follicular thyroid carcinoma
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Etiology
- iodine deficiency may play a role
Epidemiology
- 10-20% of thyroid cancers
- most commonly occur in the 5th to 6th decade of life
- female/male predominance of 3/1
Pathology
- encapsulation is typical, making differentiation from follicular thyroid adenoma difficult*
- relatively uniform, orderly cuboidal cells surrounding occasionally colloid-filled follicles
- microscopic invasion through the capsule may result in distant metastases
- vascular dissemination predominates over lymphatic spread
* Much ado about removing the name 'cancer' from noninvasive encapsulated follicular variant of papillary thyroid carcinoma which seems to amount to follicular thyroid adenoma versus follicular thyroid carcinoma[3]
Immunophenotype
- thyroglobulin +
- TTF1 +
- vimentin +
Genetics
- implicated genes: TSHR
Clinical manifestations
- slowly enlarging, painless thyroid nodules (most common presentation)
- may present with metastases to the lung or bone
- functioning metastatic cancer may rarely present as thyrotoxicosis
Laboratory
- serum thyroglobulin may be used as a marker for residual or recurrent disease
Radiology
- more differentiated lesions may take-up radiolabeled iodine
Differential diagnosis
Management
- total thyroidectomy with lymph node dissection
- radio-iodine ablation of remnant thyroid tissue following surgery
- encapsulated lesions without capsular invasion may be surgically resected, resulting in cure
- prognosis:
- follow-up evaluation for recurrence requires
- discontinuation of levothyroxine
- allowing the TSH to rise
- measuring serum thyroglobulin as a marker for residual thyroid tissue
More general terms
Additional terms
References
- ↑ Cotran et al Robbins Pathologic Basis of Disease, 5th ed. W.B. Saunders Co, Philadelphia, PA 1994 pg 1138
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2015, 2018.
- ↑ 3.0 3.1 Nikiforov YE, Seethala RR, Tallini G et al Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma. A Paradigm Shift to Reduce Overtreatment of Indolent Tumors. JAMA Oncol. Published online April 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27078145 <Internet> http://oncology.jamanetwork.com/article.aspx?articleid=2513250
Patel KN Noninvasive Encapsulated Follicular Variant of Papillary Thyroid "Cancer" (or Not)Time for a Name Change. JAMA Oncol. Published online April 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27077657 <Internet> http://oncology.jamanetwork.com/article.aspx?articleid=2513246