Tumors (Thyroid) Flashcards
Q: What are the three main classifications of thyroid tumors
Tumors from follicular cells para-follicular cells and lymphoid tissue.
Q: What is the benign tumor arising from follicular cells
Follicular adenoma.
Q: What are the malignant tumors arising from follicular cells
Papillary carcinoma follicular carcinoma and anaplastic carcinoma.
Q: What is the malignant tumor arising from para-follicular cells
Medullary carcinoma.
Q: What is the malignant tumor arising from lymphoid tissue
Lymphoma.
Q: How does follicular adenoma present
As a solitary thyroid nodule.
Q: How is follicular adenoma differentiated from follicular carcinoma
By histopathology to detect capsular or vascular invasion.
Q: Why is fine needle aspiration cytology (FNAC) unreliable for follicular tumors
It cannot differentiate between adenoma and carcinoma.
Q: What is the treatment for follicular adenoma
Hemi-thyroidectomy of the affected side.
Q: What is the most common thyroid cancer
Papillary carcinoma.
Q: Who is most affected by papillary carcinoma
Young and middle-aged females.
Q: What are the risk factors for papillary carcinoma
Neck irradiation and thyroiditis.
Q: What is the microscopic feature of papillary carcinoma
Malignant cells arranged in papillary pattern with psammoma bodies.
Q: What is the common mode of spread in papillary carcinoma
Lymphatic spread to deep cervical lymph nodes.
Q: What is the significance of thyroglobulin in papillary carcinoma
It is used as a tumor marker for follow-up and recurrence detection.
Q: What is the prognosis of papillary carcinoma
Good with early detection and treatment.
Q: Who is most affected by follicular carcinoma
Middle-aged females.
Q: What is the main predisposing factor for follicular carcinoma
Simple nodular goiter.
Q: What is the incidence of follicular carcinoma among thyroid cancers
0.17
Q: How does follicular carcinoma spread
Commonly by blood with metastasis to bones.
Q: What are the common sites of bone metastasis in follicular carcinoma
Temporal and parietal skull bones.
Q: What is the prognosis of follicular carcinoma
Bad.
Q: What type of thyroid cancer is TSH-independent
Anaplastic carcinoma.
Q: Who is most affected by anaplastic carcinoma
Old males.
Q: What is the incidence of anaplastic carcinoma
Up to 13%.
Q: What is the microscopic feature of anaplastic carcinoma
Sheets of undifferentiated spindle-shaped malignant cells.
Q: How does anaplastic carcinoma spread
Directly lymphatically and by blood in late stages.
Q: What is the prognosis of anaplastic carcinoma
Worst among thyroid cancers.
Q: What is the origin of medullary carcinoma
Para-follicular (C-cells).
Q: What hormone does medullary carcinoma secrete
Calcitonin.
Q: What is the incidence of medullary carcinoma among thyroid tumors
0.06
Q: How does medullary carcinoma spread
Directly and lymphatically.
Q: What syndrome is associated with medullary carcinoma
MEN IIa with hyperparathyroidism and pheochromocytoma.
Q: What is the tumor marker for medullary carcinoma
Calcitonin.
Q: What are the general symptoms of thyroid cancer
Distant spread symptoms like scalp or lateral neck swelling.
Q: What are the local symptoms of thyroid cancer
Neck swelling discomfort dyspnea dysphagia and hoarseness of voice.
Q: What are the general signs of thyroid cancer
Weight loss scalp swelling and sometimes no symptoms.
Q: What are the typical local signs of malignancy in thyroid cancer
Solitary hard thyroid nodule with restricted mobility or fixation and enlarged cervical lymph nodes.
Q: What is occult carcinoma
Thyroid cancer presenting with lymph node metastasis without an obvious thyroid swelling.
Q: What is a histological surprise in thyroid cancer
A benign-looking thyroid nodule revealing malignancy after surgery.
Q: What is lateral aberrant thyroid
Metastatic thyroid cancer in cervical lymph nodes.
Q: What additional symptoms may occur in medullary carcinoma
Diarrhea and abdominal pain due to serotonin and prostaglandins.
Q: What are the tumor markers for thyroid cancer
Thyroglobulin for papillary and follicular carcinoma and calcitonin for medullary carcinoma.
Q: What radiological investigations help in diagnosing thyroid cancer
Neck ultrasound thyroid isotope scan chest X-ray and bone scan.
Q: What is the limitation of thyroid isotope scan in thyroid cancer
Malignant nodules may appear as cold nodules with decreased uptake.
Q: What is the advantage of FNAC in thyroid cancer
Rapid inexpensive and useful except for follicular tumors.
Q: What is the treatment for operable thyroid cancer
Total thyroidectomy with lymph node removal if involved.
Q: Why is L-thyroxine given after thyroidectomy
To prevent hypothyroidism and suppress TSH.
Q: What indicates recurrence of thyroid cancer
Increased thyroglobulin levels.
Q: How is inoperable or anaplastic thyroid cancer treated
Radiotherapy and chemotherapy.
Solitary thyroid nodule
It is a clinically detected single thyroid nodule.
Types of solitary thyroid nodule
True solitary nodule or dominant nodule in multi-nodular goiter.
Differential diagnosis of solitary thyroid nodule
Simple nodule toxic nodule or neoplastic nodule.
FNAC limitation in follicular tumors
It cannot differentiate follicular carcinoma from adenoma.
Treatment of toxic thyroid nodule
Total lobectomy or hemithyroidectomy.
Treatment of simple thyroid nodule
Lobectomy.
Treatment of thyroid adenoma
Total lobectomy or hemithyroidectomy.
Treatment of thyroid carcinoma
Total thyroidectomy.
Definition of retrosternal goiter
Thyroid enlargement extending downward behind the sternum.
Causes of primary retrosternal goiter
Ectopic thyroid tissue in the mediastinum separated from the main thyroid.
Blood supply of primary retrosternal goiter
Nearby mediastinal vessels.
Causes of secondary retrosternal goiter
Extension from cervical goiter due to short neck negative intra-thoracic pressure and anatomical barriers.
Main blood supply of secondary retrosternal goiter
Inferior thyroid artery.
Definition of plunging goiter
Retrosternal goiter that moves up with swallowing and descends again.
Definition of mediastinal goiter
Intrathoracic goiter connected to the thyroid by a narrow stalk.
Blood supply of mediastinal goiter
Mainly through the inferior thyroid artery.
Definition of intra-thoracic goiter
Goiter completely located in the chest separated from the thyroid.
Blood supply of intra-thoracic goiter
Mediastinal vessels.
Common symptoms of retrosternal goiter
Mostly asymptomatic but can cause pressure symptoms in large cases.
Pressure symptoms of large retrosternal goiter
Dyspnea inability to lie flat and dysphagia.
Gender more commonly affected by retrosternal goiter
Men.
Inspection finding in retrosternal goiter
Dilated veins over the anterior chest.
Palpation finding in retrosternal goiter
Evidence of cervical goiter.
Percussion finding in retrosternal goiter
Dullness over the manubrium.
Radiological investigation for retrosternal goiter
X-ray to detect tracheal shift.
Best imaging modality for retrosternal goiter diagnosis
Neck ultrasound.
Role of CT scan in retrosternal goiter
Detects goiter and its relation to intra-thoracic structures.
Main treatment for retrosternal goiter
Thyroidectomy.
When is median sternotomy needed in retrosternal goiter
In huge retrosternal goiters.
Why is de-vascularization done in the neck during retrosternal goiter surgery
To prevent excessive bleeding.
Precaution during delivery of retrosternal goiter in surgery
Avoid recurrent laryngeal nerve injury.
