Thyroid Tumors

Gdubs
Mind Map by Gdubs, updated more than 1 year ago
Gdubs
Created by Gdubs over 5 years ago
22
1

Description

Medicine Mind Map on Thyroid Tumors, created by Gdubs on 08/04/2014.

Resource summary

Thyroid Tumors
1 Benign
1.1 Types
1.1.1 Follicular Adenoma
1.1.1.1 "Cold"
1.1.1.1.1 Almost all are cold
1.1.1.1.1.1 May still produce worrisome symptoms
1.1.1.1.1.1.1 Compression of trachea
1.1.1.1.1.1.2 Dysphagia
1.1.1.2 "Hot"
1.1.1.2.1 Functioning
1.1.1.2.1.1 Clinical Findings
1.1.1.2.1.1.1 Increased radioactive iodine uptake
1.1.1.2.1.1.2 May have signs of hyperthyroidism
1.1.1.3 Subtypes
1.1.1.3.1 Macro (colloid)
1.1.1.3.2 Normo
1.1.1.3.3 Micro
1.1.1.3.4 Trabecular
1.1.1.4 General
1.1.1.4.1 Most common benign thyroid tumor
1.1.1.4.2 Encapsulated tumor with follicular differentiation
1.1.1.4.3 Very low malignant potential
1.1.1.4.4 Almost always solitary
1.1.1.5 Treatment
1.1.1.5.1 Partial or complete thyroidectomy
1.1.2 Solitary Nodule
1.1.3 Granular Cell Tumor
2 Malignant
2.1 Types
2.1.1 Papillary Carcinoma
2.1.1.1 General
2.1.1.1.1 Most common thyroid malignancy
2.1.1.1.2 F>M, 3:1
2.1.1.1.3 a/w childhood radiation exposure
2.1.1.1.4 Excellent prognosis
2.1.1.2 Gross and Microscopic Findings
2.1.1.2.1 Multifocal
2.1.1.2.2 Empty appearing nuclei
2.1.1.2.2.1 Orphan Annie eyes
2.1.1.2.3 Papillary projections within glandular space
2.1.1.2.4 Psamomma bodies
2.1.1.2.4.1 Collection of calcified cancer cells; stain deep purple
2.1.1.2.5 Lymphatic invasion
2.1.1.2.5.1 Mets to cervical LNs and lung
2.1.1.3 Diagnosis and Treatment
2.1.1.3.1 Dx: FNA
2.1.1.3.2 Partial or complete thyroidectomy
2.1.1.3.2.1 Followed by radiotherapy with radioactive Iodine
2.1.1.3.3 Suppression therapy
2.1.1.3.3.1 levothyroxine to increase negative feedback on TSH secretion
2.1.1.3.3.1.1 Shrinks the tumor
2.1.2 Follicular Carcinoma
2.1.2.1 General
2.1.2.1.1 F>M
2.1.2.1.2 Good prognosis
2.1.2.1.3 a/w radiation exposure (less so than papillary) and iodine deficiency
2.1.2.2 Gross and Microscopic Findings
2.1.2.2.1 Usually a single cold, encapsulated nodule
2.1.2.2.2 Haematogenous spread

Annotations:

  • Rather than lymphatic spread as seen in papillary carcinoma
2.1.2.2.2.1 Mets to lung and bone first
2.1.2.2.3 Well-differentiated, uniform follicles
2.1.2.2.4 No psamomma bodies
2.1.2.2.5 Widely invasive or minimally invasive classification

Annotations:

  • Minimally invasive: capsule invasion only (may have some vascular invasion of a few small vessels) Widely invasive: extends through capsule and into thyroid parenchyma and vasculature
2.1.2.3 Hurthle cell carcinoma often considered a variant
2.1.2.4 Diagnosis and Treatment
2.1.2.4.1 FNA is NOT diagnostic
2.1.2.4.1.1 Microscopically the same as follicular adenoma
2.1.2.4.1.1.1 Need evidence of invasion
2.1.2.4.2 Definitive dx requires lobectomy
2.1.2.4.3 Treated similarly to papillary carcinoma
2.1.3 Medullary Carcinoma
2.1.3.1 Findings
2.1.3.1.1 Increased serum calcitonin
2.1.3.1.1.1 Causes diarrhoea
2.1.3.1.1.2 Tumor marker
2.1.3.1.2 May have ectopic hormone production, paraneoplastic syndromes
2.1.3.1.2.1 Ex. ACTH causing Cushing syndrome
2.1.3.1.3 Calcitonin amyloid material in stroma
2.1.3.1.4 Mets
2.1.3.1.4.1 Early regional LN mets common
2.1.3.1.4.2 Distant mets to liver, lung, bone and brain
2.1.3.2 Diagnosis and Treatment
2.1.3.2.1 Dx: FNA, increased calcitonin
2.1.3.2.2 Total thyroidectomy and genetic screening of RET gene if familial
2.1.3.3 General
2.1.3.3.1 Neuroendocrine tumor of parafollicular C cells
2.1.3.3.1.1 C-cell hyperplasia is a precursor lesion
2.1.3.3.2 Causes
2.1.3.3.2.1 Sporadic (80%)
2.1.3.3.2.1.1 Poorer prognosis than familial type
2.1.3.3.2.1.2 Unilateral
2.1.3.3.2.2 Familial (20%)
2.1.3.3.2.2.1 a/w MEN 2A and 2B

Annotations:

  • Recall:  MEN 2A- medullary carcinoma, hyperparathyroidism, pheochromocytoma MEN 2B- medullary carcinoma, mucosal neuromas, pheochromocytoma
2.1.3.3.2.2.2 Younger patients
2.1.3.3.2.2.3 Bilateral and multicentric
2.1.4 Anaplastic
2.1.4.1 General
2.1.4.1.1 Elderly women
2.1.4.1.2 a/w multinodular goiter and positive follicular cancer history
2.1.4.1.3 Rapidly aggressive
2.1.4.1.3.1 VERY poor prognosis
2.1.4.1.3.2 Early dissemination
2.1.4.1.3.3 Invasion of local structures (trachea, oesophagus) common
2.1.4.1.3.4 50% have lung mets at presentation
2.1.4.2 Gross and Microscopic Findings
2.1.4.2.1 Regions of spontaneous haemorrhage and necrosis
2.1.4.2.2 Infiltration of adjacent structures
2.1.4.3 Diagnosis and Treatment
2.1.4.3.1 Dx: FNA or surgery if inconclusive
2.1.4.3.2 Palliative treatment
2.1.4.3.2.1 Partial surgical resection
2.1.4.3.2.1.1 Tumor often compresses the trachea
2.1.4.3.2.1.2 Extensive resection of tumor and surrounding structures generally NOT indicated
2.1.4.3.2.1.2.1 High post-op morbidity
2.1.4.3.2.1.2.1.1 Ex. vocal cord paralysis
2.1.4.3.2.1.2.2 No proven survival benefit
2.1.4.3.2.2 Chemo or radiation
2.1.5 Primary B Cell Lymphoma
2.1.5.1 Most commonly a/w Hashimoto's thyroiditis
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