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Thyroid tumors

Thyroid tumors. Dr. Gehan Mohamed. Classification of thyroid tumors. A- benign tumors: more common than malignant thyroid neoplasm. e.g follicular thyroid adenoma B- Malignant thyroid tumors. Criteria for diagnosis of follicular adenoma. 1- solitary nodule 2- encapsulated

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Thyroid tumors

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  1. Thyroid tumors Dr. Gehan Mohamed

  2. Classification of thyroid tumors • A- benign tumors: more common than malignant thyroid neoplasm. e.g follicular thyroid adenoma B- Malignant thyroid tumors.

  3. Criteria for diagnosis of follicular adenoma • 1- solitary nodule • 2- encapsulated • 3- presence of compressed thyroid tissue outside capsule of thyroid adenoma.

  4. Papillary carcinoma Follicular variant Tall cell Diffuse sclerosing Encapsulated Follicular carcinoma Overtly invasive Minimally invasive Hurthle cell carcinoma Anaplastic carcinoma Giant cell Small cell Medullary Carcinoma Miscellaneous Sarcoma Lymphoma Squamous cell carcinoma Mucoepidermoid carcinoma Clear cell tumors Plasma cell tumors Metastatic Direct extention Kidney Colon Melanoma Classification of Malignant Thyroid Neoplasms

  5. colloid Thyroid epithelial cells T4 90% T3 10% Normal Thyroid TSH

  6. Types of Thyroid Cancer • Papillary (80%-85%): develops from thyroid follicle cells in 1 or both lobes; grows slowly but can spread • Follicular (5%-10%): common in countries with insufficient iodine consumption; lymph node metastases are uncommon • Medullary: develops from C-cells, can spread quickly; sporadic . • Anaplastic: develops from existing papillary or follicular cancers; aggressive, usually fatal • Lymphoma: develops from lymphocytes; uncommon

  7. Risk Factors for development of thyroid carcinoma • Radiation • High dose x-rays of the neck or face during infancy or teenage years is a risk factor specially for papillary carcinoma • Family History • Goiters and prolonged TSH stimulation is a risk for follicular carcinoma. • Mutated RET oncogene • Gender • males

  8. When suspect malignancy in thyroid mass • 1-Male sex • 2- Solitary thyroid nodules in patients >60 or <30 years of age • 3-Large Nodules (>3 or 4 cm) with rapid Growth • 4-Symptoms especially a change in voice,Pain,dysphagia,Stridor,hemoptysis

  9. Molecular Level • Medullary Carcinoma • Mutation in RET gene • Papillary Carcinoma • Mutated RET, RAS, or BRAF gene

  10. Typical Presentation of Thyroid Cancer • Painless lump • Normal thyroid function tests • Found on routine examination or by the patient

  11. Papillary Carcinoma • Most common type • Females outnumber males 3:1 • Highest incidence in women in midlife. • Lymph node involvement is common • Major route of metastasis is lymphatic

  12. Papillary Thyroid CancerCharacteristics • Unencapsulated tumor nodule with ill-defined margins • Tumor typically firm and solid • First presentation of the patient may be lymph node enlargment. • Commonly metastasizes to neck and mediastinal lymph nodes • 40% to 60% in adults and 90% in children • <5% of patients have distant metastases at time of diagnosis • Lung is most common site

  13. Thyroid carcinoma

  14. Micropapillary thyroid carcinomas • Definition - papillary carcinoma smaller than 1.0 cm • Most are found incidentally at autopsy • Usually clinically silent

  15. Papillary Carcinoma(continued…) • Pathology • Gross - vary considerably in size - often multi-focal - unencapsulated but often have a pseudocapsule which is normal thyroid tissue compressed by the tumor mass. • Histopathology - closely packed papillae which have fibrovascular core. - psammoma bodies which is a laminated calcification - nuclei are oval or elongated, pale staining with ground glass appearance .

  16. Papillary carcinoma of thyroid

  17. Papillary Thyroid Cancer: nuclei are oval or elongated, pale staining with ground glass appearance

  18. Follicular variant of papillary carcinoma

  19. 2- Follicular Thyroid Carcinoma • Second most common type of thyroid cancer • Solid invasive tumors, usually solitary and encapsulated • Usually stays in the thyroid gland, but can spread to the bones, lungs, and central nervous system. • Usually does not spread to the lymph nodes

  20. Follicular Carcinoma • Pathology • Gross - encapsulated, solitary Histology - very well-differentiated. (distinction between follicular adenoma and follicular carcinoma is so difficult so we depend on presence of vascular and capsular invasion to diagnose follicular carcinoma.

  21. Invasive follicular carcinoma:malignant follicles invade pink fibrous capsule

  22. Follicular thyroid carcinoma

  23. Hürthle Cell Carcinoma • A variant of follicular cancer that tends to be aggressive • Microscope : there are Large, polygonal, eosinophilic thyroid follicular cells with abundant granular cytoplasm and numerous mitochondria Hürthle Cell Tumor High power magnification

  24. Hürthle Cell tumor • May be benign or malignant, based on demonstration of vascular or capsular invasion • Malignancies tend to have a worse prognosis than other follicular tumors • Tend to be locally invasive

  25. 3- Anaplastic Thyroid Cancer • Often occurs in the elderly population (mean age: 65 years) • Three fold greater risk in iodine-deficient areas • Tumor is typically hard, poorly circumscribed, and fixed to surrounding structures. • Extremely aggressive and exceptionally virulent

  26. Anaplastic Carcinoma of the Thyroid • Pathology • Classified as Composed wholly or in part of undifferentiated cells which may be large cell or small cell • Large cell is more common and has a worse prognosis • Histology - sheets of very poorly differentiated cells little cytoplasm numerous mitoses necrosis extrathyroidal invasion

  27. Medullary Thyroid Carcinoma Tumor arising from the calcitonin-secreting C-cells of the thyroid gland. • Developes in 3 clinical settings: • Sporadic MTC (SMTC) • Familial MTC (FMTC) • Multiple endocrine neoplasia.

  28. Medullary Thyroid Carcinoma characterized by presence of pink amyloid in between malignant cells.

  29. Medullary Thyroid CancerMetastases • Cervical lymph node metastases occur early • Tumors >1.5 cm are likely to metastasize, often to bone, lungs, liver, and the central nervous system • Metastases usually contain calcitonin and stain for amyloid

  30. Evaluation of any thyroid Nodule(Physical Exam) • Examination of the thyroid nodule: • consistency - hard vs. soft • size – more than 4.0 cm • Multinodular vs. solitary nodule • multi nodular : 3% chance of malignancy • solitary nodule : 5%-12% chance of malignancy

  31. Physical Exam (continued…) • Examine for ectopic thyroid tissue • Indirect or fiberoptic laryngoscopy • vocal cord mobility • evaluate airway

  32. Evaluation of the Thyroid Nodule Advantages of Ultrasonography • Noninvasive and inexpensive • Most sensitive procedure or identifying lesions in the thyroid (can detect smaller lesions even 2-3mm size) • 90% accuracy in categorizing nodules as solid, cystic, or mixed • Best method of determining the volume of a nodule • Can detect the presence of lymph node enlargement and calcifications

  33. Ultrasonography (Continued…) • Disadvantages • Cannot accurately distinguish benign from malignant nodules

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