Thyroid Cancers

This is a video on the most common cancers that originate in the thyroid tissue.

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ADDITIONAL TAGS:
Thyroid cancers
The most common carcinomas that originate in the thyroid tissue
Epi: Frequency of 80 percent (most common); good prognosis (10 year survival 95%); F:M 3:1; peak incidence in 30s to 50s
Gross: irregular contours, no capsule around it
Histo: nuclear clearing (nuclei appear empty - “Orphan Annie eye”), nuclear grooves, intranuclear pseudoinclusions, psammoma bodies (calcifications) , reduced colloid, crowded cells, papillary architecture (sometimes present)
Derived from follicular cells
Increased risk: mutations (RET and BRAF), radiation exposure as child
Spread: often by lymphatic invasion to cervical nodes, neck; slow growth
Secretes thyroglobulin; takes up radioiodine
Treat: lobectomy (maybe total thyroidectomy with lymph node removal)
High risk pts get radioiodine tx
TSH suppression with thyroid hormone replacement
Epi: Frequency of 10 percent; more aggressive than papillary with early metastases; also F:M 3:1; peak in 40s to 60s
Histo: monotonous/uniform population, overlapping follicular cells, microacinar formation, reduced colloid, might contain Hurthle cells
Derived from follicular cells
Increased risk: mutations in RAS
Spread: often by vascular invasion; locally invasive, invades thyroid capsule
Distal spread more common than papillary
Invades blood vessels and invades through the capsule
Differentiate from follicular adenoma:
Secretes thyroglobulin; takes up radioiodine (except Hurthle cells)
Same treatment: lobectomy (maybe total thyroidectomy with lymph node removal)
High risk pts get radioiodine tx
TSH suppression with thyroid hormone replacement
Epi: Frequency of 5%; more aggressive than follicular with early metastases;
Sporadic (80%) → F:M 3:2, peak in 40s to 60s
Familial (20%) → F:M 1:1, peak onset at early age
Histo: neuroendocrine appearance, ‘packets’ of uniform cells; stroma made of amyloid (stains w Congo red)
Derived from parafollicular cells (C (clear) cells); produces calcitonin
Increased risk: family with MEN 2A and 2B (association), mutation in RET (proto-oncogene)
Spread: early metastases
Does not secrete thyroglobulin; does not take up radioiodine
Same treatment: lobectomy (maybe total thyroidectomy w lymph node removal)
Thyroid hormone replacement for normal TSH (no TSH suppression)
Anaplastic carcinoma
Left of image is amyloid, right of image is near normal thyroid follicles
Anaplastic carcinoma
AKA undifferentiated carcinoma (because it’s poorly differentiated)
Epi: Frequency of 3 percent; very aggressive, poor prognosis, most deadly; M:F 2:1, peak in 60s to 80s
Histo: several variants, but all high grade
Spread: infiltrative into local structures, soft tissue of neck; widespread metastases, early mortality
Does not take up radioiodine
Papillary carcinoma
Follicular carcinoma
Medullary carcinoma
Anaplastic carcinoma

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  Thyroid Cancer