Thyroid carcinoma usually capture radioactive iodine than normal thyroid gland is located in the surroundings. Therefore, when done scintiscan, nodules will appear as an area with less retrieval, a cold lesion.
Other diagnostic techniques that can be used for differential diagnosis of thyroid nodules are thyroid Ecography. This technique allows to distinguish carefully between solid masses and cystic masses. Thyroid carcinoma usually solid, while the cystic mass is usually a benign cyst.
Thyroid carcinoma should be suspected based on clinical signs if there is only one palpable nodules, hard, basically can not be moved, and is associated with satellite lymphadenopathy.
It was generally agreed that clinical thyroid cancer can be divided into a large group of well differentiated neoplasms, with a slow growth rate and high cure is possible, and a small group of anaplastic tumor with possible fatal. There are four types of thyroid cancer according to morphologic and biological properties: papillary, follicularis, medullary, and anaplastic. (Price, 1995, p: 1078)
Papillary carcinoma of the thyroid gland is usually in the form of hard nodules, single, "cold" on the isotope scan, and "solid" on thyroid ultrasound, which is very different from other parts of the gland. In multinodular goiter, cancer in the form of "dominant nodule" bigger, louder and clear from the surroundings. Approximately 10% of papillary carcinoma, especially in children, with enlarged cervical lymph nodes, but careful examination will usually reveal nodules are "cold" in the thyroid. Rarely, will hemorrhage, necrosis and cyst formation in malignant nodules but on thyroid ultrasonography, there will be a clearly bounded internal echo is useful for semi malignant cystic lesions of "pure cysts" were not malignant. Finally, papillary carcinoma can be found accidentally as a microscopic focus of cancer in the middle of the gland removed for other reasons such as: Graves' disease or multinodular goitre.
Microscopically, the tumor is composed of a single layer of thyroid cells organized in "vascular stalk", with protrusion of the optic disc into the microscopic space such as a cyst. Cell nuclei are large and often contain inclusion bodies pale nucleus intra clear and glassy. Approximately 40% of papillary carcinoma forming a layered spheres classification, often at the end of the optic disc bulge called "psammoma body", is usually diagnostic for papillary carcinoma. This cancer is usually spread by metastasis in the gland and the thyroid gland invasion and local lymph nodes. In elderly patients, they can be more aggressive and invade locally into the muscle and trachea. In stage further, they can spread to the lungs. Death is usually due to local disease, with invasion into the neck, more rarely death could be due to extensive pulmonary metastases. In some elderly patients, a slow-growing papillary carcinoma will begin to grow rapidly and transform into anaplastic carcinoma. Further anaplastic changes are another cause of death from papillary carcinoma, papillary carcinoma secreting lots of thyroglobulin, which can be used as a sign of recurrence or metastasis of cancer.
Follicular carcinoma is characterized by the persistence of small follicles despite bad colloid formation. Indeed, follicular carcinoma can not be distinguished from follicular adenomas except with capsule invasion or vascular invasion. The tumor is slightly more aggressive than papillary carcinoma and spreads either by local invasion or lymph node invasion of blood vessels accompanied by distant metastases to bone or lung. Microscopically, these cells are cuboidal shaped with large nuclei were irregular around the follicle, often containing colloid. These tumors are often still have the ability to concentrate radioactive iodine to form tiroglubulin and rarely, to synthesize T3 and T4. Thus, the function of the thyroid cancer that is almost always a rare follicular carcinoma. These characteristics make these tumors more it is likely to give good results against radioactive iodine treatment. In untreated patients, death due to local extension or distant metastases because the flow of blood with extensive involvement of the bones, lungs, and viscera.
A variant of follicular carcinoma is carcinoma "Hurthle cell" which is characterized by cells alone great with pink cytoplasm containing mitochondria. They behave more like papillary carcinoma unless they are rare radioiodine uptake. Papillary and follicular carcinoma of the mixture is more like a papillary carcinoma. Thyroglobulin secretion produced by follicular carcinoma can be used to follow the course of the disease.
Medullary carcinoma is a disease of the cell C (parafolikular cells) derived from primary branchial body and is able to secrete calcitonin, histaminase, prostaglandins, serotonin, and other peptides. Microscopically, the tumor is composed of layers of cells separated by stained with a red substance. Amyloid is composed of a chain of calcitonin, which are arranged in the pattern of fibrils, or as opposed to other forms of amyloid, which can have a light chain immunoglobulins or other proteins that are deposited with a pattern of fibrils.
Medullary carcinoma is more aggressive than papillary or follicular carcinomas but not as aggressive as undifferentiated thyroid cancer. It extends locally to the lymph nodes and into the surrounding muscles and trachea. Could lymphatic invasion, and blood vessels and metastasis to the lungs and viscera. Calcitonin and Carcinoembryonic antigen (CEA), which is secreted by the tumor is of clinical signs that aid in the diagnosis and follow-up. Approximately one third of medullary carcinoma, is familial, involving multiple nodes (Multiple Endocrin neoplasia type II = MEN II, Sipple syndrome). MEN II is characterized by medullary carcinoma, pheochromocytoma, and multiple neuromas on the tongue, lips, and intestines. Approximately one-third is simply a case of malignancy. If medullary carcinoma diagnosed by fine needle aspiration biopsy or during surgery, it is important patients examined for other endocrine disorders encountered in MEN II and members are checked for the presence of medullary carcinoma and MEN II. Measurement of serum calcitonin after pentagastrin stimulation or infusion of calcium can be used to screen for medullary carcinoma. Abnormal increase of serum calcitonin in the minutes to 3 or 5 is indicative of malignancy.
Anaplastic carcinoma, undifferentiated thyroid gland tumors including small cell carcinoma, giant cells, and spindle cells. It usually occurs in older patients with a long history of goiter in which the glands suddenly within a few weeks or months began to swell and produce pressure symptoms, dysphagia or vocal cord paralysis, death due to local expansion usually occurs within 6-36 months . These tumors are highly resistant to treatment.
Other diagnostic techniques that can be used for differential diagnosis of thyroid nodules are thyroid Ecography. This technique allows to distinguish carefully between solid masses and cystic masses. Thyroid carcinoma usually solid, while the cystic mass is usually a benign cyst.
Thyroid carcinoma should be suspected based on clinical signs if there is only one palpable nodules, hard, basically can not be moved, and is associated with satellite lymphadenopathy.
It was generally agreed that clinical thyroid cancer can be divided into a large group of well differentiated neoplasms, with a slow growth rate and high cure is possible, and a small group of anaplastic tumor with possible fatal. There are four types of thyroid cancer according to morphologic and biological properties: papillary, follicularis, medullary, and anaplastic. (Price, 1995, p: 1078)
Papillary carcinoma of the thyroid gland is usually in the form of hard nodules, single, "cold" on the isotope scan, and "solid" on thyroid ultrasound, which is very different from other parts of the gland. In multinodular goiter, cancer in the form of "dominant nodule" bigger, louder and clear from the surroundings. Approximately 10% of papillary carcinoma, especially in children, with enlarged cervical lymph nodes, but careful examination will usually reveal nodules are "cold" in the thyroid. Rarely, will hemorrhage, necrosis and cyst formation in malignant nodules but on thyroid ultrasonography, there will be a clearly bounded internal echo is useful for semi malignant cystic lesions of "pure cysts" were not malignant. Finally, papillary carcinoma can be found accidentally as a microscopic focus of cancer in the middle of the gland removed for other reasons such as: Graves' disease or multinodular goitre.
Microscopically, the tumor is composed of a single layer of thyroid cells organized in "vascular stalk", with protrusion of the optic disc into the microscopic space such as a cyst. Cell nuclei are large and often contain inclusion bodies pale nucleus intra clear and glassy. Approximately 40% of papillary carcinoma forming a layered spheres classification, often at the end of the optic disc bulge called "psammoma body", is usually diagnostic for papillary carcinoma. This cancer is usually spread by metastasis in the gland and the thyroid gland invasion and local lymph nodes. In elderly patients, they can be more aggressive and invade locally into the muscle and trachea. In stage further, they can spread to the lungs. Death is usually due to local disease, with invasion into the neck, more rarely death could be due to extensive pulmonary metastases. In some elderly patients, a slow-growing papillary carcinoma will begin to grow rapidly and transform into anaplastic carcinoma. Further anaplastic changes are another cause of death from papillary carcinoma, papillary carcinoma secreting lots of thyroglobulin, which can be used as a sign of recurrence or metastasis of cancer.
Follicular carcinoma is characterized by the persistence of small follicles despite bad colloid formation. Indeed, follicular carcinoma can not be distinguished from follicular adenomas except with capsule invasion or vascular invasion. The tumor is slightly more aggressive than papillary carcinoma and spreads either by local invasion or lymph node invasion of blood vessels accompanied by distant metastases to bone or lung. Microscopically, these cells are cuboidal shaped with large nuclei were irregular around the follicle, often containing colloid. These tumors are often still have the ability to concentrate radioactive iodine to form tiroglubulin and rarely, to synthesize T3 and T4. Thus, the function of the thyroid cancer that is almost always a rare follicular carcinoma. These characteristics make these tumors more it is likely to give good results against radioactive iodine treatment. In untreated patients, death due to local extension or distant metastases because the flow of blood with extensive involvement of the bones, lungs, and viscera.
A variant of follicular carcinoma is carcinoma "Hurthle cell" which is characterized by cells alone great with pink cytoplasm containing mitochondria. They behave more like papillary carcinoma unless they are rare radioiodine uptake. Papillary and follicular carcinoma of the mixture is more like a papillary carcinoma. Thyroglobulin secretion produced by follicular carcinoma can be used to follow the course of the disease.
Medullary carcinoma is a disease of the cell C (parafolikular cells) derived from primary branchial body and is able to secrete calcitonin, histaminase, prostaglandins, serotonin, and other peptides. Microscopically, the tumor is composed of layers of cells separated by stained with a red substance. Amyloid is composed of a chain of calcitonin, which are arranged in the pattern of fibrils, or as opposed to other forms of amyloid, which can have a light chain immunoglobulins or other proteins that are deposited with a pattern of fibrils.
Medullary carcinoma is more aggressive than papillary or follicular carcinomas but not as aggressive as undifferentiated thyroid cancer. It extends locally to the lymph nodes and into the surrounding muscles and trachea. Could lymphatic invasion, and blood vessels and metastasis to the lungs and viscera. Calcitonin and Carcinoembryonic antigen (CEA), which is secreted by the tumor is of clinical signs that aid in the diagnosis and follow-up. Approximately one third of medullary carcinoma, is familial, involving multiple nodes (Multiple Endocrin neoplasia type II = MEN II, Sipple syndrome). MEN II is characterized by medullary carcinoma, pheochromocytoma, and multiple neuromas on the tongue, lips, and intestines. Approximately one-third is simply a case of malignancy. If medullary carcinoma diagnosed by fine needle aspiration biopsy or during surgery, it is important patients examined for other endocrine disorders encountered in MEN II and members are checked for the presence of medullary carcinoma and MEN II. Measurement of serum calcitonin after pentagastrin stimulation or infusion of calcium can be used to screen for medullary carcinoma. Abnormal increase of serum calcitonin in the minutes to 3 or 5 is indicative of malignancy.
Anaplastic carcinoma, undifferentiated thyroid gland tumors including small cell carcinoma, giant cells, and spindle cells. It usually occurs in older patients with a long history of goiter in which the glands suddenly within a few weeks or months began to swell and produce pressure symptoms, dysphagia or vocal cord paralysis, death due to local expansion usually occurs within 6-36 months . These tumors are highly resistant to treatment.
1 Comment for "Pathophysiology of Thyroid Carcinoma"
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