Thyroid Neoplasias and PTH disorders

Question 1

When is a thyroid nodule more likely malginant?

Answer 1

Solitary, younger, males, history of radiation, “cold” nodules

Question 2

What are the 3 kinds of benign thyroid nodules?

Answer 2

Colloid nodules, follicular adenomas, cysts

Question 3

What are the types of malignant thyroid nodules?

Answer 3

papillary, follicular, medullary, anaplastic carcinoma

Question 4

Which is the most common type of malignant thyroid nodule?

Answer 4

Papillary (75-85%)

Question 5

How do you tell the difference between follicular adenoma and follicular carcinoma?

Answer 5

Capsular and/or vascular invasion must be demonstrated

Question 6

Describe the gross appearance of follicular adenoma?

Answer 6

solid, well-circumscribed, encapsulated, fairly homogenous

Question 7

Describe the histological appearnce of follicular adenoma.

Answer 7

solid, trabecular or follicular patterns can be expressed. All produce colloid to some extent. lack of microsopic invasion

Question 8

What are the key factors in prognosis of thyroid cancer?

Answer 8

age and spread beyond capsule at diagnosis

Question 9

Which has the better prognosis, follicular or papillary carcinoma?

Answer 9

Papillary

Question 10

T or F The thryoid malignancy is the direct cause of death in half of papillary carcinoma and 2/3 of the follicular type.

Answer 10

T

Question 11

Immediate post-operative mortality of thyroid cancer is ___

Answer 11

1%

Question 12

What is the post-treatment recurrence rate of thyroid carcinoma?

Answer 12

8.7%

Question 13

Gross appearance of papillary carcinoma

Answer 13

not as circumscribed

Question 14

HIsto appearance of papillary carcinoma

Answer 14

psammoma bodies, lamellar calcified structures

Question 15

Gross appearance of follicular carcinoma

Answer 15

tends to not be as well circumscribed

Question 16

Histo appearnce of follicular carcinoma

Answer 16

presence of capsular invasion in carcinoma and vascular invasion

Question 17

Medullary carcinoma is a cancer of what cells?

Answer 17

parafollicular cells that produce calcitonin

Question 18

With medullary carcinoma, how do pt present?

Answer 18

hypocalcemia

Question 19

Do medullary carcinomas present with other disorders? Are they solitary or multiple?

Answer 19

80% are sporadic; others seen in MENIIA (RET protooncogene), MENIIB, and non-MEN familial cases. May be solitary or mutliple/bilateral and typically produce amyloid

Question 20

How common is anaplastic carcinoma? What is the prognosis?

Answer 20

rare, but terrible prognosis.

Question 21

Epidemeology of anaplastic carcinoma?

Answer 21

mean age of 65 years, equal in M to F, most have history of thyroid disease, 20-30% have concurrent carcinoma.

Question 22

What genetic event is though to occur in anaplastic carcinoma?

Answer 22

loss of p53

Question 23

What is the principal symptom of anaplastic carcinoma?

Answer 23

rapidly enlarging neck.

Question 24

What kind of anaplastic carcinomas have better results?

Answer 24

less than 6 cm

Question 25

T or F Lymphoma represents 10% of all malignant thyroid tumors and is almost always T cell lineage.

Answer 25

F: 2%, B cell lineage

Question 26

What is the main presenting symptom with lymphoma of thyroid?

Answer 26

rapidly enlarging goiter

Question 27

What is the only known risk factor for lymphoma of thryoid

Answer 27

pre-existing chronic autoimmune thyroiditis

Question 28

Describe SCC in thyroid.

Answer 28

most commonly seen in lungs, primary thyroid is highly malignant and usually metastatic at presentation

Question 29

A carcinoma in struma ovarii is what type usually?

Answer 29

papillary, follicular, or undifferentiated

Question 30

Describe the development and anatomy of parathyroids.

Answer 30

The four parathyroid glands (2 superior and 2 inferior) develop from the third and fourth branchial pouches. The 2 inferior parathyroids develop from the third branchial pouch, which also gives rise to the thymus, whilst the 2 superior parathyroids develop from the fourth branchial pouch. Recent molecular genetic studies have identified some of the genes (eg. GATA3, Gcm2 and Hoxa3) involved in these developmental pathways of the branchial pouches and parathyroids. Normally, the four parathyroids are located posterior to the thyroid at the upper an lower poles; up to eight parathyroids have been described, however, and they may be seen intrathyroidally or even in the mediastinum.

Question 31

What is the most common disorder of the parathyoid gland?

Answer 31

PT adenoma. RARELY a carcinoma

Question 32

What happens in to the gland in adenomas?

Answer 32

increases in size, produces too much PTH with resultant hypercalcemia

Question 33

How do parathyroid adenomas present?

Answer 33

A tumor of the parathyroid gland and the most common disorder of the gland. The vast majority of parathyroid tumors are benign; parathyroid carcinoma is very, very rare.. With adenomas the gland increases in size and produces PTH in excess with resultant hypercalcemia.
In most cases, patients are unaware of the tumors, and they are found when a patient’s routine blood test results have elevated blood calcium and PTH levels. In more serious cases, the bone density will diminish and kidney stones can form. Other non-specific symptoms include depression, muscle weakness, and fatigue. Remember the clinical triad: Moans, bones, and stones.

Question 34

Histo appearance of parathyroid adenomas.

Answer 34

larger than normal parathyroid glands and by not having the usual complement of fat seen in normal parathyroids; also, there will often be a rim of normal parathyroid tissue “hugging” the adenoma.

Question 35

Define parathyroid hyperplasia.

Answer 35

absolute increase in the mass of the parenchymal cells of the parathyroid gland, usually via hyperplasia of all of the glands.

Question 36

The vast majority of parathyroid hyperplasia is secondary to _____.

Answer 36

hyperplasia of chief cells

Question 37

How do pt with parathyroid hyperplasia present?

Answer 37

similar with parathyroid adenomas

Question 38

How can you tell the difference between parathyroid adenoma and hyperplasia?

Answer 38

Adenoma is usually one gland. Hyperpl. is all or most of the glands.