3 - tumours, pathology

Question 1

give some brief info about pituitary tumours?

Answer 1

1. pituitary adenoma = benign, on anterior pituitary, sporadic or MEN1
2. atypical parathyroid tumours = between adenoma & carcinoma. not malignant yet but suspicious
3. pituitary carcinoma = very rare, strict criteria in that has to invade something important like nerve or vessel
4. craniopharyngioma = benign in sellar turcica region (headaches & visual disturbances)

*pituitary tumours can compress optic chiasm

Question 2

what is meant by functioning and non functioning tumours?

Answer 2

functioning = makes hormones
non-functioning = doesn’t make hormones

Question 3

what hormones can be made by pituitary functional tumours?

Answer 3

• prolactin →most common functional tumour
• FSH/LH
• GH (growth hormones) →causes gigantism in children or acromegaly in adults
• ACTH →usually a microadenoma →cushing’s, bilateral adrenocortical hyperplasia

Question 4

what is benign thyroid tumour to know?

Answer 4

follicular adenoma = benign encapsulated surrounded by thin fibrous capsule. usually non-functional. found by accident unless large then dysphagia

Question 5

what is most common cause of cancer in thyroid?

Answer 5

papillary carcinoma

Question 6

what are some malignant tumours of thyroid gland?

Answer 6

• papillary carcinoma = differentiated. from follicular epithelium
• follicular carcinoma = differentiated. from follicular epithelium
• anaplastic carcinoma = undifferentiated & aggressive. from follicular epithelium
• medullary carcinoma = tumour of parafollicular cells which secrete calcitonin (c-cells)
• thyroid lymphoma = lymphoma that arises in thyroid gland

Question 7

what are the 2 differentiated tumours of thyroid? what do they secrete and take in? what is their prognosis like?

Answer 7

papillary & follicular carcinoma

• they take up iodine and secrete thyroglobulin
• they have good prognosis/outcome compared to others

Question 8

what cancer is associated with hashimoto’s?

Answer 8

papillary

Question 9

how do follicular and papillary carcinoma spread?

Answer 9

papillary - lymphatic spread so lymph node enlargement (spread more likely to cervical lymph nodes)

follicular - haematogenous spread so no lymph node enlargement (means spread more likely to lungs, brain, bone, liver)

Question 10

what investigations done for thyroid cancer?

Answer 10

• TSH
• ultrasound 1st line (can do US guided FNA)

*can also do biopsy of lymph nodes if they’re enlarged

Question 11

what is too low calcium? (when to replace?)

Answer 11

give if below 2 mmol/l

IV calcium if below 1.8 mmol/l

*this could be post- surgery

Question 12

what is treatment of papillary & follicular carcinoma?

Answer 12

• you would do some sort of surgery = hemilobectomy or thyroidectomy
• you’d then do whole body iodine scanning (swallow iodine to kill remnants) or thyroid remnant ablation (to kill remnants)

Question 13

what is thyroglobulin? why are they useful?

Answer 13

precursor of T3&T4 proteins made by thyroid epithelial follicular cells

• they’re useful to measure as tumour markers as follow up after treatment. if find any thyroglobulin then know that still come sort of cancerous thyroid cells somewhere in body

Question 14

what is follow up for papillary & follicular carcinoma??

Answer 14

• life-long follow up = checking TSH & thyroglobulin every 6 months for first 5 years then annually
• you also treat with suppressive doses of levothyroxine (enough so not super high TSH all the time)