9/20/2013

9/20/2013

Answers:

All of the following are risk factors for papillary carcinoma except...

A)Radiation exposure
B)Hashimoto's
C) Cowden Syndrome
D) FAP
E) None of the above are risk factors

Prior radiation exposure, Cowden syndrome (multiple hamartomas) and Familial Adenomatous Polyposis are all risk factors for papillary carcinoma.

What are the four main types of thyroid cancer?

Papillary, Follicular, Medullary and Anaplastic

MC Questions:
If the following is found on histology of a thyroid nodule this would indicate a diagnoses of...

A) Papillary Carcinoma 

B) Papillary Adenoma 

C) Follicular Carcinoma 

D) Follicular Adenoma 

E) Medullary Carcinoma 

F) Anaplastic Thyroid Cancer

Free Response Question:
What is the most common type of thyroid cancer?  What is the second most common type?

Quick Facts:
Medullary Thyroid CA
-5% of thyroid CA
-From parafollicular/C cells
Clinical Findings
-Histo = sheets of cells w/ amyloid (stains congo red).
-Secretes calcitonin, histaminase, prostaglandins, serotonin.
-Extension often occurs to LN, muscle and trachea and can spread via heme to lunds/viscera.-Radiation not effective, treat surgically.
-MEN 2b has most aggressive form, MEN 2a and FMTC are least aggressive.
-Rule of 3rds: 1/3 sporadic, 1/3 MEN2, 1/3 familial w/o other associations.
-MEN2a = medullary CA, Pheo, Hyperparathyroidism
-MEN2b = medullary carcinoma, Pheo and multiple mucosal neuromas.
-FMTC = MEN2a with MTC as the only manifestation, must r/o pheo or primary hyperparathyroidism.
-Germline RET mutations present in MEN2 and FMTC.  Offer testing to family members.