Chapter 57: Thyroid Gland- Papillary Adenocarcinoma

Question 1

What is papillary carcinoma’s claim to fame?

Answer 1

Most common thyroid cancer (Think: Papillary = Popular) = 80% of all thyroid

Question 2

What is the environmental risk?

Answer 2

Radiation exposure

Question 3

What is the average age?

Answer 3

30 to 40 years

Question 4

What is the sex distribution?

Answer 4

Female > male; 2:1

Question 5

What are the associated histologic findings?

Answer 5

Psammoma bodies (Remember, P = Psammoma = Papillary)

Question 6

Describe the route and rate of spread

Answer 6

Most spread via lymphatics (cervical adenopathy); spread occurs slowly

Question 7

131I uptake?

Answer 7

Good uptake

Question 8

What is the 10-year survival rate?

Answer 8

≈95%

Question 9

What is the treatment for:
<1.5 cm and no history of neck radiation exposure?

Answer 9

Options:

1. Thyroid lobectomy and isthmectomy
2. Near-total thyroidectomy
3. Total thyroidectomy

Question 10

What is the treatment for:

>1.5 cm, bilateral, + cervical node metastasis OR a history of
radiation exposure?

Answer 10

Total thyroidectomy

Question 11

What is the treatment for:
Lateral palpable cervical LNs?

Answer 11

Selective neck dissection (ipsilateral)

Question 12

What is the treatment for:
Central?

Answer 12

Central neck dissection

Question 13

Do positive cervical nodes affect the prognosis?

Answer 13

NO!

Question 14

What is a “lateral aberrant thyroid” in papillary cancer?

Answer 14

Misnomer—it is metastatic papillary carcinoma to a LN

Question 15

What postoperative medication should be administered?

Answer 15

Thyroid hormone replacement, to suppress TSH

Question 16

What is a postoperative treatment option for papillary carcinoma?

Answer 16

Postoperative 131I scan can locate residual tumor and distant metastasis that can be treated with ablative doses of 131I

Question 17

What is the most common site of distant metastases?

Answer 17

Pulmonary (lungs)

Question 18

What are the “P’s” of papillary thyroid cancer (7)?

Answer 18

Papillary cancer:

1. Popular (most common)
2. Psammoma bodies
3. Palpable LNs (spreads most commonly by lymphatics, seen in ≈33% of patients)
4. Positive 131I uptake
5. Positive prognosis
6. Postoperative 131I scan to diagnose/treat metastases
7. Pulmonary metastases