Thyroid cancer: Difference between revisions

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__NOTOC__
__NOTOC__
{{Thyroid cancer}}
{{Thyroid cancer}}
{{CMG}}; {{AE}} {{MJM}}; {{Ammu}},{{SMP}},{{Sahar}}
{{CMG}}; {{AE}} {{MJM}}; {{Ammu}}{{SMP}}{{Sahar}}
==Overview==
==Overview==
Thyroid cancer refers to any of four kinds of [[tumor]]s of the [[thyroid]] gland which include [[Papillary thyroid cancer|papillary]], [[Follicular thyroid cancer|follicular]], [[Medullary thyroid cancer|medullary]] and [[Anaplastic thyroid cancer|anaplastic tumors]]. [[Papillary thyroid cancer|Papillary]] and [[Follicular thyroid cancer|follicular]] tumors are the most common and are usually [[benign tumor|benign]].  [[Papillary thyroid cancer|Papillary]] and [[Follicular thyroid cancer|follicular]] tumors have a slow growth and may recur, but are generally not fatal in patients under 45 years of age. [[Medullary thyroid cancer|Medullary]] and [[Anaplastic thyroid cancer|anaplastic tumors]] are [[cancer|malignant]].  [[Medullary]] tumors have a good prognosis if the are restricted to the thyroid gland and a poorer prognosis if [[metastasis]] occurs.  [[Anaplastic thyroid cancer|Anaplastic tumors]] are fast-growing and respond poorly to therapy.
Thyroid cancer refers to any of four kinds of [[tumor]]s of the [[thyroid]] gland which include [[Papillary thyroid cancer|papillary]], [[Follicular thyroid cancer|follicular]], [[Medullary thyroid cancer|medullary]] and [[Anaplastic thyroid cancer|anaplastic tumors]]. [[Papillary thyroid cancer|Papillary]] and [[Follicular thyroid cancer|follicular]] tumors are the most common and are usually [[benign tumor|benign]].  [[Papillary thyroid cancer|Papillary]] and [[Follicular thyroid cancer|follicular]] tumors have a slow growth and may recur, but are generally not fatal in patients under 45 years of age. [[Medullary thyroid cancer|Medullary]] and [[Anaplastic thyroid cancer|anaplastic tumors]] are [[cancer|malignant]].  [[Medullary]] tumors have a good prognosis if the are restricted to the thyroid gland and a poorer prognosis if [[metastasis]] occurs.  [[Anaplastic thyroid cancer|Anaplastic tumors]] are fast-growing and respond poorly to therapy.
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* [[Anaplastic thyroid cancer]] (3%)
* [[Anaplastic thyroid cancer]] (3%)
* [[Primary thyroid lymphoma|Lymphoma]] (1%)
* [[Primary thyroid lymphoma|Lymphoma]] (1%)
<br>
 
<br>


{| align="center"
{| align="center"
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{{Familytree/end}}
{{Familytree/end}}
|}
|}
==Causes==
* For more information on [[papillary thyroid cancer]] [[causes]], [[Papillary thyroid cancer causes|click here]].
* For more information on [[follicular thyroid cancer]] [[causes]], [[Follicular thyroid cancer causes|click here]].
* For more information on [[medullary thyroid cancer]] [[causes]], [[Medullary thyroid cancer causes|click here]].
* For more information on [[anaplastic thyroid cancer]] [[causes]], [[Anaplastic thyroid cancer causes|click here]].
* For more information on [[primary thyroid lymphoma]] [[causes]], [[Primary thyroid lymphoma|click here]].
==Differential diagnosis==
==Differential diagnosis==
Thyroid cancers should be [[Differential diagnosis|differentiated]] from one another and from various other [[diseases]]:
Thyroid cancers should be [[Differential diagnosis|differentiated]] from one another and from various other [[diseases]]:
{| border="3"
{| border="3"
|+  
|+  
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease name}}  
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease Name}}  
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Age of onset}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Age of Onset}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Gender preponderance}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Gender Preponderance}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Signs/Symptoms}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Signs/Symptoms}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Imaging Feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Imaging Feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Macroscopic feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Macroscopic Feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic Feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Laboratory Findings(s)}}  
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Laboratory Findings(s)}}  
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Other Feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Other Feature(s)}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic appearance}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic Appearance}}
|-
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Papillary Thyroid Cancer<ref name="FaginMitsiades2008">{{cite journal|last1=Fagin|first1=James A.|last2=Mitsiades|first2=Nicholas|title=Molecular pathology of thyroid cancer: diagnostic and clinical implications|journal=Best Practice & Research Clinical Endocrinology & Metabolism|volume=22|issue=6|year=2008|pages=955–969|issn=1521690X|doi=10.1016/j.beem.2008.09.017}}</ref><ref name="Schlumberger1998">{{cite journal|last1=Schlumberger|first1=Martin Jean|title=Papillary and Follicular Thyroid Carcinoma|journal=New England Journal of Medicine|volume=338|issue=5|year=1998|pages=297–306|issn=0028-4793|doi=10.1056/NEJM199801293380506}}</ref><ref name="pmid20001718">{{cite journal |vauthors=Sipos JA |title=Advances in ultrasound for the diagnosis and management of thyroid cancer |journal=Thyroid |volume=19 |issue=12 |pages=1363–72 |date=December 2009 |pmid=20001718 |doi=10.1089/thy.2009.1608 |url=}}</ref>
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Papillary Thyroid Cancer<ref name="FaginMitsiades2008">{{cite journal|last1=Fagin|first1=James A.|last2=Mitsiades|first2=Nicholas|title=Molecular pathology of thyroid cancer: diagnostic and clinical implications|journal=Best Practice & Research Clinical Endocrinology & Metabolism|volume=22|issue=6|year=2008|pages=955–969|issn=1521690X|doi=10.1016/j.beem.2008.09.017}}</ref><ref name="Schlumberger1998">{{cite journal|last1=Schlumberger|first1=Martin Jean|title=Papillary and Follicular Thyroid Carcinoma|journal=New England Journal of Medicine|volume=338|issue=5|year=1998|pages=297–306|issn=0028-4793|doi=10.1056/NEJM199801293380506}}</ref><ref name="pmid20001718">{{cite journal |vauthors=Sipos JA |title=Advances in ultrasound for the diagnosis and management of thyroid cancer |journal=Thyroid |volume=19 |issue=12 |pages=1363–72 |date=December 2009 |pmid=20001718 |doi=10.1089/thy.2009.1608 |url=}}</ref>
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** High [[vascularity]]
** High [[vascularity]]


*[[Imaging]] features are not characteristic for this [[cancer]]
*[[Imaging]] features are not characteristic of this [[cancer]]
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*[[Solitary]] hypoechogenic [[nodule]] with [[Lobule|lobulated]] margin which may extend into adjacent [[tissues]]
*[[Solitary]] hypoechogenic [[nodule]] with [[Lobule|lobulated]] margin which may extend into adjacent [[tissues]]
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*[[Thyroid function test|Thyroid function tests]] can be normal
*[[Thyroid function test|Thyroid function tests]] can be normal
*[[Thyroglobulin]] can be used as a [[tumor marker]]
*Serum [[thyroglobulin]] can be used as a [[tumor marker]]
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* History of [[radiation]] to the [[head]] and [[neck]]
* History of [[radiation]] to the [[head]] and [[neck]]
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! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Follicular Thyroid Cancer<ref name="Schlumberger1998">{{cite journal|last1=Schlumberger|first1=Martin Jean|title=Papillary and Follicular Thyroid Carcinoma|journal=New England Journal of Medicine|volume=338|issue=5|year=1998|pages=297–306|issn=0028-4793|doi=10.1056/NEJM199801293380506}}</ref><ref name="pmid20001718">{{cite journal |vauthors=Sipos JA |title=Advances in ultrasound for the diagnosis and management of thyroid cancer |journal=Thyroid |volume=19 |issue=12 |pages=1363–72 |date=December 2009 |pmid=20001718 |doi=10.1089/thy.2009.1608 |url=}}</ref><ref name="pmid2019455">{{cite journal |vauthors=Pettersson B, Adami HO, Wilander E, Coleman MP |title=Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type |journal=Int. J. Cancer |volume=48 |issue=1 |pages=28–33 |date=April 1991 |pmid=2019455 |doi=10.1002/ijc.2910480106 |url=}}</ref>
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Follicular Thyroid Cancer<ref name="Schlumberger1998">{{cite journal|last1=Schlumberger|first1=Martin Jean|title=Papillary and Follicular Thyroid Carcinoma|journal=New England Journal of Medicine|volume=338|issue=5|year=1998|pages=297–306|issn=0028-4793|doi=10.1056/NEJM199801293380506}}</ref><ref name="pmid20001718">{{cite journal |vauthors=Sipos JA |title=Advances in ultrasound for the diagnosis and management of thyroid cancer |journal=Thyroid |volume=19 |issue=12 |pages=1363–72 |date=December 2009 |pmid=20001718 |doi=10.1089/thy.2009.1608 |url=}}</ref><ref name="pmid2019455">{{cite journal |vauthors=Pettersson B, Adami HO, Wilander E, Coleman MP |title=Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type |journal=Int. J. Cancer |volume=48 |issue=1 |pages=28–33 |date=April 1991 |pmid=2019455 |doi=10.1002/ijc.2910480106 |url=}}</ref>
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* Peak [[incidence]] is 40-60 years of age
* Peak [[incidence]] at 40 - 60 years of age
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* More commonly affects women
* More commonly affects women
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*[[Asymptomatic]] [[thyroid]] [[mass]] or [[nodule]]
*[[Asymptomatic]] [[thyroid]] [[mass]] or [[nodule]]
*Compressive [[symptoms]] such as:
*Compressive [[symptoms]], such as:
*[[Difficulty swallowing]]/[[Dyspnea|breathing]]
*[[Difficulty swallowing]]/[[Dyspnea|breathing]]
*Persistent [[cough]]
*Persistent [[cough]]
*[[Stridor]]
*[[Stridor]]
*Vocal chord [[paralysis]]
*[[Vocal cord|Vocal chord]] [[paralysis]]
*Rapid enlarging [[mass]]
*Rapid enlarging [[mass]]
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* [[Ultrasound]]: solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
* On [[ultrasound]]:
* Irregular margin
**Solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
* [[Imaging]] features are not characteristic for this [[cancer]]
**Irregular margin
*[[Imaging]] features are not characteristic of this [[cancer]]
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* Single encapsulated [[nodule]],
* Single encapsulated [[nodule]]
* Thick and irregular [[capsule]]
* Thick and irregular [[capsule]]
* May have [[cystic]] or [[hemorrhage]]
* Can be [[cystic]] or [[hemorrhage|hemorrhagic]] in appearance
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* Invades [[thyroid]] [[capsule]] and [[vasculature]]
* Invades [[thyroid]] [[capsule]] and [[vasculature]]
* Uniform [[Follicle|follicles]] <br />
* Uniform [[Follicle|follicles]] <br />
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*[[Thyroid function test]] may be normal
*[[Thyroid function test|Thyroid function tests]] can be normal
* Serum [[thyroglobulin]] may be used as a [[tumor marker]]
* Serum [[thyroglobulin]] can be used as a [[tumor marker]]
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*[[RASA3|RAS]] [[mutation]] may be present
*[[RASA3|RAS]] [[mutation]] may be present
* PAX8-PPAR [[Translocation|translocations]]
*[[PAX8]]-[[PPAR|PPARγ]] [[Translocation|translocations]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Image:Metastatic follicular thyroid carcinoma - Case 264.jpg|thumb|none|200px|Source:Wikimedia common ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Image:Metastatic follicular thyroid carcinoma - Case 264.jpg|thumb|none|200px|Source:Wikimedia common ]]
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*[[Incidence]] increases with age
*[[Incidence]] increases with age
* More common in 3rd to 4th decades of life
* More common in the 3rd to 4th decades of life
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* Both genders affected equally
* Both genders are affected equally
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* Solitary [[thyroid nodule]]
*[[Solitary]] [[thyroid nodule]]
* Mostly affects upper lobe of thyroid gland
* Mostly affects upper [[Lobe (anatomy)|lobe]] of [[thyroid gland]]
* Possible [[systemic]] [[symptoms]] due to hormonal secretion by the [[tumor]]
* Possible [[systemic]] [[symptoms]] due to [[Hormone|hormonal]] [[secretion]] by the [[tumor]]
*[[Cervical]] [[lymphadenopathy]]
*[[Cervical]] [[lymphadenopathy]]
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*[[Ultrasound]]: solitary hypoechoic [[nodule]] with or without [[calcification]]
*On [[ultrasound]]:
*Imaging features are not characteristic for this [[cancer]]
**[[Solitary]] hypoechoic [[nodule]] with or without [[calcification]]
*[[Imaging]] features are not characteristic of this [[cancer]]
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* Single nonencapsulated [[mass]]
* Single non-encapsulated mass
* Gray-tan color
* Gray-tan color
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* Sheets of [[cells]] in an [[amyloid]] [[stroma]]
* Sheets of [[cells]] in an [[amyloid]] [[stroma]]
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* Secretes [[calcitonin]]
*[[Secretion|Secretes]] [[calcitonin]]
*Normal [[thyroid function test]]
*Normal [[thyroid function test|thyroid function tests]]
*[[Carcinoembryonic antigen]] ([[CEA]]) may be used as a [[tumor marker]]
*[[Carcinoembryonic antigen]] ([[CEA]]) may be used as a [[tumor marker]]
*Rarely negative for [[calcitonin]]
*Rarely negative for [[calcitonin]]
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* May be part of [[MEN syndromes|MEN 2A]] and [[Multiple endocrine neoplasia type 2|2B syndrome]]
* Can be part of [[MEN syndromes|MEN 2A]] and [[Multiple endocrine neoplasia type 2|2B syndrome]]
* May be associated with [[RET gene|RET]] [[mutation]]
* Can be associated with [[RET gene|RET]] [[mutation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[File:Thyroid MedullaryCarcinoma SpindleCell LP PA.JPG|thumb|none|200px|Source:Wikimedia common ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[File:Thyroid MedullaryCarcinoma SpindleCell LP PA.JPG|thumb|none|200px|Source:Wikimedia common ]]
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* More common among older individuals
* More common among older individuals
*Mean age at [[diagnosis]] is 65 years
*[[Mean]] age at [[diagnosis]] is 65 years
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* More commonly affects women
* More commonly affects women
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* Rapidly enlarging thyroid [[mass]]
* Rapidly enlarging [[thyroid]] [[mass]]
* May manifest with compressive [[symptoms]]
* May manifest with compressive [[symptoms]]
*May present with [[signs]]/[[symptoms]] of [[metastasis]]
*Can present with [[signs]]/[[symptoms]] of [[metastasis]]
*Constitutional [[symptoms]] may be present
*Constitutional [[symptoms]] may be present
*Hard nodular [[goiter]] w/out [[tenderness]]
*Hard [[Nodule (medicine)|nodular]] [[goiter]] without [[tenderness]]
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[[Ultrasound]]: solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
* On [[ultrasound]]:
* Irregular margin
** Solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
* [[Imaging]] features are not characteristic for this [[cancer]]
 
** Irregular margin
*[[Imaging]] features are not characteristic of this [[cancer]]
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* Solid [[tumor]] with areas of [[necrosis]] and [[hemorrhage]]
* Solid [[tumor]] with areas of [[necrosis]] and [[hemorrhage]]
* Infiltrative pattern
*[[Infiltration (medical)|Infiltrative]] pattern
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* Undifferentiated, devastatingly aggressive variant of Papillary/[[Follicular thyroid cancer]]
* Undifferentiated, devastatingly aggressive variant of [[Papillary thyroid cancer|papillary]]/[[follicular thyroid cancer]]
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* Normal [[thyroid function test]]
* Normal [[thyroid function test|thyroid function tests]]
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* Poor [[prognosis]]
* Poor [[prognosis]]
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* Some may show [[papillary]] [[Projection areas|projections]] without [[nuclear]] characteristics of [[papillary thyroid cancer]]
* Some may show [[papillary]] [[Projection areas|projections]] without [[nuclear]] characteristics of [[papillary thyroid cancer]]
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* Classified as toxic and non-toxic
*[[Classification|Classified]] as toxic and non-toxic
* Toxic =>  hyperthyroidism
**'''Toxic:''' [[Hyperthyroidism]]
* Non-toxic => Normal [[thyroid function test]]
**'''Non-toxic:''' Normal [[thyroid function test|thyroid function tests]]
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*[[Benign]] [[condition]]
*[[Benign]] [[condition]]
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<ref name="pmid3141260">{{cite journal |vauthors=Hyjek E, Isaacson PG |title=Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis |journal=Hum. Pathol. |volume=19 |issue=11 |pages=1315–26 |date=November 1988 |pmid=3141260 |doi=10.1016/s0046-8177(88)80287-9 |url=}}</ref><ref name="pmid3759532">{{cite journal |vauthors=Tupchong L, Hughes F, Harmer CL |title=Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=12 |issue=10 |pages=1813–21 |date=October 1986 |pmid=3759532 |doi=10.1016/0360-3016(86)90324-x |url=}}</ref><ref name="pmid17042683">{{cite journal |vauthors=Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, Kobayashi K, Nakamura Y, Kakudo K, Amino N, Miyauchi A |title=Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid |journal=Thyroid |volume=16 |issue=10 |pages=983–7 |date=October 2006 |pmid=17042683 |doi=10.1089/thy.2006.16.983 |url=}}</ref>
<ref name="pmid3141260">{{cite journal |vauthors=Hyjek E, Isaacson PG |title=Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis |journal=Hum. Pathol. |volume=19 |issue=11 |pages=1315–26 |date=November 1988 |pmid=3141260 |doi=10.1016/s0046-8177(88)80287-9 |url=}}</ref><ref name="pmid3759532">{{cite journal |vauthors=Tupchong L, Hughes F, Harmer CL |title=Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=12 |issue=10 |pages=1813–21 |date=October 1986 |pmid=3759532 |doi=10.1016/0360-3016(86)90324-x |url=}}</ref><ref name="pmid17042683">{{cite journal |vauthors=Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, Kobayashi K, Nakamura Y, Kakudo K, Amino N, Miyauchi A |title=Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid |journal=Thyroid |volume=16 |issue=10 |pages=983–7 |date=October 2006 |pmid=17042683 |doi=10.1089/thy.2006.16.983 |url=}}</ref>
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* Affects adults or elderly
* Affects [[Adult|adults]] or elderly
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* More common among women
* More common among women
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* Rapidly enlarging [[mass]]/ [[nodule]] of [[thyroid]]
* Rapidly enlarging mass/[[nodule]] of [[thyroid]]
* Compression [[symptoms]] may be present
* Compressive [[symptoms]] may be present
* [[B symptoms|Constitiutional symptoms]] may be present in 10%
* [[B symptoms|Constitiutional symptoms]] can be present in 10%
* P/E:Firm, hard [[thyroid]]
*[[Physical examination|P/E]]:Firm, hard [[thyroid]]
* Fixed to the nearby structure
* Fixed to the nearby structures
* Immobile even during swallowing
* Immobile even during swallowing
* [[Cervical]] or [[supraclavicular]] [[lymphadenopathy]] may be present
* [[Cervical]] or [[supraclavicular]] [[lymphadenopathy]] may be present


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* [[Ultrasound]]: hypoechogenic appearance difficult to be distinguished from chronic [[thyroiditis]]
* On [[ultrasound]]:
**Hypoechogenic appearance
**Difficult to distinguish from [[Chronic (medical)|chronic]] [[thyroiditis]]
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* [[Thyroid nodule]]/[[mass]] fixing to adjacent [[tissue]] with a firm texture
* [[Thyroid nodule]]/mass
*Fixed to adjacent [[tissue]]
*Firm texture
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* It is of [[B cell]] lineage in the majority of cases
* It is of [[B cell]] lineage in the majority of cases
* Dffuse, large [[B-cell lymphoma|B-cell lymphomas]] is the most common subtype: diffuse infiltrate of B cells destroying thyroid follicles
* Dffuse, large [[B-cell lymphoma|B-cell lymphomas]] is the most common subtype
* [[Marginal zone lymphoma]] is the second most common type
* [[Marginal zone lymphoma]] is the second most common type
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* No specific test
* No specific test
* Some may have [[hypothyroidism]]
* Some [[Patient|patients]] may have [[hypothyroidism]]
* Some may have [[antibody]] against [[thyroid peroxidase]] or [[thyroglobulin]]  
*[[Patient|Patients]] can also have [[antibody|antibodies]] against [[thyroid peroxidase]] or [[thyroglobulin]]
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* Preexisting chronic [[Hashimoto's thyroiditis|autoimmune (Hashimoto's) thyroiditis]] is a known [[risk factor]] for this [[condition]]
* Preexisting [[Chronic (medical)|chronic]] [[Hashimoto's thyroiditis|autoimmune (Hashimoto's) thyroiditis]] is a known [[risk factor]] for this [[condition]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[File:Thyroid lymphoma large cell type fine needle aspiration biop.jpeg|thumb|none|200px|Source:pathology outline, case courtesy of Dr. Mark R. Wick]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[File:Thyroid lymphoma large cell type fine needle aspiration biop.jpeg|thumb|none|200px|Source:pathology outline, case courtesy of Dr. Mark R. Wick]]
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Latest revision as of 15:19, 26 September 2019

Thyroid Cancer Main Page

Patient Information

Overview

Classification

Papillary Thyroid Cancer
Follicular Thyroid Cancer
Medullary Thyroid Cancer
Anaplastic Thyroid Cancer
Thyroid Lymphoma

Causes

Differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.; Ammu Susheela, M.D. [2]Seyedmahdi Pahlavani, M.D. [3] Sahar Memar Montazerin, M.D.[4]

Overview

Thyroid cancer refers to any of four kinds of tumors of the thyroid gland which include papillary, follicular, medullary and anaplastic tumors. Papillary and follicular tumors are the most common and are usually benign. Papillary and follicular tumors have a slow growth and may recur, but are generally not fatal in patients under 45 years of age. Medullary and anaplastic tumors are malignant. Medullary tumors have a good prognosis if the are restricted to the thyroid gland and a poorer prognosis if metastasis occurs. Anaplastic tumors are fast-growing and respond poorly to therapy. Thyroid nodules are diagnosed by ultrasound guided fine needle aspiration or frequently by thyroidectomy (surgical removal and subsequent histological examination). As the thyroid cancer can uptake iodine, radioactive iodine is commonly used for the treatment of thyroid carcinomas. However, radioactive iodine therapy is accompanied by thyroxine therapy to ensure TSH suppression.

Classification

Thyroid cancers can be classified according to their pathological characteristics. The following variants can be distinguished (distribution over various subtypes may show regional variation):


 
 
 
 
 
 
 
 
 
 
 
 
 
Thyroid carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Papillary thyroid cancer
 
Follicular thyroid cancer
 
Medullary thyroid cancer
 
 
 
 
 
Anaplastic thyroid cancer
 
Lymphoma
 
Miscellaneous
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Follicular variant

•Tall cell
•Diffuse sclerosing
•Encapsulated

•Columnar
 
•Minimally invasive
•Overtly invasive
 
 
 
 
 
 
 
 
 
•Small cell
•Giant cell
 
 
 
 
 
•Sarcoma

•Lymphoma
•Squamous cell carcinoma
•Mucoepidermoid carcinoma
•Plasma cell tumors
•Direct extension
•Kidney
•Melanoma

•Colon
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Causes

Differential diagnosis

Thyroid cancers should be differentiated from one another and from various other diseases:

Disease Name Age of Onset Gender Preponderance Signs/Symptoms Imaging Feature(s) Macroscopic Feature(s) Microscopic Feature(s) Laboratory Findings(s) Other Feature(s) Microscopic Appearance
Papillary Thyroid Cancer[1][2][3]
  • More common in the middle aged (30 - 50 years of age)
  • More commonly affects women
Source:Wikimedia commons
Follicular Thyroid Cancer[2][3][4]
  • More commonly affects women
Source:Wikimedia common
Medullary Thyroid Cancer[5][6][7][3]
  • Incidence increases with age
  • More common in the 3rd to 4th decades of life
  • Both genders are affected equally
  • Single non-encapsulated mass
  • Gray-tan color
Source:Wikimedia common
Anaplastic Thyroid Cancer[8][9][10]
  • More common among older individuals
  • Mean age at diagnosis is 65 years
  • More commonly affects women
    • Irregular margin
  • Imaging features are not characteristic of this cancer
Source:Wikimedia common
Follicular Adenoma[11]
  • More commonly affects individuals older than 50 years of age
  • More commonly affects women
  • Solitary nodule which may show echogenicity or not
  • Solitary, spherical, and encapsulated lesion
  • Well demarcated from the surrounding parenchyma
  • Functional adenoma:
    • Elevated T3, T4
    • Decreased TSH
  • May be considered functional or hot
  • May be considered non-functional or cold
Source:Wikimedia common
Multinodular Goiter[12]
  • Commonly affects individuals older than 60 years of age
  • More commonly affects women
Source:pathology outline, case courtesy of Dr. Swati Satturwar
Thyroid Lymphoma[13]

[14][15][16]

  • More common among women
Source:pathology outline, case courtesy of Dr. Mark R. Wick

References

  1. Fagin, James A.; Mitsiades, Nicholas (2008). "Molecular pathology of thyroid cancer: diagnostic and clinical implications". Best Practice & Research Clinical Endocrinology & Metabolism. 22 (6): 955–969. doi:10.1016/j.beem.2008.09.017. ISSN 1521-690X.
  2. 2.0 2.1 Schlumberger, Martin Jean (1998). "Papillary and Follicular Thyroid Carcinoma". New England Journal of Medicine. 338 (5): 297–306. doi:10.1056/NEJM199801293380506. ISSN 0028-4793.
  3. 3.0 3.1 3.2 Sipos JA (December 2009). "Advances in ultrasound for the diagnosis and management of thyroid cancer". Thyroid. 19 (12): 1363–72. doi:10.1089/thy.2009.1608. PMID 20001718.
  4. Pettersson B, Adami HO, Wilander E, Coleman MP (April 1991). "Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type". Int. J. Cancer. 48 (1): 28–33. doi:10.1002/ijc.2910480106. PMID 2019455.
  5. Busnardo B, Girelli ME, Simioni N, Nacamulli D, Busetto E (January 1984). "Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma". Cancer. 53 (2): 278–85. doi:10.1002/1097-0142(19840115)53:2<278::aid-cncr2820530216>3.0.co;2-z. PMID 6690009.
  6. Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH (March 2000). "Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems". Cancer. 88 (5): 1139–48. doi:10.1002/(sici)1097-0142(20000301)88:5<1139::aid-cncr26>3.0.co;2-z. PMID 10699905.
  7. Hofstra, Robert M. W.; Landsvater, Rudy M.; Ceccherini, Isabella; Stulp, Rein P.; Stelwagen, Tineke; Luo, Yin; Pasini, Barbara; Hoppener, Jo W. M.; van Amstel, Hans Kristian Ploos; Romeo, Giovanni; Lips, Cornells J. M.; Buys, Charles H. C. M. (1994). "A mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B and sporadic medullary thyroid carcinoma". Nature. 367 (6461): 375–376. doi:10.1038/367375a0. ISSN 0028-0836.
  8. Nagaiah G, Hossain A, Mooney CJ, Parmentier J, Remick SC (2011). "Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment". J Oncol. 2011: 542358. doi:10.1155/2011/542358. PMC 3136148. PMID 21772843.
  9. Chang TC, Liaw KY, Kuo SH, Chang CC, Chen FW (June 1989). "Anaplastic thyroid carcinoma: review of 24 cases, with emphasis on cytodiagnosis and leukocytosis". Taiwan Yi Xue Hui Za Zhi. 88 (6): 551–6. PMID 2794956.
  10. Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA (July 1990). "Anaplastic carcinoma of the thyroid. A clinicopathologic study of 121 cases". Cancer. 66 (2): 321–30. doi:10.1002/1097-0142(19900715)66:2<321::aid-cncr2820660221>3.0.co;2-a. PMID 1695118.
  11. Mathur, Aarti; Olson, Matthew T.; Zeiger, Martha A. (2014). "Follicular Lesions of the Thyroid". Surgical Clinics of North America. 94 (3): 499–513. doi:10.1016/j.suc.2014.02.005. ISSN 0039-6109.
  12. Bronshteĭn ME, Makarov AD, Artemova AM, Bazarova EN, Kozlov GI (1994). "[Morphology of the thyroid tissue in multinodular euthyroid goiter]". Probl Endokrinol (Mosk) (in Russian). 40 (2): 36–9. PMID 8197088.
  13. Pedersen RK, Pedersen NT (January 1996). "Primary non-Hodgkin's lymphoma of the thyroid gland: a population based study". Histopathology. 28 (1): 25–32. PMID 8838117.
  14. Hyjek E, Isaacson PG (November 1988). "Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis". Hum. Pathol. 19 (11): 1315–26. doi:10.1016/s0046-8177(88)80287-9. PMID 3141260.
  15. Tupchong L, Hughes F, Harmer CL (October 1986). "Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment". Int. J. Radiat. Oncol. Biol. Phys. 12 (10): 1813–21. doi:10.1016/0360-3016(86)90324-x. PMID 3759532.
  16. Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, Kobayashi K, Nakamura Y, Kakudo K, Amino N, Miyauchi A (October 2006). "Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid". Thyroid. 16 (10): 983–7. doi:10.1089/thy.2006.16.983. PMID 17042683.


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