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26 Cards in this Set

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What is the most common thyroid malignancy in countries with idonine sufficient or excess diets?
pappillary carcinoma of the thyroid.

oddly enough, increasing iodine in europe has decreased follicular cancer and increased appillary carcioma..
Would people in chernobyl be at risk for papillary?
yes, increased incidence... these also tend to have increased aggressiveness.
who is more likely to get papillary carcinoma, women or men?
women.
What syndromes are more apt for papillary carcinoma?
Cowden sydnrome (usually benign) and FAP, HNPCC, Peutz-Jeghers, ataxia telengiectasia.
What does a papillary carcinoma look like grossly?
They can have a varied appearance grossly, usually white-tan, with some calcification, can appear anywhere.
What do they tend to look like microscopically of papillary carcinoma?
The neoplastic papilla contain a central core fo fibrovascular/fibrous tissue lined by one or occasionally several layers of cells with crowded oval nucei. Differiong from hyperplasia which can sometimes exaggerate into papillary change but have basal round/uniform nuclei. you will also see psammomma bodies with calcifications.

The nuclei look orphan annie eyed, ground glass and empty.
What do you want to be carefule of when seing ground glass nuclei and suspecting papillary thyroid carcinoma?
You want to be careful that you do not confuse for nuclear changes consistent with Hashimoto's thyroiditis.

You tend to get nuclear grooves with papillary although it is not entirely specific.

Mitosis is exceptional.
What will the surrounding tisue look like
You tend to have a surroudning desmoplasia arround the tumor... can have intensive lymphcytic infiltrate, cyst formation can occur, areas of squamous differentiation, desmoplasia.
Can you get multifocal tumors with papillary carcinoma?
yes, in the same gland.
What should you do if you only see the cancer in one lobe?
Just excise the lobe and then treat with hormonal afterwords.
What's the likelihood of lymphatic metatastasis?
Pretty high (over 50%).
Some patient's will even present with positive cervical lymph node without gross evidence of tumor.
Is there any use in grading papillary carcinomas of the thyroid?
no, 95% grade 1, can get nuclear atypia, solid growht, multiple mits, which gives a more guarded prognosis.
What do you see on EM with papillary thyroid carcinoma?
You see infolded membrane, cytoplasmic intranuclear inclusions, multiple mitochondria in the cytoplasm, and numerous cytoplasmic filaments.
What kinds of immunohisto would you order on a thyroid carcinoma?
CK 19, HBME, Glacetin 3.

(my pap eats kellogs 19, at home on a glacier)
What happens molecuarly with PTC?
You get the tyrosine kinase from the ret gene binding to the 5' end of various genes (multiple variations).

This can also occur in benign lesoins as well.
What are poor prognosis factors with papillary thryoid carcinoma?
tumor size, male, old, extrathyroid growth.
what is the appropriate size for a thyroid microcarcinoma?

What is the frequency?
WHO says 1 cm, others will say 1.5 cm. Papillary microcarcinoma has been discovered in up to 36% of carefully sectioned specimens.
What do you do with thryoid papillary microcarcinoma?
noone really knows, has been reported metastatic disease.
What is the prognosis of the familial form of papillary microcarcinoma?
Its a poor diagnosis.
What do you look for in a follicular variant of papillary carcinoma?
You want to look for a tumor that is encapsulated, with follicular pattern at the primary site, clear nuclei, psammomma bodies in the primary site, and a desmoplastic response at invasive areas.
What is the prognosis of the follicular variant?
It is usally the same of papillary carcinoma.
There are actually two types, the encapsulated type and the diffuse follicular variant.
What kinds of features do you have on the tall cell variant?
You have a large (greater than 6 cm) tumor that extends extrathyroidally, shows mitotic activity with vascular invasion more often that usual papillary cancer... usually occuring in older patients, twice as tall as wide, eosinophliic. (tall cells more than 50%).
What can tall cell variant of papillary carcinoma?
This can dedifferentiate to a squamous cell carcinoma.
What is the prognosis of tall cell carcinoma?
It is not as favorable as usuall papillary carcinoma, although it might just be that it occurs in older people, more mitotic, aggressive, etc.
Describe the columnar cell variant? What is the prognosis?
The cells are columnar but the nuclei are hyerchromatic, nuclear stratification is a prominent feature. Cells usually have a scant cytoplasm which can be celar. Mitosis are frequently seen.

The prognosis is most deaths occuring at 5 years.
What occurs in the diffuse sclerosis variant?
The diffuse sclerosis variant effects children. The papillae have associated areas of squamous metaplasia. Numerous psammomma bodies are found. The lesions appear to prepresent 10% of papillary carcinomas seen in children exposed to radioacrtive . Lymphocytic infiltrates are found around the tumor foci.

These tumors show extrapsular extension, distant and nodal metastases and decreased disease surfival carcinoma.