Thyroid Cancer
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CC (2.0): NHGRI
1
Thyroid Cancer
• Papillary
• Follicular
• Medullary
• Anaplastic
• Lymphoma
CC (2.0): NHGRI
2
Workup of a Thyroid Nodule
Thyroid nodule
Ultrasound, TSH
Normal or High
TSH
Low TSH
Is U/S concerning?
• 1. Nodule > 1 cm w/ calcifications,
irregular margins, internal
vascularity
• 2. Noncystic nodule > 2 cm
RAI scan
Hot
Yes
Not
Hot
FNA
Treat
hyperthyroidis
m
Benign Malignant Indeterminate
Monitor
Surgery
RAIU scan
No
Monitor
Inadequate
specimen
Repeat FNA
3
Thyroid Cancer
• Papillary
• Follicular
• Medullary
• Anaplastic
• Lymphoma
CC (2.0): NHGRI
4
Papillary
• Presentation: Female w/ slow growing thyroid nodule
• +/- lymphadenopathy
• Path: Lymphatic spread
• ↑ risk if RET, BRAF mutations, Childhood radiation
5
Papillary
• Dx: “Orphan Annie” nuclei (empty-appearing nuclei w/ central
clearing)
• Psammoma bodies, nuclear grooves
• Mgmt: Partial vs. Total thyroidectomy
• If high risk => Radioiodine ablation, Levothyroxine (↓ TSH)
6
Papillary
Histopathology:
• Orphan Annie nuclei
• Psammoma bodies
• Nuclear grooves
GNU (1.2): KGH
7
Psammoma Bodies
High-yield conditions:
• Papillary thyroid cancer
• Serous papillary
cystadenocarcinoma of ovary
• Meningioma
• Mesothelioma
CC (0): The Armed Forces Institute of
Pathology
8
Follicular
• Presentation: Slow-growing thyroid nodule
• Good prognosis
• Path: Hematologic spread
• RAS
9
Follicular
• Dx: Follicular cells (well-differentiated)
• If FNA suggests follicular => Need lobectomy for Dx
• Mgmt: Partial vs. Total thyroidectomy
GNU (1.2): Nephron
10
Medullary
• Presentation: Asymptomatic thyroid nodule
• Good prognosis
• Path: Sporadic, RET protooncogene
• Family history
• Dx: Calcitonin-producing C cells (but usually normal Ca2+)
• Obtain serum calcitonin
• Mgmt: Total thyroidectomy + Lymph node dissection
• Follow w/ calcitonin and carcinoembryonic antigen (CEA)
11
Medullary
MEN 2A:
MEN 2B:
• Pheochromocytoma
• Pheochromocytoma
• Medullary carcinoma of
• Medullary carcinoma of
thyroid
• Parathyroid hyperplasia
thyroid
• Oral and intestinal neuromas
• Marfanoid habitus
12
Anaplastic/Undifferentiated
• Presentation: Older patient w/ rapidly enlarging thyroid mass
• Local compression => Dysphagia, Hoarseness, Asphyxiation
• Path: Co-occurs w/ other thyroid cancers
• Dx: Poorly differentiated cells
• Stains + for PAX-8
• Mgmt: Chemotherapy and Radiation +/- Surger y (local)
• Poor prognosis
13
Thyroid Anatomy Review
© Adobe Stock / 7activestudio.
Modified.
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Thyroid Lymphoma
• Presentation: Rapidly expanding neck mass
• Local compression => Dysphagia, Hoarseness, Asphyxiation
• Path: Hashimoto thyroiditis
• Dx: FNA => B cell lymphoma (non-Hodgkin lymphoma)
• Vs. Anaplastic
• Mgmt: CHOP +/- Radiation, Surgery
• CHOP = Cyclophosphamide, Doxorubicin, Vincristine, Prednisone
15
Thyroid Cancer
• Papillary
• Follicular
• Medullary
• Anaplastic
• Lymphoma
CC (2.0): NHGRI
16