thyroid carcinomas

See also : thyroid tumors

WHO Classification (2004)

 Thyroid carcinomas

• papillary thyroid carcinoma (PTC)
• follicular thyroid carcinoma (FTC)
• thyroid poorly differentiated carcinoma
• thyroid undifferentiated carcinoma (thyroid anaplastic carcinoma)
• thyroid anaplastic squamous cell carcinoma
• thyroid mucoepidermoid carcinoma
• thyroid anaplastic sclerosing mucoepidermoid carcinoma with eosinophilia
• thyroid anaplastic mucinous carcinoma
• medullary thyroid carcinoma
• mixed medullary and follicular cell carcinoma
• spindle cell tumor with thymus-like differentiation (SETTLE)
• carcinoma showing thymus-like differentiation (CASTLE)

TNM staging system 2007

Primary tumor (T)

 TX Primary tumor cannot be assessed
 T0 No evidence of primary tumor
 T1 Tumor 2 cm or less in its greatest dimension, limited to the thyroid
 T2 Tumor more than 2 cm, but not more than 4 cm in its greatest dimension, limited to the thyroid
 T3 Tumor more than 4 cm in its greatest dimension limited to the thyroid or any
tumor with minimal extrathyroidal extension (e.g., extension to sternothyroid
muscle or perithyroid soft tissues)
 T4a Tumor of any size extending beyond the thyroid capsule to invade
subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve
 T4b Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels

Regional lymph nodes (N)
 NX Regional lymph nodes cannot be assessed
 N0 No regional lymph node metastasis
 N1 Regional lymph node metastasis

• N1a Metastasis to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes)
• N1b Metastasis to unilateral, bilateral, or contralateral cervical or superior mediastinal lymph nodes

Distant metastasis (M)
 MX Distant metastasis cannot be assessed
 M0 No distant metastasis
 M1 Distant metastasis

 http://xa.yimg.com/kq/groups/19873088/582898492/name/TNM+no+ca+de+tireoide+-+2007.pdf
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1877011/

See also

 thyroid adenomas and related tumors :

• follicular adenoma
• hyalinizing trabecular tumor

 Other thyroid tumors:

• thyroid teratoma
• primary thyroid lymphomas and thyroid plasmacytoma
• ectopic thymoma
• thyroid angiosarcoma
• thyroid smooth muscle tumors
• thyroid peripheral nerve sheath tumors
• thyroid paraganglioma
• thyroid solitary fibrous tumor
• thyroid follicular dendritic cell tumor
• thyroid Langerhans cell histiocytosis
• thyroid secondary tumors

Presentations

 Management of Invasive Thyroid Carcinoma. Camysha Wright, MD, Vicente Resto, MD, PhD. 2007; http://www.utmb.edu/otoref/grnds/thyroid-CA-070502/thyroid-CA-slides-070502.pdf

Molecular biology

 BRAF-V600E is specific for papillary carcinoma. It is found in anaplastic thyroid carcinoma when it arises from papillary thyroid carcinoma.

 Ras mutations are found in 50% of anaplastic thyroid carcinomas compared to 70% harboring p53 mutations.

 Ret rearrangements are found in medullary carcinoma.

 Pax-8 PPAR-gamma is found in follicular lesions: follicular carcinoma, some follicular adenomas and follicular variants of papillary carcinoma.

 p53 is most commonly mutated in anaplastic thyroid carcinoma (70%), followed by beta-catenin (60%) and ras (50%) . If the carcinoma has BRAF V600E, than it is arising from papillary thyroid carcinoma.

 Mutations in anaplastic thyroid carcinoma: p53 (70%), beta-catenin (60%) and ras (50%). If the carcinoma has BRAF V600E, then it is arising from papillary thyroid carcinoma.