A920: Thyroid: Papillary carcinoma

Transcription

1 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.

2 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.

3 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.

4 Primary tumor (T) Staging of thyroid cancer TX: Primary tumor cannot be assessed T0: No evidence of primary tumor : 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 T4: Tumor of any size extending beyond the thyroid capsule Regional lymph nodes (N) Regional lymph nodes are the cervical and upper mediastinal lymph nodes. NX: Regional lymph nodes cannot be assessed N0: No regional lymph node metastasis : Regional lymph node metastasis a: Metastasis in ipsilateral cervical lymph node(s) b: Metastasis in bilateral, midline, or contralateral cervical or mediastinal lymph node(s) Distant metastases (M) Papillary or follicular Under 45 years Stage I Any T, any N, M0 Stage II Any T, any N, M1 45 years and older Stage I, N0, M0 Stage II T2, N0, M0 T3, N0, M0 Stage III T4, N0, M0 Any T,, M0 Stage IV Any T, any N, M1 Medullary Stage I, N0, M0 Stage II T2, N0, M0 T3, N0, M0 T4, N0, M0 Stage III Any T,, M0 Stage IV Any T, any N, M1 Undifferentiated (anaplastic) All cases are stage IV 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

5 A920: thyroid: papillary carcinoma Lot. No : Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of 10micrometer slice Fig 1. Scanned images for H&E stained slides. RNA conc. (ng/ul) / Pathology or other information: AGE: 37 Sex: Female Stage: T2aM0 Pathology: 1.Thyroid gland, lobectomy: Papillary carcinoma 1) extension to the capsule, but not penetrated. 2) size: 3x2.2cm.

6 A920: thyroid: papillary carcinoma Lot. No : N2 T2 T T N N Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of 10micrometer slice Fig 1. Scanned images for H&E stained slides. T2 N2 RNA conc. (ng/ul) / Pathology or other information: AGE: 45 Sex: Female Stage: T3aM0 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.

7 A920: thyroid: papillary carcinoma Lot. No : Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of 10micrometer slice Fig 1. Scanned images for H&E stained slides. RNA conc. (ng/ul) / Pathology or other information: AGE: 71 Sex: Male Stage: T3aM0 Pathology: 1.Thyroid gland, left, lobectomy: Papillary carcinoma 1) encapsulated and follicular variant 2) confined to the parenchyma.

8 A920: thyroid: papillary carcinoma Lot. No : Fig 1. Scanned images for H&E stained slides. Fig2. RT-PCR for GAP3DH Sample : Serial 10 sections of 10micrometer slice RNA conc. (ng/ul) / Pathology or other information: AGE: 70 Sex: Female Stage: N0M0 Pathology: 1.Thyroid gland, frozen lobectomy: Papillary carcinoma, follicular variant, with capsular invasion.