Papillary thyroid cancer pathophysiology: Difference between revisions

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* Follicles with variable size
* Follicles with variable size
* Dark, eosinophilic colloid with scalloping ‘‘bubble gum’’ appearance
* Dark, [[eosinophilic]] [[colloid]] with scalloping ‘‘bubble gum’’ appearance
* Cytologic features including  prominent nucleoli and increased mitotic activity are diagnostic
* [[Cytologic]] features including  prominent [[nucleoli]] and increased [[mitotic]] activity are [[diagnostic]]
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|'''Conventional'''
|'''Conventional'''
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* Papillae with fibrovascular cores
* [[Papillae]] with [[fibrovascular]] cores
* Enlarged nuclei with nuclear clearing
* Enlarged [[nuclei]] with [[nuclear]] clearing
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|'''Tall cell'''
|'''Tall cell'''
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* With a height 2 to 3 times greater than the width
* With a height 2 to 3 times greater than the width
* Cytologic features are diagnostic
* [[Cytologic]] features are [[diagnostic]]
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|'''Columnar cell'''
|'''Columnar cell'''
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* Pseudostratified cells
* Pseudostratified cells
* Overlapping enlarged nuclei  
* Overlapping enlarged [[nuclei ]]
|-
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|'''Oncocytic'''
|'''Oncocytic'''
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* Large cells with abundant eosinophilic cytoplasm
* Large [[cells]] with abundant [[eosinophilic]] [[cytoplasm]]
* Enlarged nuclei with nuclear clearing
* Enlarged [[nuclei]] with [[nuclear]] clearing
|-
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|'''Solid'''
|'''Solid'''
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* Sheets of tumor cells with abundant cytoplasm
* Sheets of [[tumor]] [[cells]] with abundant [[cytoplasm]]
* Enlarged nuclei with nuclear clearing
* Enlarged [[nuclei]] with [[nuclear]] clearing
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|'''Diffuse sclerosing'''
|'''Diffuse sclerosing'''
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* Abundant psammoma bodies, and squamoid changes in the tumor cells
* Abundant [[psammoma bodies]], and squamoid changes in the [[tumor]] [[cells]]
* Lymphocytic infiltrates in the background  
* [[Lymphocytic]] infiltrates in the background  
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|'''Papillary thyroid carcinoma with prominent hobnail features'''
|'''Papillary thyroid carcinoma with prominent hobnail features'''
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* Hobnail cells with loss of polarity
* Hobnail [[cells]] with loss of polarity
* High-grade cytologic features including
* High-grade [[cytologic]] features including
* prominent nucleoli
* prominent [[nucleoli]]
* increased mitotic activity
* increased [[mitotic]] activity
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|'''Clear cell'''
|'''Clear cell'''
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* Clear cells with a papillary architecture
* Clear [[cells]] with a [[papillary]] architecture
* Cytological features of papillary thyroid cancer
* [[Cytological]] features of papillary thyroid cancer
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|'''Cribriform-Morular'''
|'''Cribriform-Morular'''
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* Cribriform pattern with solid and spindle cell areas  
* Cribriform pattern with [[solid]] and [[spindle]] [[cell]] areas  
* Squamous morules
* [[Squamous]] morules
* Nuclei with clearing and groove
* [[Nuclei]] with clearing and groove
* Involving both thyroid lobes
* Involving both thyroid lobes
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* Composed of macrofollicles
* Composed of macrofollicles
* Cytological features of papillary thyroid cancer
* [[Cytological]] features of papillary thyroid cancer
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|[[File:Papillary thyroid carcinoma oncocytic variant -- low mag.jpg|thumb|none|250px| H&E stain, Contributed by Nephron in wikimedia.commons]]
|[[File:Papillary thyroid carcinoma oncocytic variant -- low mag.jpg|thumb|none|250px| H&E stain, Contributed by Nephron in wikimedia.commons]]
|-
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|Micrograph showing cribriform-Morular variant of papillary thyroid carcinoma. H&E stain, Contributed by Sarahkayb in wikimedia.commons
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|[[File:Thyroid PapillaryCarcinoma CribriformMorularVariant HP2 13BR (1).jpg|thumb|none|250px]]
* Micrograph showing cribriform-Morular variant of papillary thyroid carcinoma
* Cribriform pattern with [[solid]] and [[spindle]] [[cell]] areas
* [[Squamous]] morules
|[[File:Thyroid PapillaryCarcinoma CribriformMorularVariant HP2 13BR (1).jpg|thumb|none|250px| H&E stain, Contributed by Sarahkayb in wikimedia.commons]]
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|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.<ref> Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015</ref>
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|[[File:Thyroid papillary carcinoma histopathology (3).jpg|thumb|none|250px]]
* Micrograph (high power view) showing nuclear changes in papillary thyroid carcinoma (PTC), which include:
** Groove formation
** Optical clearing
** Eosinophilic inclusions and overlapping of nuclei
|[[File:Thyroid papillary carcinoma histopathology (3).jpg|thumb|none|250px| H&E stain.<ref> Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015</ref>]]
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|Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei. H&E stain.<ref> Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015</ref>
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|[[File:Thyroid papillary carcinoma histopathology (2).jpg|thumb|none|250px]]
* Micrograph (high power view) of PTC demonstrating [[nuclear]] clearing and overlapping [[nuclei]]
|[[File:Thyroid papillary carcinoma histopathology (2).jpg|thumb|none|250px| H&E stain.<ref> Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015</ref>]]
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|Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores. H&E stain.<ref> Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015</ref>
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|[[File:Thyroid papillary carcinoma histopatholgy (1).jpg|thumb|none|250px]]
* Micrograph of papillary thyroid carcinoma demonstrating prominent [[papillae]] with fibrovascular cores
|[[File:Thyroid papillary carcinoma histopatholgy (1).jpg|thumb|none|250px| H&E stain.<ref> Papillary thyroid cancer. Wikipedia 2015. https://en.wikipedia.org/wiki/Papillary_thyroid_cancer Accessed on November 4, 2015</ref>]]
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Revision as of 13:48, 12 August 2019

Papillary 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]

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.
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 by in wikimedia.commons[10]
  • Micrograph showing oncocytic variant of papillary thyroid carcinoma
  • Large cells with abundant eosinophilic cytoplasm
H&E stain, Contributed by Nephron 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 by Sarahkayb 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.[11]
  • Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei
H&E stain.[12]
  • Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores
H&E stain.[13]
H&E stain[14]


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
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