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GINME > Week 7: Thyroid Cancer > Flashcards

Week 7: Thyroid Cancer Flashcards

1
Q

What is a thyroid nodule?

A

starts with the growth of a thyroid epithelial cell that escapes normal cell division regulation and leads to continuous growth and eventually leads to a clinically evident tumor mass

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2
Q

What causes thyroid nodules?

A

Mutations in both oncogenes and/or tumor suppressor genes

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3
Q

Types of thyroid nodules

A
  • Solitary nodules (monoclonal)
  • Multinodular goiters (polyclonal)
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4
Q

Prevalence of thyroid nodules and how thyroid nodules are found

A
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5
Q

Majority of nodules that are benign

A
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6
Q

Histological features of benign thyroid nodules

A
  • follicular cells
  • absence of capsular and vascular invasion
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7
Q

benign thyroid nodules AKA

A

Benign follicular adenomas

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8
Q

Workup of a thyroid nodule

A

Functional assessment

  • check TSH (hypo or hyperthyroidism)

Anatomical assessment

  • imaging
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9
Q

If TSH is low with thyroid nodule

A

Obtain radioactive iodine scan

To determine if the nodule is a “hot” nodule

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10
Q

What is a “hot” nodule?

A

Rarely malignant

if they take up a lot of radioactive iodine

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11
Q

What is a “cold” nodule

A

doesn’t uptake radioactive iodine

most are benign but some are malignant

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12
Q

What is the preferred imaging study for the thyroid and thyroid nodules

A

Ultrasound

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13
Q

Features of interest of thyroid nodules by ultrasound

A
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14
Q

What is Echogenicity and what does it indicate?

A

How dark or light appearing on ultrasound

Often less echogenic nodules are malignant (darker = malignant) AKA Hypoechoic

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15
Q

Ultrasound features of malignant thyroid nodules

A

Hypoechoic

microcalcifications

irregular margins

taller than wide

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16
Q

Size of nodules to be biopsied

A

1 cm or larger

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17
Q

Low suspicion thyroid nodules on ultrasound

A
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18
Q

Moderate suspicion thyroid nodules on ultrasound

A
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19
Q

Very low suspicion thyroid nodules on ultrasound

A

spongiform

partially cystic

lacking suspicious features such as having irregular margins

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20
Q

Thyroid cysts chance of malignancy

A

Very low

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21
Q

TI-RAD system

A

system used to report on thyroid nodule imaging

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22
Q

Features of highly suspicious thyroid nodules

A
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23
Q

Features of low suspicious thyroid nodules

A
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24
Q

Classifications of thyroid cancers

4 listed

A
  • Well-differentiated thyroid carcinomas
  • undifferentiated thyroid carcinomas
  • medullary thyroid carcinoma
  • thyroid lymphomas
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25
Q

Most common thyroid cancer

A

Papillary thyroid carcinoma

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26
Q

Papillary thyroid carcinoma derived from

A

Thyroid follicular cells

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27
Q

Histological features of Papillary thyroid carcinoma

A
  • Orphan Annie Nuclei (clearing out of chromatin/white appearance to nuclei)
  • Sonoma bodies (necrosis)
  • can be calcifications
  • nuclear grooves
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28
Q

Prevalence/ epidemiology of papillary thyroid carcinoma

A

most common thyroid cancer (70-90% of cases)

Female predominate

2.5:1

Aged 40-50

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29
Q

Risk for Papillary thyroid carcinoma

A
  • Hx of radiation in childhood
  • FHx of thyroid cancer
  • female Aged 40-50
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30
Q

the trend of papillary thyroid carcinoma

A
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31
Q

Pathogenesis of papillary thyroid carcinoma

A

Activating point mutations in tyrosine kinase MAPK pathway in RAS or BRAF constitutively activating it

Also associated with RET gene

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32
Q

Physical features of papillary thyroid carcinoma

A

Can be multifocal and invades locally

Indolent

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33
Q

Prognosis of papillary thyroid carcinoma

A

25-year mortality in patients younger than 40-> 2%

small % of patients have increased mortality

  • older patients
  • large tumor size
  • soft tissue invasion
  • Distant metastases 2-10%
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34
Q

Follicular thyroid carcinoma prevalence

A

10% of all thyroid cancers

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35
Q

Follicular thyroid carcinoma epidemiology

A

10% of all thyroid cancers

aged 40-60

Female 3:1

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36
Q

Follicular thyroid carcinoma derived from?

A

Follicular cells

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37
Q

Follicular thyroid carcinoma Dx

A

is difficult to Dx by FNA (biopsy)

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38
Q

Risk factors of Follicular thyroid carcinoma

A
  • Associated with childhood radiation
  • FHx thyroid cancer
  • Iodine deficiency
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39
Q

Follicular thyroid carcinoma Pathogenesis

A

point mutations in RAS oncogene

  • 40%

Gene rearrangement

PAX8-PPARγ translocation

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40
Q

Follicular thyroid carcinoma genetics

A

RAS

or

PAX8 (chromosome 2) -PPARγ (Chromosome 3) translocation

41
Q

Follicular thyroid carcinoma gross histology

A

uninodular

Lymph node is not usually involved

Distant metastases (usually in the lung and bone)

42
Q

Prognosis of Follicular thyroid carcinoma

A
43
Q

Hurthle cell carcinoma epidemiology

A

3-10% of differentiated thyroid cancers

44
Q

Hurthle cell carcinoma features

A

tends to be more aggressive

lymph nod involvement is common

Highest incidence of metastases

45
Q

Hurthle cell carcinoma prognosis

A

10 year disease-free survival is 41%

46
Q

Well-differentiated thyroid carcinoma clinical presentation

A
47
Q

Well-differentiated thyroid carcinoma Dx

A

thyroid ultrasound

Fine needle aspiration of nodules

48
Q
A
49
Q

Surgical Treatment of Well-differentiated thyroid carcinoma

A
50
Q

Complications of total thyroidectomy

A

Damage to recurrent laryngeal and superior laryngeal artery (can cause tracheostomy placed)

Hoarseness

vocal paralysis

Hypocalcemia due to parathyroid gland function

51
Q

Rx Treatment of Well-differentiated thyroid carcinoma

A

I-131 treatment

the radioactive form of iodine that destroys any form of the cancer present

52
Q

How does I-131 treatment work for thyroid cancer

A

pretreatment of TSH or thyroid hormone withdrawal to maximize radioactive iodine uptake

low iodine diet

cause thyroid cell death by β-particle emission

53
Q

Monitoring of well-differentiated thyroid carcinoma

A
54
Q

Medullary thyroid carcinoma derived from

A

Parafollicular cells

55
Q

Medullary thyroid carcinoma histological features

A
56
Q

Medullary thyroid carcinoma epidemiology

A

4% of thyroid carcinomas

57
Q

Medullary thyroid carcinoma associations

A

Most are sporadic but…

Familial neoplastic syndromes (25% of cases)

  • Men 2A and @b, familial medullary thyroid carcinoma
58
Q

Medullary thyroid carcinoma pathogenesis

A

RET somatic or germline mutations

HRAS and/or KRAS mutations

59
Q

Medullary thyroid carcinoma charateristics

A

secretes:

calcitonin

sometimes secretes CEA

60
Q

Medullary thyroid carcinoma clinical presentation

A

solitary nodule

predominatly located in the upper portion of each thyroid lobe

70% lymph node involvement

symptoms of compression

5-10% dital metasteses (Liver, Lungs, Bones)

61
Q

Medullary thyroid carcinoma prognosis

A
62
Q

Medullary thyroid carcinoma Treatment

A
63
Q

types of Undifferentiated thyroid carcinoma

A

Anaplastic thyroid carcinoma

and

64
Q

Anaplastic thyroid carcinoma epidemiology

A

0.9-9.8% of thyroid cancers

65 years old

female predominance 60-70% of cases

65
Q

Anaplastic thyroid carcinoma derived from

A

Follicular cells

66
Q

Anaplastic thyroid carcinoma associations

A

20% of patients have a Hx of undifferentiated thyroid cancer

20-30% have coexisting differentiated cancer

Mean age at Dx is 65

67
Q

Anaplastic thyroid carcinoma clinical presentation

A
68
Q

Anaplastic thyroid carcinoma evaluation

A
69
Q

Anaplastic thyroid carcinoma prognosis

A

moratility approaches 100%

6 months without metastases

70
Q

Treatment of Anaplastic thyroid carcinoma

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
71
Q

Thyroid follicular cells proliferative pathways

A
72
Q

Thyroid lymphoma epidemiology

A

2% of thyroid cancers

73
Q

Thyroid lymphoma associations

A

Hashimoto’s Thyroiditis

74
Q

Thyroid lymphoma types

A

60-80% are large B-cell lymphomas

30% are extranodal marginal zone lymphomas

75
Q

Thyroid lymphoma histological features

A
76
Q

Thyroid Lymphoma Clinical presentation

A
77
Q

Thyroid lymphoma evaluation

A
78
Q

Thyroid lymphoma treatment

A
79
Q

Prognosis of Thyroid lymphoma

A
80
Q

MEN1 AKA

A

Multiple Endocrine Neoplasia Type 1

81
Q

MEN1 pathogenesis

A

Autosomal dominant inheritance of MEN1 gene

Produces Menin

tumor suppressor on chromosome 11

82
Q

MEN1 tumors

A

Pituitary tumors

Parathyroid tumors

Pancreatic tumors

83
Q

Dx of MEN1

A
84
Q

Signs and symptoms of Parathyroid tumors

A
85
Q

Signs and symptoms of Pituitary tumors

A
86
Q

Signs and symptoms of Pancreatic tumors

A
87
Q

MEN1 Treatment

A
88
Q

MEN2A AKA

A

Multiple Endocrine Neoplasia Type 2A

89
Q

MEN2A pathogenesis

A

Autosomal dominant inheritance

Germiline mutation in RET protooncogene

Tyrosine kinase receptor in cells of neural crest origin

90
Q

MEN2A clinical presentation

A

Parathyroid hyperplasia

91
Q

MEN2A structures involved

A
92
Q

MEN1 structures involved

A
93
Q

Treatment of MEN2A

A
94
Q

MEN2B pathogenesis

A

autosomal dominant inheritance

Mutation in RET proto-oncogene

95
Q

MEN2B components

A
96
Q

MEN2B clinical presentations and structures invovled

A
97
Q

What are mucosal neuromas? And what condition are they found in?

A

MEN2B

98
Q

MEN2B hallmark

A

Marfinoid habitus

99
Q

Genetic testing in MEN2

A

GINME (63 decks)

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