Answers:
What percentage of FNAs demonstrate a benign lesion?
A) 10%
B) 25%
C) 50%
D) 75%
E) 90%
Roughly 75% are benign, 10% are considered suspicious, 5% are malignant, 15% are nondiagnostic
If a thyroid nodule is evaluated with a 99mTc pertechnetate scan and found to be "hot", what significance does this have?
"Hot" nodules have a low risk for malignancy, "cold" nodules are more likely to be malignant and an FNA should be performed.
MC Questions:
A 55 year old patient with a single 1.9cm thyroid nodule found to be papillary carcinoma on FNA with no evidence of LN involvement should receive what treatment?
A) Lobectomy and modified neck dissection with postop L-thyroxine, no surveillance needed
B)Total thyroidectomy and modified neck dissection with postop Lthyroxine and long term surveillance
C) total thyroidectomy with postop Lthyroxine, no surveillance needed
D) total thyroidectomy with postop Lthyroxine and longterm surveillance
E) total thyroidectomy with postop ablation, Lthyroxine and long term surveillance
A) 10%
B) 25%
C) 50%
D) 75%
E) 90%
Roughly 75% are benign, 10% are considered suspicious, 5% are malignant, 15% are nondiagnostic
If a thyroid nodule is evaluated with a 99mTc pertechnetate scan and found to be "hot", what significance does this have?
"Hot" nodules have a low risk for malignancy, "cold" nodules are more likely to be malignant and an FNA should be performed.
MC Questions:
A 55 year old patient with a single 1.9cm thyroid nodule found to be papillary carcinoma on FNA with no evidence of LN involvement should receive what treatment?
A) Lobectomy and modified neck dissection with postop L-thyroxine, no surveillance needed
B)Total thyroidectomy and modified neck dissection with postop Lthyroxine and long term surveillance
C) total thyroidectomy with postop Lthyroxine, no surveillance needed
D) total thyroidectomy with postop Lthyroxine and longterm surveillance
E) total thyroidectomy with postop ablation, Lthyroxine and long term surveillance
Free Response Question:
Why is it difficult to r/o follicular carcinoma on FNA?
Quick Facts:
Papillary Carcinoma
-most common thyroid cancer (75%)
-best prognosis (5% mortality @ 20 yrs if no local invasion @ presentation)
-Risk factors = childhood irradiation, fhx, cowden syndrome (multiple hamartomas) and familial adenomatous polyposis coli.
Clinical Findings
-Histo = single layers of thyroid cells in avascular projections or papillae. Large pale nuclei, intranuclear inclusion bodies and anaplastic features.
-"Psammoma bodies" = laminated calcified spheres = dx papillary carcinoma.
-Can be pure or mixed w/ follicular.
-Higher risk of recurrence in tall cell, columnar or diffuse sclerosing subtypes.
-Lesions grow slowly, rarely converts to anaplastic CA.
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