A4- Endocrine Pathology

Question 1

Thyroid neoplasms

Example of benign

Answer 1

follicular adenoma

Question 2

Name 5 malignant Thyroid neoplasms

Answer 2

–Follicular carcinoma
–Papillary carcinoma
–Medullary carcinoma
–Anaplastic carcinoma
–Lymphoma

Question 3

Follicular Adenoma are Encapsulated and invasive

TRUE OR FALSE

Answer 3

Encapsulated and non-invasive

FALSE

Question 4

Follicular Carcinoma

Where is it commonly spread?

Answer 4

commonly to bones and lungsrarely to lymph nodes

Question 5

What does Follicular Carcinoma look like on histology?

Answer 5

Capsular and vascular invasion

Question 6

What does papillary carcinoma look like on diagnosis?

Answer 6

papillary architecture and
characteristic nuclear changes

Question 7

Medullary Carcinoma are derived from what kind of cells?

Answer 7

C cells (calcitonin)

Question 8

Medullary carcionmas are causes by

Answer 8

• Caused by activating mutations of ret
oncogene
• 80% sporadic
• 20% familial

Question 9

Examples of familial medullary carcinomas are called?

Answer 9

• MEN2A or 2B
• Familial medullary thyroid carcinoma

Question 10

Anaplastic carcinoma is usually associated with what type of mutation?

Answer 10

p53 mutation
by the tumour.

Question 11

does anaplastic carcinoma have a poor/good prognsis

Answer 11

poor

Question 12

All anaplastic carcinomas are regarded as stage __
regardless of size

Answer 12

T4

Question 13

Thyroid neoplasms usually present as _______ nodules

Answer 13

Thyroid neoplasms usually present as solitary nodules

Question 14

thyroid cancer management first line

Answer 14

surgery followed by radioiodine ablation of
remaining tissue

Question 15

What is a thyroid FNA?

Answer 15

A thyroid fine needle aspiration biopsy is a procedure that removes a small sample of tissue from your thyroid gland. Cells are removed through a small, hollow needle. The sample is sent to the lab for analysis. The thyroid gland is in the front of your neck.

Question 16

What is the Role of Thyroid FNA

Answer 16

• Diagnosis of a solitary or dominant nodule.
• A proportion of patients with a benign diagnosis will be spared from surgery.
• Cytology is scored using the Thy scoring system.

Question 17

Thyroid nodules can be..

Answer 17

• May be solitary or multiple
• May be solid or cystic
• May be “hot” (hyperfunctioning) or “cold” (hypofunctioning) on thyroid scan

Question 18

When do you do FNA

Answer 18

• Solitary or dominant nodule.
• Check TSH.
• If TSH normal or high, need FNA.
• If TSH low, need scan.
• If hot nodule, FNA not required.
• If cold nodule, need FNA.

Question 19

What is the thy Scoring system

Answer 19

• Thy 1: Non-diagnostic or unsatisfactory
– Virtually acellular specimen
– Other (obscuring blood, clotting artefact etc.)
• Thy 1c: Non diagnostic –cystic lesion
– Cyst fluid only
• Thy 2: Benign
– Consistent with a benign follicular nodule (includes adenomatoid nodule, colloid nodule, etc)
– Consistent with lymphocytic (Hashimoto) thyroiditis in the proper clinical context
– Consistent with granulomatous (subacute) thyroiditis
– Other

• Thy 3a: Neoplasm possible –atypia/ non-diagnostic
– Atypia of undetermined significance or follicular lesion of undetermined significance
– Should be used sparingly
• Thy 3f: Neoplasm possible, suggesting follicular neoplasm
– Follicular neoplasm or suspicious for a follicular neoplasm
– Specify if Hürthle cell (oncocytic) type
• Thy 4: Suspicious of malignancy
– Suspicious for papillary carcinoma
– Suspicious for medullary carcinoma
– Suspicious for metastatic carcinoma
– Suspicious for lymphoma
– Other
• Thy 5: Malignant
– Papillary thyroid carcinoma
– Medullary thyroid carcinoma
– Undifferentiated (anaplastic) carcinoma

Question 20

A proportion of patients will be spared further
surgery

Who would these be?

Answer 20

mostly those with Thy 2 or Thy 1 in the presence of reassuring radiology and clinical features