thyroid last part (neoplasms) Flashcards by Deja Gause

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

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

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funcitonal/hot nodules are more likely to be

benign

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

FNA or surgical resection

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a follicular adenoma is a solitary mass derived from?

follicular epithelium

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does a follicular adenoma predispose you to follicular carcinoma?

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majority of follicular adenomas are?

nonfunctional

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what are toxic adenomas

produce thyroid hormones independent of TSH stimulation **

toxic meaning autonomous meaning producing hormone

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what is the mutation in toxic adenomas and toxic nodular goiters

somatic TSH receptor gain of function

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gain of functio in the TSHR allow for _ from TSH

autonomy

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toxic adenomas and toxic adenomas produce a _ thyroid nodule

HOT

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describe what a thyroid adenoma looks like

solitary, encapsulated (well circumscribed)

bulges from the cut surface

and compressess adjacent thyroid

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thyroid adenomas can be gray white to red brown dpending on

amount of colloid present (brown and glassy with colloid)

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

hemorrhage, fibrosis, calcification, cystic change

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follicular adenomas are uniform follicles containing _

what cells are seen in thyroid adenomas

hallmark of thyroid adenomas

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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follicular adenoma=

thyroid adenoma

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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?

painless

cold

10%

hot

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

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follicular adenomas do not _ and are an excellent prognosis

recur/metastsize

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what are the different type of thyroid carcinomas

papillary
follicular
anaplastic
medullary

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where are the thyroid carcinomas derived from

Follicular, Papillary, and Anaplastic are from follicular epithelium

medullary is from parafollicular C cells

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what are the 3 precursor lesions for follicular carcinomas

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

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what are the driver genes for follicular neoplasms

gain of function mutations RAS, PAX8- PPARG

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conventional PTCs drivier mutations

RET, NTRK, BRAF

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poorly differentiated/anaplastic driver mutations

TP53

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medullary thyroid carcinoma driver mutation

RET

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what are the major risk factors for thyroid carcinoma

ionizing radiation (papillary carcinoma/chernobyl disaster) def dietary iodine (follicular)

what are the variants of papillary carcinoma

invasive follicular variant of PTC and noninvasive follicular thyroid neoplasm with papillary like nuclear features follicular tall cell diffuse sclerosing papillar microcarcinoma

what are the common variants of papillary carcinoma

coventional PTC invasive encapsulated follicular variant of PTC

papillary carcinoma is associated with _ exposure

ionizing radiation exposure

what is the first sign of papillary carcinoma

cervical lymph node mass

how does papillary carcinoma of the thyroid present

freely movable, can have metastases to the lung, not distinguishable from a benign nodule causes mass effects (dyspnea would be advanced disease)

papilallary carcinoma is a _ mass and you need _ to diagnose it has _ prognosis and is dependent on _ and _ extension

cold FNA good age and extrathyroidal extension

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

microcarcinoma follicular vocal cord palsy hypoparathyroidism

PTC morphology

foci of lymphatic invasion**** cervical node cystic/fibrosis/calcifications branching papillae with fibrovascular core**** psomomas bodies**** ground glass/coffee bean nuclei

what are ground glass nuclei

intranuclear grooves from invaginations of cytoplasm

what does the follicular variant of PTC look like mutation?

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

tall cell papillary carcinoma variant looks? mutations

tall columnar cells eosionophilic cytoplasma aggressive (increased invasion and mets) BRAF RET/PTC

diffuse sclerosing variant of PTC

younger patients distnant metz papillary pattern, solid aread lymphocytic infiltrate LN metz

diffuse sclerosing PTC variant simulates?

hasimotos

papillary microcarcinoma variant

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

follicular carcinomas are _ nodules caused by? most of them are _ (cold/hot)

painless caused by idodine def cold

follicular carcinomas are low risk and invade the _ they infiltrate the _ and there can be hematogenous spread

lymphatics tissues

prognosis of follicular carcinoma depends on

invasion and stage at presentation widely invasive

treatment of follicular carcinoma

total thyrodectomy and radioactive iodine thyroid hormone to suppress residual carcinoma from responding to TSH monitor thyroglobulin for recurrence

histology of follicular carcinoma

penetrate capsule and infiltrative neck goes into capsules and vessels can have central fibrosis and calcifications

poorly differentiated /anaplastic carcinomas are _ (benign/aggressive) 1/4 of them come from a _ _ carcinoma

aggressive well differentiated

anaplastic carcinoma presents as a ?

rapidly enlarging mass

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

lungs

symptoms of anaplastic carcinoma

compression; dsypnea, dysphagia, hoarsness

treatment for anaplastic carcinoma poorly differentiated

anaplastic: none, death poorly diff: radical surgery/radioactive iodine

histology of anaplastic carcinoma

variable: giant cells, pleomorphic, spindle cells just depends

histology of poorly differentiated carcinoma

varies; necorsis, trabecular growth pattern, insular gorwth patterns

epithelial markers for anaplastic and poorly differentiated carcinoma

cytokeratin

what marker is negative in anaplastic and poorly differentiated carcinoma

thyroglobulin (thyroid differentiation marker)

medullary carcinomais a _ neoplasm and is derived from?

neuroendocrine parafollicular cells (c cells)

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

calcitonin hypocalcemia

medulalry carcinoma is a _ syndrome and will secrete

paraneoplastic serotonin, ACTH, VIP

most medullary carcinoma are sporadic caused by?

MEN 2A or MEN2B FMTC (familial medullary thyroid carcinoma)

MEN syndome has a point mutation in?

RET

which one is more aggressive MEn2A or MEN2B

all MEN2 patients with RET 2 are offered a prohylactic

thyroidectomy

sporadic medullary carcinoma presentation

solitary mass paraneoplastic syndrome calcitonin and CEA biomarkers

biomarkers for sporadic medullary carcinoma

calcitonin and CEA

familial medullary carcinoma (FMTC) presentation

bilateral and multicentric

familial meduallry thyroid carcinoma findings

RET and C cell hyperplasia

morphology of medullary carcinoma

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

amyloid in medullary carcinoma will show _ on congo red stain

apple green birefrengence

what are the congenital anomolies of the thyroid

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