questions 3

Thyroid Cancer

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Topic updated on 10/26/17 10:48am

Snapshot
  • A 36-year-old woman complains of severe episodes of headache, tremulousness, palpitations, and anxiety. The patient has noted a change in her voice and she has difficulty swallowing solids. On physical exam, there is a palpable, nontender swelling in the front of her neck that moves with swallowing. There is no cervical lymphadenopathy. Lab studies show hypercalcemia. A radiograph of the cervical region shows irregular calcifications in mass, while an MRI of the abdomen shows confirms the presence of bilateral adrenal lesions. 
Follicular Adenoma
  • Introduction
    • most common benign thyroid neoplasm
  • Evaluation
    • radioactive iodine imaging 
      • cold nodule
    • histology
      • complete capsular confinement
  • Prognosis
    • small minority progress to follicular carcinoma
Papillary Adenocarcinoma
  • Introduction
    • 90% of all thyroid cancers 
    • female dominance
    • often multifocal
    • risk factors include radiation exposure to the head and neck
      • also associated with BRAF and RET oncogenes
  • Evaluation
    • histology
      • psammoma bodies (calcifications)
        • also seen in ovarian dysgerminomas and meningiomas
      • ground glass/empty nuclei
        • nuclear grooves
        • known as "Orphan Annie" eyes
      • cells organized into papillary "fingers"
  • Treatment
    • thyroidectomy + iodine radiotherapy
  • Prognosis
    • metastasis via lymphatics
    • very good prognosis
Follicular Carcinoma
  • Introduction
    • usually unifocal
      • cold nodule
  • Evaluation
    • histology
      • preservation of normal thyroid follicular architecture but proliferation
        • uniform follicles
      • may invade capsule or blood vessels
  • Prognosis
    • hematogenous metastasis
      • lungs most common
    • good prognosis
Medullary Carcinoma
  • Introduction
    • derived from calcitonin synthesizing C cells
      • presentation may be hypocalcemia
      • may also produce ACTH
    • 10% of the cases are familiar and associated with MEN IIa or IIb
      • associated with a ret mutation
    • 90% are sporadic.
    • risk factors for malignancy are previous irradiation of the neck, cold nodules, and family history.
  • Evaluation
    • serum calcitonin
      • tumor marker
    • histology
      • amyloid (consisting of calcitonin) 
    • pentagastrin infusion
      • hyperplasia present with high calcitonin level response following administration
B-Cell Malignant Lymphoma
  • Introduction
    • sequelae of Hashimoto's thyroiditis
Anaplastic Thyroid Cancer
  • Introduction
    • seen most commonly in the elderly
    • may be superimposed on multinodular goiter, follicular cancer
  • Prognosis
    • very poor prognosis


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Qbank (2 Questions)

TAG
(M1.ON.27) A 27-year-old female presents to her physician with a palpable thyroid nodule. Iodine uptake testing shows that the nodule has decreased iodine uptake compared with the rest of the thyroid gland. A fine-needle aspiration is performed and the physician calls telling the patient that she has a neoplasm of the thyroid. Which of the following diagnoses is the most likely? Topic Review Topic

1. Papillary carcinoma
2. Medullary carcinoma
3. Follicular carcinoma
4. Anaplastic carcinoma
5. Hurthle cell carcinoma

PREFERRED RESPONSE ▶
TAG
(M1.ON.4754) A 43-year-old female presents to her primary care physician complaining of a gradually enlarging neck mass. She reports that she first developed a firm nodular midline mass on the anterior aspect of her neck two months ago. She is otherwise healthy and takes no medications. A fine-needle aspiration is performed and a histological sample of the specimen is shown. Which of the following is the most likely diagnosis? Topic Review Topic
FIGURES: A          

1. Medullary thyroid carcinoma
2. Follicular thyroid carcinoma
3. Papillary thyroid carcinoma
4. B-cell lymphoma
5. Anaplastic thyroid carcinoma

PREFERRED RESPONSE ▶
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