Follicular thyroid cancer pathophysiology

Follicular thyroid cancer Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Pathogenesis

Gross pathological section of a follicular thyroid carcinoma (tumor at the bottom).

• This occurs more commonly in women of over 50 years old. 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, while papillary thyroid carcinoma commonly metastasizes to cervical lymph nodes.Unlike papillary it metastasises late to lymph nodes, with only 5-10% of patients having nodal metastases at the time of diagnosis. Haematogenous spread is however much more common with 20% or so of patients having distant haematogenous metastases at presentation.

Genetics

• The Ras oncogene is positive in a significant proportion of individuals
• Other genes involved in the pathogenesis of follicular thyroid cancer are as follows.

• RET/PTC (translocation) associated with MAPK and PI3K-AKT signaling pathways

• HRAS, KRAS, NRAS (mutation) associated with MAPK and PI3K-AKT signaling pathways

• PAX8/PPARγ (translocation) associated with PAX8-associated nuclear transcription signaling pathways

• PTEN (mutation) associated with PI3K-AKT signaling pathways

• PTEN (deletion) associated with PI3K-AKT signaling pathways

• IDH1 (mutation) assciated with IDH1-associated metabolic pathways signaling pathways

Associated Conditions

• Cowden disease
• Carney complex, type I

Microscopic Pathology

• It is not possible to distinguish between follicular adenoma and carcinoma on cytological grounds. If fine needle aspiration cytology (FNAC) suggests follicular neoplasm, thyroid lobectomy should be performed to establish the histopathological diagnosis.
• Trabecular, solid, follicular tumor cells that invade tumor capsule or surrounding vascular structures.