Papillary thyroid cancer pathophysiology: Difference between revisions
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==Pathogenesis== | ==Pathogenesis== | ||
*Lymphatic spread is more common than [[hematogenous]] spread | |||
*Multifocality is common | |||
*The so-called [[Lateral Aberrant Thyroid]] is actually a lymph node metastasis from papillary thyroid carcinoma.<ref name="pmid17319317">{{cite journal |author=Escofet X, Khan AZ, Mazarani W, Woods WG |title=Lessons to be learned: a case study approach. Lateral aberrant thyroid tissue: is it always malignant? |journal=J R Soc Health |volume=127 |issue=1 |pages=45–6 |year=2007 |pmid=17319317 |doi=10.1177/1466424007073207}}</ref> | |||
*Papillary microcarcinoma is a subset of papillary thyroid cancer defined as measuring less than or equal to 1 cm.<ref name="pmid17308849">{{cite journal |author=Shaha AR |title=TNM classification of thyroid carcinoma |journal=World J Surg |volume=31 |issue=5 |pages=879–87 |year=2007 |pmid=17308849 |doi=10.1007/s00268-006-0864-0}}</ref> The highest incidence of papillary thyroid microcarcinoma in an autopsy series was reported by Harach et al. in 1985, who found 36 of 101 consecutive autopsies to have an incidental microcarcinoma.<ref name="pmid2408737">{{cite journal |author=Harach HR, Franssila KO, Wasenius VM |title=Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study |journal=Cancer |volume=56 |issue=3 |pages=531–8 |year=1985 |pmid=2408737 |doi=10.1002/1097-0142(19850801)56:3<531::AID-CNCR2820560321>3.0.CO;2-3}}</ref> Michael Pakdaman et al. report the highest incidence in a retrospective surgical series at 49.9 percent of 860 cases.<ref name="pmid18984270">{{cite journal |author=Pakdaman MN, Rochon L, Gologan O, Tamilia M, Garfield N, Hier MP, Black MJ, Payne RJ |title=Incidence and histopathological behavior of papillary microcarcinomas: Study of 429 cases |journal=Otolaryngol Head Neck Surg |volume=139 |issue=5 |pages=718–22 |year=2008 |pmid=18984270 |doi=10.1016/j.otohns.2008.08.014}}</ref> Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having cancer. It was Woolner et al. who first arbitrarily coined the term "occult papillary carcinoma" in 1960, to describe papillary carcinomas ≤ 1.5 cm in diameter.<ref>{{cite journal | pmid = 13845950 | volume=20 | title=Occult papillary carcinoma of the thyroid gland: a study of 140 cases observed in a 30-year period |date=January 1960 | author=Woolner LB, Lemmon ML, Beahrs OH, Black BM, Keating FR | journal=J. Clin. Endocrinol. Metab. | pages=89–105 | doi = 10.1210/jcem-20-1-89 }}</ref> | |||
Although papillary carcinoma has a propensity to invade [[lymphatics]], it is less likely to invade [[blood vessels]].<ref>{{cite web|url=http://emedicine.medscape.com/article/282276-overview| title=Thyroid, Papillary Carcinoma|date=|accessdate= 2010-07-15}}</ref> | |||
These kinds of 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.<ref>{{cite journal|last1=Grani|first1=G|last2=Fumarola|first2=A|title=Thyroglobulin in Lymph Node Fine-Needle Aspiration Washout: A Systematic Review and Meta-analysis of Diagnostic Accuracy.|journal=The Journal of Clinical Endocrinology and Metabolism|date=Jun 2014|volume=99|issue=6|pages=1970–82|pmid=24617715|doi=10.1210/jc.2014-1098}}</ref><ref name="The Thyroid and its Diseases">{{cite web|url=http://www.thyroidmanager.org/Chapter18/18-cause.htm| title=The Thyroid and its Diseases|date=|accessdate= 2010-07-15}}</ref> Furthermore, papillary tumors may metastasize to the [[lungs]] and produce a few nodules or the lung fields may exhibit a [[snowflake]] appearance throughout. | |||
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.<ref>{{cite web|url=http://www.pathology.vcu.edu/education/endocrine/endocrine/newthyroid/| title=Papillary Carcinomas|date=|accessdate= 2010-07-15}} {{Dead link|date=October 2010|bot=H3llBot}}</ref> | |||
==Genetics== | ==Genetics== | ||
Revision as of 13:30, 3 November 2015
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Papillary thyroid cancer Microchapters |
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Differentiating Papillary 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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Papillary thyroid cancer pathophysiology On the Web |
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American Roentgen Ray Society Images of Papillary thyroid cancer pathophysiology |
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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
- Lymphatic spread is more common than hematogenous spread
- Multifocality is common
- The so-called Lateral Aberrant Thyroid is actually a lymph node metastasis from papillary thyroid carcinoma.[1]
- Papillary microcarcinoma is a subset of papillary thyroid cancer defined as measuring less than or equal to 1 cm.[2] The highest incidence of papillary thyroid microcarcinoma in an autopsy series was reported by Harach et al. in 1985, who found 36 of 101 consecutive autopsies to have an incidental microcarcinoma.[3] Michael Pakdaman et al. report the highest incidence in a retrospective surgical series at 49.9 percent of 860 cases.[4] Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having cancer. It was Woolner et al. who first arbitrarily coined the term "occult papillary carcinoma" in 1960, to describe papillary carcinomas ≤ 1.5 cm in diameter.[5]
Although papillary carcinoma has a propensity to invade lymphatics, it is less likely to invade blood vessels.[6] These kinds of 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.[7][8] Furthermore, papillary tumors may metastasize to the lungs and produce a few nodules or the lung fields may exhibit a snowflake appearance throughout.
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.[9]
Genetics
Associated Conditions
Gross Pathology
Microscopic Pathology
- Characteristic Orphan Annie eye nuclear inclusions (nuclei with uniform staining, which appear empty)[10] and psammoma bodies on light microscopy. The former is useful in identifying the follicular variant of papillary thyroid carcinomas.[11]
References
- ↑ 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.
- ↑ Shaha AR (2007). "TNM classification of thyroid carcinoma". World J Surg. 31 (5): 879–87. doi:10.1007/s00268-006-0864-0. PMID 17308849.
- ↑ Harach HR, Franssila KO, Wasenius VM (1985). "Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study". Cancer. 56 (3): 531–8. doi:10.1002/1097-0142(19850801)56:3<531::AID-CNCR2820560321>3.0.CO;2-3. PMID 2408737.
- ↑ Pakdaman MN, Rochon L, Gologan O, Tamilia M, Garfield N, Hier MP, Black MJ, Payne RJ (2008). "Incidence and histopathological behavior of papillary microcarcinomas: Study of 429 cases". Otolaryngol Head Neck Surg. 139 (5): 718–22. doi:10.1016/j.otohns.2008.08.014. PMID 18984270.
- ↑ Woolner LB, Lemmon ML, Beahrs OH, Black BM, Keating FR (January 1960). "Occult papillary carcinoma of the thyroid gland: a study of 140 cases observed in a 30-year period". J. Clin. Endocrinol. Metab. 20: 89–105. doi:10.1210/jcem-20-1-89. PMID 13845950.
- ↑ "Thyroid, Papillary Carcinoma". Retrieved 2010-07-15.
- ↑ 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.
- ↑ "The Thyroid and its Diseases". Retrieved 2010-07-15.
- ↑ "Papillary Carcinomas". Retrieved 2010-07-15. [dead link]
- ↑ "Papillary Carcinoma of Thyroid (Hi Pow)". University of Connecticut Health Center. Retrieved 2008-09-14.
- ↑ Yang GC, Liebeskind D, Messina AV (2001). "Ultrasound-guided fine-needle aspiration of the thyroid assessed by Ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to six-year follow-up". Thyroid. 11 (6): 581–89. doi:10.1089/105072501750302895. PMID 11442006.