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Block 10 week 1 > Thyroid Neoplasms- Usera > Flashcards

Thyroid Neoplasms- Usera Flashcards

1
Q

What are the four types of thyroid neoplasms?

A
  • Adenomas
  • Primary B cell Lymphoma
  • Carcinomas
  • Metastases to Endocrine organs
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2
Q

What is the most common BENIGN thyroid neoplasm?
What does it look like
What are its characteristics?

A

thyroid adenoma
discrete solitary mass
“cold nodule” (i.e may not be functional, not likely to produce hormones)

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3
Q

What can you get if you have long standing hashimotos and what does it look like?

A

primary b cell lymphoma

monoclonal lymphocytic hyperplasia

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4
Q

What are the four types of thyroid carcinomas?

A

papillary (>85%)
follicular (5-15%)
anaplastic (>5%)
medullary (5%)

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5
Q

What is the MOST common MALIGNANT thyroid tumor?
Who is it most prevalent in?
What is it associated with?

A

papillary
F:M 3:1 second and third decade
radiation exposure

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6
Q

What is the characterization of papillary carcinoma?

A

multifocal

metastasize to cervical LN and lung

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7
Q

What is the histology of papillary carcinoma?

A
  • Papillae lined by cells with clear “orphan annie eye” nuclei and nuclear grooves
  • psammoma bodies
  • pseudoincludion
  • fibrovascular core
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8
Q

How do you diagnose papillary thyroid carcinomas?

What is the prognosis?

A

FNA
>95% 5-year survival
45% associated with BRAF mutation

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9
Q

What percentage of thyroid carcinomas are follicular?

What does follicular carcinoma look like?

A

5-15%

follicular adenoma but with malignant behavior

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10
Q

What makes a follicular adenoma a follicular carcinoma?
Where can it metastasize?
How is follicular carcinoma spread?

A 
Extracapsular invasion or invasion into blood vessels
Mets to bone and lung
Hematogenous spread (only carcinoma spread through blood rather than lymphatics)
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11
Q

How do you diagnose follicular carcinoma?

A

FNA-> determines a follicular neoplasm

Microscopy-> differentiates follicular neoplasm from follicular carcinoma due to capsular invasion

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12
Q

Who mostly gets follicular carcinoma?

A

females

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13
Q

What percent of thyroid carcinomas are anaplastic?

A

<5%

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14
Q

What does anaplastic carcinoma look like? What can it lead to?

A
  • undifferentiated malignant tumor of the thyroid

- leads to dysphagia and respiratory compromise

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15
Q

Who typically gets anaplastic thyroid carcinoma and what are some risk factors for this?

A

elderly

Risk factors: multinodular goiter, history of follicular neoplasms

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16
Q

What is the prognosis of anaplastic carcinoma?

A

Rapidly aggressive and fatal
5 year survival 5%
BRAF mutations (sometimes)

17
Q

What percent of thyroid cancers are medullary?

A

5%

18
Q

What percent of medullary thyroid cancers are familial? sporadic?

A

20%

80%

19
Q

What genetic mutation is medullary carcinoma associated with?

A

Autosomal Dominant MEN IIA
Autosomal Dominant MEN IIB
Mutations in RET oncogene

20
Q

What are all the diseases that MEN IIA is associated with?

A

Medullary carcinoma
Hypoparathyroidism
Parathyroid adenomas
Pheochromocytomas

21
Q

What are all the diseases that MEN IIB is associated with?

A

Medullary carcinoma
Mucosal neuromas
Ganglioneuromas of the oral mucosa
Pheochromocytomas

22
Q

What is the pathogenesis of medullary carcinoma?

A

Malignant proliferation of C-Cells and hyperproduction of calcitonin

23
Q

What does medullary carcinoma look like histologically?

A

amyloid deposition (amyloid replaces calcitonin)

24
Q

What is the characterization of medullary carcinoma?

A
  • amyloid deposition
  • increased calcitonin
  • hypocalcemia
  • produces other hormones (i.e ACTH)
25
Q

How do you diagnose medullary carcinoma?

A
  • FNA: sheets of malignant cells in an amyloid stroma
  • serum calcitonin
  • RET oncogene detection
26
Q

If you detect RET oncogene in a medullary carcinoma, what should you do?

A

prophylactic thyroidectomy

27
Q

Why are endocrine organs so susceptible to metastases?

A

very vascular so susceptible to hematogenous spread

Block 10 week 1 (4 decks)

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