Download A920: Thyroid: Papillary carcinoma

A920: Thyroid: Papillary carcinoma
General facts of lung cancer
The thyroid gland is located under the Adam's apple in the front part of the neck. In most
people it cannot be seen or felt. It has 2 lobes, called the right lobe and the left lobe, joined
by a narrow isthmus. This gland takes up iodine from the diet and the blood and makes a
thyroid hormone important for many body functions. The thyroid gland contains mainly 2
types of cells:
-Thyroid follicle cells actually make and store thyroid hormone. They also make a special
thyroid protein called thyroglobulin.
-C cells make another hormone, calcitonin.
Different cancers develop from each kind of cell. The differences are important because they
determine the seriousness of the cancer and the type of treatment needed.
Many types of tumors can develop in the thyroid gland. Most of these tumors are benign, or
noncancerous. Others are cancerous, which means they can spread into nearby tissues and
to other parts of the body. Because the thyroid gland is close to the skin, tumors often
appear as bumps in the neck. They are called thyroid nodules. Thyroid nodules can develop
at any age, but they are most common in adults, occurring in one third of all people. Often
people find these bumps themselves by seeing or feeling them. Other times they are never
noticed and never cause a problem.
Benign Thyroid Tumors
Almost all (95%) of thyroid nodules or tumors are benign. They develop from thyroid
follicular cells and can be found in normal-sized thyroid glands and goiters (enlarged thyroid
glands). The thyroid may contain 1 nodule or several nodules. A gland with several benign
nodules is called a multinodular goiter. Often these nodules are cysts filled with fluid, or they
may be "lumps" of stored thyroid hormone called colloid nodules. Colloid nodules have very
few cells in them.
Other nodules may have too many cells, but the cells are not cancer cells. This type of nodule
includes hyperplastic nodules and adenomas. Sometimes hyperplastic nodules or adenomas
make too much thyroid hormone, causing a condition called hyperthyroidism. Symptoms of
hyperthyroidism include nervousness, irregular and rapid beating of the heart, excessive
sweating, and weight loss. But even these nodules are not cancerous.
Malignant Thyroid Tumors
Only 5% to10% of thyroid nodules are cancerous. There are several types of thyroid cancer.
Papillary carcinoma and follicular carcinoma are the most common. Some doctors group
these together and call them differentiated thyroid cancer or well-differentiated thyroid
cancer. Medullary carcinoma, H?thle cell carcinoma (a subtype of follicular carcinoma),
anaplastic carcinoma, and thyroid lymphoma occur less often.
Papillary carcinoma: About 80% to 85% of thyroid cancers are papillary carcinomas (also
called papillary cancer or papillary adenocarcinoma). Papillary carcinomas develop from the
thyroid follicle cells and typically grow very slowly. Usually they occur in only one lobe of the
thyroid gland, but about 10% to 20% of the time both lobes are involved. Several different
variants (subtypes) of papillary carcinoma can be recognized under the microscope. These
include the follicular variant, tall cell variant, columnar cell variant, and diffuse sclerosing
variant.
The usual form of papillary adenocarcinoma and the follicular variant have the same outlook
for survival ( prognosis), and treatment is the same for both. The other variants tend to
spread more quickly and have a worse prognosis. Even though papillary cancer grows slowly,
it often spreads early to the lymph nodes in the neck. Fortunately, most people with papillary
cancer do not die from it.
ٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛٛ
Follicular carcinoma: Follicular carcinoma is the next most common type of thyroid cancer. It
is also sometimes called follicular cancer or follicular adenocarcinoma. Follicular cancer is
much less common than papillary thyroid cancer, making up about 5% to 10% of thyroid
cancers. It is more common in countries where people don't get enough iodine in their diet.
These cancers usually remain in the thyroid gland but can spread to other parts of the body,
such as lungs and bone. Unlike papillary carcinoma, follicular carcinomas spread to lymph
nodes less often.
The prognosis of follicular carcinoma is probably the same or slightly worse than that of
papillary carcinoma. H?thle cell carcinoma, also known as oxyphil cell carcinoma, is thought
to be a subtype of follicular cancer and has about the same survival outlook.
Anaplastic carcinoma: Anaplastic carcinoma is an uncommon form of thyroid cancer. It is
believed to develop from an existing papillary or follicular cancer. It is an aggressive cancer
that rapidly invades the neck, often spreads to other parts of the body, and is usually fatal.
Anaplastic carcinoma is sometimes called undifferentiated thyroid cancer. Both of these
names indicate that, under the microscope, they have very little, if any, similarity to normal
thyroid tissue. In contrast, the similarity of differentiated thyroid cancer to normal thyroid
tissue is easily seen under the microscope.
Medullary thyroid carcinoma: Medullary thyroid carcinoma (MTC) is the only thyroid cancer
that develops from the C cells of the thyroid gland. Sometimes this cancer can spread to
lymph nodes, the lungs, or liver even before a thyroid nodule is discovered or a screening
test is done. These cancers usually make calcitonin and carcinoembryonic antigen (CEA).
Calcitonin, a hormone also produced by normal C cells, helps control the amount of calcium in
blood. CEA is a protein produced by certain cancers, such as colorectal cancer and MTC. Both
the blood and can be found by blood tests. About 5% of thyroid cancers are medullary.
There are 2 types of MTC. The first type, occurring in 80% of cases, is called sporadic MTC.
Sporadic MTC is not inherited; that is, it does not run in families. It occurs mostly in older
adults and in only 1 thyroid lobe.
The other type of MTC is inherited and can occur in each generation of a family. When MTC
is the only type of cancer found in the family, it is called isolated familial medullary thyroid
carcinoma (FMTC). The combination of FMTC and tumors of certain other organs is called
type 2 multiple endocrine neoplasia (MEN 2). Type 2 MEN has 2 subtypes, MEN 2a and MEN
2b:
-In MEN 2a, MTC occurs with adrenal gland tumors called pheochromocytomas and with
parathyroid gland tumors that cause high blood calcium levels. The adrenal glands are found
next to the upper part of each kidney. Most people have 4 parathyroid glands, which are
found next to the thyroid.
-In MEN 2b, MTC is associated with pheochromocytoma but not parathyroid gland disease.
Instead, MEN 2b includes benign growths of nerve tissues on the tongue and elsewhere
called neuromas. In these familial or genetic forms of MTC, the cancers often develop during
childhood or early adulthood and can spread early. MTC is most aggressive in the MEN 2b
syndrome.
Thyroid lymphoma: Lymphoma can develop in the thyroid gland but is very uncommon in
that location. It does not develop from either thyroid follicular cells or C cells. Rather,
lymphomas develop from lymphocytes, the main cell type of the immune system. Most
lymphocytes are found in pea-sized collections scattered throughout the body called lymph
nodes, and that is where most lymphomas begin. These types of lymphomas are discussed in
the ACS document on Non-Hodgkin Lymphoma.
Staging of thyroid cancer
Primary tumor (T)
TX: Primary tumor cannot be assessed
Papillary or follicular
T0: No evidence of primary tumor
T1: Tumor 1 cm or less in greatest dimension limited to the thyroid
T2: Tumor more than 1 cm but not more than 4 cm in greatest dimension
limited to the thyroid
T3: Tumor more than 4 cm in greatest dimension limited to the thyroid
Under 45 years
45 years and older
Stage
I Any T, any N, M0
Stage
II Any T, any N, M1
Stage
Stage
I T1, N0, M0
II T2, N0, M0
T4: Tumor of any size extending beyond the thyroid capsule
T3, N0, M0
Stage
Regional lymph nodes (N)
Any T, N1, M0
Stage
Regional lymph nodes are the cervical and upper mediastinal lymph nodes.
NX: Regional lymph nodes cannot be assessed
III T4, N0, M0
IV Any T, any N, M1
Medullary
Stage
Stage
I T1, N0, M0
II T2, N0, M0
N0: No regional lymph node metastasis
T3, N0, M0
N1: Regional lymph node metastasis
T4, N0, M0
N1a: Metastasis in ipsilateral cervical lymph node(s)
N1b: Metastasis in bilateral, midline, or contralateral cervical or mediastinal
lymph node(s)
Stage III Any T, N1, M0
Stage IV Any T, any N, M1
Undifferentiated (anaplastic)
All cases are stage IV
Distant metastases (M)
Stage IV Any T, any N, any M
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis
References
1. Thyroid Gland. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa:
Lippincott-Raven Publishers, 1997, pp 59-64.
A920: thyroid: papillary carcinoma
Lot. No :
N1
T1
T1
N1
Fig 1. Scanned images for H&E
stained slides.
Pathology or other information:
AGE:
Sex:
Stage:
120213050611
37
Female
T2N1aM0
Pathology:
1.Thyroid gland, lobectomy:
Papillary carcinoma
1) extension to the capsule, but not penetrated.
2) size: 3x2.2cm.
Fig2. RT-PCR for GAP3DH
Sample : Serial 10 sections of
10micrometer slice
RNA conc.
(ng/ul)
260/280
T1
N1
624.41
142.61
1.98
1.97
A920: thyroid: papillary carcinoma
Lot. No :
N1
N2
T1
T2
120214012711
Fig2. RT-PCR for
GAP3DH
Sample : Serial 10
sections of
10micrometer slice
T
T
N
N
Fig 1. Scanned images
for H&E stained slides.
RNA conc.
(ng/ul)
260/280
T1
T2
N1
N2
377.87
567.21
102.71
40.18
1.93
1.9
1.9
1.85
Pathology or other information:
AGE:
Sex:
Stage:
45
Female
T3N1aM0
Pathology:
1.Thyroid gland, left, lobectomy:
Papillary carcinoma
1) extension to the perithyroidal soft tissue.
2) lymph node, regional (1/1): Metastatic carcinoma.
3) presence of a parathyroid gland.
A920: thyroid: papillary carcinoma
Lot. No :
N1
120214012721
T1
Fig2. RT-PCR for GAP3DH
Sample : Serial 10 sections of
10micrometer slice
Fig 1. Scanned images
for H&E stained slides.
T1
N1
RNA conc.
(ng/ul)
260/280
Pathology or other information:
AGE:
Sex:
Stage:
71
Male
T3N1aM0
Pathology:
1.Thyroid gland, left, lobectomy:
Papillary carcinoma
1) encapsulated and follicular variant
2) confined to the parenchyma.
T1
N1
282.66
133.47
2
1.9
A920: thyroid: papillary carcinoma
Lot. No :
N1
T1
Fig 1. Scanned images
for H&E stained slides.
T1
N1
Fig2. RT-PCR for GAP3DH
Sample : Serial 10 sections of
10micrometer slice
RNA conc.
(ng/ul)
260/280
Pathology or other information:
AGE:
Sex:
Stage:
1202104010811
70
Female
T1N0M0
Pathology:
1.Thyroid gland, frozen lobectomy:
Papillary carcinoma, follicular variant, with capsular invasion.
T1
N1
327.8
138.65
2
1.98