Difference between revisions of "Follicular thyroid cancer pathophysiology"

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* On microscopic examination, trabecular, solid, follicular tumor cells that invade [[capsule|tumor capsule]] or surrounding vascular structures are found.
 
* On microscopic examination, trabecular, solid, follicular tumor cells that invade [[capsule|tumor capsule]] or surrounding vascular structures are found.
 
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Image:Follicular thyroid cancer 01.png|Thyroid, total thyroidectomy. Widely invasive follicular carcinoma, 4.5 cm, with lymphovascular invasion and extracapsular extension. Negative margins<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
 
Image:Lymph node FNAC metastatic follicular carcinoma.png|Lymph node FNA showing metastatic follicular carcinoma.<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
 
Image:Lymphnode FNAC metastatic follicular carcinoma 02.png|Lymph node FNA showing metastatic follicular carcinoma.<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
 
Image:FNAC lymph node metastatic follicular carcinoma 03.png|Lymph node FNA showing metastatic follicular carcinoma<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
 
Image:Metastatic follicular carcinoma in the bone.png|C1 vertebrae biopsy positive for metastatic follicular carcinoma<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
 
Image:Metastatic follicular cancer in the bone.png|C1 vertebrae biopsy positive for metastatic follicular carcinoma<ref name="AbidStack2014">{{cite journal|last1=Abid|first1=Syed A.|last2=Stack|first2=Brendan C.|last3=Bodenner|first3=Donald L.|title=Metastatic Follicular Thyroid Carcinoma Secreting Thyroid Hormone and Radioiodine Avid without Stimulation: A Case Report and Literature Review|journal=Case Reports in Endocrinology|volume=2014|year=2014|pages=1–6|issn=2090-6501|doi=10.1155/2014/584513}}</ref>
 
 
Image:Metastatic follicular thyroid carcinoma - Case 264 (8558730243).jpg|Metastatic follicular carcinoma<ref> Follicular thyroid cancer librepathology
 
Image:Metastatic follicular thyroid carcinoma - Case 264 (8558730243).jpg|Metastatic follicular carcinoma<ref> Follicular thyroid cancer librepathology
 
(2015). http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg Accessed on October, 29 2015</ref>
 
(2015). http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8558730243).jpg Accessed on October, 29 2015</ref>
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(2015). http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8559837390).jpg  Accessed on October, 29 2015</ref>
 
(2015). http://librepathology.org/wiki/index.php/File:Metastatic_follicular_thyroid_carcinoma_-_Case_264_(8559837390).jpg  Accessed on October, 29 2015</ref>
 
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==Histopathological Video==
 
==Histopathological Video==
 
===Video===
 
===Video===

Revision as of 22:19, 30 May 2019

Follicular thyroid cancer Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Follicular thyroid cancer arises from follicular cells of thyroid, which are secretory cells that are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3). Genes involved in the pathogenesis of follicular thyroid cancer include RAS, PAX8/PPARγ, and PTEN.

Pathogenesis

  • Follicular thyroid cancer is the second most common type of cancer. It constitutes about 15% of thyroid cancers.
Pathogenesis of follicular thyroid carcinoma





























  • Follicular thyroid cancer occurs more commonly in women of over 50 years old.
  • Thyroglobulin (Tg) can be used as a tumor marker for well-differentiated follicular thyroid cancer.
  • Follicular carcinoma tends to metastasize to the lungs and bone via the bloodstream. Follicular thyroid cancer metastasize late to lymph nodes, with only 5-10% of patients having nodal metastases at the time of diagnosis. Hematogenous spread is however much more common with 20% of patients having distant hematogenous metastases at at the time of diagnosis.[1]
  • A Hürthle cell (also known as Askanazy cell) is an oncocytic cell in the thyroid that is often associated with Hashimoto's thyroiditis as well as follicular thyroid cancer. Hürthle cells are characterized as enlarged epithelial cells with abundant eosinophilic granular cytoplasm as a result of altered mitochondria.[2] They generally stain pink and are prominently found in histological sections of thyroid glands affected with Hashimoto's.

Genetics

  • The Ras oncogene is positive in a significant proportion of individuals. The Ras oncogene acts through the RAF-MEK-MAPK kinase pathway.
  • Other genes involved in the pathogenesis of follicular thyroid cancer are:
  • RET/PTC (translocation) associated with MAPK and PI3K-AKT signaling pathways
  • PAX8/PPARγ (translocation) associated with PAX8-associated nuclear transcription signaling pathways. PAX8 is responsible for follicular cell differentiation.
  • PTEN (mutation) associated with PI3K-AKT signaling pathways
  • PTEN (deletion) associated with PI3K-AKT signaling pathways
  • IDH1 (mutation) assciated with IDH1-associated metabolic pathways signaling pathways
  • Phosphatase and tensin homologue suppressor gene and the phosphatidylinositol 3-kinase pathway are also involved in the pathogenesis of follicular thyroid tumor.
  • P53 (protein), c-myc, c-fos, and the thyrotropin (TSH) receptor are some other factors involved in the pathogenesis of follicular thyroid cancer.
  • MicroRNAs namely miR-192, miR-197, miR-328, and miR-346 have increased expression in follicular cell carcinoma.
Schema of key pathways in the development and progression of thyroid cancer.

Associated Conditions

Gross Pathology

  • Encapsulated tumors
Gross pathological section of a follicular thyroid carcinoma (tumor at the bottom).

Microscopic Pathology

  • It is not possible to distinguish between follicular adenoma and carcinoma on cytological grounds. If fine needle aspiration cytology (FNAC) suggests follicular neoplasm, thyroid lobectomy should be performed to establish th histopathological diagnosis.
  • On microscopic examination, trabecular, solid, follicular tumor cells that invade tumor capsule or surrounding vascular structures are found.

Histopathological Video

Video

References

  1. "Radiopedia 2015 Follicular thyroid cancer [Dr Matt A. Morgan and Dr Frank Gaillard]".
  2. Aytug, Serhat (June 13, 2006). "Hurthle Cell Carcinoma". eMedicine. Check date values in: |date= (help)

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