spreade common associated with MEN 2A/2B

Thyroglobulin -, Calcitonin +, Chromogranin +

Question 8

undifferentiated/anaplastic carcinoma

Answer 8

older patients, invades local structures, very poor prognosis

Question 9

lymphoma

Answer 9

associated with hashimoto thyroiditis

Question 10

what is proto oncogen signaling in thyroid cancer

Answer 10

MAP kinase–>RET, RAS, BRAF, MET/ERK–> cell growth

PAP carcinoma 20% RET-PTC rearrangement
RAS point mutation 20%
BRAF mutation 40%

loss of P53 makes things way worse
B-catenin makes things way worse
-both cxan make transition to anaplastic