1. An Introduction to
thyroid neoplasms
Hosam Mohamad Hamza, MD
Lecturer of General & laparo-endoscopic surgery
Minia Medicine
Minia
Egypt
2016
2. teratoma
lipoma
adenoma
• A neoplasm or a tumour is a condition where automonus
irreversible purposeless proliferation of cells leads to
formation of an abnormal mass or growth.
• Thyroid tumours are either
Primary
tumours
metastatic
tumours
Benign
tumours Malignant
tumours
3. BENIGN TUMOURS OF THE THYROID
Follicular Adenoma
• Benign, encapsulated tumour showing
evidence of follicular differentiation
• Predominantly in young to middle women
• Presents as solitary thyroid nodule (painless
nodular mass, cold on isotopic scan)
4.
5. Types of follicular adenomas:
1- Microfollicular adenoma (very small follicles)
2- Normofollicular adenoma (normal sized follicles)
3- Macrofollicular adenoma (large follicles distended with colloid)
4- Hurthle cell adenoma (follicles lined by large polyhedral cells =
Hurthle cells)
Thyroid noduleSolitary:presentationClinical
thyroid scan–biopsy–USthyroidInvestigations:
+ biopsyhemithyroidectomy:Treatment
7. MALIGNANT TUMOURS OF THE THYROID
Primary tumours Secondary tumours
From:
* Nearby cancer
* Renal Carcinoma
* Breast Carcinoma
* Colonic Cancer
* Melanoma
1- Epithelial:
a- follicular
b- non-follicular (C-cells)
2- Mesenchymal = sarcoma
3- Others:
a- lymphoma
b- squamous cell carcin
c- mucoepidermoid arcin
8. 1- Prior neck irradiation early in life (the most
important single factor):
• External:
- Treatment for malignancies
- Nuclear weapons/accidents
• Internal:
treatment with I131
2- Prior thyroid lesions:
• Thyroid cancer
• STN (esp. males in age extremes)
• Simple Nodular Goitre (uncertian)
• Hashimoto’s thyroiditis (uncertain)
3- Genetic. e,g. Cowden’s syndrome
thyroid malignancyprimaryRisk Factors of
(POINTERS to thyroid malignancy)
11. 1- Carcinoma of follicular origin:
a. Well-differentiated thyroid carcinoma (WDTC):
- papillary carcinoma (60%)
- follicular carcinoma.
- mixed type
b. Non-differentiated thyroid carcinoma:
anaplastic carcinoma
2- Carcinoma of non-follicular origin:
medullary carcinoma
Types of primary thyroid carcinomas
12. • 60%-80% of all thyroid cancers.
• Multiple histologic subtypes.
• Children and young adults.
• Females > Males.
• Lymphatic > haematogenous spread
(46%-90% of patients have lymph node involvement)
• Often multicenteric.
• Microcarcinomas may occur
Papillary thyroid carcinoma
13. Microcarcinomas (occult carcinomas):
• Definition - papillary carcinomas < 1.0 cm
• Usually clinically silent.
• Most are found incidentally at autopsy.
Papillary thyroid carcinoma, continued
14. Microscopic Pathology:
• Closely packed papillae with little colloid.
• Psammoma bodies – laminated calcified bodies.
• Nuclei are oval or elongated and pale.
Papillary thyroid carcinoma, continued
19. • 20% of all thyroid malignancies.
• Women > Men.
• More in middle age.
• Metastasis by angioinvasion and haematogenous
spread.
• 15% present with distant metastases (bone and
lung).
Follicular thyroid carcinoma
21. Microscopic Pathology:
• Evidence of vascular and capsular invasion.
• FNAC cannot accurately distinquish between
benign and malignant lesions
Follicular thyroid carcinoma, continued
24. • Highly lethal form of thyroid cancer (median
survival < 8 months )
• 1%-10% of all thyroid cancers.
• Affects the elderly (30% of thyroid cancers in
patients >70 years).
• Direct spread.
Anaplstic thyroid carcinoma
25. Microscopic Pathology:
• Clusters or sheets of very poorly differentiated
cells.
• Numerous mitoses.
• extrathyroidal invasion.
Anaplastic thyroid carcinoma, continued
26.
27. • Arises from the para-follicular C-cells of the
thyroid gland which secrete calcitonin (Ca
metabolism).
• Diarrhea may be the presenting complain.
• Develops either as sporadic or familial types:
1- Sporadic MTC:
- no family history.
- middle and old age.
- Slightly more aggressive than Familial type.
2- Familial MTC:
- young age.
- autosomal dominant transmission.
- Multiple Endocrine Neoplasia II a and b
Medullary thyroid carcinoma
29. Microscopic Pathology:
Medullary thyroid carcinoma, continued
- Same for sporadic & familial
- Solid, lobular or insular growth
patterns
- Tumour cells round, polygonal or
spindle-shaped
- Amyloid deposits in many
Cases
- Haematogenous and lymphatic
spread
30. Diagnosis
Labs:
1. serum calcitonin levels
2. 24 hour urinary catecholamines
Rad:
Others:
1. Fine needle aspiration
2. Genetic testing of all first
degree relatives (RET proto
oncogene)
Medullary thyroid carcinoma, continued
31. Primary Thyroid Lymphoma
- A rare type (5% of thyroid cancers)
- Develops in the setting of pre-existing
lymphocytic thyroiditis.
- Often diagnosed because of airway
obstruction symptoms
- Radiosensitive.
- Good prognosis.
33. TreaTmenT of thyroid carcinomas
* Surgery is the main line of treatment.
* In WDTC:
1- total thyroidectomy.
2- If any cervical nodes are clinically palpable or
identified by MR or CT imaging as being suspicious,
neck dissection should be done (prophylactic neck
dissections are not done)
3- Hormone replacement therapy (T3)
4- Radioactive iodine (RAI):
= thyroid scan is done 30 days postoperatively (to allow
metastases – if present – to flourish.
= if secondaries are detected → ablative dose of RAI → 2
weeks later scan. Then every 6 months for 2 years. Then
every 12 months for 5 years
35. TreaTmenT of thyroid carcinomas
continued
* In Anaplastic carcinoma:
- Most cases have extensive extrathyroidal involvement
at the time of diagnosis = surgery is limited to biopsy &
tracheostomy.
- Current standard of care is maximum surgical debulking
if possible then adjuvant radiotherapy and chemotherapy.
36. TreaTmenT of thyroid carcinomas
continued
* In Sporadic medullary carcinoma:
- Total thyroidectomy.
- Central lymph node dissection
In Familial medullary carcinoma:
- patient: ??
= remove pheochromocytoma before thyroid surgery
- relatives ??
= total thyroidectomy and central lymph node dissection
= SURGERY IS ONLY EFFECTIVE THERAPY
