Let’s take a look at all the different times
in which you want to worry about thyroid cancer
in your patient.
First, take a look at adenomas, then we actually
will take a look at the carcinomas and when,
as I told you, it becomes relevant.
Let’s take a look at the risk factors of
Incidence of 3 per 100,000 per year.
Ionizing radiation, genetic factors are pretty
big, big risk factors for thyroid cancer.
A picture here, do not be afraid.
We have dealt with this or we have dealt with
parts of this that are quite important to
you in neoplasia.
However, in thyroid cancer, let us focus upon
the RET that you see here in your box.
The RET proto-oncogene is specific for a type
of thyroid cancer that you want to know of
and that is going to be medullar cancer of
the thyroid which is then seen as being part
of a component of MEN 2A and 2B; not the most
common thyroid cancer, is it?
Encodes for receptor tyrosine kinase, the
things that you’ve seen before.
Just to make sure that we put things into
perspective is the left branch here.
You’ve dealt with RAAS before.
And with RAAS, at some point in time, you’ll
be focusing about… will be focusing upon
follicular cancer of the thyroid.
Follicular cancer of the thyroid, not follicular
lymphoma; that’s translocation.
14,18 bcl-2 has nothing to do with follicular
cancer of the thyroid.
So, I need you to be familiar with what I’m
referring to here…
Now, with RAAS, we already know about RAAS,
so is it with GTP, so is it with RAF and MEK
Then you get on into tumour suppressor genes
including P15 and especially P16.
In this wonderful picture that you should
not be afraid for, in fact, you’re welcoming
this into your heart, ha!
We have our papillary cancer of the thyroid
that’s the most common and that’s BRAF,
BRAF is a big one for us…
BRAF associated with melanoma, you know about
the drug called vemurafenib.
Put things into perspective looking at three
different types of thyroid cancers with genetic
Worrisome factors for thyroid cancer: solitary
nodules, nodules in younger patients, nodules
in males, radiation exposure and those nodules
are cold; risk factors and when you would
be worried about your patient possibly coming
back positive for thyroid cancer.
Remember papillary, medullary, follicular
type of thyroid cancers, but all be cold nodules.
So, cold nodule just means malignancy, but
it doesn’t tell you what type.
Keep that in mind.
Thyroid cancer here further we’ll take you
through a really nice map here.
Our focus and we’ve dealt with this plenty
of time, we have seen this repeatedly and
every time I show it to you, hopefully you
have a better understanding of what’s going
on with the entire integration of molecular
pathology, which is the future of medicine,
isn’t it really?
So, once again, RET thyroid, MEN 2a and 2b
is all that I wish for you to focus upon here
and the rest of these is your RAAS, BRAF,
MEK, mitogen activated protein… all of these
also responsible for communicating with the
nucleus so that you increase your transcription,
increase cell cycle within the nucleus so
that the cell is eternal and never dies.
Welcome to neoplasia and specifically here
dealing with thyroid cancer.
What’s the one with RET?
Medullary cancer of thyroid.
What’s the one with papillary cancer of
What’s the one with follicular?
Good, the one with follicular that we saw
Thyroid cancer: 3 per 100,000…
I wish to say that over and over again…
ionizing radiation, the RET with medullary.
Do not forget about how it’s responsible
for encoding for RTK which stands for receptor
Our topic now brings us to thyroid adenomas.
Adenomas… discrete, solitary masses.
Take a look at the picture that we see on
the right and that is a well capsulated solitary
mass known as an adenoma.
Variety of histologic patterns, however, the
key feature will be the… well, circumscribed
capsule with no invasion, an adenoma.
Adenoma, benign or malignant?
Benign, benign, benign.
The Gain-of-function type of issue with TSH
receptor or an alpha subunit what’s known
as a Gs.
If I were you, I’d know the gene known as
GNAS… very important, you’ll see that
a couple of times.
Must be differentiated from follicular carcinoma,
Because anginvasive versus lymphoinvasive
and I will harp on that when the time is right.
Present as painless mass, an adenoma is; usually
non-functional, that’s important.
So, therefore, present as hypothyroidism.
Larger masses can produce local obstruction.
Once again, compression of the esophagus or
the trachea resulting in dysphagia or dyspnoea
Let’s now move into carcinomas of the thyroid.
Most commonly in adults by far the most common…
Chernobyl, the atomic explosions in the Far
East and in Japan.
All of that, all those patients decades and
50 years after Chernobyl what we can expect
with atomic explosion exposure is this cancer,
papillary cancer of the thyroid.
We’ll talk about this in great detail.
Make sure you know everything about papillary
that I will tell you.
Follicular is the second most common.
Look at this, the discrepancy between 75 or
85 percent and a far distant second at 10
to 20 percent of your thyroid cancer is follicular.
Medullary, a measly 5 percent, but why do
you need to know it so well?
Because it’s part of MEN 2a and 2b, then
you have a measly less than 5 percent for
anaplastic, thank goodness, because things-things
become a lot more dangerous when it gets into
anaplastic and then you would have lymphoma
of the thyroid.
Oftentimes, you might be thinking about autoimmune
diseases and here, Hashimoto may give rise
to lymphoma type of picture with thyroid.