Papillary thyroid cancer differential diagnosis: Difference between revisions

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Revision as of 23:51, 1 August 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2] Sahar Memar Montazerin, M.D.[3]

Overview

Papillary thyroid cancer must be differentiated from other diseases that cause neck mass, such as branchial cleft cyst, thyroglossal duct cyst, cystic metastasis, and multiple neurofibromas.

Differentiating Papillary thyroid cancer from other Diseases

Other thyroid neoplasms should be considered in the absence of cavitary cervical lymph nodes.^[1]
The differential of a cystic neck mass(es) includes:

Thyroglossal duct cyst (only if single)
Branchial cleft cyst (only if single)
Cystic metastasis
Abscess including tuberculous lymphadenitis
Multiple neurofibromas

Papillary thyroid cancer must be differentiated from other thyroid cancers as well as other disorders such as:


Disease name	Age of onset	Gender preponderance	Signs/Symptoms	Imaging Feature(s)	Macroscopic feature(s)	Microscopic feature(s)	Laboratory Feature(s)	Other Feature(s)	Microscopic appearance
Papillary Thyroid Cancer^[2]^[3]^[4]	More common in middle aged (30-50 years of age)	More commonly affects women	Asymptomatic thyroid mass or nodule Compressive symptoms such as: Difficulty swallowing/breathing Persistent cough Stridor Vocal chord paralysis Rapid enlarging mass	Ultrasound: solitary mass with an irregular outline, in the subcapsular region and with high vascularity Imaging features are not characteristic for this cancer	Solitary hypoechogenic nodule with lobulated margin which may extend into adjacent tissues Calcification may be present or not	Empty-appearing nuclei with central clearing (Orphan Annie eye) Psammoma bodies	Thyroid function test may be normal Thyroglobulin may be used as a tumor marker	History of radiation in head and neck BRAF and/or RET mutation may be present Most common type of thyroid cancer	Source:Wikimedia commons
Follicular Thyroid Cancer^[3]^[4]^[5]	Peak incidence is 40-60 years of age	More commonly affects women	Asymptomatic thyroid mass or nodule Compressive symptoms such as: Difficulty swallowing/breathing Persistent cough Stridor Vocal chord paralysis Rapid enlarging mass	Ultrasound: solid hypoechoic nodule with a peripheral halo indicating fibrous capsule Irregular margin Imaging features are not characteristic for this cancer	Single encapsulated nodule, Thick and irregular capsule May have cystic or hemorrhage	Invades thyroid capsule and vasculature Uniform follicles	Thyroid function test may be normal Serum thyroglobulin may be used as a tumor marker	RAS mutation may be present PAX8-PPAR-γ translocations	Source:Wikimedia common
Medullary Thyroid Cancer^[6]^[7]^[8]^[4]	Incidence increases with age More common in 3rd to 4th decades of life	Both genders affected equally	Solitary thyroid nodule Mostly affects upper lobe of thyroid gland Possible systemic symptoms due to hormonal secretion by the tumor Cervical lymphadenopathy	Ultrasound: solitary hypoechoic nodule with or without calcification Imaging features are not characteristic for this cancer	Single nonencapsulated mass Gray-tan color	Sheets of cells in an amyloid stroma	Secretes calcitonin Normal thyroid function test Carcinoembryonic antigen (CEA) may be used as a tumor marker Rarely negative for calcitonin	May be part of MEN 2A and 2B syndrome May be associated with RET mutation	Source:Wikimedia common
Anaplastic Thyroid Cancer^[9]^[10]^[11]	More common among older individuals Mean age at diagnosis is 65 years	More commonly affects women	Rapidly enlarging thyroid mass May manifest with compressive symptoms May present with signs/symptoms of metastasis Constitutional symptoms may be present Hard nodular goiter w/out tenderness	Ultrasound: solid hypoechoic nodule with a peripheral halo indicating fibrous capsule Irregular margin Imaging features are not characteristic for this cancer	Solid tumor with areas of necrosis and hemorrhage Infiltrative pattern	Undifferentiated, devastatingly aggressive variant of Papillary/Follicular thyroid cancer	Normal thyroid function test	Poor prognosis May be associated with TP53 mutation	Source:Wikimedia common
Follicular Adenoma^[12]	More commonly affects individuals older than 50 years of age	More commonly affects women	Asymptomatic or symptoms of hyperthyroidism	Solitary nodule which may show echogenicity or not	Solitary, spherical, and encapsulated lesion Well demarcated from the surrounding parenchyma	Uniform follicles Absence of capsular or vascular invasion	Functional adenoma: Elevated T3, T4 Decreased TSH	May be considered functional or hot May be considered non-functional or cold	Source:Wikimedia common
Multinodular Goiter^[13]	Commonly affects individuals older than 60 years of age	More commonly affects women	Thyroid enlargement Signs/symptoms of hypo/hyperthyroidism	Multiple nodules with different echogenicity Calcification may be present	Multiple thyroid nodules	Variable sized follicles Some may show papillary projections without nuclear characteristics of papillary thyroid cancer	Classified as toxic and non-toxic Toxic => hyperthyroidism Non-toxic => Normal thyroid function test	Benign condition	Source:pathology outline, case courtesy of Dr. Swati Satturwar
Thyroid Lymphoma^[14] ^[15]^[16]^[17]	Affects adults or elderly	More common among women	Rapidly enlarging mass/ nodule of thyroid Compression symptoms may be present Constitiutional symptoms may be present in 10% P/E:Firm, hard thyroid Fixed to the nearby structure Immobile even during swallowing Cervical or supraclavicular lymphadenopathy may be present	Ultrasound: hypoechogenic appearance difficult to be distinguished from chronic thyroiditis	Thyroid nodule/mass fixing to adjacent tissue with a firm texture	It is of B cell lineage in the majority of cases Dffuse, large B-cell lymphomas is the most common subtype: diffuse infiltrate of B cells destroying thyroid follicles Marginal zone lymphoma is the second most common type	No specific test Some may have hypothyroidism Some may have antibody against thyroid peroxidase or thyroglobulin	Preexisting chronic autoimmune (Hashimoto's) thyroiditis is a known risk factor for this condition	Source:pathology outline, case courtesy of Dr. Mark R. Wick

Reference

↑ Accessed on November, 4 2015 "Papillary thyroid cancer [Dr Yuranga Weerakkody and Dr Frank Gaillard et al.].Radiopedia 2015" Check |url= value (help).
↑ Fagin, James A.; Mitsiades, Nicholas (2008). "Molecular pathology of thyroid cancer: diagnostic and clinical implications". Best Practice & Research Clinical Endocrinology & Metabolism. 22 (6): 955–969. doi:10.1016/j.beem.2008.09.017. ISSN 1521-690X.
↑ ^3.0 ^3.1 Schlumberger, Martin Jean (1998). "Papillary and Follicular Thyroid Carcinoma". New England Journal of Medicine. 338 (5): 297–306. doi:10.1056/NEJM199801293380506. ISSN 0028-4793.
↑ ^4.0 ^4.1 ^4.2 Sipos JA (December 2009). "Advances in ultrasound for the diagnosis and management of thyroid cancer". Thyroid. 19 (12): 1363–72. doi:10.1089/thy.2009.1608. PMID 20001718.
↑ Pettersson B, Adami HO, Wilander E, Coleman MP (April 1991). "Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type". Int. J. Cancer. 48 (1): 28–33. doi:10.1002/ijc.2910480106. PMID 2019455.
↑ Busnardo B, Girelli ME, Simioni N, Nacamulli D, Busetto E (January 1984). "Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma". Cancer. 53 (2): 278–85. doi:10.1002/1097-0142(19840115)53:2<278::aid-cncr2820530216>3.0.co;2-z. PMID 6690009.
↑ Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH (March 2000). "Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems". Cancer. 88 (5): 1139–48. doi:10.1002/(sici)1097-0142(20000301)88:5<1139::aid-cncr26>3.0.co;2-z. PMID 10699905.
↑ Hofstra, Robert M. W.; Landsvater, Rudy M.; Ceccherini, Isabella; Stulp, Rein P.; Stelwagen, Tineke; Luo, Yin; Pasini, Barbara; Hoppener, Jo W. M.; van Amstel, Hans Kristian Ploos; Romeo, Giovanni; Lips, Cornells J. M.; Buys, Charles H. C. M. (1994). "A mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B and sporadic medullary thyroid carcinoma". Nature. 367 (6461): 375–376. doi:10.1038/367375a0. ISSN 0028-0836.
↑ Nagaiah G, Hossain A, Mooney CJ, Parmentier J, Remick SC (2011). "Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment". J Oncol. 2011: 542358. doi:10.1155/2011/542358. PMC 3136148. PMID 21772843.
↑ Chang TC, Liaw KY, Kuo SH, Chang CC, Chen FW (June 1989). "Anaplastic thyroid carcinoma: review of 24 cases, with emphasis on cytodiagnosis and leukocytosis". Taiwan Yi Xue Hui Za Zhi. 88 (6): 551–6. PMID 2794956.
↑ Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA (July 1990). "Anaplastic carcinoma of the thyroid. A clinicopathologic study of 121 cases". Cancer. 66 (2): 321–30. doi:10.1002/1097-0142(19900715)66:2<321::aid-cncr2820660221>3.0.co;2-a. PMID 1695118.
↑ Mathur, Aarti; Olson, Matthew T.; Zeiger, Martha A. (2014). "Follicular Lesions of the Thyroid". Surgical Clinics of North America. 94 (3): 499–513. doi:10.1016/j.suc.2014.02.005. ISSN 0039-6109.
↑ Bronshteĭn ME, Makarov AD, Artemova AM, Bazarova EN, Kozlov GI (1994). "[Morphology of the thyroid tissue in multinodular euthyroid goiter]". Probl Endokrinol (Mosk) (in Russian). 40 (2): 36–9. PMID 8197088.
↑ Pedersen RK, Pedersen NT (January 1996). "Primary non-Hodgkin's lymphoma of the thyroid gland: a population based study". Histopathology. 28 (1): 25–32. PMID 8838117.
↑ Hyjek E, Isaacson PG (November 1988). "Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis". Hum. Pathol. 19 (11): 1315–26. doi:10.1016/s0046-8177(88)80287-9. PMID 3141260.
↑ Tupchong L, Hughes F, Harmer CL (October 1986). "Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment". Int. J. Radiat. Oncol. Biol. Phys. 12 (10): 1813–21. doi:10.1016/0360-3016(86)90324-x. PMID 3759532.
↑ Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, Kobayashi K, Nakamura Y, Kakudo K, Amino N, Miyauchi A (October 2006). "Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid". Thyroid. 16 (10): 983–7. doi:10.1089/thy.2006.16.983. PMID 17042683.

[Radiopaedia2015-1] Accessed on November, 4 2015 "Papillary thyroid cancer [Dr Yuranga Weerakkody and Dr Frank Gaillard et al.].Radiopedia 2015" Check |url= value (help).

[FaginMitsiades2008-2] Fagin, James A.; Mitsiades, Nicholas (2008). "Molecular pathology of thyroid cancer: diagnostic and clinical implications". Best Practice & Research Clinical Endocrinology & Metabolism. 22 (6): 955–969. doi:10.1016/j.beem.2008.09.017. ISSN 1521-690X.

[Schlumberger1998-3] 3.0 ^3.1 Schlumberger, Martin Jean (1998). "Papillary and Follicular Thyroid Carcinoma". New England Journal of Medicine. 338 (5): 297–306. doi:10.1056/NEJM199801293380506. ISSN 0028-4793.

[pmid20001718-4] 4.0 ^4.1 ^4.2 Sipos JA (December 2009). "Advances in ultrasound for the diagnosis and management of thyroid cancer". Thyroid. 19 (12): 1363–72. doi:10.1089/thy.2009.1608. PMID 20001718.

[pmid2019455-5] Pettersson B, Adami HO, Wilander E, Coleman MP (April 1991). "Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type". Int. J. Cancer. 48 (1): 28–33. doi:10.1002/ijc.2910480106. PMID 2019455.

[pmid6690009-6] Busnardo B, Girelli ME, Simioni N, Nacamulli D, Busetto E (January 1984). "Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma". Cancer. 53 (2): 278–85. doi:10.1002/1097-0142(19840115)53:2<278::aid-cncr2820530216>3.0.co;2-z. PMID 6690009.

[pmid10699905-7] Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH (March 2000). "Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems". Cancer. 88 (5): 1139–48. doi:10.1002/(sici)1097-0142(20000301)88:5<1139::aid-cncr26>3.0.co;2-z. PMID 10699905.

[HofstraLandsvater1994-8] Hofstra, Robert M. W.; Landsvater, Rudy M.; Ceccherini, Isabella; Stulp, Rein P.; Stelwagen, Tineke; Luo, Yin; Pasini, Barbara; Hoppener, Jo W. M.; van Amstel, Hans Kristian Ploos; Romeo, Giovanni; Lips, Cornells J. M.; Buys, Charles H. C. M. (1994). "A mutation in the RET proto-oncogene associated with multiple endocrine neoplasia type 2B and sporadic medullary thyroid carcinoma". Nature. 367 (6461): 375–376. doi:10.1038/367375a0. ISSN 0028-0836.

[pmid21772843-9] Nagaiah G, Hossain A, Mooney CJ, Parmentier J, Remick SC (2011). "Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment". J Oncol. 2011: 542358. doi:10.1155/2011/542358. PMC 3136148. PMID 21772843.

[pmid2794956-10] Chang TC, Liaw KY, Kuo SH, Chang CC, Chen FW (June 1989). "Anaplastic thyroid carcinoma: review of 24 cases, with emphasis on cytodiagnosis and leukocytosis". Taiwan Yi Xue Hui Za Zhi. 88 (6): 551–6. PMID 2794956.

[pmid1695118-11] Venkatesh YS, Ordonez NG, Schultz PN, Hickey RC, Goepfert H, Samaan NA (July 1990). "Anaplastic carcinoma of the thyroid. A clinicopathologic study of 121 cases". Cancer. 66 (2): 321–30. doi:10.1002/1097-0142(19900715)66:2<321::aid-cncr2820660221>3.0.co;2-a. PMID 1695118.

[MathurOlson2014-12] Mathur, Aarti; Olson, Matthew T.; Zeiger, Martha A. (2014). "Follicular Lesions of the Thyroid". Surgical Clinics of North America. 94 (3): 499–513. doi:10.1016/j.suc.2014.02.005. ISSN 0039-6109.

[pmid8197088-13] Bronshteĭn ME, Makarov AD, Artemova AM, Bazarova EN, Kozlov GI (1994). "[Morphology of the thyroid tissue in multinodular euthyroid goiter]". Probl Endokrinol (Mosk) (in Russian). 40 (2): 36–9. PMID 8197088.

[pmid8838117-14] Pedersen RK, Pedersen NT (January 1996). "Primary non-Hodgkin's lymphoma of the thyroid gland: a population based study". Histopathology. 28 (1): 25–32. PMID 8838117.

[pmid3141260-15] Hyjek E, Isaacson PG (November 1988). "Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis". Hum. Pathol. 19 (11): 1315–26. doi:10.1016/s0046-8177(88)80287-9. PMID 3141260.

[pmid3759532-16] Tupchong L, Hughes F, Harmer CL (October 1986). "Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment". Int. J. Radiat. Oncol. Biol. Phys. 12 (10): 1813–21. doi:10.1016/0360-3016(86)90324-x. PMID 3759532.

[pmid17042683-17] Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, Kobayashi K, Nakamura Y, Kakudo K, Amino N, Miyauchi A (October 2006). "Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid". Thyroid. 16 (10): 983–7. doi:10.1089/thy.2006.16.983. PMID 17042683.

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@@ Line 16: / Line 16: @@
 {| border="3"
 |+
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease Name}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease name}}
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Age of Onset}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Age of onset}}
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Gender Preponderance}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Gender preponderance}}
 ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Signs/Symptoms}}
 ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Imaging Feature(s)}}
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Macroscopic Feature(s)}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Macroscopic feature(s)}}
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic Feature(s)}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic feature(s)}}
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Laboratory Findings(s)}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Laboratory Feature(s)}}
 ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Other Feature(s)}}
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic Appearance}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Microscopic appearance}}
 |-
 ! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Papillary Thyroid Cancer<ref name="FaginMitsiades2008">{{cite journal|last1=Fagin|first1=James A.|last2=Mitsiades|first2=Nicholas|title=Molecular pathology of thyroid cancer: diagnostic and clinical implications|journal=Best Practice & Research Clinical Endocrinology & Metabolism|volume=22|issue=6|year=2008|pages=955–969|issn=1521690X|doi=10.1016/j.beem.2008.09.017}}</ref><ref name="Schlumberger1998">{{cite journal|last1=Schlumberger|first1=Martin Jean|title=Papillary and Follicular Thyroid Carcinoma|journal=New England Journal of Medicine|volume=338|issue=5|year=1998|pages=297–306|issn=0028-4793|doi=10.1056/NEJM199801293380506}}</ref><ref name="pmid20001718">{{cite journal |vauthors=Sipos JA |title=Advances in ultrasound for the diagnosis and management of thyroid cancer |journal=Thyroid |volume=19 |issue=12 |pages=1363–72 |date=December 2009 |pmid=20001718 |doi=10.1089/thy.2009.1608 |url=}}</ref>
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* More common in the middle aged (30 - 50 years of age)
+* More common in middle aged (30-50 years of age)
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * More commonly affects women
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Asymptomatic]] [[thyroid]] [[mass]] or [[nodule]]
-*Compressive [[symptoms]], such as:
+*Compressive [[symptoms]] such as:
 *[[Dysphagia|Difficulty swallowing]]/[[Dyspnea|breathing]]
 *Persistent [[cough]]
 *[[Stridor]]
-*[[Vocal cord|Vocal chord]] [[paralysis]]
+*Vocal chord [[paralysis]]
 *Rapid enlarging [[mass]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* On [[ultrasound]]
+*[[Ultrasound]]: solitary [[mass]] with an irregular outline, in the subcapsular region and with high [[vascularity]]
-** [[Solitary]] [[mass]] with an irregular outline
+*[[Imaging]] features are not characteristic for this [[cancer]]
-** Located in the sub-capsular region
-** High [[vascularity]]
-*[[Imaging]] features are not characteristic of this [[cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Solitary]] hypoechogenic [[nodule]] with [[Lobule|lobulated]] margin which may extend into adjacent [[tissues]]
+* Solitary hypoechogenic [[nodule]]  with lobulated margin which may extend into adjacent [[tissues]]
 *[[Calcification]] may be present or not
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
@@ Line 54: / Line 50: @@
 *[[Psammoma body|Psammoma bodies]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Thyroid function test|Thyroid function tests]] can be normal
+*[[Thyroid function test]] may be normal
-*Serum [[thyroglobulin]] can be used as a [[tumor marker]]
+*[[Thyroglobulin]] may be used as a [[tumor marker]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* History of [[radiation]] to the [[head]] and [[neck]]
+* History of [[radiation]] in head and neck
 *[[BRAF]] and/or [[RET gene|RET]] [[mutation]] may be present
-*The most common type of thyroid cancer
+*Most common type of [[thyroid cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Image:Thyroid papillary carcinoma histopathology (3).jpg|thumb|none|200px|Source:Wikimedia commons ]]
 |-
 ! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Follicular Thyroid Cancer<ref name="Schlumberger1998">{{cite journal|last1=Schlumberger|first1=Martin Jean|title=Papillary and Follicular Thyroid Carcinoma|journal=New England Journal of Medicine|volume=338|issue=5|year=1998|pages=297–306|issn=0028-4793|doi=10.1056/NEJM199801293380506}}</ref><ref name="pmid20001718">{{cite journal |vauthors=Sipos JA |title=Advances in ultrasound for the diagnosis and management of thyroid cancer |journal=Thyroid |volume=19 |issue=12 |pages=1363–72 |date=December 2009 |pmid=20001718 |doi=10.1089/thy.2009.1608 |url=}}</ref><ref name="pmid2019455">{{cite journal |vauthors=Pettersson B, Adami HO, Wilander E, Coleman MP |title=Trends in thyroid cancer incidence in Sweden, 1958-1981, by histopathologic type |journal=Int. J. Cancer |volume=48 |issue=1 |pages=28–33 |date=April 1991 |pmid=2019455 |doi=10.1002/ijc.2910480106 |url=}}</ref>
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Peak [[incidence]] at 40 - 60 years of age
+* Peak [[incidence]] is 40-60 years of age
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * More commonly affects women
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Asymptomatic]] [[thyroid]] [[mass]] or [[nodule]]
-*Compressive [[symptoms]], such as:
+*Compressive [[symptoms]] such as:
 *[[Difficulty swallowing]]/[[Dyspnea|breathing]]
 *Persistent [[cough]]
 *[[Stridor]]
-*[[Vocal cord|Vocal chord]] [[paralysis]]
+*Vocal chord [[paralysis]]
 *Rapid enlarging [[mass]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* On [[ultrasound]]:
+* [[Ultrasound]]: solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
-**Solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
+* Irregular margin
-**Irregular margin
+* [[Imaging]] features are not characteristic for this [[cancer]]
-*[[Imaging]] features are not characteristic of this [[cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Single encapsulated [[nodule]]
+* Single encapsulated [[nodule]],
 * Thick and irregular [[capsule]]
-* Can be [[cystic]] or [[hemorrhage|hemorrhagic]] in appearance
+* May have [[cystic]] or [[hemorrhage]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Invades [[thyroid]] [[capsule]] and [[vasculature]]
-* Uniform [[Follicle|follicles]] <br />
+* Uniform  [[Follicle|follicles]] <br />
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Thyroid function test|Thyroid function tests]] can be normal
+*[[Thyroid function test]] may be normal
-* Serum [[thyroglobulin]] can be used as a [[tumor marker]]
+* Serum [[thyroglobulin]] may be used as a [[tumor marker]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[RASA3|RAS]] [[mutation]] may be present
-*[[PAX8]]-[[PPAR|PPARγ]]  [[Translocation|translocations]]
+* PAX8-PPAR-γ  [[Translocation|translocations]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Image:Metastatic follicular thyroid carcinoma - Case 264.jpg|thumb|none|200px|Source:Wikimedia common ]]
 |-
@@ Line 99: / Line 94: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Incidence]] increases with age
-* More common in the 3rd to 4th decades of life
+* More common in 3rd to 4th decades of life
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Both genders are affected equally
+* Both genders affected equally
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Solitary]] [[thyroid nodule]]
+* Solitary [[thyroid nodule]]
-* Mostly affects upper [[Lobe (anatomy)|lobe]] of [[thyroid gland]]
+* Mostly affects upper lobe of thyroid gland
-* Possible [[systemic]] [[symptoms]] due to [[Hormone|hormonal]] [[secretion]] by the [[tumor]]
+* Possible [[systemic]] [[symptoms]] due to hormonal secretion by the [[tumor]]
 *[[Cervical]] [[lymphadenopathy]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*On [[ultrasound]]:
+*[[Ultrasound]]: solitary hypoechoic [[nodule]] with or without [[calcification]]
-**[[Solitary]] hypoechoic [[nodule]] with or without [[calcification]]
+*Imaging features are not characteristic for this [[cancer]]
-*[[Imaging]] features are not characteristic of this [[cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Single non-encapsulated mass
+* Single nonencapsulated [[mass]]
 * Gray-tan color
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Sheets of [[cells]] in an [[amyloid]] [[stroma]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Secretion|Secretes]] [[calcitonin]]
+* Secretes [[calcitonin]]
-*Normal [[thyroid function test|thyroid function tests]]
+*Normal [[thyroid function test]]
 *[[Carcinoembryonic antigen]] ([[CEA]]) may be used as a [[tumor marker]]
 *Rarely negative for [[calcitonin]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Can be part of [[MEN syndromes|MEN 2A]] and [[Multiple endocrine neoplasia type 2|2B syndrome]]
+* May be part of [[MEN syndromes|MEN 2A]] and [[Multiple endocrine neoplasia type 2|2B syndrome]]
-* Can be associated with [[RET gene|RET]] [[mutation]]
+* May be associated with [[RET gene|RET]] [[mutation]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[File:Thyroid MedullaryCarcinoma SpindleCell LP PA.JPG|thumb|none|200px|Source:Wikimedia common ]]
 |-
@@ Line 129: / Line 123: @@
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 * More common among older individuals
-*[[Mean]] age at [[diagnosis]] is 65 years
+*Mean age at [[diagnosis]] is 65 years
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * More commonly affects women
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Rapidly enlarging [[thyroid]] [[mass]]
+* Rapidly enlarging thyroid [[mass]]
 * May manifest with compressive [[symptoms]]
-*Can present with [[signs]]/[[symptoms]] of [[metastasis]]
+*May present with [[signs]]/[[symptoms]] of [[metastasis]]
 *Constitutional [[symptoms]] may be present
-*Hard [[Nodule (medicine)|nodular]] [[goiter]] without [[tenderness]]
+*Hard nodular [[goiter]] w/out [[tenderness]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* On [[ultrasound]]:
+[[Ultrasound]]: solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
-** Solid hypoechoic [[nodule]] with a peripheral halo indicating [[fibrous capsule]]
+* Irregular margin
+* [[Imaging]] features are not characteristic for this [[cancer]]
-** Irregular margin
-*[[Imaging]] features are not characteristic of this [[cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Solid [[tumor]] with areas of [[necrosis]] and [[hemorrhage]]
-*[[Infiltration (medical)|Infiltrative]] pattern
+* Infiltrative pattern
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Undifferentiated, devastatingly aggressive variant of [[Papillary thyroid cancer|papillary]]/[[follicular thyroid cancer]]
+* Undifferentiated, devastatingly aggressive variant of Papillary/[[Follicular thyroid cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Normal [[thyroid function test|thyroid function tests]]
+* Normal [[thyroid function test]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * Poor [[prognosis]]
@@ Line 197: / Line 189: @@
 * Some may show [[papillary]] [[Projection areas|projections]] without [[nuclear]] characteristics of [[papillary thyroid cancer]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-*[[Classification|Classified]] as toxic and non-toxic
+* Classified as toxic and non-toxic
-**'''Toxic:''' [[Hyperthyroidism]]
+* Toxic =>  hyperthyroidism
-**'''Non-toxic:''' Normal [[thyroid function test|thyroid function tests]]
+* Non-toxic => Normal [[thyroid function test]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 *[[Benign]] [[condition]]
@@ Line 207: / Line 199: @@
 <ref name="pmid3141260">{{cite journal |vauthors=Hyjek E, Isaacson PG |title=Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis |journal=Hum. Pathol. |volume=19 |issue=11 |pages=1315–26 |date=November 1988 |pmid=3141260 |doi=10.1016/s0046-8177(88)80287-9 |url=}}</ref><ref name="pmid3759532">{{cite journal |vauthors=Tupchong L, Hughes F, Harmer CL |title=Primary lymphoma of the thyroid: clinical features, prognostic factors, and results of treatment |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=12 |issue=10 |pages=1813–21 |date=October 1986 |pmid=3759532 |doi=10.1016/0360-3016(86)90324-x |url=}}</ref><ref name="pmid17042683">{{cite journal |vauthors=Ota H, Ito Y, Matsuzuka F, Kuma S, Fukata S, Morita S, Kobayashi K, Nakamura Y, Kakudo K, Amino N, Miyauchi A |title=Usefulness of ultrasonography for diagnosis of malignant lymphoma of the thyroid |journal=Thyroid |volume=16 |issue=10 |pages=983–7 |date=October 2006 |pmid=17042683 |doi=10.1089/thy.2006.16.983 |url=}}</ref>
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Affects [[Adult|adults]] or elderly
+* Affects adults or elderly
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * More common among women
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Rapidly enlarging mass/[[nodule]] of [[thyroid]]
+* Rapidly enlarging [[mass]]/ [[nodule]] of [[thyroid]]
-* Compressive [[symptoms]] may be present
+* Compression [[symptoms]] may be present
-* [[B symptoms|Constitiutional symptoms]] can be present in 10%
+* [[B symptoms|Constitiutional symptoms]] may be present in 10%
-*[[Physical examination|P/E]]:Firm, hard [[thyroid]]
+* P/E:Firm, hard [[thyroid]]
-* Fixed to the nearby structures
+* Fixed to the nearby structure
 * Immobile even during swallowing
 * [[Cervical]] or [[supraclavicular]] [[lymphadenopathy]] may be present
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* On [[ultrasound]]:
+* [[Ultrasound]]: hypoechogenic appearance difficult to be distinguished from chronic [[thyroiditis]]
-**Hypoechogenic appearance
-**Difficult to distinguish from [[Chronic (medical)|chronic]] [[thyroiditis]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* [[Thyroid nodule]]/mass
+* [[Thyroid nodule]]/[[mass]] fixing to adjacent [[tissue]] with a firm texture
-*Fixed to adjacent [[tissue]]
-*Firm texture
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * It is of [[B cell]] lineage in the majority of cases
-* Dffuse, large [[B-cell lymphoma|B-cell lymphomas]] is the most common subtype
+* Dffuse, large [[B-cell lymphoma|B-cell lymphomas]] is the most common subtype: diffuse infiltrate of B cells destroying thyroid follicles
 * [[Marginal zone lymphoma]] is the second most common type
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
 * No specific test
-* Some [[Patient|patients]] may have [[hypothyroidism]]
+* Some may have [[hypothyroidism]]
-*[[Patient|Patients]] can also have [[antibody|antibodies]] against [[thyroid peroxidase]] or [[thyroglobulin]]
+* Some may have [[antibody]] against [[thyroid peroxidase]] or [[thyroglobulin]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
-* Preexisting [[Chronic (medical)|chronic]] [[Hashimoto's thyroiditis|autoimmune (Hashimoto's) thyroiditis]] is a known [[risk factor]] for this [[condition]]
+* Preexisting chronic [[Hashimoto's thyroiditis|autoimmune (Hashimoto's) thyroiditis]] is a known [[risk factor]] for this [[condition]]
 | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[File:Thyroid lymphoma large cell type fine needle aspiration biop.jpeg|thumb|none|200px|Source:pathology outline, case courtesy of Dr. Mark R. Wick]]
 |}
 ==Reference==
 {{Reflist|2}}

Papillary thyroid cancer differential diagnosis: Difference between revisions

Revision as of 23:51, 1 August 2019

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Differentiating Papillary thyroid cancer from other Diseases

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