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?

14% Signup and view all the answers

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

Solid, white, firm, often multifocal Signup and view all the answers

Which characteristic is most associated with papillary thyroid carcinoma?

Presence of psammoma bodies Signup and view all the answers

What is the clinical behavior of poorly differentiated thyroid carcinoma?

Intermediate between well differentiated and anaplastic carcinoma Signup and view all the answers

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

Presence of psammoma bodies Signup and view all the answers

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

Monolayer sheets with three-dimensional architecture Signup and view all the answers

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

Overlapping nuclei with irregular contours 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?

40 - 50% Signup and view all the answers

What histologic pattern is NOT associated with anaplastic thyroid carcinoma?

Follicular Signup and view all the answers

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

5 - 7 cm Signup and view all the answers

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

40 - 70% Signup and view all the answers

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

Cystic structures Signup and view all the answers

What percentage of patients with insular carcinoma experience vascular invasion?

60 - 90% Signup and view all the answers

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

Papillary carcinoma Signup and view all the answers

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

38% Signup and view all the answers

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

RET gene mutation Signup and view all the answers

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

Familial medullary carcinoma Signup and view all the answers

How is sporadic medullary carcinoma most commonly detected?

Screening test for serum calcitonin Signup and view all the answers

What histological feature is commonly observed in medullary carcinoma?

Round nuclei with stippled chromatin Signup and view all the answers

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

Kidney Signup and view all the answers

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

Amyloid deposits from calcitonin Signup and view all the answers

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

Cytokeratin Signup and view all the answers

What percentage of thyroid carcinomas is represented by medullary carcinoma?

1 - 2% Signup and view all the answers

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

A butterfly Signup and view all the answers

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

Left side of the isthmus Signup and view all the answers

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

30% - 75% Signup and view all the answers

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

Leonardo Da Vinci Signup and view all the answers

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

Prominent or cystic Signup and view all the answers

What is a practical implication for pathologists regarding thyroid specimens?

Grossing of specimens typically involves various procedures such as lobectomy Signup and view all the answers

What term describes the thyroid gland's histological composition?

Thyroid follicles with cuboidal to columnar epithelium Signup and view all the answers

What derived the English name for the thyroid gland?

Its shape resembling a shield Signup and view all the answers

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

Graves' disease Signup and view all the answers

What histological feature is commonly associated with multinodular goiter?

Variable sized dilated follicles with flattened hyperplastic epithelium Signup and view all the answers

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

Capsular or vascular invasion Signup and view all the answers

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

Infiltrative ophthalmopathy Signup and view all the answers

Which histological pattern is observed in follicular adenoma?

Closely packed follicles without invasion Signup and view all the answers

What is the most common cause of multinodular goiter worldwide?

Iodine deficiency Signup and view all the answers

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

Minimally invasive follicular carcinoma Signup and view all the answers

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

Nuclear features characteristic of papillary cancer Signup and view all the answers

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

Asymmetric thyroid enlargement Signup and view all the answers

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

Capsular and/or vascular invasion Signup and view all the answers

What is a common imaging characteristic of a follicular adenoma?

Cold nodule on radionuclide scan Signup and view all the answers

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

Peripheral scalloping Signup and view all the answers

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

Pretibial myxedema Signup and view all the answers

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

Dysfunctional mitochondria Signup and view all the answers

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.