• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/32

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

32 Cards in this Set

  • Front
  • Back
__________ are derived from neural crest cells and are incorporated into the _______ thyroid in a _______ pattern.
C-Cells derived from NCC
Incorporated into mid-lateral thyroid lobes
Non-uniform distribution

(MEDULLARY CARCINOMAS have same non-uniform distribution)
The majority of medullary carcinomas are _________.
Sporadic (75-80%)
Familial (20-25%)
This type of tumor is well circumscribed and fleshy appearance.
Medullary Carcinoma
MEN2A RET mutation results in ________.
Medullary Thyroid Carcinoma
Pheo
PT

Familial medullary carcinomas bilateral, multicentric

Smaller, bilateral tumors
MEN2B RET mutations
Marfanoid habitus (long limbs, spidery fingers, hyermobility--double jointedness)

Neuromas (tumor of nerve tissue)

Lip neuromas, tongue neuromas
Familial medullary thyroid carcinomas are considered a variant of __________ because _________.
MEN2A bc both contains mutations to RET gene exons 10, 11, (13, 14--rare)
MEN syndromes lead to _______ mutations of the _______ gene and can result in _________.
MEN Syndromes-->activating mutations of RET gene-->neural proliferation (neuromas)
Which MEN tumor is most aggressive?

Associated RET gene mutation?

Associated lesions?
MEN2B most aggressive (Exon 16 mutation)

Lesions:
Pheochromocytoma
Ganglioneuromas
Marfanoid habitus
Which MEN tumor is least aggressive?

Associated RET gene mutations?

Associated lesions?
FMTC

Exons, 10, 11, 13, 14, 15

No associated lesions.
Which MEN syndrome is intermediate in aggression?

Associated RET gene mutations?

Associated lesions?
MEN2A = intermediate aggression

Mutations to excons 10, 11, (13, 14 rare)

Lesions:
Pheochromocytoma
Hyperparathyroidism
Congo Red is used to stain for ________.

What would you expect to see in a congo red test for medullary carcinoma?
Amyloid proteins (apple green biofringence = positive test)

Would expect to see calcitonin (from C Cells) with amyloid deposits.
How do familial medullary carcinomas differ from non-familial medullary carcinomas?
Familial medullary carcinomas are BILATERAL and MULTICENTRIC

Non-familial carcinomas are unilateral
Which MEN syndromes exhibit mutations to codon 634? Effect on signaling?
MEN2A
FMTC

Effect: constitutive activation by dimerization WITHOUT ligand
Which MEN syndromes exhibit mutations to codon 938? Effect on signaling?
MEN2B

Altered signal transduction (?)
__________ is derived from the IVth pharyngeal pouch.
Upper parathyroid
_________ is derived from the IIIrd pharyngeal pouch.
Lower parathyroids
Which region of parathyroid is much more variable in location?
LOWER GLANDS (occasionally found in mediastinum)
What is parathyromatosis?
multiple nodules of hyperfunctioning parathyroid tissue scattered through the neck and mediastinum (due to developmental variation or seeding)

CAN MIMIC CARCINOMA
How do adult parathyroid glands differ from those of children?
Adult ones have fat!
_________ is the most common cause of clinically apparent hypercalcemia.
Malignancy
Diagnose:
Loss of bone within the medulla with the formation of multiple “brown” cysts, which contain giant cells and iron-containing histiocytes.
hypercalcemia

bone can be invaded with fibrous tissue with subsequent loss
What are the most common causes of primary hyperparathyroidism?
Adenoma (75-80%): single gland involvement

Hyperplasia (10-15%)
Carcinoma (<5%)
Characteristics of parathyroid adenoma.

Discuss cells involved.
Diffuse growth of chief cells in a single gland; should have rim of non-neoplastic thyroid tissue
Little fat within tumor
Characteristics of parathyroid carcinomas.
Rare

Thick fibrous bands
Mitotic activity (MITOSES)
CAPSULAR and VASCULAR invasion (need invasion to make definitive diagnosis of carcinoma)
Which carcinoma characteristics are not definitive for diagnosis of a carcinoma?
Thick fibrous bands
Mitotic activity

These are often lumped under the category of "atypical adenoma"--behave in benign fashion, need active surveillance

NEED INVASION AND/OR METS
_____________ can involve all 4 parathyroid glands, usually with variation in extent of involvement.
Primary PThy hyperplasia
What is Wermer Syndrome?

Characteristic findings?
Multiple endocrine neoplasia (MEN) type I - disorder in which one or more of the endocrine glands are overactive or form a tumor.

Tumors of:
Parathyroids
Pituitary (prolactinomas)
Pancreas (gastrinomas, duodenal tumors)

Hyperparathyroidism due to hyperplasia in 95% of all cases
What mutation is associated with Wermer Syndrome?
MEN1 mutation (tumor suppressor gene)--menin
Findings of secondary hyperparathyroidism?
All 4 glands enlarged (even more than in primary hyperpara)

Fibrosis (diff to distinguish from carcinomas)
Ambiguities of hyperplasia vs adenoma
Hyperplasia: asyncrhonous

Fat present in either

Some compression occasionally present in hyperplasia
Treatment of primary and tertiary hyperplasia of parathyroid.
Surgery and autografting (to forearm)
Causes of hypoparathyroidism.
Surgically induced (removal of parathyroid)

DiGeorge

Autoimmune Regulator Gene Mutation (AIRE)