Tyroid Nodule

Question 1

4 types of malignant tyroid neoplasms

Answer 1

1. Papillary (85%)
   - multifocal, LN
2. Follicular/Hurthle (5%)
   - vascular spread
3. Anaplastic ( undiff)
4. medullary
   - spread via blood

Question 2

Two types of follicular/Hurthle cell carcinoma

Answer 2

1. minimally invasive

2. Widely invasive

Question 3

Anaplastic carcinoma

Answer 3

1. older age group
   - poor survival
2. rapidly growing
3. 3 patterns
   - spindle cells
   - giant cell
   - squamoid cells
4. necrosis or hemorrhage

Question 4

Medullary carcinoma

Answer 4

1. solid proliferation of cells with granular cytoplasm (parafollicular C Cells)
2. Highly vascular stroma
3. Hyalinized collagen and/or amyloid

• RET mut

Question 5

What nerve runs behind the thyroid and into the trachea?

Answer 5

recurrent laryngeal

Question 6

Metastatic cancers that like to spread to thyroid gland

Answer 6

1. melanoma
2. lung
3. head and neck
4. renal
5. breast
6. colon

Question 7

If a patient has a TSH test, US and gets an FNA, and the results turn out to be indeterminant, what is the next step?

Answer 7

Consider nuclear imaging

Question 8

Proto-oncogene

Answer 8

nl gene which codes for a protein that promotes nl cell division

Question 9

Oncogene

Answer 9

Mutated gene which codes for a protein that causes unregulated cell division

(gas)

Question 10

Tumor suppressor gene

Answer 10

Nl gene which codes for a protein that restrains cell division or that promotes cell differentiation, DNA repair or apoptosis

(P53, RB - brakes)

Question 11

Tumors result from ____ activation or _______ loss

Answer 11

oncogene, TSG loss

Question 12

Most common mutation in all thyroid cancers

Answer 12

BRAF - proto oncogene is point mutated

*BRAF alone cant cause anaplastic, need to take off the brakes too (p53)

Question 13

Pax8-PPARy mut can cause which type of thyroid cancer?

Answer 13

follicular thyroic carcinoma

Question 14

Some mutations that can cause papillar thyroid carcinoma

Answer 14

RET/PTC
Trk
Met
Ras
BRAF!!