THYROID CANCER PATHOLOGY

CLINICOPATHOLOGIC CORRELATIONS
VIRGINIA A. LiVOLSI, MD

THYROID CARCINOMA
PATHOLOGY

4 Major pathologic types

FOLLICULAR CELL DERIVED

Papillary carcinoma and variants Follicular carcinoma Hurthle cell carcinoma Anaplastic carcinoma

PAPILLARY THYROID CARCINOMA

Clinical Any age Microscopic to large Female: Male= 2-4:1 Radiation history Lymph nodes Prognosis 95% at 25 years

PAPILLARY THYROID CARCINOMA

Gross Any size Confined or extrathyroidal May show capsule (especially follicular variant) May be cystic May note gross calcification or even bone

PAPILLARY THYROID CARCINOMA

Pathology Papillae and/or follicles Can be totally follicular Sclerosis Calcification (psammoma bodies) NUCLEI

PAPILLARY THYROID CARCINOMA

NUCLEI

Define the subtype of carcinoma Allow for diagnosis even on small sample (FNA)

PAPILLARY THYROID CARCINOMA

PATHOLOGY

Lymphatic invasion early on May show vascular invasion also Lymph nodes positive over 50% at diagnosis May present as nodal metastasis in neck especially cystic (confused with branchial cleft cyst)

PAPILLARY THYROID CARCINOMA

Despite

nodal metastases, prognosis remains excellent This is different from any other malignant tumor in the human body.

PAPILLARY THYROID CARCINOMA

SUBTYPES

TALL CELL FOLLICULAR VARIANT MICROCARCINOMA OTHERS

PAPILLARY THYROID CARCINOMA

TALL

CELL VARIANT

Older patients Large tumors Extrathyroidal Vascular invasion

FOLLICULAR THYROID LESIONS

Follicular

variant papillary carcinoma Definition +/- capsule +/- Uniform Follicular pattern +/- invasion NUCLEI

FOLLICULAR THYROID LESIONS

FOLLICULAR

VARIANT PAPILLARY

CARCINOMA Often encapsulated Less lymph node mets (25% vs 55%) More vascular invasion (20%) More risk of distant mets-especially to bone

PAPILLARY MICROCARCINOMA
DEFINED

BY SIZE: 1 cm or less Usually incidental finding Can be found in up to 35% of adult thyroids Virtually never of clinical significance Should not be over treated.
SUGGESTED

DX: MICROTUMOR

FOLLICULAR THYROID LESIONS

Follicular

carcinoma Definition Capsule (thick, often calcified) Solitary Uniform INVASION

FOLLICULAR CARCINOMA

CURRENT CLASSIFICATION

NEW CLASSIFICATION

Minimally invasive (gross encapsulation) Widely invasive

Minimally invasive (capsule only) Angioinvasive grossly encapsulated Widely invasive

FOLLICULAR THYROID LESIONS

FOLLICULAR

CARCINOMA Capsule invasion only Very rare if only capsule invasion to recur or metastasize

FOLLICULAR THYROID LESIONS

FOLLICULAR

CARCINOMA VASCULAR INVASION

MEDULLARY CARCINOMA
Not

of follicular cell origin, but C-cell origin Secrete calcitonin (tumor marker) Can be familial (20-25%) Screening possible
Sporadic

cases significant risk 50-60% survival at 5 years.

CALCITONIN

MEDULLARY CARCINOMA
SCREENING

For patient allows to have evaluation of other endocrine lesions and their treatment For relatives, allows early diagnosis and prophylactic surgery AND even surgery in the premalignant state (C cell hyperplasia).

THE PATHOLOGY REPORT

WHAT YOU AND YOUR DOCTOR SHOULD EXPECT. A. Type of tumor B. Size of tumor C. Extent of tumor (in or outside of gland) D. Lymphatic/vascular invasion E. Presence of nodal metastases

THANK YOU I appreciate your attention. ANY QUESTIONS?

THYROID CANCER PATHOLOGY

CLINICOPATHOLOGIC CORRELATIONS
VIRGINIA A. LiVOLSI, MD