Follicular thyroid cancer pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
Follicular thyroid cancer arises from follicular cells of thyroid, which are secretory cells that are normally involved in production and secretion of [[thyroid hormones]], [[thyroxine | Follicular thyroid cancer arises from [[Follicular cell|follicular cells]] of [[thyroid]], which are [[Secretion|secretory]] [[Cell (biology)|cells]] that are normally involved in production and [[secretion]] of [[thyroid hormones]], [[thyroxine|thyroxine (T4)]] and [[Triiodothyronine|triiodothyronine (T3)]]. [[Gene|Genes]] involved in the [[pathogenesis]] of follicular thyroid cancer include [[Ras|''RAS'']], ''[[PAX8 gene|PAX8]]/[[Peroxisome proliferator-activated receptor|PPARγ]]'', and [[PTEN|''PTEN'']]. | ||
==Pathogenesis== | ==Pathogenesis== | ||
* Follicular thyroid cancer is the second most common type of [[cancer]]. It | * Follicular thyroid cancer is the second most common type of [[cancer]]. It constitutes about 15% of [[Thyroid cancer|thyroid cancers]]. | ||
[[File:Follicular thyroid carcinoma pathogenesis. | [[File:Follicular thyroid carcinoma pathogenesis 2.0.jpg|thumb|left|700px|Pathogenesis of follicular thyroid carcinoma]] | ||
<br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br> | <br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br> | ||
* | * Follicular thyroid cancer occurs more commonly in women over 50 years of age. | ||
>{{cite web | title = Radiopedia 2015 Follicular thyroid cancer [Dr Matt A. Morgan and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/follicular-thyroid-cancer }}</ref> | * [[Thyroglobulin|Thyroglobulin (Tg)]] can be used as a [[tumor marker]] for well-differentiated follicular thyroid cancer. | ||
* Follicular carcinoma tends to [[Metastasis|metastasize]] to the [[lung]]s and [[bone]] via the [[bloodstream]]. | |||
*Follicular thyroid cancer [[Metastasis|metastasizes]] to [[lymph node|lymph nodes]] late in the course of the [[disease]], with only 5 - 10% of [[Patient|patients]] having [[Lymph node|nodal]] [[metastases]] at the time of [[diagnosis]]. | |||
*Hematogenous spread is however much more common with 20% of the [[Patient|patients]] having distant hematogenous [[Metastasis|metastases]] at at the time of [[diagnosis]].<ref 2015="" name="Radiopaedia" papillary="" thyroid="" cancer="">{{cite web | title = Radiopedia 2015 Follicular thyroid cancer [Dr Matt A. Morgan and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/follicular-thyroid-cancer }}</ref> | |||
* A [[Hurthle cells|Hürthle cell]] (also known as Askanazy [[Cell (biology)|cell]]) is an [[large cell|oncocytic cell]] in the [[thyroid]] that is often associated with [[Hashimoto's thyroiditis]] as well as follicular thyroid cancer.<ref name="Hurthle Cell Carcinoma">{{cite web|url=http://www.emedicine.com/med/topic1045.htm |title=Hurthle Cell Carcinoma |author=Aytug, Serhat |publisher=[[eMedicine]] |date=[[June 13]], 2006}}</ref> | |||
==Genetics== | ==Genetics== | ||
* The [[ras|''Ras'' oncogene]] is positive in a significant proportion of individuals. [[ras|''Ras'' oncogene]] | * The [[ras|''Ras'' oncogene]] is positive in a significant proportion of individuals.<ref name="pmid123644662">{{cite journal |vauthors=Martelli ML, Iuliano R, Le Pera I, Sama' I, Monaco C, Cammarota S, Kroll T, Chiariotti L, Santoro M, Fusco A |title=Inhibitory effects of peroxisome poliferator-activated receptor gamma on thyroid carcinoma cell growth |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=10 |pages=4728–35 |date=October 2002 |pmid=12364466 |doi=10.1210/jc.2001-012054 |url=}}</ref> | ||
* Other [[gene|genes]] involved in the pathogenesis of follicular thyroid cancer are | *The [[ras|''Ras'' oncogene]] acts through the RAF-MEK-MAPK kinase pathway. | ||
* Other [[gene|genes]] involved in the [[pathogenesis]] of follicular thyroid cancer are:<ref name="pmid12866375">{{cite journal |vauthors=Zhu Z, Gandhi M, Nikiforova MN, Fischer AH, Nikiforov YE |title=Molecular profile and clinical-pathologic features of the follicular variant of papillary thyroid carcinoma. An unusually high prevalence of ras mutations |journal=Am. J. Clin. Pathol. |volume=120 |issue=1 |pages=71–7 |date=July 2003 |pmid=12866375 |doi=10.1309/ND8D-9LAJ-TRCT-G6QD |url=}}</ref> | |||
:* '' | :*''[[RET gene|RET]]/[[PTC]]'' ([[translocation]]) associated with [[Mitogen-activated protein kinase|MAPK]] and [[Phosphoinositide 3-kinase|PI3K]]-[[AKT]] signaling pathways. | ||
:* '' | :*[[HRAS|''HRAS'']], [[KRAS|''KRAS'']], [[Neuroblastoma RAS viral oncogene homolog|''NRAS'']] ([[mutation]]) associated with [[mitogen-activated protein kinase]] and [[Phosphoinositide 3-kinase|PI3K]]-[[AKT]] signaling pathways. | ||
:* [[ | :*''[[PAX8 gene|PAX8]]/[[Peroxisome proliferator-activated receptor|PPARγ]]'' ([[translocation]]) associated with [[PAX8|''PAX8'']]-associated [[Cell nucleus|nuclear]] [[Transcription (genetics)|transcription]] signaling pathways. [[PAX8|''PAX8'']] is responsible for the [[Thyroid epithelial cell|follicular cell]] differentiation. | ||
:* | :*[[PTEN|''PTEN'']] ([[mutation]]) associated with [[Phosphoinositide 3-kinase|PI3K]]-[[AKT]] signaling pathways. | ||
:* ''IDH1'' (mutation) assciated with IDH1-associated metabolic pathways signaling pathways | :*[[PTEN|''PTEN'']] ([[Deletion (genetics)|deletion]]) associated with [[Phosphoinositide 3-kinase|PI3K]]-[[AKT]] signaling pathways. | ||
:*''[[IDH1]]'' ([[mutation]]) assciated with [[IDH1]]-associated [[Metabolism|metabolic]] pathways signaling pathways. | |||
*[[Phosphatase]] and tensin homologue suppressor [[gene]] and the [[Phosphoinositide 3-kinase|phosphatidylinositol 3-kinase]] pathway are also involved in the [[pathogenesis]] of follicular thyroid tumor. | |||
* [[P53 (protein)]], [[Myc|''c-myc'']], [[C-Fos|''c-fos'']], and the [[Thyroid-stimulating hormone|thyrotropin (TSH)]] [[Receptor (biochemistry)|receptor]] are some other factors involved in the [[pathogenesis]] of follicular thyroid cancer. | |||
* [[microRNA|MicroRNAs]] namely miR-192, miR-197, miR-328, and miR-346 have increased expression in follicular cell carcinoma. | |||
[[File:Thyroid cancer carcinogensis.jpg|thumb|center|Schema of key pathways in the development and progression of thyroid cancer.]] | [[File:Thyroid cancer carcinogensis.jpg|thumb|center|Schema of key pathways in the development and progression of thyroid cancer.]] | ||
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==Gross Pathology== | ==Gross Pathology== | ||
* Encapsulated tumors | * Encapsulated tumors | ||
[[ | [[File:Folladen.jpg|thumb|left|Gross pathological section of a follicular thyroid carcinoma (tumor at the bottom).]] | ||
<br style="clear:left"> | |||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
* | |||
* On [[Microscopy|microscopic examination]], [[Trabeculae|trabecular]], solid, [[Follicular cell|follicular]] [[Tumor cell|tumor cells]] that [[Invasion|invade]] [[capsule|tumor capsule]] or surrounding [[Vessels|vascular structures]], are found. | |||
<gallery> | <gallery> | ||
Image: | Image:Metastatic follicular thyroid carcinoma - Case 264 (8558730243).jpg|Metastatic follicular thyroid carcinoma<ref>http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg Accessed on October, 29 2015</ref> | ||
Image:Metastatic follicular thyroid carcinoma - Case 264.jpg|Metastatic follicular thyroid carcinoma<ref>http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8559837390).jpg Accessed on October, 29 2015</ref> | |||
Image:Metastatic follicular thyroid carcinoma - Case 264.jpg|Metastatic follicular carcinoma | |||
</gallery> | </gallery> | ||
==Histopathological Video== | |||
===Video=== | ===Video=== | ||
{{#ev:youtube|3_eCHeOkdgg}} | {{#ev:youtube|3_eCHeOkdgg}} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
[[Category:Hereditary cancers]] | [[Category:Hereditary cancers]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 17:48, 29 October 2019
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Follicular thyroid cancer Microchapters |
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Differentiating Follicular thyroid cancer from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Follicular thyroid cancer pathophysiology On the Web |
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American Roentgen Ray Society Images of Follicular thyroid cancer pathophysiology |
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Risk calculators and risk factors for Follicular thyroid cancer pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Follicular thyroid cancer arises from follicular cells of thyroid, which are secretory cells that are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3). Genes involved in the pathogenesis of follicular thyroid cancer include RAS, PAX8/PPARγ, and PTEN.
Pathogenesis
- Follicular thyroid cancer is the second most common type of cancer. It constitutes about 15% of thyroid cancers.
- Follicular thyroid cancer occurs more commonly in women over 50 years of age.
- Thyroglobulin (Tg) can be used as a tumor marker for well-differentiated follicular thyroid cancer.
- Follicular carcinoma tends to metastasize to the lungs and bone via the bloodstream.
- Follicular thyroid cancer metastasizes to lymph nodes late in the course of the disease, with only 5 - 10% of patients having nodal metastases at the time of diagnosis.
- Hematogenous spread is however much more common with 20% of the patients having distant hematogenous metastases at at the time of diagnosis.
- A Hürthle cell (also known as Askanazy cell) is an oncocytic cell in the thyroid that is often associated with Hashimoto's thyroiditis as well as follicular thyroid cancer.[1]
Genetics
- The Ras oncogene is positive in a significant proportion of individuals.[2]
- The Ras oncogene acts through the RAF-MEK-MAPK kinase pathway.
- Other genes involved in the pathogenesis of follicular thyroid cancer are:[3]
- PAX8/PPARγ (translocation) associated with PAX8-associated nuclear transcription signaling pathways. PAX8 is responsible for the follicular cell differentiation.
- Phosphatase and tensin homologue suppressor gene and the phosphatidylinositol 3-kinase pathway are also involved in the pathogenesis of follicular thyroid tumor.
- P53 (protein), c-myc, c-fos, and the thyrotropin (TSH) receptor are some other factors involved in the pathogenesis of follicular thyroid cancer.
- MicroRNAs namely miR-192, miR-197, miR-328, and miR-346 have increased expression in follicular cell carcinoma.
Associated Conditions
- Cowden disease
- Carney complex, type I
Gross Pathology
- Encapsulated tumors
Microscopic Pathology
- On microscopic examination, trabecular, solid, follicular tumor cells that invade tumor capsule or surrounding vascular structures, are found.
![Metastatic follicular thyroid carcinoma[4]](/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg)
![Metastatic follicular thyroid carcinoma[5]](/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264.jpg)
Histopathological Video
Video
{{#ev:youtube|3_eCHeOkdgg}}
References
- ↑ Aytug, Serhat (June 13, 2006). "Hurthle Cell Carcinoma". eMedicine. Check date values in:
|date=(help) - ↑ Martelli ML, Iuliano R, Le Pera I, Sama' I, Monaco C, Cammarota S, Kroll T, Chiariotti L, Santoro M, Fusco A (October 2002). "Inhibitory effects of peroxisome poliferator-activated receptor gamma on thyroid carcinoma cell growth". J. Clin. Endocrinol. Metab. 87 (10): 4728–35. doi:10.1210/jc.2001-012054. PMID 12364466.
- ↑ Zhu Z, Gandhi M, Nikiforova MN, Fischer AH, Nikiforov YE (July 2003). "Molecular profile and clinical-pathologic features of the follicular variant of papillary thyroid carcinoma. An unusually high prevalence of ras mutations". Am. J. Clin. Pathol. 120 (1): 71–7. doi:10.1309/ND8D-9LAJ-TRCT-G6QD. PMID 12866375.
- ↑ http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg Accessed on October, 29 2015
- ↑ http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8559837390).jpg Accessed on October, 29 2015
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