Thyroid Neoplasms- Usera Flashcards
What are the four types of thyroid neoplasms?
- Adenomas
- Primary B cell Lymphoma
- Carcinomas
- Metastases to Endocrine organs
What is the most common BENIGN thyroid neoplasm?
What does it look like
What are its characteristics?
thyroid adenoma
discrete solitary mass
“cold nodule” (i.e may not be functional, not likely to produce hormones)
What can you get if you have long standing hashimotos and what does it look like?
primary b cell lymphoma
monoclonal lymphocytic hyperplasia
What are the four types of thyroid carcinomas?
papillary (>85%)
follicular (5-15%)
anaplastic (>5%)
medullary (5%)
What is the MOST common MALIGNANT thyroid tumor?
Who is it most prevalent in?
What is it associated with?
papillary
F:M 3:1 second and third decade
radiation exposure
What is the characterization of papillary carcinoma?
multifocal
metastasize to cervical LN and lung
What is the histology of papillary carcinoma?
- Papillae lined by cells with clear “orphan annie eye” nuclei and nuclear grooves
- psammoma bodies
- pseudoincludion
- fibrovascular core
How do you diagnose papillary thyroid carcinomas?
What is the prognosis?
FNA
>95% 5-year survival
45% associated with BRAF mutation
What percentage of thyroid carcinomas are follicular?
What does follicular carcinoma look like?
5-15%
follicular adenoma but with malignant behavior
What makes a follicular adenoma a follicular carcinoma?
Where can it metastasize?
How is follicular carcinoma spread?
Extracapsular invasion or invasion into blood vessels Mets to bone and lung Hematogenous spread (only carcinoma spread through blood rather than lymphatics)
How do you diagnose follicular carcinoma?
FNA-> determines a follicular neoplasm
Microscopy-> differentiates follicular neoplasm from follicular carcinoma due to capsular invasion
Who mostly gets follicular carcinoma?
females
What percent of thyroid carcinomas are anaplastic?
<5%
What does anaplastic carcinoma look like? What can it lead to?
- undifferentiated malignant tumor of the thyroid
- leads to dysphagia and respiratory compromise
Who typically gets anaplastic thyroid carcinoma and what are some risk factors for this?
elderly
Risk factors: multinodular goiter, history of follicular neoplasms
What is the prognosis of anaplastic carcinoma?
Rapidly aggressive and fatal
5 year survival 5%
BRAF mutations (sometimes)
What percent of thyroid cancers are medullary?
5%
What percent of medullary thyroid cancers are familial? sporadic?
20%
80%
What genetic mutation is medullary carcinoma associated with?
Autosomal Dominant MEN IIA
Autosomal Dominant MEN IIB
Mutations in RET oncogene
What are all the diseases that MEN IIA is associated with?
Medullary carcinoma
Hypoparathyroidism
Parathyroid adenomas
Pheochromocytomas
What are all the diseases that MEN IIB is associated with?
Medullary carcinoma
Mucosal neuromas
Ganglioneuromas of the oral mucosa
Pheochromocytomas
What is the pathogenesis of medullary carcinoma?
Malignant proliferation of C-Cells and hyperproduction of calcitonin
What does medullary carcinoma look like histologically?
amyloid deposition (amyloid replaces calcitonin)
What is the characterization of medullary carcinoma?
- amyloid deposition
- increased calcitonin
- hypocalcemia
- produces other hormones (i.e ACTH)
