Thyroid Neoplasms

Question 1

what are benign lesions

Answer 1

main one is follicular adenoma

colloid nodule, cyst, hyperplastic adenoma

Question 2

a follicular adenoma is a…

Answer 2

discreet solitary mass- often incidental finding, encapsulated by surrounding collagen cuff

Question 3

s/s of a follicular adenoma

Answer 3

non-functional, may secrete thyroid hormones hence remove surgically

Question 4

pathophysiology of malignant thyroid cancers

Answer 4

most are well differentiated and derived from follicular epithelium

Question 5

what are the 4 types of malignant thyroid cancers

Answer 5

papillary
follicular
medullary
anaplastic

Question 6

the 2 types of differentiated- histological/ physical appearance- are?

Answer 6

papillary: most common, MAPk pathway, solitary palpable nodule- may present with mets/ local invasion e.g. hoarseness
follicular: 2nd most common, single nodule (slow growing painless)

Question 7

papillary cancer spread

Answer 7

mainly lymphatic

Question 8

papillary cancer ix & mx

Answer 8

ix- USS FNA, LN biopsy, iodine scan

mx- surgery (lobectomy, thyroidectomy- total/sub-total) + thyroid remnant ablation

Question 9

prognosis for follicular carcinoma

Answer 9

good- 95% survival at 10yrs

Question 10

spread of follicular

Answer 10

haematogenous- bone, lungs, liver hence more invasive

Question 11

2 types of follicular carcinoma are…

Answer 11

widely invasive, minimally invasive

Question 12

which of the 2 follicular carcinomas are hard to distinguish from a follicular adenoma

Answer 12

minimally invasive

Question 13

T/F: tx for follicular is same as papillary carcinoma

Answer 13

T: may also have systemic anti-cancer therapy

Question 14

what is the name of the parafollicular cell carcinoma

Answer 14

medullary thyroid carcinoma: tumour of the c-cells so secretes calcitonin

Question 15

what is the aetiology

Answer 15

environmental, MEN2 association

Question 16

morphology of medullary carcinoma

Answer 16

solitary nodule, may be bilateral and multicentric

Question 17

s/s of medullary carcinoma

Answer 17

neck mass + local effects

Question 18

ix for medullary cancer

Answer 18

urinary metanphrines, calcitonin marker

Question 19

tx for medullary cancer

Answer 19

thyroidectomy

Question 20

what is the only undifferentiated carcinoma of thyroid

Answer 20

anaplastic carcinoma: undifferentiated and aggressive. poor prognosis

Question 21

red flag signs for cancer

Answer 21

local involvement- hoarse voice, wt loss, firm hard immobile nodule

Question 22

classification of nodules?

Answer 22

U classification: U2 (benign), U5 (malignant)

Question 23

classification of cancer?

Answer 23

TNM

Question 24

thyroid lymphoma…

Answer 24

females, aetiology is AI hypothyroidism, rapid onset of mass in thyroid, core biopsy as ix, champ/radio