Thyroid Cancer an M. A. Khachatry
The anatomo-histological structure of Thyroid Gland
Thyroid Cancer • • Papillary C-r Folliculary C-r Medullary C-r Anaplastic C-r
Characteristics of Papillary Thyroid Cancer • • 80% of TC Common in females Peak onset ages 30 -50 Follicular cell genesis Well-differentiated Minimally invasive Lymphogenic spread
Causes/ Risk Factors • • Family history/genetic defect maybe involved Radiation Men Older persons AACE/AME/ETA Thyroid Nodule Guidelines, Endocr Pract. 2010; 16(Suppl 1
Symptoms and Signs • Few or no symptoms • Small lump(nodule) • Painless during palpation
Exams and Tests • • • History Physical examination US FNA Thyroid function tests
PTC US Features • • Hypoechogenicity Inhomogeneous echo pattern Microcalcifications Absence of peripheral halo Irregular borders, blurred margins Often intranodular hypervascularity Regional lymphadenopathy
Cytology of PTC; Nuclear inclusion.
Primary treatment • No prospective clinical trials have clearly determined the “best treatment” of patients with PTC • Appropiate surgical planning 202 ENDOCRINE PRACTICE Vol. 7 No. 3 May/June 2001
Macroscopic pathology-photograph
Microscopic examination
Adjuvant Therapy • Thyroid Hormone-suppresive therapy • Radioiodine Remnant Ablation(131 J) 202 ENDOCRINE PRACTICE Vol. 7 No. 3 May/June 2001
Follicular Thyroid Cancer The Second Most Common Type of Thyroid Cancer
Characteristics of Folliculary Thyroid Cancer More malignant Common in females Peak onset ages 40 -60 Follicular cell genesis Well-differentiated Invasion into vascular structures (veins and arteries) • haematogenic spread • • •
Symptoms and Signs • Few or no symptoms • Small lump(nodule) • Painless during palpation
Common Features of Follicular Adenomas • • Solitary Egg shape Thin, hypoechoic capsule Homogeneous echogenicity Hyper-, iso-, hypoechoic, or mixed May have cystic degeneration “Spoke-and-wheel-like” vascularity
Common Features of Follicular Thyroid Carcinomas • • Solitary Egg shape Thick, uneven hypoechoic capsule Homogeneous echogenicity Hyper-, iso-, hypoechoic, or mixed May have cystic degeneration Hypervascular “Spoke-and-wheel-like” vascularity less prominent
Treatment of FTC and follicular adenoma/neoplasia • Thyroidectomy • Thyroid Hormone-suppresive therapy • Radioiodine Remnant Ablation(131 J) • Follow up( TG measurment <2 ng/ml) Thyroid Carcinoma Guidelines, Endocr Pract. 2001; 7(No. 3) 217
Medullary thyroid cancer Characteristics of Medullary Thyroid Cancer • 75% are sporadic and 25% are hereditary • C cell genesis • Common in females • Differentiated • Spread-local lymch nodes, lungs, bone, liver, brain(rare) • High serum calcitonin level • Diarrhea
US Common Features of MTC Hypoechoic Well marginated, sharply circumscribed Upper/mid lobe Centrally located separate coarse or microcalcifi cations • Regional lymphadenopathy • •
Hereditory MTC • • 25% of MTC MEN type IIA MEN type IIB Isolated familial MTC
MEN type IIA • MTC (generally bilateral) • pheochromocytoma or adrenal medullary hyperplasia (also bilateral) • Hyperparathyroidism
MEN type IIB • MTC • Pheochromocytoma • Marfanoid habitus, mucosal neuromas involving the lips, tongue, eyes, and pharynx, and ganglioneuromatosis of the gastrointestinal tract.
Treatment • Total thyroidectomy and central(? evidence grade C) compartment lymph node dissection • No radioiodine Remnant Ablation(131 J) • Calcitonin measurment(postoperation) Thyroid Carcinoma Guidelines, Endocr Pract. 2001; 7(No. 3) 217
Anaplastic TC Undifferentiated Highly aggressive Male=female Manifestations(thyroid mass, dyspnea, dysphagia, and cervical pain. Other manifestations include superior vena cava syndrome, ball-valve tracheal obstruction, hyperthyroidism • MTS lung, bone, brain, and, rarely, skin and bowel • •
Common Features • • Large size Hypoechoic Inhomogeneous Multilobular Rapid growth Clinical symptoms Elderly patient
Treatment • Thyroidectomy • External radiotherapy • Chemotherapy? (doxorubicin) Thyroid Carcinoma Guidelines, Endocr Pract. 2001; 7(No. 3) 217
M. A. Khachatryan