This document provides an introduction to thyroid neoplasms (tumors). It discusses the main types of benign and malignant thyroid tumors. For benign tumors, it describes follicular adenomas, which are benign, encapsulated tumors showing follicular differentiation. For malignant tumors, it outlines the primary tumor types: epithelial tumors like papillary and follicular carcinoma, and non-follicular tumors like medullary carcinoma. It then provides more detail on the most common malignant tumors. Papillary carcinoma accounts for 60% of thyroid cancers and often presents as multiple tumors. Follicular carcinoma spreads via angioinvasion and hematogenously. Anaplastic carcinoma is highly lethal and aggressive. Medullary carcinoma can

1. An Introduction to
thyroid neoplasms
Hosam Mohamad Hamza, MD
Lecturer of General & laparo-endoscopic surgery
Minia Medicine
Minia
Egypt
2016

2. teratoma
lipoma
adenoma
• A neoplasm or a tumour is a condition where automonus
irreversible purposeless proliferation of cells leads to
formation of an abnormal mass or growth.
• Thyroid tumours are either
Primary
tumours
metastatic
tumours
Benign
tumours Malignant
tumours

3. BENIGN TUMOURS OF THE THYROID
Follicular Adenoma
• Benign, encapsulated tumour showing
evidence of follicular differentiation
• Predominantly in young to middle women
• Presents as solitary thyroid nodule (painless
nodular mass, cold on isotopic scan)

5. Types of follicular adenomas:
1- Microfollicular adenoma (very small follicles)
2- Normofollicular adenoma (normal sized follicles)
3- Macrofollicular adenoma (large follicles distended with colloid)
4- Hurthle cell adenoma (follicles lined by large polyhedral cells =
Hurthle cells)
Thyroid noduleSolitary:presentationClinical
thyroid scan–biopsy–USthyroidInvestigations:
+ biopsyhemithyroidectomy:Treatment

6. ADENOMA
NORMAL

7. MALIGNANT TUMOURS OF THE THYROID
Primary tumours Secondary tumours
From:
* Nearby cancer
* Renal Carcinoma
* Breast Carcinoma
* Colonic Cancer
* Melanoma
1- Epithelial:
a- follicular
b- non-follicular (C-cells)
2- Mesenchymal = sarcoma
3- Others:
a- lymphoma
b- squamous cell carcin
c- mucoepidermoid arcin

8. 1- Prior neck irradiation early in life (the most
important single factor):
• External:
- Treatment for malignancies
- Nuclear weapons/accidents
• Internal:
treatment with I131
2- Prior thyroid lesions:
• Thyroid cancer
• STN (esp. males in age extremes)
• Simple Nodular Goitre (uncertian)
• Hashimoto’s thyroiditis (uncertain)
3- Genetic. e,g. Cowden’s syndrome
thyroid malignancyprimaryRisk Factors of
(POINTERS to thyroid malignancy)

9. A-
5 suggestive manifestations.
B-
5 sure manifestations.
C-
Occasional presentations.
Clinical manifestations of thyroid carcinomas

10. A- laboratory:
- thyroid function tests.
- tumour markers.
B- radiological:
- US
- CT
C- others:
- thyroid scan
- biopsy
Investigations

11. 1- Carcinoma of follicular origin:
a. Well-differentiated thyroid carcinoma (WDTC):
- papillary carcinoma (60%)
- follicular carcinoma.
- mixed type
b. Non-differentiated thyroid carcinoma:
anaplastic carcinoma
2- Carcinoma of non-follicular origin:
medullary carcinoma
Types of primary thyroid carcinomas

12. • 60%-80% of all thyroid cancers.
• Multiple histologic subtypes.
• Children and young adults.
• Females > Males.
• Lymphatic > haematogenous spread
(46%-90% of patients have lymph node involvement)
• Often multicenteric.
• Microcarcinomas may occur
Papillary thyroid carcinoma

13. Microcarcinomas (occult carcinomas):
• Definition - papillary carcinomas < 1.0 cm
• Usually clinically silent.
• Most are found incidentally at autopsy.
Papillary thyroid carcinoma, continued

14. Microscopic Pathology:
• Closely packed papillae with little colloid.
• Psammoma bodies – laminated calcified bodies.
• Nuclei are oval or elongated and pale.
Papillary thyroid carcinoma, continued

15. Papillary thyroid carcinoma, continued

17. Psammoma Bodies

18. Optically clear nuclei
(Orphan Annei-eye nuclei)

19. • 20% of all thyroid malignancies.
• Women > Men.
• More in middle age.
• Metastasis by angioinvasion and haematogenous
spread.
• 15% present with distant metastases (bone and
lung).
Follicular thyroid carcinoma

20. 20
Follicular thyroid carcinoma

21. Microscopic Pathology:
• Evidence of vascular and capsular invasion.
• FNAC cannot accurately distinquish between
benign and malignant lesions
Follicular thyroid carcinoma, continued

22. Capsular invasion
Capsular invasion

23. Capsular invasion Vascular invasion
Nuclear features Vascular invasion

24. • Highly lethal form of thyroid cancer (median
survival < 8 months )
• 1%-10% of all thyroid cancers.
• Affects the elderly (30% of thyroid cancers in
patients >70 years).
• Direct spread.
Anaplstic thyroid carcinoma

25. Microscopic Pathology:
• Clusters or sheets of very poorly differentiated
cells.
• Numerous mitoses.
• extrathyroidal invasion.
Anaplastic thyroid carcinoma, continued

27. • Arises from the para-follicular C-cells of the
thyroid gland which secrete calcitonin (Ca
metabolism).
• Diarrhea may be the presenting complain.
• Develops either as sporadic or familial types:
1- Sporadic MTC:
- no family history.
- middle and old age.
- Slightly more aggressive than Familial type.
2- Familial MTC:
- young age.
- autosomal dominant transmission.
- Multiple Endocrine Neoplasia II a and b
Medullary thyroid carcinoma

28. MEN IIA:
MTC.
Phaeochromocytoma.
Parathyroid adenoma or hyperplasia
MEN IIB:
MTC
Phaeochromocytoma
Mucosal ganglioneuromas
Marfanoid habitus
Hirscheprung’s disease
Medullary thyroid carcinoma, continued

29. Microscopic Pathology:
Medullary thyroid carcinoma, continued
- Same for sporadic & familial
- Solid, lobular or insular growth
patterns
- Tumour cells round, polygonal or
spindle-shaped
- Amyloid deposits in many
Cases
- Haematogenous and lymphatic
spread

30. Diagnosis
Labs:
1. serum calcitonin levels
2. 24 hour urinary catecholamines
Rad:
Others:
1. Fine needle aspiration
2. Genetic testing of all first
degree relatives (RET proto
oncogene)
Medullary thyroid carcinoma, continued

31. Primary Thyroid Lymphoma
- A rare type (5% of thyroid cancers)
- Develops in the setting of pre-existing
lymphocytic thyroiditis.
- Often diagnosed because of airway
obstruction symptoms
- Radiosensitive.
- Good prognosis.

32. Large Cell Lymphoma of the Thyroid

33. TreaTmenT of thyroid carcinomas
* Surgery is the main line of treatment.
* In WDTC:
1- total thyroidectomy.
2- If any cervical nodes are clinically palpable or
identified by MR or CT imaging as being suspicious,
neck dissection should be done (prophylactic neck
dissections are not done)
3- Hormone replacement therapy (T3)
4- Radioactive iodine (RAI):
= thyroid scan is done 30 days postoperatively (to allow
metastases – if present – to flourish.
= if secondaries are detected → ablative dose of RAI → 2
weeks later scan. Then every 6 months for 2 years. Then
every 12 months for 5 years

34. I131 Total Body Scan

35. TreaTmenT of thyroid carcinomas
continued
* In Anaplastic carcinoma:
- Most cases have extensive extrathyroidal involvement
at the time of diagnosis = surgery is limited to biopsy &
tracheostomy.
- Current standard of care is maximum surgical debulking
if possible then adjuvant radiotherapy and chemotherapy.

36. TreaTmenT of thyroid carcinomas
continued
* In Sporadic medullary carcinoma:
- Total thyroidectomy.
- Central lymph node dissection
In Familial medullary carcinoma:
- patient: ??
= remove pheochromocytoma before thyroid surgery
- relatives ??
= total thyroidectomy and central lymph node dissection
= SURGERY IS ONLY EFFECTIVE THERAPY

37. PapillaryBest prognosis
Follicular
Medullary
AnaplasticWorst prognosis

38. Thank You
hosam_hamza@ymail.com