neoplasms of thyroid gland
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Pathology of thyroid malignancies
Mohit kadyanRoll no:26
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Carcinomas
Papillary carcinoma (>85% os cases)
Follicular carcinoma (5 to 15% of cases)
Medullary carcinomas (5% of cases)
Anaplastic carcinomas(<5%) of cases)
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Most thyroid carcinomas (except medullary carcinomas) are derived from the thyroid follicular epithelium and are well differentiated lesions.
Medullary carcinomas are derived from parafollicular cells or “ C” cells.
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Papillary carcinoma Commonest form of thyroid carcinoma
Can occur at any age but more often seen in 25 to 50 yrs of age
Commonest form associated with radiation exposure
Metastasis via lymphatics
Excellent prognosis with 10yr survival rate in 95% patients
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Morphology
Solitary or multifocal lesions
It can be soft, cystic, hard, firm.
Well circumscribed & encapsulated.
Cut surface reveals papillae
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Histology
The nuclei appear optically clear, giving rise to “ ground glass appearance”
It shows cystic spaces , papillary projections with psammoma bodies
Malignant cells shows invaginations of cytoplasm in nuclei “ Orphan annie eye” (pseudo-inclusions)
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Orphan annie eyes
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Follicular carcinoma Common in women (3:1) & present at
older age than papillary carcinoma.
Peak incidence in 40 t0 60 yrs of age.
More incidence in areas with dietary iodine deficiency
Metastasise through blood to lungs , bone &liver. Prognosis is poorer than papillary Ca.
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Morphology Histology Single nodules,
may be well circumscribed or infiltrative
Gray to tan on cut section and translucent due to colloid filled follicles
Uniform cells form small follicles containing colloid.
Sometimes differentiation is less. Nests and sheets of cells & no colloid.
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Hurthle cell carcinoma
Is a varient of follicular carcinoma of thyroid which contains abundant oxyphill cells
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Medullary carcinoma
Neuroendocrine neoplasm derived from parafollicular cells ,”C” cells.
Secrete calcitonin –helpful in diagnosis & follow-up.
They are aggressive and metastasise more frequently.
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Morphology Histology
Solitary nodules Large lesions contain
areas of hemorrhage and necrosis
Tumor tissue is firm, pale, gray to tan and infiltrative.
Composed of polygonal to spindle shaped cells, which form nests , trabaculae and even follicles.
Acellular amyloid deposits are present.
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Anaplastic(undifferentiated) Ca One of the most aggressive malignancies
Found in elderly , rare , less than <5%
Metastasis is common, through lymphatics &blood
Death is usually from rapid from aggressive local growth
Mortality is 100%
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Morphology
Large solid tumour with necrosis & hemorrhage that invades surrounding structures
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Histology
Composed of highly anaplastic cells , includes
Pleomorphic giant cells Spindle cells Mixed spindle and giant cells
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Points to be noted..
Solitary nodules are more likely to be neoplastic than multiple nodules.
Nodules in younger patients are more likely to be neoplastic than those in elder.
Nodules in males are more likely to be neoplastic than are those in females.
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