clinical features & staging,thyroid

8/2/2019 Clinical Features & Staging,Thyroid

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RUKMAN MECCA


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Annual incidence 3.7 per 100 000Male: Female - 3:1Older pts more aggressive , worse

prognosisPresentation Thyroid swelling-Enlarged cervical lymph

nodes

-Voice changes-Pain ,referred to ear


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Papillary & Colloid-filled folliclesHistology - papillary projections

-pale empty nuclei ORPHAN

ANNIE NUCLEI [on FNAC]-very seldom encapsulatedMultiple foci- lymphatic spread , multicentric

growth, good prognosisExtra thyroidal blood-borne mets


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Young femalesPresent as solitary noduleThyroid swelling + significant lymph nodes

OCCULT CARCINOMA-pap ca less than 1.5cm diameter , excellent prognosisPapillary microcarcinoma- pap ca


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Long-standing multinodular goitres , rapidlygrowingDiagnosis-thyroid scan; [not wd FNAC]

Hard with restricted mobilityBlood-borne mets twice commonMortality-twice highBone mets-flat bones ,warm & pulsatile


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Macroscopically-encapsulatedMicroscopically-invasion of capsule & of vascular spaces

Multiple foci & lymphatic mets rarely seen

HURTHLE CELL TUMOUR- variant of follicularca where oxyphil cells predominate

- all are malignant,.multicentric-lymph node mets, poorer prognosis


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PAPILLARY FOLLICULARMale incidence 22 35Lymph node mets 35 13Blood vessel invasion 40 60Recurrence rate 19 29Overall mortality rate 11 24

Location of recurrent carcinomaDistant mets 45 75Nodal mets 34 12Local recurrence 20 12


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LOW RISK GROUP-Men-40yrs & younger-women-50yrs&younger,wd no distant mets-older pts wd extrathyroid papillary &

folliclar, wd minor capsular inv,5cm diam , regardless of extend


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AGES

AMES

MACIS


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Undifferentiated carcinomaElderly women,60-70yrsRapidly growing ,hard & irregular

Blood-borne & lymphatic mets , poorprognosisDiagnosis-FNAC


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Early infiltration of trachea-obstruction.,needs decompression,isthmusectomy doneDifficult to diff from lymphoma of thyroid

Infiltration of carotids-BERRY SIGN POSITIVEEarly fixity , nil resectabilityRadiotherapy-palliative


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Older patients are commonly affected.Prognosis is good if no involement of cervicalLNMay be ass wd Hashimotos thyroiditisEither as primary lymphoma or as a part of gen lymphomaFNAC helps to diagnose

Good response to radio & chemotherapy


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TUMOUR TX-primary cannot be assessedT0-no evidence of primaryT1-limited to thyroid,1cm or less

T2-limited to thyroid,>1cmbut4cmT4-extending beyond capusle,any

size


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NODES-NX-cannot be assessedN0-no regional node mets

N1-regional node metsMETASTASIS-MX-cannot be assessed

M0-no metsM1-mets present


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STAGE: Under 45yrs Over 45yrs

1 : anyT,anyN,M0 T1,NO,M02 : anyT,anyN,M1 T2,N0,M0 or T3,

M0 ,NO3 : T4,N0,M0 or

any T,N1,M04 : anyT,any N,M1


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clinical features & staging,thyroid

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