A4- Endocrine Pathology Flashcards
Thyroid neoplasms
Example of benign
follicular adenoma
Name 5 malignant Thyroid neoplasms
–Follicular carcinoma
–Papillary carcinoma
–Medullary carcinoma
–Anaplastic carcinoma
–Lymphoma
Follicular Adenoma are Encapsulated and invasive
TRUE OR FALSE
Encapsulated and non-invasive
FALSE
Follicular Carcinoma
Where is it commonly spread?
commonly to bones and lungsrarely to lymph nodes
What does Follicular Carcinoma look like on histology?
Capsular and vascular invasion
What does papillary carcinoma look like on diagnosis?
papillary architecture and
characteristic nuclear changes
Medullary Carcinoma are derived from what kind of cells?
C cells (calcitonin)
Medullary carcionmas are causes by
• Caused by activating mutations of ret
oncogene
• 80% sporadic
• 20% familial
Examples of familial medullary carcinomas are called?
- MEN2A or 2B
- Familial medullary thyroid carcinoma
Anaplastic carcinoma is usually associated with what type of mutation?
p53 mutation
by the tumour.
does anaplastic carcinoma have a poor/good prognsis
poor
All anaplastic carcinomas are regarded as stage __
regardless of size
T4
Thyroid neoplasms usually present as _______ nodules
Thyroid neoplasms usually present as solitary nodules
thyroid cancer management first line
surgery followed by radioiodine ablation of
remaining tissue
What is a thyroid FNA?
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.
What is the Role of Thyroid FNA
- 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.
Thyroid nodules can be..
- May be solitary or multiple
- May be solid or cystic
- May be “hot” (hyperfunctioning) or “cold” (hypofunctioning) on thyroid scan
When do you do FNA
- 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.
What is the thy Scoring system
• 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
A proportion of patients will be spared further
surgery
Who would these be?
mostly those with Thy 2 or Thy 1 in the presence of reassuring radiology and clinical features
