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Endocrine
endocrinePathology
131-I radioactive uptake studies:
uptake seen in Graves or nodular goiter;
uptake seen in adenoma and carcinoma (warrants FNA biopsy don't take regular biopsy because it will bleed like crazy)
Thyroid cancer
Papillary carcinoma
Most common, excellent prognosis. Empty-appearing nuclei with central clearing (Orphan
Annie eyes) A , psammoma bodies, nuclear grooves. Lymphatic invasion common. risk with
Esp. cervical nodes. Even with
RET and BRAF mutations, childhood irradiation. e.g., old treatment for severe acne
spread, prognosis is excellent
Follicular carcinoma
Good prognosis, invades thyroid capsule (unlike follicular adenoma), uniform follicles.
Medullary carcinoma
Undifferentiated/
anaplastic carcinoma
Lymphoma
Note that FNA cannot distinguish between follicular adenoma (left) vs.
carcinoma (right). It will just show follicular cells either way. The only
way to distinguish them is to see the capsule, either on gross specimen
or under microscope to see if there is microscopic invasion.
Although the general rule is that carcinoma
likes to spread to lymph node, this likes to
spread hematogenously (other "rule
violators" = renal cell carcinoma [via renal
v.], hepatocellular carcinoma [via hepatic
v.], choriocarcinoma [placenta/uterus])
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