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GINME > Week 7: Thyroid Cancer > Flashcards

Week 7: Thyroid Cancer Flashcards

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1
Q

What is a thyroid nodule?

A

starts with the growth of a thyroid epithelial cell that escapes normal cell division regulation and leads to continuous growth and eventually leads to a clinically evident tumor mass

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2
Q

What causes thyroid nodules?

A

Mutations in both oncogenes and/or tumor suppressor genes

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3
Q

Types of thyroid nodules

A
  • Solitary nodules (monoclonal)
  • Multinodular goiters (polyclonal)
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4
Q

Prevalence of thyroid nodules and how thyroid nodules are found

A
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5
Q

Majority of nodules that are benign

A
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6
Q

Histological features of benign thyroid nodules

A
  • follicular cells
  • absence of capsular and vascular invasion
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7
Q

benign thyroid nodules AKA

A

Benign follicular adenomas

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8
Q

Workup of a thyroid nodule

A

Functional assessment

  • check TSH (hypo or hyperthyroidism)

Anatomical assessment

  • imaging
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9
Q

If TSH is low with thyroid nodule

A

Obtain radioactive iodine scan

To determine if the nodule is a “hot” nodule

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10
Q

What is a “hot” nodule?

A

Rarely malignant

if they take up a lot of radioactive iodine

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11
Q

What is a “cold” nodule

A

doesn’t uptake radioactive iodine

most are benign but some are malignant

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12
Q

What is the preferred imaging study for the thyroid and thyroid nodules

A

Ultrasound

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13
Q

Features of interest of thyroid nodules by ultrasound

A
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14
Q

What is Echogenicity and what does it indicate?

A

How dark or light appearing on ultrasound

Often less echogenic nodules are malignant (darker = malignant) AKA Hypoechoic

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15
Q

Ultrasound features of malignant thyroid nodules

A

Hypoechoic

microcalcifications

irregular margins

taller than wide

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16
Q

Size of nodules to be biopsied

A

1 cm or larger

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17
Q

Low suspicion thyroid nodules on ultrasound

A
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18
Q

Moderate suspicion thyroid nodules on ultrasound

A
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19
Q

Very low suspicion thyroid nodules on ultrasound

A

spongiform

partially cystic

lacking suspicious features such as having irregular margins

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20
Q

Thyroid cysts chance of malignancy

A

Very low

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21
Q

TI-RAD system

A

system used to report on thyroid nodule imaging

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22
Q

Features of highly suspicious thyroid nodules

A
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23
Q

Features of low suspicious thyroid nodules

A
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24
Q

Classifications of thyroid cancers

4 listed

A
  • Well-differentiated thyroid carcinomas
  • undifferentiated thyroid carcinomas
  • medullary thyroid carcinoma
  • thyroid lymphomas
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25
Most common thyroid cancer
Papillary thyroid carcinoma
26
Papillary thyroid carcinoma derived from
Thyroid follicular cells
27
Histological features of Papillary thyroid carcinoma
* Orphan Annie Nuclei (clearing out of chromatin/white appearance to nuclei) * Sonoma bodies (necrosis) * can be calcifications * nuclear grooves
28
Prevalence/ epidemiology of papillary thyroid carcinoma
most common thyroid cancer (70-90% of cases) Female predominate 2.5:1 Aged 40-50
29
Risk for Papillary thyroid carcinoma
* Hx of radiation in childhood * FHx of thyroid cancer * female Aged 40-50
30
the trend of papillary thyroid carcinoma
31
Pathogenesis of papillary thyroid carcinoma
Activating point mutations in tyrosine kinase MAPK pathway in RAS or BRAF constitutively activating it Also associated with RET gene
32
Physical features of papillary thyroid carcinoma
Can be multifocal and invades locally Indolent
33
Prognosis of papillary thyroid carcinoma
25-year mortality in patients younger than 40-\> 2% small % of patients have increased mortality * older patients * large tumor size * soft tissue invasion * Distant metastases 2-10%
34
Follicular thyroid carcinoma prevalence
10% of all thyroid cancers
35
Follicular thyroid carcinoma epidemiology
10% of all thyroid cancers aged 40-60 Female 3:1
36
Follicular thyroid carcinoma derived from?
Follicular cells
37
Follicular thyroid carcinoma Dx
is difficult to Dx by FNA (biopsy)
38
Risk factors of Follicular thyroid carcinoma
* Associated with childhood radiation * FHx thyroid cancer * Iodine deficiency
39
Follicular thyroid carcinoma Pathogenesis
point mutations in RAS oncogene * 40% Gene rearrangement PAX8-PPARγ translocation
40
Follicular thyroid carcinoma genetics
RAS or PAX8 (chromosome 2) -PPARγ (Chromosome 3) translocation
41
Follicular thyroid carcinoma gross histology
uninodular Lymph node is not usually involved Distant metastases (usually in the lung and bone)
42
Prognosis of Follicular thyroid carcinoma
43
Hurthle cell carcinoma epidemiology
3-10% of differentiated thyroid cancers
44
Hurthle cell carcinoma features
tends to be more aggressive lymph nod involvement is common Highest incidence of metastases
45
Hurthle cell carcinoma prognosis
10 year disease-free survival is 41%
46
Well-differentiated thyroid carcinoma clinical presentation
47
Well-differentiated thyroid carcinoma Dx
thyroid ultrasound Fine needle aspiration of nodules
48
49
Surgical Treatment of Well-differentiated thyroid carcinoma
50
Complications of total thyroidectomy
Damage to recurrent laryngeal and superior laryngeal artery (can cause tracheostomy placed) Hoarseness vocal paralysis Hypocalcemia due to parathyroid gland function
51
Rx Treatment of Well-differentiated thyroid carcinoma
I-131 treatment the radioactive form of iodine that destroys any form of the cancer present
52
How does I-131 treatment work for thyroid cancer
pretreatment of TSH or thyroid hormone withdrawal to maximize radioactive iodine uptake low iodine diet cause thyroid cell death by β-particle emission
53
Monitoring of well-differentiated thyroid carcinoma
54
Medullary thyroid carcinoma derived from
Parafollicular cells
55
Medullary thyroid carcinoma histological features
56
Medullary thyroid carcinoma epidemiology
4% of thyroid carcinomas
57
Medullary thyroid carcinoma associations
Most are sporadic but... Familial neoplastic syndromes (25% of cases) * Men 2A and @b, familial medullary thyroid carcinoma
58
Medullary thyroid carcinoma pathogenesis
RET somatic or germline mutations HRAS and/or KRAS mutations
59
Medullary thyroid carcinoma charateristics
secretes: calcitonin sometimes secretes CEA
60
Medullary thyroid carcinoma clinical presentation
solitary nodule predominatly located in the upper portion of each thyroid lobe 70% lymph node involvement symptoms of compression 5-10% dital metasteses (Liver, Lungs, Bones)
61
Medullary thyroid carcinoma prognosis
62
Medullary thyroid carcinoma Treatment
63
types of Undifferentiated thyroid carcinoma
Anaplastic thyroid carcinoma and
64
Anaplastic thyroid carcinoma epidemiology
0.9-9.8% of thyroid cancers 65 years old female predominance 60-70% of cases
65
Anaplastic thyroid carcinoma derived from
Follicular cells
66
Anaplastic thyroid carcinoma associations
20% of patients have a Hx of undifferentiated thyroid cancer 20-30% have coexisting differentiated cancer Mean age at Dx is 65
67
Anaplastic thyroid carcinoma clinical presentation
68
Anaplastic thyroid carcinoma evaluation
69
Anaplastic thyroid carcinoma prognosis
moratility approaches 100% 6 months without metastases
70
Treatment of Anaplastic thyroid carcinoma
* Surgery * Radiotherapy * Chemotherapy
71
Thyroid follicular cells proliferative pathways
72
Thyroid lymphoma epidemiology
2% of thyroid cancers
73
Thyroid lymphoma associations
Hashimoto's Thyroiditis
74
Thyroid lymphoma types
60-80% are large B-cell lymphomas 30% are extranodal marginal zone lymphomas
75
Thyroid lymphoma histological features
76
Thyroid Lymphoma Clinical presentation
77
Thyroid lymphoma evaluation
78
Thyroid lymphoma treatment
79
Prognosis of Thyroid lymphoma
80
MEN1 AKA
Multiple Endocrine Neoplasia Type 1
81
MEN1 pathogenesis
Autosomal dominant inheritance of MEN1 gene Produces Menin tumor suppressor on chromosome 11
82
MEN1 tumors
Pituitary tumors Parathyroid tumors Pancreatic tumors
83
Dx of MEN1
84
Signs and symptoms of Parathyroid tumors
85
Signs and symptoms of Pituitary tumors
86
Signs and symptoms of Pancreatic tumors
87
MEN1 Treatment
88
MEN2A AKA
Multiple Endocrine Neoplasia Type 2A
89
MEN2A pathogenesis
Autosomal dominant inheritance Germiline mutation in RET protooncogene Tyrosine kinase receptor in cells of neural crest origin
90
MEN2A clinical presentation
Parathyroid hyperplasia
91
MEN2A structures involved
92
MEN1 structures involved
93
Treatment of MEN2A
94
MEN2B pathogenesis
autosomal dominant inheritance Mutation in RET proto-oncogene
95
MEN2B components
96
MEN2B clinical presentations and structures invovled
97
What are mucosal neuromas? And what condition are they found in?
MEN2B
98
MEN2B hallmark
Marfinoid habitus
99
Genetic testing in MEN2

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