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SPINE > Endocrine Neoplasia > Flashcards

Endocrine Neoplasia Flashcards

1
Q

What is the key histology of the thyroid gland?

A

Thyroid follicular cells form circular edges around colloid = thyroid follicle
Colloid contains thyroglobulin which is secreted from follicular cells -> formation of T3 andT4
Parafollicular cells or C cells ->secrete calcitonin
Stroma

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2
Q

What is meant by a thyroid nodule?
How does it present?

A

A solitary thyroid nodule - unusual growth on thyroid (fluid or solid)
Palpable/visible swelling of the thyroid gland
Up to 10% incidence
Pressure symptoms
Pain

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3
Q

What is thyroid neoplasia?
How does it normally present?

A

Abnormal growth in the thyroid gland
Thyroid nodules are common
Benign : Malignant 10:1
Increased frequency with age
Solitary nodule > neoplastic
Solitary nodule in young person more likely to be cancerous than in older person
More common in female

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4
Q

What test should be done to identify thyroid malignancy?

A

Serum TSH
(as growth factor stimulate growth of thyroid tissue including cancer cells)

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5
Q

What factors are important to understand in a history surrounding the thyroid lump?

A

Duration of swelling
Risk factors - radiation to head/neck
Family history - MEN syndrome
Concerning features - rapid growth, pressure symptoms, hoarseness of voice (vocal cord paralysis)
Lump - fixed and hard, lymphadenopathy, signs of hyper/hypothyroidism

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6
Q

What is thyroid scintigraphy?
How to interpret it?

A

Type of nuclear imaging, uses a radiotracer that mimics Iodine
Taken up by thyroid gland - shows activity of te thyroid gland in terms of T3/4 production
Hot nodules - more intense signal - increased uptake
Cold nodules - less intense signal - reduced uptake.

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7
Q

What type of thyroid nodule is more common hot or cold?

A

Cold nodules are more common (85%) compared to hot/functional nodules (15%)

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8
Q

How does hot(functional) or cold thyroid nodule relate to cancer risk?

A

Cold - 15% malignant
Hot - 5% malignant

Note patients are more likely to have a cold nodule, cold nodules are more likely to be malignant that hot.

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9
Q

What is the gold standard test for evaluation of a thyroid nodule?

A

Fine needle aspiration cytology (FNAC)
Safe, accurate and cost effective

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10
Q

When/how is a fine needle aspiration done for a thyroid nodule?

A

For nodules >1cm
Is palpation or ultraound guided
Uses a 23-27 gauge needle

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11
Q

What are the signs on cytology of thyroid cancer?

A

Look at thyroid follicular cells
Bubble in nucleus = intranuclear inclusion
Line through nucleus = nuclear groove

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12
Q

What are the different rating for thyroid cytology results?

A

Thy1 to Thy5
Thy1 - non diagnostic (not enough cells) cancer risk 5 to 10%
Thy2 - benign, up to 3% risk
Thy3a - insignificant atypia (up to 30% risk)
Thy3f - follicular neoplasm - up to 40% risk
Thy4 - suspicious for malignancy - up to 75% risk
Thy5 - malignant up to 99% risk

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13
Q

Give an example of a benign thyroid neoplasia

A

Thyroid adenoma / follicular adenoma

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14
Q

Give some examples of malignant thyroid neoplasia

A

Follicular thyroid carcinoma
Papillary thyroid carcinoma
Medullary carcinoma
Anaplastic carcinoma

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15
Q

What is the most common malignant thyroid tumour?

A

Papillary thyroid carcinoma = 85%

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16
Q

How does the lump in papillary thyroid carcinoma present?

A

Solitary or multifocal
Well-circumscribed or encapsulated or infiltrative
Cauliflower like gross appearance

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17
Q

What is the histological appearance of a papillary thyroid carcinoma?

A

Branching Papillae - finger like projections lined by cancerous cells
Cancerous cells appear empty
On closer inspect have a circular ring to the nucleus (intranuclear inclusions)

18
Q

What is the clinical course of papillary thyroid carcinoma?

A

Tends to metastasise through the lymphatic channels -> cervical lymph nodes
Excellent prognosis with a 95% 10 year survival

19
Q

What are the treatment options commonly used for papillary thyroid carcinoma?

A

Surgery for >1cm
If less than 1cm - papillary microcarcinoma may use active surveillance.

20
Q

How does a thyroid adenoma/follicular adenoma lump present?

A

Benign
Solitary and painless
Encapsulated - does NOT invade surrounding capsule/vasculature
Large = pressure symptoms and difficulty swallowing

21
Q

How does thyroid adenoma/follicular adenoma appear on diagnostics?

A

On radioiodine scan - is a cold nodule
Fine needle aspiration - Thy3f

22
Q

What is the typical treatment for a thyroid adenoma/follicular adenoma?

A

Surgical excision with capsule intact

23
Q

How common are follicular carcinoma of the thyroid?

A

5-15% of thyroid carcinoma

24
Q

How does follicular carcinoma present on exam and investigation?

A

Solitary nodule, slowly enlarging
Frequently cold on scintigraphy, but may appear warm - requires FNA

25
Q

How to differentiate between follicular adenoma v follicular carcinoma on cytology/histology?

A

On histology both show colloid containing follicles uniform nuclei, encapsulated
In histology adenoma does not show capsular and vascular invasion
Carcinoma - shows capsular and vascular invasion (mushroom-shaped)
Must have histology and FNAC will not show a difference

26
Q

Is this a follicular adenoma or carcinoma?
How can you tell?

A

Adenoma
Intact capsule surrounding the tumour - no capsular or vascular invasion

27
Q

In reference to the histology below, how do you differentiate between a follicular adenoma/carcinoma?

A

Adenoma = A = respects thin capsule boundaries
Carcinoma = B = mushroom shaped invasion of tumour (more purple) into surrounding capsule and tissue (Light pink)

28
Q

What is the clinical coures of follicular thyroid carcinoma?

A

Tends to metastasise through the blood vessels to the bone, lungs and liver. (commonly lumps on scalp)
Prognosis depends on extent of invasion and stage at presentation
Widely invasive <10yrs
Minamally invasive - >90% survival at ten years

29
Q

What is the most common treatment for follicular thyroid carcinoma?

A

Total thyroidectomy
Radioactive iodine for Mets

30
Q

What is meant by anaplastic carcinoma of the thyroid?

A

“Lack of differentiations” to form backwards
Agressive tumour - mean age of honest is 65yrs.
Invasion of neck structures - dyspnea, dysphagia, hoarness and cough
Metastatsis
Mortality rate near 100%

31
Q

What carcinoma of the thyroid is this?

A

Anaplastic carcinoma of the thyroid
High pleomorphic, multinucleated cells
High grade tumour

32
Q

What is medullary carcinoma of the thyroid?

A

Originates from parafollicular cells or C cells
Neuroendocrine tumour
Increase calcitoninc levels
70% are sporadic rest are associated with MEN2A/2B

33
Q

What thyroid carcinoma is this?

A

Salt and pepper chromatin
Forms sheets and layers
Calcitonin deposits (pink material ) in the stroma are termed amyloid.

34
Q

What is multiple endocrine neoplasia?

A

MEN syndrome
Autosomal dominant - genetic disorder
Causes proliferative/neoplastic disorders in multiple endocrine organs
Starting asymptomatic hyperplasia of organs
Tumours occur at younger age
Can affect multiple organs - simultaneous or different times

35
Q

What are the two different types of MEN syndrome?

A

MEN 1
MEN 2A/2B

36
Q

What are the genetics of MEN 1 syndrome?

A

Affects the menin gene on chromosome 11
Inactivating mutation

37
Q

What is the genetics of the MEN2A/2B syndrome?

A

Affects the RET protoncogene
Chromosome 10
Gain of function mutation.

38
Q

What endocrine organs are commonly affected in MEN 1?

A

Pituitary
Parathyroid
Pancreatic endocrine

39
Q

What are the endocrine organs commonly affect in MEN2A syndrome?

A

Medullary thyroid
Parathyroid
Bilateral phaeochromocytoma

40
Q

What are the endocrine organs commonly affected in MEN 2B syndrome?

A

Neuromas (nerves in mouth, lips, tongue)
Medullary carcinoma of the thyroid
Phaeochromocytoma

41
Q
A

SPINE (23 decks)

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