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ENRP Exam 2 > thyroid last part (neoplasms) > Flashcards

thyroid last part (neoplasms) Flashcards

1
Q

what are some clinical critieria you can use to see if a thyroid nodule is more likely neoplastic

A

solitary
in younger patients
in men
history of radiation to head and neck

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2
Q

funcitonal/hot nodules are more likely to be

A

benign

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3
Q

how can you definitively tell if a thyroid nodule is malignant or benign

A

FNA or surgical resection

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4
Q

a follicular adenoma is a solitary mass derived from?

A

follicular epithelium

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5
Q

does a follicular adenoma predispose you to follicular carcinoma?

A

NO

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6
Q

majority of follicular adenomas are?

A

nonfunctional

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7
Q

what are toxic adenomas

A

produce thyroid hormones independent of TSH stimulation **

toxic meaning autonomous meaning producing hormone

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8
Q

what is the mutation in toxic adenomas and toxic nodular goiters

A

somatic TSH receptor gain of function

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9
Q

gain of functio in the TSHR allow for _ from TSH

A

autonomy

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10
Q

toxic adenomas and toxic adenomas produce a _ thyroid nodule

A

HOT

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11
Q

describe what a thyroid adenoma looks like

A

solitary, encapsulated (well circumscribed)

bulges from the cut surface

and compressess adjacent thyroid

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12
Q

thyroid adenomas can be gray white to red brown dpending on

A

amount of colloid present (brown and glassy with colloid)

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13
Q

thyroid adenomas are well demarcated from adjacent normal thyroid tissue but can show what signs simular to a multinodular goiter

A

hemorrhage, fibrosis, calcification, cystic change

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14
Q

follicular adenomas are uniform follicles containing _

what cells are seen in thyroid adenomas

hallmark of thyroid adenomas

A

colloid

hurthle cells occasionally

well formed capsule seperating it from adjacent tissue (compresses normal tissue)

hurthle cells are seen in hasimotos with many germinal centers

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15
Q

follicular adenoma=

A

thyroid adenoma

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16
Q

adneomas present as a solitary _ (painless/painful) mass

nonfunctioning adenomas appear as _ nodules on radionucleotide scans

_ percent of cold nodules prove to be malignant

malignancy is rare in _ nodules (toxic adenomas)

definitive diagnosis by?

A

painless

cold

10%

hot

resctions (need to exclude capsular or vascular invasioni n carcinomas)

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17
Q

follicular adenomas do not _ and are an excellent prognosis

A

recur/metastsize

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18
Q

what are the different type of thyroid carcinomas

A

papillary
follicular
anaplastic
medullary

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19
Q

where are the thyroid carcinomas derived from

A

Follicular, Papillary, and Anaplastic are from follicular epithelium

medullary is from parafollicular C cells

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20
Q

what are the 3 precursor lesions for follicular carcinomas

A

papillary microcarcinoma –> PTC
noninvasive thyroid neoplasms –> follicular variant PTC
nonfunctioning follicular adenoma–> follicular carcinoma

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21
Q

what are the driver genes for follicular neoplasms

A

gain of function mutations RAS, PAX8- PPARG

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22
Q

conventional PTCs drivier mutations

A

RET, NTRK, BRAF

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23
Q

poorly differentiated/anaplastic driver mutations

A

TP53

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24
Q

medullary thyroid carcinoma driver mutation

A

RET

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25
Q

what are the major risk factors for thyroid carcinoma

A

ionizing radiation (papillary carcinoma/chernobyl disaster)

def dietary iodine (follicular)

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26
Q

what are the variants of papillary carcinoma

A

invasive follicular variant of PTC and noninvasive follicular thyroid neoplasm with papillary like nuclear features

follicular
tall cell
diffuse sclerosing
papillar microcarcinoma

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27
Q

what are the common variants of papillary carcinoma

A

coventional PTC

invasive encapsulated follicular variant of PTC

28
Q

papillary carcinoma is associated with _ exposure

A

ionizing radiation exposure

29
Q

what is the first sign of papillary carcinoma

A

cervical lymph node mass

30
Q

how does papillary carcinoma of the thyroid present

A

freely movable, can have metastases to the lung, not distinguishable from a benign nodule

causes mass effects (dyspnea would be advanced disease)

31
Q

papilallary carcinoma is a _ mass and you need _ to diagnose

it has _ prognosis and is dependent on _ and _ extension

A

cold

FNA

good

age and extrathyroidal extension

32
Q

patients with papillary _ and nonivasive _ thyroid neoplas do good with a lobectomy alone. Total thyroidectomy can cause _ _ _ and iatrogenic _

A

microcarcinoma

follicular

vocal cord palsy

hypoparathyroidism

33
Q

PTC morphology

A

foci of lymphatic invasion**
cervical node
cystic/fibrosis/calcifications

branching papillae with fibrovascular core**
psomomas bodies**
ground glass/coffee bean nuclei

34
Q

what are ground glass nuclei

A

intranuclear grooves from invaginations of cytoplasm

35
Q

what does the follicular variant of PTC look like

mutation?

A

coffee bean nuclei (ground glass) no papillae, all follicles

RAS mutation

36
Q

tall cell papillary carcinoma variant looks?

mutations

A

tall columnar cells

eosionophilic cytoplasma

aggressive (increased invasion and mets)

BRAF RET/PTC

37
Q

diffuse sclerosing variant of PTC

A

younger patients

distnant metz

papillary pattern, solid aread
lymphocytic infiltrate
LN metz

38
Q

diffuse sclerosing PTC variant simulates?

A

hasimotos

39
Q

papillary microcarcinoma variant

A

very small less than 1cm, identical to PTC and is an accidental finding

40
Q

follicular carcinomas are _ nodules caused by?

most of them are _ (cold/hot)

A

painless

caused by idodine def

cold

41
Q

follicular carcinomas are low risk and invade the _

they infiltrate the _

and there can be hematogenous spread

A

lymphatics

tissues

42
Q

prognosis of follicular carcinoma depends on

A

invasion and stage at presentation

widely invasive

43
Q

treatment of follicular carcinoma

A

total thyrodectomy and radioactive iodine

thyroid hormone to suppress residual carcinoma from responding to TSH

monitor thyroglobulin for recurrence

44
Q

histology of follicular carcinoma

A

penetrate capsule and infiltrative neck

goes into capsules and vessels

can have central fibrosis and calcifications

45
Q

poorly differentiated /anaplastic carcinomas are _ (benign/aggressive)

1/4 of them come from a _ _ carcinoma

A

aggressive

well differentiated

46
Q

anaplastic carcinoma presents as a ?

A

rapidly enlarging mass

47
Q

in anaplastic carcinoma there is often metastasis to the _ at the time of presentation

A

lungs

48
Q

symptoms of anaplastic carcinoma

A

compression; dsypnea, dysphagia, hoarsness

49
Q

treatment for anaplastic carcinoma

poorly differentiated

A

anaplastic: none, death

poorly diff: radical surgery/radioactive iodine

50
Q

histology of anaplastic carcinoma

A

variable: giant cells, pleomorphic, spindle cells just depends

51
Q

histology of poorly differentiated carcinoma

A

varies; necorsis, trabecular growth pattern, insular gorwth patterns

52
Q

epithelial markers for anaplastic and poorly differentiated carcinoma

A

cytokeratin

53
Q

what marker is negative in anaplastic and poorly differentiated carcinoma

A

thyroglobulin (thyroid differentiation marker)

54
Q

medullary carcinomais a _ neoplasm and is derived from?

A

neuroendocrine

parafollicular cells (c cells)

55
Q

medullary carcinoma is derived from C cells that secrete _ but _ is not a prominent feature

A

calcitonin

hypocalcemia

56
Q

medulalry carcinoma is a _ syndrome and will secrete

A

paraneoplastic

serotonin, ACTH, VIP

57
Q

most medullary carcinoma are sporadic caused by?

A

MEN 2A or MEN2B

FMTC (familial medullary thyroid carcinoma)

58
Q

MEN syndome has a point mutation in?

A

RET

59
Q

which one is more aggressive MEn2A or MEN2B

A

2B

60
Q

all MEN2 patients with RET 2 are offered a prohylactic

A

thyroidectomy

61
Q

sporadic medullary carcinoma presentation

A

solitary mass

paraneoplastic syndrome

calcitonin and CEA biomarkers

62
Q

biomarkers for sporadic medullary carcinoma

A

calcitonin and CEA

63
Q

familial medullary carcinoma (FMTC) presentation

A

bilateral and multicentric

64
Q

familial meduallry thyroid carcinoma findings

A

RET and C cell hyperplasia

65
Q

morphology of medullary carcinoma

A

calcitonin on IHC
multicentric c-cell hyperplasia
amyloid deposits
cluster of c cells
polygonal/spindle cells

66
Q

amyloid in medullary carcinoma will show _ on congo red stain

A

apple green birefrengence

67
Q

what are the congenital anomolies of the thyroid

A

thyroglossal duct or cyst

midline and anterior (superimposed infection can give an abcess and rarely give rise to cancer)

can happen at any age.

stratified squamous epi

ENRP Exam 2 (13 decks)

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