Thyroid Carcinoma Characteristics
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Questions and Answers

What is the typical demographic profile for individuals with thyroid carcinoma?

  • Children and adolescents
  • Older men over 65 years
  • Women of reproductive age (correct)
  • Individuals with a family history of thyroid disease

Which characteristic is NOT typically associated with thyroid carcinomas?

  • Usually presents as a painless nodule
  • Frequently involved in systemic spread at first diagnosis (correct)
  • Commonly diagnosed through Fine Needle Aspiration
  • Often appears cold on scan

What histological feature is commonly seen in thyroid carcinoma?

  • Complex, branching papillae with fibrovascular cores (correct)
  • Amorphous cell arrangement without clear structure
  • Large necrotic areas with abscess formation
  • Presence of large multinucleated giant cells

What percentage of thyroid carcinoma cases typically show nodal involvement at presentation?

<p>14% (C)</p> Signup and view all the answers

Which of the following descriptions best characterizes the gross appearance of thyroid carcinoma?

<p>Solid, white, firm, often multifocal (D)</p> Signup and view all the answers

Which characteristic is most associated with papillary thyroid carcinoma?

<p>Presence of psammoma bodies (C)</p> Signup and view all the answers

What is the clinical behavior of poorly differentiated thyroid carcinoma?

<p>Intermediate between well differentiated and anaplastic carcinoma (C)</p> Signup and view all the answers

Which feature may suggest the need to rule out papillary thyroid carcinoma in a lymph node?

<p>Presence of psammoma bodies (C)</p> Signup and view all the answers

In cytology, what cellular arrangement is commonly observed in papillary thyroid carcinoma?

<p>Monolayer sheets with three-dimensional architecture (D)</p> Signup and view all the answers

What is a defining characteristic of the cellular aspirate in papillary thyroid carcinoma?

<p>Overlapping nuclei with irregular contours (B)</p> Signup and view all the answers

What percentage of anaplastic thyroid carcinoma cases may be associated with hoarseness, dysphagia, or dyspnea due to the rapidly enlarging neck mass?

<p>40 - 50% (B)</p> Signup and view all the answers

What histologic pattern is NOT associated with anaplastic thyroid carcinoma?

<p>Follicular (A)</p> Signup and view all the answers

In the context of insular carcinoma, what is the typical size range of the tumor?

<p>5 - 7 cm (B)</p> Signup and view all the answers

What is the range of distant metastasis observed in insular carcinoma cases?

<p>40 - 70% (D)</p> Signup and view all the answers

Which finding is least likely to be present in anaplastic thyroid carcinoma?

<p>Cystic structures (D)</p> Signup and view all the answers

What percentage of patients with insular carcinoma experience vascular invasion?

<p>60 - 90% (D)</p> Signup and view all the answers

Which of the following is a characteristic of well-differentiated thyroid carcinoma that anaplastic carcinoma may arise from?

<p>Papillary carcinoma (A)</p> Signup and view all the answers

What is the general survival rate for patients with nodal and hematogenous metastases in insular carcinoma?

<p>38% (A)</p> Signup and view all the answers

What genetic mutation is primarily associated with familial medullary thyroid carcinoma?

<p>RET gene mutation (A)</p> Signup and view all the answers

Which thyroid carcinoma subtype typically presents as bilateral or multiple foci?

<p>Familial medullary carcinoma (A)</p> Signup and view all the answers

How is sporadic medullary carcinoma most commonly detected?

<p>Screening test for serum calcitonin (D)</p> Signup and view all the answers

What histological feature is commonly observed in medullary carcinoma?

<p>Round nuclei with stippled chromatin (B)</p> Signup and view all the answers

Which of the following is the most frequent primary site of distant metastases to the thyroid?

<p>Kidney (A)</p> Signup and view all the answers

What is a common characteristic of the stroma in medullary carcinoma?

<p>Amyloid deposits from calcitonin (A)</p> Signup and view all the answers

Which of the following markers is NOT typically associated with medullary carcinoma?

<p>Cytokeratin (B)</p> Signup and view all the answers

What percentage of thyroid carcinomas is represented by medullary carcinoma?

<p>1 - 2% (D)</p> Signup and view all the answers

Which anatomical feature is the thyroid gland most closely compared to in its shape?

<p>A butterfly (C)</p> Signup and view all the answers

What is the most common location for the pyramidal lobe to attach to the thyroid gland?

<p>Left side of the isthmus (C)</p> Signup and view all the answers

What percentage range of thyroid glands typically have a pyramidal lobe present?

<p>30% - 75% (C)</p> Signup and view all the answers

Who is credited with the first anatomical drawing of the thyroid gland?

<p>Leonardo Da Vinci (D)</p> Signup and view all the answers

In pathological conditions, how does the pyramidal lobe usually appear?

<p>Prominent or cystic (C)</p> Signup and view all the answers

What is a practical implication for pathologists regarding thyroid specimens?

<p>Grossing of specimens typically involves various procedures such as lobectomy (A)</p> Signup and view all the answers

What term describes the thyroid gland's histological composition?

<p>Thyroid follicles with cuboidal to columnar epithelium (C)</p> Signup and view all the answers

What derived the English name for the thyroid gland?

<p>Its shape resembling a shield (D)</p> Signup and view all the answers

Which autoimmune condition is characterized by hyperthyroidism and the presence of thyrotropin receptor antibodies?

<p>Graves' disease (C)</p> Signup and view all the answers

What histological feature is commonly associated with multinodular goiter?

<p>Variable sized dilated follicles with flattened hyperplastic epithelium (C)</p> Signup and view all the answers

What is a key distinguishing feature of follicular carcinoma compared to follicular adenoma?

<p>Capsular or vascular invasion (C)</p> Signup and view all the answers

What clinical feature is often associated with Graves' disease but not with other forms of hyperthyroidism?

<p>Infiltrative ophthalmopathy (B)</p> Signup and view all the answers

Which histological pattern is observed in follicular adenoma?

<p>Closely packed follicles without invasion (B)</p> Signup and view all the answers

What is the most common cause of multinodular goiter worldwide?

<p>Iodine deficiency (B)</p> Signup and view all the answers

What type of thyroid carcinoma has a better prognosis if it has limited vascular invasion?

<p>Minimally invasive follicular carcinoma (D)</p> Signup and view all the answers

What is the primary histological criterion that distinguishes papillary carcinoma from other thyroid conditions?

<p>Nuclear features characteristic of papillary cancer (C)</p> Signup and view all the answers

Which of the following is NOT a clinical feature of Graves' disease?

<p>Asymmetric thyroid enlargement (B)</p> Signup and view all the answers

Oncocytic tumors are classified as malignant when they exhibit which feature?

<p>Capsular and/or vascular invasion (D)</p> Signup and view all the answers

What is a common imaging characteristic of a follicular adenoma?

<p>Cold nodule on radionuclide scan (B)</p> Signup and view all the answers

What type of histological change is seen in the colloid of hyperplastic thyroid follicles in Graves' disease?

<p>Peripheral scalloping (D)</p> Signup and view all the answers

Which of the following is a common symptom of infiltrative dermopathy associated with Graves' disease?

<p>Pretibial myxedema (A)</p> Signup and view all the answers

What cellular characteristic is commonly found in oncocytic (Hürthle cell) tumors?

<p>Dysfunctional mitochondria (D)</p> Signup and view all the answers

Flashcards

What is the thyroid gland?

A bilobed gland in the lower part of the anterior neck, composed of two lateral lobes connected by a thin isthmus.

What is the isthmus of the thyroid?

This is the middle part of the thyroid gland that connects the two lateral lobes.

What is a pyramidal lobe?

These are extensions of the thyroid gland that can be present in roughly half of all people, often on the left side.

What are thyroid follicles?

These are small, spherical structures that make up the thyroid gland. They are lined by a single layer of cells and contain a substance called colloid.

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What is colloid?

This is a protein-rich substance found inside thyroid follicles. Its appearance depends on the activity of the thyroid gland.

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Why is it important to know if a thyroid surgery is a lobectomy, hemithyroidectomy, or total thyroidectomy?

It is important in surgical resections of the thyroid gland. Surgeons need to know if it's a total, partial, or specific lobe removal.

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Why is it important for pathologists to understand thyroid anatomy?

It is important for diagnosing thyroid diseases. Pathologists can examine biopsies and autopsies.

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Why is thyroid scintigraphy useful?

It provides information about the thyroid gland's activity. This can help diagnose thyroid diseases.

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Papillary Thyroid Carcinoma

The most prevalent type of thyroid carcinoma, accounting for 75-80% of all cases.

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Papillary Thyroid Carcinoma and Gender

A type of thyroid carcinoma that is frequently found in women of reproductive age.

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Papillary Thyroid Carcinoma Presentation

The typical way papillary thyroid carcinoma presents, often as a painless nodule or mass.

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Orphan Annie Nuclei

A distinctive feature of papillary thyroid carcinoma cells characterized by overlapping nuclei and dispersed chromatin.

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Eosinophilic Intranuclear Inclusions

A characteristic of papillary thyroid carcinoma cells, where eosinophilic inclusions are seen within the nucleus, representing cytoplasmic invaginations.

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Psammoma bodies

Small, calcified structures often found in papillary thyroid carcinoma. They form due to the tumor cell's necrosis and calcification. While relatively specific for papillary carcinoma, they can also be seen in metastases. Their presence in the neck or cervical lymph node signifies a high suspicion of papillary thyroid carcinoma.

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Cytology of Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is characterized by large nuclei, distinctive nuclear features, and an often papillary architecture. The cells have dense cytoplasm, enlarged nuclei with irregular outlines, intranuclear inclusions, and grooves.

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Bethesda System for Thyroid Cytology

A system for classifying thyroid cytology samples. It helps standardize the reporting of thyroid fine-needle aspiration biopsies by categorizing them into different levels of suspicion for malignancy.

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Poorly Differentiated Thyroid Carcinoma

A type of malignant thyroid cancer that lacks well-defined follicular differentiation, making it difficult to classify as a typical follicular or papillary carcinoma. It exhibits aggressive behavior, often presenting as a large, solitary thyroid mass.

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Anaplastic Thyroid Carcinoma

A rare and highly aggressive type of thyroid cancer that lacks follicular differentiation, resulting in rapid growth and a poor prognosis.

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Graves' disease

An autoimmune disease where the body attacks the thyroid gland, leading to hyperthyroidism (excess thyroid hormone).

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Multinodular goiter

A common thyroid disease characterized by multiple nodules, often without symptoms.

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Follicular adenoma

A benign tumor of the thyroid gland that originates from follicular cells.

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Follicular Carcinoma

A type of thyroid cancer that originates from follicular cells, with varying degrees of invasiveness.

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Oncocytic (Hürthle Cell) Tumors

A follicular neoplasm characterized by an abundance of oncocytic cells due to mitochondrial accumulation.

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Papillary Carcinoma

The most common type of thyroid cancer, characterized by distinctive papillary structures and nuclear features.

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Diffuse Toxic Goiter

Diffuse enlargement of the thyroid gland due to overproduction of thyroid hormone (hyperthyroidism).

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Goiter

A condition where the thyroid gland is abnormally enlarged, often without symptoms.

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Thyroid hormone

The main hormone produced by the thyroid gland, essential for metabolism and growth.

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Thyroid Stimulating Hormone (TSH)

The hormone produced by the pituitary gland that stimulates thyroid hormone production.

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Hyperthyroidism

A condition where the thyroid gland produces too much thyroid hormone.

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Hypothyroidism

A condition where the thyroid gland produces too little thyroid hormone.

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Infiltrative Ophthalmopathy

A condition of inflammation and swelling of the tissues around the eyes, often associated with Graves' disease.

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Autoimmune Hyperthyroidism

A type of hyperthyroidism characterized by excessive thyroid hormone production due to an overactive thyroid gland.

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Basedow Disease

A type of hyperthyroidism characterized by swelling of the thyroid gland.

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What is insular carcinoma of the thyroid?

A type of thyroid cancer characterized by intermediate aggressiveness between well-differentiated and anaplastic carcinoma.

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What is anaplastic thyroid carcinoma?

Anaplastic thyroid carcinoma is an aggressive, poorly differentiated thyroid cancer that is often fatal.

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How does anaplastic thyroid carcinoma develop?

Anaplastic thyroid carcinoma often arises from existing, well-differentiated thyroid cancers like papillary, follicular, or Hürthle cell carcinomas.

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What are the symptoms of anaplastic thyroid carcinoma?

Anaplastic thyroid carcinoma is characterized by a large, bulky tumor that invades surrounding tissues and causes symptoms like hoarseness, difficulty swallowing, and shortness of breath.

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What are the microscopic features of anaplastic thyroid carcinoma?

The microscopic appearance of anaplastic thyroid carcinoma is varied, with three common patterns: sarcomatoid, giant cell, and epithelial.

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What is the survival rate for patients with anaplastic thyroid carcinoma?

Anaplastic thyroid carcinoma is a very serious disease, with only a 38% survival rate at three years.

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How does anaplastic thyroid carcinoma spread?

Anaplastic thyroid carcinoma metastasizes (spreads) quickly through lymph nodes and blood vessels.

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What does anaplastic thyroid carcinoma look like under a microscope?

The gross description of anaplastic thyroid carcinoma shows a large tumor with areas of necrosis and hemorrhage.

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Medullary Thyroid Carcinoma

A type of thyroid cancer arising from C cells (formerly known as parafollicular cells), which produce calcitonin. It accounts for 1-2% of thyroid carcinomas.

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Medullary Thyroid Carcinoma: Sporadic vs. Familial

Medullary thyroid carcinoma can either be sporadic (nonhereditary) or familial (hereditary). Sporadic cases are typically solitary and affect individuals aged 40-60. Familial cases are associated with inherited syndromes like MEN 2A, 2B, or FMTC and arise due to mutations in the RET gene, often presenting as bilateral and multicentric.

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Medullary Thyroid Carcinoma: Gross Appearance

Medullary thyroid carcinoma often presents as a single, well-defined mass but lacks a capsule. Familial cases usually involve multiple foci.

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Medullary Thyroid Carcinoma: Microscopic Features

Medullary thyroid carcinoma cells can exhibit a variety of appearances, making it difficult to differentiate from other thyroid cancers. They are often found in clusters or cords, featuring round, plasma-like, or spindle-shaped cells. They have round nuclei with distinct chromatin and eosinophilic cytoplasm containing secretory granules.

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Medullary Thyroid Carcinoma: Metastases

Medullary thyroid carcinoma metastases can occur through direct extension from adjacent structures or vascular spread from distant sites. However, the thyroid is a rare site for distant metastases. Although the thyroid is highly vascular, distant metastases are uncommon, occurring in less than 0.2% of thyroid malignancies.

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Medullary Thyroid Carcinoma: Metastasis Primary Sites

Common primary sites for distant metastasis to the thyroid include the kidney, lung, gastrointestinal tract, and breast. Kidney is the most common primary site for distant metastasis.

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Secondary Thyroid Tumors

Secondary tumors arising in the thyroid typically occur from direct extension of nearby tumors or vascular spread from other organs. Squamous cell carcinoma is a common secondary tumor.

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IHC and Neural Markers

Immunohistochemistry and neural biomarkers are used to detect cancer cells and aid in diagnosis. Many neural markers are secreted by neuroendocrine tumors.

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Study Notes

Thyroid Pathology: General Overview

  • Thyroid pathology encompasses various diseases and conditions affecting the thyroid gland.
  • The thyroid gland is a bilobed organ located in the lower anterior neck.
  • The gland has a butterfly shape, characterized by two lateral lobes joined by a thin isthmus.

Thyroid Gland: Anatomy

  • The adult thyroid gland resembles a butterfly or the capital letter H.
  • Each lobe has a pointed upper pole and a blunted lower pole.
  • The thyroid gland specimens submitted for surgical analysis may be a single lobe (lobectomy), a lobe with the isthmus (hemithyroidectomy), or the whole gland (total thyroidectomy).
  • Additional procedures include subtotal thyroidectomy and neck dissection.
  • Interventional cytopathologists commonly perform thyroid fine-needle aspiration (FNA) biopsies, often combined with ultrasound imaging.
  • The thyroid gland's Greek name, thyreo-eidos, means "shield-shaped".
  • Leonardo da Vinci is credited with being the first to illustrate the thyroid gland anatomically.
  • Thomas Wharton named the gland due to its proximity to the thyroid cartilage.

Pyramidal Lobe of the Thyroid

  • The pyramidal lobe is a remnant of the thyroid-glossal duct.
  • It's a small conical projection emanating from the thyroid isthmus.
  • It extends upward to the hyoid bone, often lying on the thyroid cartilage.
  • Between 30-75% of thyroids contain a pyramidal lobe.
  • The average length of the pyramidal lobe is 24mm.
  • The pyramidal lobe is typically attached to the left side of the isthmus or to the left thyroid lobe.
  • In some cases, the pyramidal lobe is attached to the left lobe itself.
  • It typically is non-functional thyroid tissue.
  • Surgical removal is sometimes necessary if the pyramidal lobe represents a source of recurrent disease.

Thyroid Gland: Histology

  • The thyroid gland is composed of follicles, with a single layer of cuboidal to low columnar epithelium.
  • Follicles' lumens contain colloid, which appears scalloped and pale in active secretory follicles and densely eosinophilic in inactive ones.
  • The stroma between the follicles contains C cells (formerly parafollicular cells).
  • C cells produce calcitonin.
  • C cells constitute 0.1% of the gland.

Thyroid Gland: Physiology

  • The hypothalamus releases thyrotropin-releasing hormone (TRH).
  • TRH stimulates the anterior pituitary to release thyroid-stimulating hormone (TSH).
  • TSH prompts the thyroid gland to produce and release tetraiodothyronine (T4) and triiodothyronine (T3).
  • Thyroid hormones (T3 and T4) increase basal metabolic rates in the body.
  • Elevated levels of T3 and T4 can feed back and inhibit TRH and TSH release.

Sanderson's Polsters

  • These are collections of small, actively secreting follicles.
  • They often project into the lumen of larger follicles.
  • They may mimic papillary thyroid carcinomas.

Oncocytes (Hürthle Cells)

  • Oncocytes are large, prominent cells marked by abundant granular, deeply eosinophilic cytoplasm.
  • Some have many mitochondria.
  • They are important characteristics in various pathologies of the thyroid.

Positive Stains in Thyroid Pathology

  • Follicular cells stain positive for thyroglobulin, TTF1, and low-molecular-weight keratin.
  • Colloid stains positive for thyroglobulin.
  • C cells stain positive for calcitonin, neuron-specific enolase, chromogranin A, and synaptophysin.
  • C cells are negative for thyroglobulin.

Thyroglossal Duct Cyst

  • The thyroglossal duct cyst is a common developmental anomaly of the thyroid gland.
  • Its formation stems from the persistence of the thyroglossal duct.
  • It arises from the anterior midline of the neck.
  • It may appear as a single or multilocular cyst with smooth external surfaces.
  • Often, the cyst fluid varies in color, ranging from clear mucinous to yellowish tan or reddish brown, and potentially purulent with infection.

Hashimoto Thyroiditis

  • Hashimoto thyroiditis is an autoimmune disease.
  • It is characterized by inflammation in the thyroid and elevated circulating antithyroid antibodies, including anti-peroxidase and anti-thyroglobulin antibodies.
  • Most common in women (90-95%) between 45 and 65 years of age.

Graves Disease

  • Also known as diffuse toxic goiter.
  • It involves circulating autoantibodies targeting the thyrotropin receptor, leading to increased thyroid hormone production and gland enlargement.
  • An associated condition is orbitopathy.

Multinodular Goiter

  • It's the most common thyroid disease.
  • It's identified as an enlarged thyroid with multiple nodules.

Follicular Adenoma

  • A benign tumor of the thyroid.
  • Usually presents as a solitary, encapsulated nodule, ranging from 1 to 10 cm in diameter.
  • It's frequently solid and fleshy, ranging in color from light brown to tan.

Follicular Carcinoma

  • It is a malignant tumor characterized by follicular differentiation, commonly appearing as a solitary nodule.

Oncocytic (Hürthle Cell) Tumors

  • A type of follicular neoplasm with over 75% oncocytic (Hürthle cell) tumor cells.
  • Hürthle cells have prominent acidophilic (eosinophilic) granular cytoplasm due to abundant mitochondria.
  • They can be malignant if they present with capsular and/or vascular invasion.

Poorly Differentiated Thyroid Carcinoma

  • A thyroid malignancy with intermediate clinical behavior.
  • It lies between well-differentiated and anaplastic thyroid carcinomas.
  • It is often large, solitary, and frequently invasive into adjacent structures.
  • It exhibits intermediate clinical behavior between well differentiated (papillary and follicular carcinoma) and anaplastic carcinoma.

Anaplastic Carcinoma

  • A highly aggressive malignancy with rapid growth and invasion of neighboring structures.
  • It is considered the most aggressive form of thyroid cancer, typically arising from pre-existing differentiated thyroid cancers.
  • It often presents as a large, bulky neck mass that invades adjacent structures, such as the esophagus or trachea.

Medullary Carcinoma

  • Originates from the parafollicular (C) cells in the thyroid, secreting calcitonin.
  • The genetic mutation that predisposes to such a carcinoma is in RET.
  • It often presents as a solitary or multicentric thyroid nodule in both sporadic and familial forms.
  • It exhibits a wide range of morphologies and may occur in either familial or sporadic patterns.

Secondary Tumors/Metastasis

  • A non-thyroidal malignancy (occurring in other tissues) with direct extension or metastasis into the thyroid gland, a less common event.

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Description

This quiz explores key characteristics of thyroid carcinoma, including demographic profiles, histological features, and presentation statistics. Test your knowledge on the typical attributes and descriptions associated with this type of cancer.

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