Thyroid cancer types.
Differentiated, papillary, female preponderance
peaking between 30 to 50; you should know
everything that I will be referring to here
with papillary, differentiated.
Lymphatic spread versus angioinvasive, this
is lymphoinvasive, usually excellent prognosis,
thank goodness, because it is common.
High incidence in patients with a Gardner’s
syndrome, which is familial adenomatous polyposis;
young patient with hundreds and thousands
Along with this, also has sebaceous cysts,
skin issues, dull bone pain, osteoma and a
desmoid tumor, meaning to say your fibroma,
Follicular, second most common, female preponderance,
slow growth, painless nodules, cold nodules,
both would be any type of cancer, this is…
invades the capsule in vascular system.
Let’s stop here for a second.
An adenoma was angioinvasive more so than
Papillary cancer, on your left, lymphoinvasive,
follicular angioinvasive, but follicular,
it will go beyond the capsule whereas adenoma,
by definition, well encapsulated.
Are we clear?
If not, review that point.
Angioinvasive, hematogenous; once again, excellent
Medullary, 10 percent, arises from parafollicular
C cells which produces calcitonin and if there
is any discussion of amyloid, it will be the
Do not forget that.
20 percent with MEN IIA or IIB, it will be
associated with both.
We will talk about this in greater detail
when we talk about IIA and IIB; both of them
will have pheochromocytoma, both of them will
have medullary cancer with thyroid, RET, RET,
RET, proto-oncogene; good prognosis.
I will quickly mention anaplastic, less than
5 percent, poor prognosis, as you can expect
with anaplastic; often prior history of goiter
or perhaps even papillary thyroid cancer.
And the final type that you do want to keep
in mind would be lymphoma, less than 5 percent
of thyroid cancers, seen associated with,
this is important, Hashimoto, autoimmune disease,
lymphocytic infiltration of the thyroid gland;
it may, it may then go on to as a sequelae
Usually good prognosis.
Let’s talk about papillary cancer in greater
Now, what I wish to show you here is the following.
We have papillary carcinoma and we have the
lumen, we have the fibrovascular core, the
fluid in the epithelium.
We will take a cross section… we take a
cross section of it, then we call this a papillary
So, this is the nodule that we are seeing
in which we are now taking an amplified version
of it or amplified image of it and in the
cartoon, you should be able to see a papilla.
Now, the arrow represents calcification, calcification
or histology of what appears to being dark,
welcome to psammoma bodies.
Take a look at the spelling of psammoma, P-S-A…
the name of the cancer here is P-A-; P if
that helps you, the P is silent obviously
in psammoma, or both letters begin with the
letter P. Histologically, extremely important,
psammoma bodies, once again, are non specific
Psammoma bodies could be found with various
cancers including meningiomas, including your
serious cyst adenocarcinomas in the ovaries,
Cross section is what we are doing here of
a papillary cancer.
Follicular cancer, second most common form
of thyroid cancer.
Clinical features: slow enlarging painless
nodules, we talked about, it is extremely
angioinvasive, it is going to invade the capsule.
Here, if we take a look at the picture, we
do not find papilla, we do not find psammoma
bodies like we did in papillary cancer of
the thyroid, you will find that the follicular
epithelial cells of your thyroid gland are
The colloid that you see in the middle there,
see that homogenously eosinophilic structure?
It becomes less abundant because the follicular
epithelial cells are now becoming excessive;
invades the capsule and vascular system hematogenous
Treated with lobectomy, subtotal thyroidectomy,
you need to remove it.
What kind of nodule?
Medullary cancer, this is a neuroendocrine,
C cells, parafollicular C cells, calcitonin.
Hypercalcemia controversial, I have put it
there, but calcitonin is important.
Sheets of nests of tumor cells in an amyloid
Okay, so, medullary, why did I say this so
Because amyloid is an important topic for
us in pathology.
Amyloid, to you, a number of places multiple
myeloma, different types of amyloid, diabetes
type II called amylin.
We have amyloid that is seen with amyloid
percussive protein, beta amyloid sheets with
It is important that you are able to establish
and identity amyloid in very common pathologies,
Here, we have medullary and the reason that
this becomes important is because of MEN IIA
and IIB, sheets of massive tumor cells and
amyloid stroma, Congo red stain.
RET-proto-oncogene, peak incidence a little
bit later 40 to 50.
Clinical features: paraneoplastic syndrome,
diarrhea due to secretion of VIP.
Neuroendocrine type of cells and could be
responsible for producing all kinds of interesting
peptides and hormones.
The big one here though calcitonin, neuroendocrine,
Anaplastic, completely undifferentiated, huh!
Whereas if it is papillary cancer thyroid,
it is well differentiated.
Undifferentiated; very aggressive; mortality,
look at this, 100 percent; 65 years of age;
pathogenesis maybe due to inactivation of
p53, tumor suppressor gene.
Clinical features: rapidly enlarging versus
slowly enlarging with follicular, dyspnea,
dysphagia because of the amount of enlargements
taking place, guaranteed that your patient
here with anaplastic.
Take a look at this picture here, completely
undifferentiated, can’t really make out
anything and causing then compression of the
esophagus and trachea, a common theme that
we have seen over and over again with thyroid.
Thyroid cancer, primary therapy of papillary,
follicular, medullary, surgery.
Lymphoma, radiotherapy, chemotherapy, anaplastic,
no doubt surgery.
If you can get there soon enough to remove
it, but there is every possibility that your
patient is not even going to make it.
Radioiodine is used as an adjunct in differentiated
thyroid cancer such as papillary, follicular,
keep those together as being a differentiated
type of thyroid cancer whereas anaplastic
would be undifferentiated.
Serum markers include the following.
Thyroglobulin becomes very important to you
when we have-we have emphasized these clinical
significance of thyroglobulin over and over
Calcitonin and CEA for medullary thyroid cancer
cause… embryonic antigen.
Prognosis in differentiated pretty good, better
with age less than 50, small or less invasive
primary tumor and absence of distant metastases;
obviously, all of that would contribute to
a favorable prognosis.
Remember, differentiated will be thyroid with
those… thyroid cancer would be follicular
or papillary, undifferentiated, anaplastic,
just be able to do that properly with organization.