Thyroid Tumors/Cancers

Question 1

What are the two benign tumors of the thyroid?

Answer 1

Hyperplastic adenomatoid nodules

Follicular adenomas

Question 2

What are the 4 malignant tumors of the thyroid gland?

Answer 2

Papillary thyroid carcinoma
Follicular cell carcinoma
Anaplastic carcinoma
Medullary carcinoma

Question 3

What is the most important morph feature when diagnosing a follicular adenoma?

Answer 3

Evaluate the capsule. Adenomas will have a very well demarcated, intact capsule with no invasion of surrounding tissue.

Question 4

What is the patho of a follicular adenoma?

Answer 4

Gain of function mutation in the TSH receptor

Question 5

What would the radioactive screening show for a follicular adenoma and why?

Answer 5

If its non functioning, It would be cold because it takes up less iodine than normal functioning thyroid tissue.

Question 6

What are the 4 major malignancies of the thyroid gland, which one is most common, and what is the peak age?

Answer 6

Papillary carcinoma, follicular carcinoma, anaplastic carcinoma, and medullary carcinoma. Pap is most common
25-50 years of age.

Question 7

What do all of the carcinomas of the thyroid have in common except medullary?

Answer 7

They derive from the follicular epithelium

Question 8

What does t1, t2, t3, and t4 mean for staging of thyroid carcinoma?

Answer 8

T1: tumor is less than 2cm
T2: tumor is between 2 and 4 cm
T3: greater than 4 and can invade strap muscles
T4: invasions belong strap muscles

Question 9

What does NO and N1, and MO and M1 mean for staging of thyroid carcinoma?

Answer 9

NO is no lymph node, and N1 means regional LN involvement.

MO is no distant metastasis and M1 means distant metastasis.

Question 10

What is the signaling pathway mutated in follicular cell derived malignancies?

Answer 10

Growth factor receptor signaling pathway

Question 11

What are the two main genetic mutations for papillary carcinomas?

Answer 11

RET and BRAF

Question 12

Histologically, what is the diagnostic feature of papillary thyroid carcinoma?

Answer 12

Enraged nuclei with a clear appearance.

Question 13

What are two other histo features we are looking for in papillary carcinoma?

Answer 13

Papillary architecture and psammoma bodies

Question 14

What is the most common variant of papillary carcinoma and what are two main differences between it and normal papillary carcinoma?

Answer 14

Follicular variant.
More follicular architecture but still the same nuclear features
higher prevalence of RAS mutations than BRAF or RET

Question 15

What are two main differences in the Tall Cell variant version of papillary carcinoma?

Answer 15

Typically in older patients and very aggressive in its invasion.

Question 16

3 differences between the diffuse sclerosing variant and conventional papillary?

Answer 16

Kids and young people
Higher incidence of distant metastasis
Lack BRAF but have RET mutations

Question 17

Not only is papillary carcinoma the most common form of thyroid cancer, but it is also associated more than any other thyroid cancer with what?

Answer 17

Previous exposure to radiation

Question 18

Two tests for determining papillary carcinomas?

Answer 18

Radionuclide and fine needle aspiration

Question 19

What will papillary carcinomas show up as on radionuclide?

Answer 19

Cold nodules

Question 20

Overall, what is the prognosis of papillary carcinoma?

Answer 20

Very good.

Question 21

What conditions/situations are follicular carcinomas more common?

Answer 21

Areas with dietary iodine deficiency

Question 22

Gender and age peak of follicular carcinoma?

Answer 22

Women and 40-60

Question 23

2 key histo properties of follicular carcinoma to know?

Answer 23

Invade the capsule

Invade vasculature

Question 24

What is a big difference between invasion between papillary and follicular carcinoma?

Answer 24

Pap goes to regional LN and follicular rarely involve regional LN

Question 25

2 key features of anaplastic cancer clinically?

Answer 25

Highly aggressive and high mortality

Much older patients

Question 26

3 histo features of anaplastic carcinoma?

Answer 26

Giants cells, spindle cells, and mixed giant and spindle cells

Question 27

What are two mutations for all follicular neoplasms?

Answer 27

RAS and PTEN

Question 28

What is a unique mutations specific to follicular carcinoma?

Answer 28

Fusion gene PAX8-PPARG

Question 29

What is the 1 mutation for Anaplastic carcinoma?

Answer 29

TP53

Question 30

Where do medullary carcinomas arise from? What type of tumor is a medullary carcinoma?

Answer 30

Neuroendocrine tumor arising from C cells

Question 31

What is the most common mutation for a medullary carcinoma?

Answer 31

RET

Question 32

What is the result on radionuclide test for follicular carcinoma?

Answer 32

Cold

Question 33

What are the two types of medullary carcinoma and which one is more common?

Answer 33

Sporadic (70%) and familial (30%)

Question 34

What syndrome is the familial type associated with?

Answer 34

Men type 2a and b

Question 35

2 histo features of medullary carcinoma?

Answer 35

Amyloid deposits and c cell hyperplasia

Question 36

What are two features unique to familial medullary carcinoma?

Answer 36

Bilateral and multicentric, meaning it has multiple spots of origin

Question 37

Prognosis of sporadic vs. familial?

Answer 37

Familial is much better

Question 38

Talk about the 3 levels of prognosis for 10 year survival rates for medullary?

Answer 38

90% if its just in the thyroid gland
70% if its in the cervical LN
20% if there is distant metastasis