Anaplastic thyroid cancer pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Anaplastic thyroid cancer arises from cells of the thyroid, which are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3). Anaplastic thyroid tumor is always considered as stage IV. Genes involved in the pathogenesis of follicular thyroid cancer include P53 and BRAF.

Pathogenesis

  • Anaplastic tumors have a high mitotic rate and lymphovascular invasion. It rapidly invades surrounding tissues (such as the trachea).
  • Most patients with anaplastic thyroid cancer have distant metastasis at the time of diagnosis because of the rapid growth and aggressive nature of this type of cancer.
  • Common sites of metastasis include the lungs, pleura, bones, and brain.

Genetics

  • Anaplastic thyroid cancer has been associated with the following genetic mutations:[1][2]

Associated Conditions

Gross Pathology

  • Macroscopic features of anaplastic thyroid cancer include:
    • Unencapsulated, fleshy, tan-white tumor
    • Soft-tissue infiltration of the neck

Microscopic Pathology

  • Three types of histologic variety will be expected in anaplastic thyroid cancer:
  • Spindle cell
  • Giant cell
  • Squamoid cell
  • Features include:
    • Cytologically malignant:
    • Huge nuclear-cytoplasmic ratio
    • Mitoses
    • Presence or absence of necrosis

Immunohistochemistry

  • Anaplastic thyroid cancer may be positive for the following markers:
    • Pankeratin (AE1/AE3)
    • High molecular weight keratins
    • TTF-1
    • PAX8
    • P53
    • B-catenin

References

  1. Patel KN, Shaha AR (2006). "Poorly differentiated and anaplastic thyroid cancer". Cancer Control. 13 (2): 119–28. PMID 16735986.
  2. Quiros RM, Ding HG, Gattuso P, Prinz RA, Xu X (June 2005). "Evidence that one subset of anaplastic thyroid carcinomas are derived from papillary carcinomas due to BRAF and p53 mutations". Cancer. 103 (11): 2261–8. doi:10.1002/cncr.21073. PMID 15880523.



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