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==Pathogenesis==
==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.<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>
* 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.<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>
* 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>  
* 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>
* Furthermore, papillary tumors may metastasize to the [[lungs]] and produce a few nodules or the lung fields may exhibit a [[snowflake]] appearance throughout.
* 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.<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>
* 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>
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==Associated Conditions==
==Associated Conditions==
* [[Gardner syndrome]]<ref name=Radiopaedia2015>{{cite web | title = Papillary thyroid cancer [Dr Yuranga Weerakkody and Dr Frank Gaillard et al.].Radiopedia 2015| url = http://radiopaedia.org/articles/papillary-thyroid-cancer Accessed on October, 29 2015 }}</ref>
* [[Gardner syndrome]]<ref name="Radiopaedia2015">{{cite web | title = Papillary thyroid cancer [Dr Yuranga Weerakkody and Dr Frank Gaillard et al.].Radiopedia 2015| url = http://radiopaedia.org/articles/papillary-thyroid-cancer Accessed on October, 29 2015 }}</ref>
* [[Cowden syndrome]]
* [[Cowden syndrome]]


==Gross Pathology==
==Gross Pathology==
* Solitary nodule which can extend into [[trachea]] and [[vocal cord|vocal cords]].
* Solitary nodule which can extend into [[trachea]] and [[vocal cord|vocal cords]].
[[File:Papillary thyroid carcinoma.jpeg|thumb|center|Papillary thyroid cancer gross pathology<ref name=radio> Image courtesy of  Dr David Cuete. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/articles/papillary-thyroid-cancer ‘’here’’].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
[[File:Papillary thyroid carcinoma.jpeg|thumb|center|Papillary thyroid cancer gross pathology<ref name="radio"> Image courtesy of  Dr David Cuete. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/articles/papillary-thyroid-cancer ‘’here’’].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
==Microscopic Pathology==
==Microscopic Pathology==
*Characteristic Orphan Annie eye nuclear inclusions (nuclei with uniform [[staining]], which appear empty)<ref>{{cite web|url=http://esynopsis.uchc.edu/eAtlas/Endo/1802.htm|title=Papillary Carcinoma of Thyroid (Hi Pow)|publisher=University of Connecticut Health Center|accessdate=2008-09-14}}</ref> and [[psammoma]] bodies on light microscopy. The former is useful in identifying the follicular variant of papillary thyroid carcinomas.<ref name="pmid11442006">{{cite journal |author=Yang GC, Liebeskind D, Messina AV |title=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 |journal=Thyroid |volume=11 |issue=6 |pages=581–89 |year=2001 |pmid=11442006 |doi=10.1089/105072501750302895}}</ref>
*Characteristic Orphan Annie eye nuclear inclusions (nuclei with uniform [[staining]], which appear empty)<ref>{{cite web|url=http://esynopsis.uchc.edu/eAtlas/Endo/1802.htm|title=Papillary Carcinoma of Thyroid (Hi Pow)|publisher=University of Connecticut Health Center|accessdate=2008-09-14}}</ref> and [[psammoma]] bodies on light microscopy. The former is useful in identifying the follicular variant of papillary thyroid carcinomas.<ref name="pmid11442006">{{cite journal |author=Yang GC, Liebeskind D, Messina AV |title=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 |journal=Thyroid |volume=11 |issue=6 |pages=581–89 |year=2001 |pmid=11442006 |doi=10.1089/105072501750302895}}</ref>
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|-
|-
|-
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|''' Dysgerminomas'''||
| ||
* large, uniform, clear [[cells]] arranged in sheets <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
*  
* Uniform [[cells]] has an "fried egg [[appearance]]"(large [[cytoplasm]] and small [[nucleus]]) that resemble [[primordial germ cells]]
|  
* The [[stroma]] contains [[lymphocytes]] and [[septa]] like components.
| [[File:Dysgerminoma of the ovary.jpeg|thumb|none|400px|Contributed by CoRus13 in wikimedia.commons]]


|-
|-
|''' Embryonal carcinoma'''||
| ||
* Pseudoglandular pattern of [[Primitive (integral)|primitive]] [[cells]] <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
|  
* [[Nuclei]] are:
** Large
** Croweded
** Pleomorphic
** With prominent [[nucleoli]]
| [[Image:800px-Embryonal_carcinoma_-_high_mag.jpg‎|300px|thumb|none| Contributed by Nephron in wikimedia.commons]]
|-
|-
|'''Endodermal sinus tumor or yolk sac tumors'''||
| ||
* Schiller-Duval bodies (resemble renal [[glomeruli]]) - key feature <ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
*  
| [[Image:800px-Mixed_germ_cell_tumour_-_high_mag.jpg|thumb|none|300px|Micrograph showing the yolk sac component of a mixed germ cell tumor. Contributed by Nephrone in wikimedia.commons]]
|  
|-
|-
|'''Polyemryoma'''||
| ||
* Usually as a part of mixed [[germ cell]] [[tumor]]<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
***  
* Contains small [[embryo]]-like bodies with central germ disks
***  
* Germ disk [[cavity]] has two part:
|  
** Embryonal carcinoma [[epithelia]]
** Two cavities:
*** [[Dorsal cavity]] that resembles the [[amniotic cavity]]
*** [[Ventral cavity]] that resembles the [[yolk sac]] cavity
| [[Image:TestispolyembryomaPerez37n.jpg|thumb|none|300px|Micrograph showing the embryoma component of a mixed germ cell tumor. Attributed by "courtesy of PathologyOutlines.com"]]
|-
|-
|'''Teratoma'''||
|'''Teratoma'''||
'''Mature teratoma'''
*[[diagnosis|agnosis]].
* The sections show [[ovarian]] [[parenchyma]] with a [[lesion]] consisting of [[benign]] [[dermal]], [[gastrointestinal]], and [[neural]] elements.<ref name="wpp">Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015</ref>
|
* The [[neural]] elements show focal [[degenerative]] changes with [[macrophages]] and [[giant cells]]
* Siderophages are present.
* In general, mature [[teratoma]] usually appears as a well-established organization of [[tissues]] mimicking the relationship observed in normal organs such as:<ref name="pmid15761467">{{cite journal |vauthors=Ulbright TM |title=Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues |journal=Mod. Pathol. |volume=18 Suppl 2 |issue= |pages=S61–79 |date=February 2005 |pmid=15761467 |doi=10.1038/modpathol.3800310 |url=}}</ref>
** [[Respiratory epithelium|respiratory epithelial]] layer surrounded by [[smooth muscle]] and [[cartilage]]
* Usually, there is scant [[mitosis]] in the [[Tumor cell|tumor cells]] usually limited to the normal proliferative zone of the body part that they produce.
* No [[Cytological|cytologic]] [[atypia]] is present.
* Different type of tissues may be observed in the mature [[Teratoma|teratomas]] of the ovary such as:
**[[Choroid plexus]]
**[[Thyroid]] tissues
**[[Pituitary]] tissues, although not commonly.<ref name="KallenbergPesce1991">{{cite journal|last1=Kallenberg|first1=GA|last2=Pesce|first2=CM|last3=Norman|first3=B|last4=Ratner|first4=RE|last5=Silverberg|first5=SG|title=Ectopic hyperprolactinemia resulting from an ovarian teratoma|journal=International Journal of Gynecology & Obstetrics|volume=34|issue=2|year=1991|pages=194–195|issn=00207292|doi=10.1016/0020-7292(91)90266-8}}</ref>
***Rarely, they produce [[prolactin]] and is associated with [[prolactinoma]].
'''Immature teratoma'''
* [[Tissues]] originating from the two or three embryonal layers are present.<ref name="ShaabanRezvani2014">{{cite journal|last1=Shaaban|first1=Akram M.|last2=Rezvani|first2=Maryam|last3=Elsayes|first3=Khaled M.|last4=Baskin|first4=Henry|last5=Mourad|first5=Amr|last6=Foster|first6=Bryan R.|last7=Jarboe|first7=Elke A.|last8=Menias|first8=Christine O.|title=Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features|journal=RadioGraphics|volume=34|issue=3|year=2014|pages=777–801|issn=0271-5333|doi=10.1148/rg.343130067}}</ref>
* There is a mixture of mature and immature [[tissue]] (primitive cells).
* The presence of primitive elements is necessary to make the [[diagnosis]].
|[[File:Mature Cystic Teratoma of the Ovary Bone Tissue (4047143950).jpg|thumb|none|300px|Mature cystic teratoma of the ovary: Bone Tissue
Pathological and histological images courtesy of Ed Uthman at flickr. Contributed by wikimedia commons]]
|-
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|}
|}

Revision as of 14:55, 9 August 2019

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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]

Overview

On gross pathology, a painless enlarging mass is a characteristic finding of papillary thyroid cancer. On microscopic histopathological analysis, Orphan Annie eye nuclear inclusions and psammoma bodies are characteristic findings of papillary thyroid cancer.

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

  • Mutations associated with papillary thyroid cancer are mainly two forms of chromosomal translocation and one form of point mutation. These alterations lead to activation of a common carcinogenic pathway known as the MAPK/ERK pathway.
  • Chromosomal translocations involving the RET proto-oncogene (encoding a tyrosine kinase receptor that plays essential roles in the development of neuroendocrine cells) located on chromosome 10q11 occur in approximately a fifth of papillary thyroid cancers. The fusion oncoproteins generated are termed RET/PTC proteins (ret/papillary thyroid carcinoma), and constitutively activate RET and the downstream MAPK/ERK pathway. The frequency of ret/PTC translocations is significantly higher in papillary cancers arising in children and after radiation exposure. The gene NTRK1 (encoding the TrkA receptor), located on chromosome 1q, is similarly translocated in approximately 5 percent to 10 percent of papillary thyroid cancers.
  • Approximately a third to a half of papillary thyroid carcinomas harbor point mutations in the BRAF oncogene, also activating the MAPK/ERK pathway. In those cases the BRAF mutations found were V600E mutation. According to recent studies, papillary cancers carrying the common V600E mutation tend to have a more aggressive long term course. BRAF mutations are frequent in papillary carcinoma and in undifferentiated cancers that have developed from papillary tumors.

Associated Conditions

Gross Pathology

Papillary thyroid cancer gross pathology[7]

Microscopic Pathology

  • Characteristic Orphan Annie eye nuclear inclusions (nuclei with uniform staining, which appear empty)[8] and psammoma bodies on light microscopy. The former is useful in identifying the follicular variant of papillary thyroid carcinomas.[9]
  • Histologically papillary carcinoma demonstrates 'delicate stalks of epithelial cells' which account for its name.
Ovarian germ cell tumor subtype Features on Histopathological Microscopic Analysis Image
Teratoma
  • Micrograph of metastatic papillary thyroid carcinoma to a lymph node. H&E stain.[10]
    Micrograph of metastatic papillary thyroid carcinoma to a lymph node. H&E stain.[10]
  • Micrograph of papillary thyroid carcinoma, tall cell variant - high magnification. H&E stain.[11]
    Micrograph of papillary thyroid carcinoma, tall cell variant - high magnification. H&E stain.[11]
  • Micrograph of metastatic papillary thyroid carcinoma to a lymph node. H&E stain.[12]
    Micrograph of metastatic papillary thyroid carcinoma to a lymph node. H&E stain.[12]
  • Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores. H&E stain.[13]
    Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores. H&E stain.[13]
  • Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei. H&E stain.[14]
    Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei. H&E stain.[14]
  • 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.[15]
    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.[15]

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. ↑ Accessed on October, 29 2015 "Papillary thyroid cancer [Dr Yuranga Weerakkody and Dr Frank Gaillard et al.].Radiopedia 2015" Check |url= value (help).
  7. ↑ Image courtesy of Dr David Cuete. Radiopaedia (original file ‘’here’’.Creative Commons BY-SA-NC
  8. ↑ "Papillary Carcinoma of Thyroid (Hi Pow)". University of Connecticut Health Center. Retrieved 2008-09-14.
  9. ↑ 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.
  10. ↑ Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015
  11. ↑ Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015
  12. ↑ Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015
  13. ↑ Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015
  14. ↑ Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015
  15. ↑ Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015
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