thyroid part III Flashcards
follicular carcinomas are more prevalent where
dietary iodine deficiency areas like mountains
peak incidence of follicular carcinomas
between 40 and 60
morphology of follicular carcinomas
single nodules that are well circumscribed or widely infiltrative
gray- tan to pink on cut section
large colloid filled follicles
diference of adenoma vs carcinoma of follicular thyroid
adenoma has thin capsule
carcinoma has thick capsule with invasion
what type of spread is common with follicular carcinoma
vascular dissemination with mets to bone lungs and liver
how will follicular carcinoma appear on scintigram
cold nodules but some that are hyperfunctional may appear warm
prognosis of follicular carcinoma
depends on extent of invasion and stage
Tx follicular carcinoma
total thyroidectomy with administration of radioactive iodine which is used to identify mets and ablate them
why are patients with follicular carcinomas treated with thyroid hormone post surgery
to suppress endogenous TSH levels
how do we monitor the tumor recurrence in follicular carcinomas
thyroglobulin levels
should be barely detectable in patient free of the disease
Prognosis of anaplastic carcinomas of thyroid
100% mortality
undifferentiated tumors
usually mean age 65
what should you ask in Hx of patient Dx with anaplastic carcinoma of thyroid
Hx of well differentiated thyroid carcinoma because 25% have had this
micro morphology of anaplastic carcinoma of thyroid
pleomorphic giant cells
spindle cells
mixed of both types
epithelial marker for anaplastic carcinoma of thyroid
cytokeratin
presentation and course of anaplastic carcinoma
rapidly enlarging bulky neck mass that usually spread beyond thyroid capsule into adjacent neck structures or mets to lungs
Sx of anaplastic carcinoma
dyspnea, dysphagia, hoarseness and cough
avg life span once Dx with anaplastic carcinoma of thyroid
less than 1 year
what are medullary carcinomas of thyroid
neuroendocrine neoplasms derived from parafollicular cells or C cells
what do medullary carcinomas secrete and why is this important
calcitonin!! used to Dx and follow-up
majority of medullary carcinomas arise how
sporadically and the remainder in MEN 2A or 2B or familial medullary thyroid carcinoma
difference morph of sporadic medullary carcinoma vs familial
sporadic are solitary nodules
familial are b/l and multicentricity
what is a key feature morphologically of medullary carcinomas of thyroid
deposition of amyloid from the calcitonin molecules
dense core granules
derived from endocrine system
clincal presentation of sporadic medullary carcinoma
mass in neck sometimes with dysphagia or hoarseness
sometimes paraneoplastic syndrome (secretion of a peptide hormone)
is hypocalcemia a prominent feature of medullary carcinomas
no even though high calcitonin
biomarker for medullary carcinoma
carcinoembryonic antigen CEA from neoplastic cells
which type of medullary carcinoma is more aggressive
MEN2B associated
Patient has MEN2 with RET mutation, though asymptomatic what is recommended
prophylactic thyroidectomy to prevent development of medullary carcinoma
PAX8PPARG fusion gene
follicular carcinoma
RAS or PI-3K actication
follicular carcinoma
chrom translocation RET oncogene
papillary carcinoma
mutaitons in RET
medullary carcinoma
