Neoplasm of the Thyroid Gland Flashcards Preview

Endocrinology > Neoplasm of the Thyroid Gland > Flashcards

Flashcards in Neoplasm of the Thyroid Gland Deck (18):
1

How does thyroid NEOPLASIA classically present?

- distinct, SOLITARY nodule.

2

Are thyroid nodules more likely to be malignant or benign?

- BENIGN

3

What study can you do if you think a pt has a thyroid neoplasia?

- radioactive iodine uptake study
*will see INCREASED uptake in Graves or nodular goiter.
*will see DECREASED uptake in adenoma and carcinoma (warrants FNA biopsy).

4

*** If you have DECREASED radioactive iodine uptake, what type of biopsy should you do?

- FINE NEEDLE ASPIRATION (FNA) biopsy.

5

What is a Follicular adenoma?

- BENIGN proliferation of follicles surrounded by a FIBROUS CAPSULE.
- usually nonfunctional; rarely may secrete thyroid hormone.
*HURTHLE cell subtype= eosinophilic cytoplasm.

6

**** What is a Papillary carcinoma?

- MOST COMMON type of thyroid carcinoma.
- forms papillary fingerlike projections.
- ORPHAN ANNIE NUCLEI= white clearing in center of nuclei.
- NUCLEAR GROOVES.
- PSAMMOMA BODY= layering of calcium.
- exposure to IONIZING RADIATION in childhood is a major risk factor.

7

Where does Papillary carcinoma often spread?

- to cervical nodes, but has EXCELLENT prognosis :)

8

**** What is a Follicular carcinoma?

- MALIGNANT proliferation of FOLLICLES.
- surrounded by a FIBROUS CAPSULE with INVASION through the capsule.
- PI-3K/AKT, RAS, PTEN, PAX8, or PPARG mutations

9

Can fine needle biopsy distinguish between follicular adenoma and follicular carcinoma?

- NO, bc you need to examine the capsule.

10

How does Follicular carcinoma metastasize?

- HEMATOGENOUSLY
*odd bc normally carcinoma spreads via lymphatics.

11

What is Medullary carcinoma?

- MALIGNANT proliferation of parafollicular C-cells (sit adjacent to follicles).
- high levels of CALCITONIN produced by tumor and may lead to HYPOcalcemia.
*calcitonin often deposits within tumor as AMYLOID; aka localized amyloidosis.

12

**** What are some familial cases of Medullary carcinoma of the thyroid?

- due to Multiple Endocrine Neoplasia (MEN2A) and (2B).
- associated with mutations in RET ONCOGENE.
*detection of RET mutation warrants prophylactic thyroidectomy.

13

What 3 neoplasias are associated with MEN2A?

1. medullary carcinoma of THYROID
2. PHEOCHROMOCYTOMA (adrenals)
3. PARATHYROID adenoma

14

What 3 neoplasias are associated with MEN2B

1. medullary carcinoma of THYROID
2. PHEOCHROMOCYTOMA (adrenals)
3. GANGLIONEUROMAS (particularly of oral mucosa).

15

*** What is Anaplastic carcinoma of the thyroid?

- undifferentiated MALIGNANT tumor of thyroid.
- usually seen in ELDERLY.
- often invades local structures leading to DYSHPAGIA or RESPIRATORY compromise.
- may be positive for cytokeratin.
- RAS or PIK3 mutations.
*poor prognosis.

16

Remember, what does anaplastic carcinoma mimic?

- Reidel Fibrosing Thyroiditis, but this would be in a YOUNG FEMALE.

17

Do thyroid adenomas generally give rise to carcinoma?

- NO (unlike the GI tract).

18

What is the most aggressive variant of Papillary carcinoma?

- Tall cell variant