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==Genetics==
==Genetics==
* Genetic alteration associated with papillary thyroid cancer include:<ref name="LloydBuehler2011">{{cite journal|last1=Lloyd|first1=Ricardo V.|last2=Buehler|first2=Darya|last3=Khanafshar|first3=Elham|title=Papillary Thyroid Carcinoma Variants|journal=Head and Neck Pathology|volume=5|issue=1|year=2011|pages=51–56|issn=1936-055X|doi=10.1007/s12105-010-0236-9}}</ref>
* Genetic alteration associated with papillary thyroid cancer include:<ref name="LloydBuehler2011">{{cite journal|last1=Lloyd|first1=Ricardo V.|last2=Buehler|first2=Darya|last3=Khanafshar|first3=Elham|title=Papillary Thyroid Carcinoma Variants|journal=Head and Neck Pathology|volume=5|issue=1|year=2011|pages=51–56|issn=1936-055X|doi=10.1007/s12105-010-0236-9}}</ref>
** [[Mutations]] in [[RET proto-oncogene]]
**[[Mutations]] in [[RET proto-oncogene]]
** [[Mutations]] in the BRAF oncogene
** [[Mutations]] in the BRAF oncogene
** [[RAS]] mutations
** [[RAS]] mutations
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==Associated Conditions==
==Associated Conditions==
* Papillary thyroid cancer may be associated with:<ref name="LloydBuehler2011">{{cite journal|last1=Lloyd|first1=Ricardo V.|last2=Buehler|first2=Darya|last3=Khanafshar|first3=Elham|title=Papillary Thyroid Carcinoma Variants|journal=Head and Neck Pathology|volume=5|issue=1|year=2011|pages=51–56|issn=1936-055X|doi=10.1007/s12105-010-0236-9}}</ref><ref name="HallAbdollahian2013">{{cite journal|last1=Hall|first1=Joseph E.|last2=Abdollahian|first2=Davood J.|last3=Sinard|first3=Robert J.|last4=Eisele|first4=David W.|title=Thyroid disease associated with cowden syndrome: A meta-analysis|journal=Head & Neck|volume=35|issue=8|year=2013|pages=1189–1194|issn=10433074|doi=10.1002/hed.22971}}</ref>
* Papillary thyroid cancer may be associated with:<ref name="LloydBuehler2011">{{cite journal|last1=Lloyd|first1=Ricardo V.|last2=Buehler|first2=Darya|last3=Khanafshar|first3=Elham|title=Papillary Thyroid Carcinoma Variants|journal=Head and Neck Pathology|volume=5|issue=1|year=2011|pages=51–56|issn=1936-055X|doi=10.1007/s12105-010-0236-9}}</ref><ref name="HallAbdollahian2013">{{cite journal|last1=Hall|first1=Joseph E.|last2=Abdollahian|first2=Davood J.|last3=Sinard|first3=Robert J.|last4=Eisele|first4=David W.|title=Thyroid disease associated with cowden syndrome: A meta-analysis|journal=Head & Neck|volume=35|issue=8|year=2013|pages=1189–1194|issn=10433074|doi=10.1002/hed.22971}}</ref>
** [[Gardner syndrome]] (especially seen with cribriform-Morular Variant of PTC)
**[[Gardner syndrome]] (especially seen with cribriform-Morular Variant of PTC)
** [[Cowden syndrome]]
** [[Cowden syndrome]]
==Gross Pathology==
==Gross Pathology==
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* Micrograph of psammoma body in papillary thyroid cancer
* Micrograph of [[psammoma body]] in papillary thyroid cancer
* A single necrotic tumor cell in the center of this structure acts as the nidus for its formation  
* A single [[necrotic]] [[tumor cell]] in the center of this structure acts as the nidus for its formation
|[[File:WBR0863.jpg|thumb|none|250px| H&E stain. Contributed in wikimedia.commons]]
|[[File:WBR0863.jpg|thumb|none|250px| H&E stain. Contributed in wikimedia.commons]]
|}
|}
==Immunohistochemistry==
==Immunohistochemistry==
* Papillary thyroid cancer may be positive for following markers:<ref name="Lloyd2010">{{cite journal|last1=Lloyd|first1=Ricardo V.|year=2010|doi=10.1007/978-1-4419-1069-1}}</ref>
* Papillary thyroid cancer may be positive for following markers:<ref name="Lloyd2010">{{cite journal|last1=Lloyd|first1=Ricardo V.|year=2010|doi=10.1007/978-1-4419-1069-1}}</ref>
** TTF-1
**[[TTF-1]]
** Thyroglobulin
**[[Thyroglobulin]]
** Thyroid peroxidase
**[[Thyroid peroxidase]]
** CD56 (NCAM)
**[[CD56]] (NCAM)
** PAX8
**[[PAX8]]
** HBME-1
** HBME-1
** CITED1
**[[CITED1]]
** Cytokeratin 19
**[[Cytokeratin]] 19
** Galectin 3
**[[Galectin-3|Galectin 3]]
* These markers are helpful in the confirmation of thyroid origin of the tumor particularly when the tumor is outside of the thyroid gland.  
* These markers are helpful in the confirmation of [[thyroid]] origin of the [[tumor]] particularly when the [[tumor]] is outside of the [[thyroid gland]].
==Histopathological Video==
==Histopathological Video==
===Video===
===Video===

Revision as of 18:59, 12 August 2019

Papillary thyroid cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Papillary thyroid cancer from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

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Risk calculators and risk factors for Papillary 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

Pathogenesis

  • Papillary thyroid tumors are most commonly unencapsulated, and they have a high tendency to metastasize locally to lymph nodes, which may produce cystic structures near the thyroid that are difficult to diagnose because of the paucity of malignant tissue.[1][2]
  • Although papillary carcinoma has a propensity to invade lymphatics, it is less likely to invade blood vessels.[3]
  • Furthermore, papillary tumors may metastasize to the lungs and produce a few nodules or the lung fields may exhibit a snowflake appearance throughout.
  • Lateral aberrant thyroid is actually a lymph node metastasis from papillary thyroid carcinoma.[4]
  • Other characteristics of the papillary carcinoma is that E.M. shows increased mitochondria, increased RER, as well as increased apical microvilli. Moreover, papillary carcinomas have an indolent growth, and 40 percent of cases spread out of the capsule.[5]

Genetics

Associated Conditions

Gross Pathology

  • On gross pathology, an ill-defined tumor, irregular borders, and firm consistency are characteristic findings of papillary thyroid cancer.[8]
  • Clacification may also be present.
  • Other less common features include:
    • Cystic nodule with attached papillary growth
    • A well-circumscribed, encapsulated nodule with a fleshy appearance that may show some cystic change
Papillary thyroid cancer gross pathology[9]

Microscopic Pathology

  • Papillary thyroid carcinoma has numerous histological subtypes. Each subtype has some specific characteristics.[8][6]
  • However, there is no unique consensus on the definition of each subtype, so different pathologists may not agree with these definitions.
  • Cytologic features of papillary thyroid cancer are diagnostic for this tumor. These features include:
    • enlarged, irregular, oval shape nuclei that are overlapped because of the nuclear enlargement
    • Nuclear clearing
    • Ground glass appearance with prominent nuclear grooves
    • Pink cytoplasmic invaginations
Papillary thyroid cancer subtype Features on Histopathological Microscopic Analysis
Follicular
Conventional
Tall cell
Columnar cell
  • Pseudostratified cells
  • Overlapping enlarged nuclei
Oncocytic
Solid
Diffuse sclerosing
Papillary thyroid carcinoma with prominent hobnail features
Clear cell
Cribriform-Morular
Macrofollicular
  • Composed of macrofollicles
  • Cytological features of papillary thyroid cancer
Papillary thyroid cancer Image
  • Micrograph of papillary thyroid carcinoma, tall cell variant - high magnification
  • "Tall cells": the largest dimension is 3x the smaller dimension
  • Abundant eosinophilic cytoplasm
  • Lack of pseudostratification is a significant differentiator from columnar cell variant of papillary thyroid carcinoma
H&E stain. Contributed in wikimedia.commons
  • Micrograph showing oncocytic variant of papillary thyroid carcinoma
  • Large cells with abundant eosinophilic cytoplasm
H&E stain, Contributed in wikimedia.commons
  • Micrograph showing cribriform-Morular variant of papillary thyroid carcinoma
  • Cribriform pattern with solid and spindle cell areas
  • Squamous morules
H&E stain, Contributed in wikimedia.commons
  • Micrograph (high power view) showing nuclear changes in papillary thyroid carcinoma (PTC), which include:
    • Groove formation
    • Optical clearing
    • Eosinophilic inclusions and overlapping of nuclei
H&E stain. Contributed in wikimedia.commons
  • Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei
H&E stain. Contributed in wikimedia.commons
  • Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores
H&E stain. Contributed in wikimedia.commons
H&E stain. Contributed in wikimedia.commons
H&E stain. Contributed in wikimedia.commons

Immunohistochemistry

Histopathological Video

Video

{{#ev:youtube|JwymE_Lfs44}}

References

  1. ↑ Grani, G; Fumarola, A (Jun 2014). "Thyroglobulin in Lymph Node Fine-Needle Aspiration Washout: A Systematic Review and Meta-analysis of Diagnostic Accuracy". The Journal of Clinical Endocrinology and Metabolism. 99 (6): 1970–82. doi:10.1210/jc.2014-1098. PMID 24617715.
  2. ↑ "The Thyroid and its Diseases". Retrieved 2010-07-15.
  3. ↑ "Thyroid, Papillary Carcinoma". Retrieved 2010-07-15.
  4. ↑ Escofet X, Khan AZ, Mazarani W, Woods WG (2007). "Lessons to be learned: a case study approach. Lateral aberrant thyroid tissue: is it always malignant?". J R Soc Health. 127 (1): 45–6. doi:10.1177/1466424007073207. PMID 17319317.
  5. ↑ "Papillary Carcinomas". Retrieved 2010-07-15. [dead link]
  6. ↑ 6.0 6.1 6.2 Lloyd, Ricardo V.; Buehler, Darya; Khanafshar, Elham (2011). "Papillary Thyroid Carcinoma Variants". Head and Neck Pathology. 5 (1): 51–56. doi:10.1007/s12105-010-0236-9. ISSN 1936-055X.
  7. ↑ Hall, Joseph E.; Abdollahian, Davood J.; Sinard, Robert J.; Eisele, David W. (2013). "Thyroid disease associated with cowden syndrome: A meta-analysis". Head & Neck. 35 (8): 1189–1194. doi:10.1002/hed.22971. ISSN 1043-3074.
  8. ↑ 8.0 8.1 8.2 Lloyd, Ricardo V. (2010). doi:10.1007/978-1-4419-1069-1. Missing or empty |title= (help)
  9. ↑ Image courtesy of Dr David Cuete. Radiopaedia (original file ‘’here’’.Creative Commons BY-SA-NC
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