The new 2022 WHO classification of thyroid neoplasms introduces several changes from the 2017 classification, including new and redefined categories. Key changes include separating encapsulated follicular variant papillary carcinoma (FVPTC) as its own entity, reclassifying some lesions as low risk tumors rather than benign or malignant, and adding new salivary gland-type carcinomas. The new classification aims to provide clearer understanding of thyroid tumors based on cell of origin, pathology, molecular features, and biological behavior.
Thyroid Neoplasms an update based on latest WHOVivekanand A
This document discusses updates to the classification of thyroid neoplasms in the latest WHO classification. It describes the hierarchical classification system used which is based on cell of origin, pathologic features, molecular characteristics, and biological behavior. It provides details on the classification of benign and malignant follicular cell-derived neoplasms. It introduces new entities such as noninvasive encapsulated follicular variant of papillary thyroid carcinoma (NIFTP) and differentiated high-grade thyroid carcinoma (DHGTC). It also discusses criteria for diagnosing poorly differentiated thyroid carcinoma and provides recommendations for management and follow-up of thyroid neoplasms based on risk stratification.
The document discusses molecular subtyping of breast cancer through gene expression profiling which has identified major subtypes including luminal A, luminal B, HER2-enriched, and basal-like. It describes the characteristic gene expressions and clinical features of each subtype. Molecular subtyping is shown to have prognostic and predictive relevance for breast cancer outcomes and treatment responses.
This document discusses the pathology and molecular classification of breast cancer. It begins by listing different tumor types that can affect the breast, including epithelial tumors, myoepithelial lesions, and mesenchymal tumors. It then describes the gross and microscopic features of common invasive breast cancer subtypes like invasive ductal carcinoma and invasive lobular carcinoma. Next, it discusses the molecular mechanisms and pathways involved in breast cancer pathogenesis, focusing on the roles of estrogen receptor, HER2, and other factors. The document concludes by outlining the molecular classification of invasive breast cancers into luminal A, luminal B, HER2-enriched, and basal-like/triple negative subtypes based on gene expression and biomarker profiles.
Prognostic & predictive factors of breast cancerMohammed Fathy
1) Prognostic factors provide information about a patient's outcome without treatment, while predictive factors provide information about how a patient may respond to a specific treatment.
2) Many clinical factors, pathological features, tissue markers, and genomic expression profiles can provide prognostic and predictive information for breast cancer patients.
3) Key prognostic factors include age, tumor stage, tumor size, nodal involvement, histological grade, hormone receptor status, and intrinsic subtypes. Predictive factors include hormone receptor and HER2 status.
The document discusses molecular testing for breast cancer. It describes how molecular testing can provide insights into breast cancer subtypes, predict response to treatments, and assess recurrence risk. Several molecular tests are discussed, including Oncotype DX, Mammaprint, Prosigna, and tumor sequencing to identify actionable mutations. Molecular profiling is becoming increasingly important for personalized prevention, diagnosis, and treatment of breast cancer.
This document discusses various histological structures and lesions that can mimic prostate carcinoma on biopsy. It describes entities such as atrophy, basal cell hyperplasia, adenosis, non-specific granulomatous prostatitis, and clear cell cribriform hyperplasia that resemble low or high-grade prostate cancer. Distinguishing these mimickers from cancer relies on architectural features, cytology, immunohistochemistry, and the presence of basal cells. While some mimickers can be difficult to differentiate from cancer on limited biopsy sampling, correlation with clinical findings and use of immunohistochemical markers are important to arrive at an accurate diagnosis.
This document discusses immunohistochemistry (IHC), which is used to identify tissue antigens through antigen-antibody interactions. It provides details on the IHC process, common antibodies and their targets, and tumor markers. IHC is useful for tumor diagnosis, narrowing differential diagnoses, and detecting unexpected diagnoses. The antibody panels discussed can help determine the primary site of cancers and differentiate between tumor types.
Classification and diagnostic approach to fnac of mediastinalIndira Shastry
This document discusses the classification and diagnostic approach to fine needle aspiration cytology (FNAC) of mediastinal tumors. It describes the various tumor types that can occur in the mediastinum, including thymic tumors, germ cell tumors, lymphomas, and others. For each tumor type, it provides details on cytological features, differential diagnoses, immunohistochemistry findings, and other diagnostic information useful for FNAC-based diagnosis of mediastinal masses. The goal is to simplify the classification and provide guidance on distinguishing between benign and malignant mediastinal tumors using cytology samples.
Thyroid Neoplasms an update based on latest WHOVivekanand A
This document discusses updates to the classification of thyroid neoplasms in the latest WHO classification. It describes the hierarchical classification system used which is based on cell of origin, pathologic features, molecular characteristics, and biological behavior. It provides details on the classification of benign and malignant follicular cell-derived neoplasms. It introduces new entities such as noninvasive encapsulated follicular variant of papillary thyroid carcinoma (NIFTP) and differentiated high-grade thyroid carcinoma (DHGTC). It also discusses criteria for diagnosing poorly differentiated thyroid carcinoma and provides recommendations for management and follow-up of thyroid neoplasms based on risk stratification.
The document discusses molecular subtyping of breast cancer through gene expression profiling which has identified major subtypes including luminal A, luminal B, HER2-enriched, and basal-like. It describes the characteristic gene expressions and clinical features of each subtype. Molecular subtyping is shown to have prognostic and predictive relevance for breast cancer outcomes and treatment responses.
This document discusses the pathology and molecular classification of breast cancer. It begins by listing different tumor types that can affect the breast, including epithelial tumors, myoepithelial lesions, and mesenchymal tumors. It then describes the gross and microscopic features of common invasive breast cancer subtypes like invasive ductal carcinoma and invasive lobular carcinoma. Next, it discusses the molecular mechanisms and pathways involved in breast cancer pathogenesis, focusing on the roles of estrogen receptor, HER2, and other factors. The document concludes by outlining the molecular classification of invasive breast cancers into luminal A, luminal B, HER2-enriched, and basal-like/triple negative subtypes based on gene expression and biomarker profiles.
Prognostic & predictive factors of breast cancerMohammed Fathy
1) Prognostic factors provide information about a patient's outcome without treatment, while predictive factors provide information about how a patient may respond to a specific treatment.
2) Many clinical factors, pathological features, tissue markers, and genomic expression profiles can provide prognostic and predictive information for breast cancer patients.
3) Key prognostic factors include age, tumor stage, tumor size, nodal involvement, histological grade, hormone receptor status, and intrinsic subtypes. Predictive factors include hormone receptor and HER2 status.
The document discusses molecular testing for breast cancer. It describes how molecular testing can provide insights into breast cancer subtypes, predict response to treatments, and assess recurrence risk. Several molecular tests are discussed, including Oncotype DX, Mammaprint, Prosigna, and tumor sequencing to identify actionable mutations. Molecular profiling is becoming increasingly important for personalized prevention, diagnosis, and treatment of breast cancer.
This document discusses various histological structures and lesions that can mimic prostate carcinoma on biopsy. It describes entities such as atrophy, basal cell hyperplasia, adenosis, non-specific granulomatous prostatitis, and clear cell cribriform hyperplasia that resemble low or high-grade prostate cancer. Distinguishing these mimickers from cancer relies on architectural features, cytology, immunohistochemistry, and the presence of basal cells. While some mimickers can be difficult to differentiate from cancer on limited biopsy sampling, correlation with clinical findings and use of immunohistochemical markers are important to arrive at an accurate diagnosis.
This document discusses immunohistochemistry (IHC), which is used to identify tissue antigens through antigen-antibody interactions. It provides details on the IHC process, common antibodies and their targets, and tumor markers. IHC is useful for tumor diagnosis, narrowing differential diagnoses, and detecting unexpected diagnoses. The antibody panels discussed can help determine the primary site of cancers and differentiate between tumor types.
Classification and diagnostic approach to fnac of mediastinalIndira Shastry
This document discusses the classification and diagnostic approach to fine needle aspiration cytology (FNAC) of mediastinal tumors. It describes the various tumor types that can occur in the mediastinum, including thymic tumors, germ cell tumors, lymphomas, and others. For each tumor type, it provides details on cytological features, differential diagnoses, immunohistochemistry findings, and other diagnostic information useful for FNAC-based diagnosis of mediastinal masses. The goal is to simplify the classification and provide guidance on distinguishing between benign and malignant mediastinal tumors using cytology samples.
This document provides an approach for evaluating undifferentiated tumors. It begins by categorizing undifferentiated tumors into 4 groups based on morphology: small round cell tumors, epithelioid cell tumors, spindle cell tumors, and pleomorphic tumors. It then outlines the diagnostic algorithm which involves determining the main lineage (epithelial, melanocytic, hematopoietic/lymphoid, or mesenchymal), specifying a diagnosis using immunohistochemistry and clinical correlation, and considering the differential diagnoses for each category. A variety of immunohistochemical markers are also described that can help identify the cell or tumor type.
KI67 is a nuclear protein associated with cellular proliferation. The Ki-67 labeling index measures the percentage of tumor cells with nuclear Ki-67 staining and can provide prognostic information for breast cancer patients. Ki-67 expression is associated with common histopathological parameters and independently predicts disease-free and overall survival. However, methodological issues with Ki-67 measurement and a lack of standardized assessment and definition of clinically meaningful cut-off values limit its widespread clinical use as a prognostic or predictive biomarker at this time.
Immunohistochemistry of Thyroid Gland tumorhome education
Galectin-3 and HBME-1 are highly sensitive and specific molecular markers for diagnosing thyroid cancer. Galectin-3 has a sensitivity of 93.7% and specificity of 83% for differentiating benign from malignant thyroid tumors, while HBME-1 has a sensitivity of 81% and specificity of 84.7% for diagnosing thyroid cancer. Using a panel of multiple molecular markers together can provide nearly 100% accuracy in diagnosing thyroid cancer, as individual markers may not be expressed in all tumors.
This document discusses various types of liver lesions including regenerative nodules, dysplastic nodules, hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma. It provides details on the histological and immunohistochemical features that can help differentiate these lesions. Key points include that dysplastic nodules are believed to be HCC precursors, hepatocellular adenomas can be single or multifocal and classified based on molecular features, and the distinction between well-differentiated HCC and hepatocellular adenoma can be challenging based on overlapping histological features alone.
The bethesda system for reporting thyroid cytopathologyIndira Shastry
The document describes the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which was introduced in 2007 to standardize the reporting of thyroid fine needle aspiration (FNA) results. The BSRTC recommends diagnostic categories with implied cancer risks and clinical management guidelines. It provides criteria for adequate samples and defines each diagnostic category, including non-diagnostic, benign, atypia of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant. The BSRTC aims to improve communication between cytopathologists and clinicians regarding thyroid FNA interpretations and patient management.
This is a brief overview of the evolving field of prophylactic and therapeutic cancer vaccines.
Cancer vaccines are active immunotherapies. As seen in the accompanying figure, the distinction from passive immunotherapies is based on different mechanisms of action. Passive immunotherapies and adoptive T-cell transfer, for example, are made/modified outside of the body.
Once inside the body they can compensate for missing or deficient functions. Active immunotherapies, on the other hand, stimulate effector functions in vivo. What this means, is that the patient’s immune system can respond to the challenge and be stimulated to mediate effector cells that defend the body in an immune response. Examples of active immunotherapies include peptide, dendritic cell, and allogeneic whole-cell vaccines.
This document discusses various histopathological patterns seen under the microscope. It defines terms like trabecular, syncytial, alveolar, herringbone, stromiform, fascicular, glandular, cribriform, tubular, papillary, micropapillary, Indian file, hobnail, and follicular patterns. It also explains structures like rossettes, microcysts, and different types of rossettes seen in various tumors. Examples of tumors showing each pattern are provided. The document aims to help differentiate between the most common histopathological patterns.
The document discusses the role of immunohistochemistry (IHC) in head and neck pathology. IHC uses antibodies to identify antigens in tissues and can help diagnose cancers and determine tumor type. It plays an important role in pathology subspecialties like oncology, neuropathology, and hematopathology. The document provides details on the principle of IHC, various tissue and tumor markers used in IHC, and how IHC can help diagnose lesions in the head and neck region like oral cancers, salivary gland tumors, melanomas, sarcomas, and lymphomas.
Molecular profiling of breast cancer can classify tumor types, identify appropriate therapeutic targets, determine prognosis, and predict treatment response. Techniques include immunohistochemistry, fluorescence in situ hybridization, reverse transcription PCR, microarrays, and next generation sequencing to analyze protein expression, gene copy number, mutations, and gene expression levels. Breast cancers are classified into intrinsic subtypes including luminal A/B, HER2-enriched, basal-like, and claudin-low based on distinct gene expression patterns that predict clinical behavior and response to therapy.
This document discusses the use of immunohistochemistry in breast pathology. It covers several topics:
1. Analyzing prognostic markers like hormone receptors in breast cancer and their predictive value.
2. Using myoepithelial cell markers to help solve diagnostic dilemmas and distinguish lesions.
3. Identifying tumor subtypes and assessing diagnoses using markers like luminal vs basal.
4. Evaluating cell populations in proliferative breast lesions and assessing neoplasia vs hyperplasia.
NEW UPDATES IN KIDNEY TUMOR PATHOLOGY: WHO 5th EDITION.pptxAnjalyNarendran
The WHO 5th Edition updates to kidney tumour pathology include changes to established renal tumors such as papillary renal cell carcinoma and chromophobe RCC, as well as the definition of new molecularly defined renal tumors including TFEB-rearranged RCC, ELOC-mutated RCC, fumarate hydratase-deficient RCC, succinate dehydrogenase-deficient RCC, and ALK-rearranged RCC. Emerging and provisional entities are also discussed such as thyroid-like follicular carcinoma, hybrid oncocytic chromophobe tumor, eosinophilic vacuolated tumor, low-grade oncocytic tumor, and biphasic hyalinizing psam
This document discusses the cytologic diagnosis of metastatic malignancies of unknown primary origin via fine needle aspiration (FNA) cytology. It notes that FNA cytology is highly accurate and can help determine the primary site and modify patient management. Metastatic malignancies of unknown primary account for 8% of all cancers and up to 15% of oncology referrals. A clinico-pathologic approach incorporating cytomorphology, immunohistochemistry, and patterns of metastasis is recommended. Several case examples are provided to demonstrate this approach.
This document discusses the changing landscape of cancer of unknown primary (CUP) over four decades from 1976 to the present. It describes the evolution from recognition of favorable prognostic subsets in 1976-1986, to improved diagnostic techniques in 1986-1996, to empiric chemotherapy in 1996-2006, and currently to improved pathologic and genetic diagnostic technologies and better outcomes for many CUP patients from 2006 onward. The document provides details on histologic classification, clinicopathologic entities, diagnostic approaches including imaging, histopathology, immunohistochemistry, and molecular analysis, as well as discussion of favorable and unfavorable prognostic subsets and treatment approaches.
1. Breast cancer is a heterogeneous disease caused by genetic and environmental factors. Global gene expression profiling can classify breast cancers into biological classes associated with survival.
2. Genetic mutations in high, moderate, and low penetrance genes like BRCA1, BRCA2, CHEK2, p53 contribute to hereditary breast cancers.
3. Molecular subtypes including luminal A/B, HER2-enriched, and basal-like have distinct gene expression patterns, responses to treatment, and clinical behaviors.
The document discusses several pediatric neoplasms that appear as small round blue cell tumors due to their primitive histological features. These include neuroblastoma, Wilms tumor, rhabdomyosarcoma, Ewing's sarcoma, medulloblastoma, retinoblastoma, and lymphoma. For each tumor, the document outlines characteristics such as common age of diagnosis, clinical features, histopathological appearance under the microscope, immunohistochemistry profiles, genetics where relevant, and important prognostic factors. Differential diagnosis of these small round blue cell tumors in children is provided for accurate diagnosis and treatment.
This document discusses the role of immunohistochemistry (IHC) in diagnosing soft tissue tumours. It begins by defining soft tissue and the WHO classification of soft tissue tumours. IHC is an important ancillary technique that can be used to identify discrete tissue components using antigen-antibody binding. The document outlines the IHC protocol and discusses various markers that can help diagnose different types of soft tissue tumours, including markers for fibroblastic, adipocytic, vascular, neural, osseous and cartilaginous tumours. Specific markers and the tumours they are useful for identifying are provided. The document emphasizes that IHC should be used along with other techniques as markers sometimes show cross-reactivity.
This document discusses immunohistochemistry (IHC), which combines immunology, histology, and chemistry to identify tissue antigens using antibodies. IHC allows identification of cell types and origins. The document outlines the principles and history of IHC, the IHC process, common markers used to identify tissues like epithelial, mesenchymal and hematopoietic tissues. Examples of IHC use in identifying lung cancer subtypes, gastrointestinal cancers, breast cancer subtypes, and lymphoma subtypes are provided. In summary, the document provides a comprehensive overview of the field of immunohistochemistry.
Bethesda system for reporting thyroid cytologyariva zhagan
The document discusses the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which provides a standardized classification system for thyroid fine needle aspiration (FNA) results. The BSRTC aims to improve communication between clinicians by establishing uniform diagnostic terminology. It categorizes FNA results as non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy, or malignant. The document outlines the criteria for each category and risk of malignancy. It notes recent enhancements in the 2017 version of BSRTC, including recalculated risk of malignancy and the
Cervical cancer is one of the most common cancers among women worldwide, with over 500,000 new cases annually. Developing countries account for 86% of cases. Risk factors include HPV infection, smoking, number of children, contraceptive use, and a weakened immune system. Histologically, cervical cancer includes squamous cell carcinoma and adenocarcinoma. Precancerous lesions are classified as CIN (cervical intraepithelial neoplasia) grades 1-3 based on nuclear abnormalities and maturation alterations. Molecular markers like p16 and Ki-67 help with diagnosis. Rare variants include basaloid, verrucous, and lymphoepithelioma-like carcinomas. Accurate
This document provides an overview of salivary gland tumors. It discusses that salivary gland tumors are heterogeneous and most are benign. The majority originate in the parotid glands. Pleomorphic adenoma is the most common benign tumor and occurs most often in the parotid glands. The document describes the histopathology and classification of various salivary gland tumors including pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. It also discusses the genetics and hypothesized cells of origin for different salivary gland neoplasms.
This document provides an approach for evaluating undifferentiated tumors. It begins by categorizing undifferentiated tumors into 4 groups based on morphology: small round cell tumors, epithelioid cell tumors, spindle cell tumors, and pleomorphic tumors. It then outlines the diagnostic algorithm which involves determining the main lineage (epithelial, melanocytic, hematopoietic/lymphoid, or mesenchymal), specifying a diagnosis using immunohistochemistry and clinical correlation, and considering the differential diagnoses for each category. A variety of immunohistochemical markers are also described that can help identify the cell or tumor type.
KI67 is a nuclear protein associated with cellular proliferation. The Ki-67 labeling index measures the percentage of tumor cells with nuclear Ki-67 staining and can provide prognostic information for breast cancer patients. Ki-67 expression is associated with common histopathological parameters and independently predicts disease-free and overall survival. However, methodological issues with Ki-67 measurement and a lack of standardized assessment and definition of clinically meaningful cut-off values limit its widespread clinical use as a prognostic or predictive biomarker at this time.
Immunohistochemistry of Thyroid Gland tumorhome education
Galectin-3 and HBME-1 are highly sensitive and specific molecular markers for diagnosing thyroid cancer. Galectin-3 has a sensitivity of 93.7% and specificity of 83% for differentiating benign from malignant thyroid tumors, while HBME-1 has a sensitivity of 81% and specificity of 84.7% for diagnosing thyroid cancer. Using a panel of multiple molecular markers together can provide nearly 100% accuracy in diagnosing thyroid cancer, as individual markers may not be expressed in all tumors.
This document discusses various types of liver lesions including regenerative nodules, dysplastic nodules, hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma. It provides details on the histological and immunohistochemical features that can help differentiate these lesions. Key points include that dysplastic nodules are believed to be HCC precursors, hepatocellular adenomas can be single or multifocal and classified based on molecular features, and the distinction between well-differentiated HCC and hepatocellular adenoma can be challenging based on overlapping histological features alone.
The bethesda system for reporting thyroid cytopathologyIndira Shastry
The document describes the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which was introduced in 2007 to standardize the reporting of thyroid fine needle aspiration (FNA) results. The BSRTC recommends diagnostic categories with implied cancer risks and clinical management guidelines. It provides criteria for adequate samples and defines each diagnostic category, including non-diagnostic, benign, atypia of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant. The BSRTC aims to improve communication between cytopathologists and clinicians regarding thyroid FNA interpretations and patient management.
This is a brief overview of the evolving field of prophylactic and therapeutic cancer vaccines.
Cancer vaccines are active immunotherapies. As seen in the accompanying figure, the distinction from passive immunotherapies is based on different mechanisms of action. Passive immunotherapies and adoptive T-cell transfer, for example, are made/modified outside of the body.
Once inside the body they can compensate for missing or deficient functions. Active immunotherapies, on the other hand, stimulate effector functions in vivo. What this means, is that the patient’s immune system can respond to the challenge and be stimulated to mediate effector cells that defend the body in an immune response. Examples of active immunotherapies include peptide, dendritic cell, and allogeneic whole-cell vaccines.
This document discusses various histopathological patterns seen under the microscope. It defines terms like trabecular, syncytial, alveolar, herringbone, stromiform, fascicular, glandular, cribriform, tubular, papillary, micropapillary, Indian file, hobnail, and follicular patterns. It also explains structures like rossettes, microcysts, and different types of rossettes seen in various tumors. Examples of tumors showing each pattern are provided. The document aims to help differentiate between the most common histopathological patterns.
The document discusses the role of immunohistochemistry (IHC) in head and neck pathology. IHC uses antibodies to identify antigens in tissues and can help diagnose cancers and determine tumor type. It plays an important role in pathology subspecialties like oncology, neuropathology, and hematopathology. The document provides details on the principle of IHC, various tissue and tumor markers used in IHC, and how IHC can help diagnose lesions in the head and neck region like oral cancers, salivary gland tumors, melanomas, sarcomas, and lymphomas.
Molecular profiling of breast cancer can classify tumor types, identify appropriate therapeutic targets, determine prognosis, and predict treatment response. Techniques include immunohistochemistry, fluorescence in situ hybridization, reverse transcription PCR, microarrays, and next generation sequencing to analyze protein expression, gene copy number, mutations, and gene expression levels. Breast cancers are classified into intrinsic subtypes including luminal A/B, HER2-enriched, basal-like, and claudin-low based on distinct gene expression patterns that predict clinical behavior and response to therapy.
This document discusses the use of immunohistochemistry in breast pathology. It covers several topics:
1. Analyzing prognostic markers like hormone receptors in breast cancer and their predictive value.
2. Using myoepithelial cell markers to help solve diagnostic dilemmas and distinguish lesions.
3. Identifying tumor subtypes and assessing diagnoses using markers like luminal vs basal.
4. Evaluating cell populations in proliferative breast lesions and assessing neoplasia vs hyperplasia.
NEW UPDATES IN KIDNEY TUMOR PATHOLOGY: WHO 5th EDITION.pptxAnjalyNarendran
The WHO 5th Edition updates to kidney tumour pathology include changes to established renal tumors such as papillary renal cell carcinoma and chromophobe RCC, as well as the definition of new molecularly defined renal tumors including TFEB-rearranged RCC, ELOC-mutated RCC, fumarate hydratase-deficient RCC, succinate dehydrogenase-deficient RCC, and ALK-rearranged RCC. Emerging and provisional entities are also discussed such as thyroid-like follicular carcinoma, hybrid oncocytic chromophobe tumor, eosinophilic vacuolated tumor, low-grade oncocytic tumor, and biphasic hyalinizing psam
This document discusses the cytologic diagnosis of metastatic malignancies of unknown primary origin via fine needle aspiration (FNA) cytology. It notes that FNA cytology is highly accurate and can help determine the primary site and modify patient management. Metastatic malignancies of unknown primary account for 8% of all cancers and up to 15% of oncology referrals. A clinico-pathologic approach incorporating cytomorphology, immunohistochemistry, and patterns of metastasis is recommended. Several case examples are provided to demonstrate this approach.
This document discusses the changing landscape of cancer of unknown primary (CUP) over four decades from 1976 to the present. It describes the evolution from recognition of favorable prognostic subsets in 1976-1986, to improved diagnostic techniques in 1986-1996, to empiric chemotherapy in 1996-2006, and currently to improved pathologic and genetic diagnostic technologies and better outcomes for many CUP patients from 2006 onward. The document provides details on histologic classification, clinicopathologic entities, diagnostic approaches including imaging, histopathology, immunohistochemistry, and molecular analysis, as well as discussion of favorable and unfavorable prognostic subsets and treatment approaches.
1. Breast cancer is a heterogeneous disease caused by genetic and environmental factors. Global gene expression profiling can classify breast cancers into biological classes associated with survival.
2. Genetic mutations in high, moderate, and low penetrance genes like BRCA1, BRCA2, CHEK2, p53 contribute to hereditary breast cancers.
3. Molecular subtypes including luminal A/B, HER2-enriched, and basal-like have distinct gene expression patterns, responses to treatment, and clinical behaviors.
The document discusses several pediatric neoplasms that appear as small round blue cell tumors due to their primitive histological features. These include neuroblastoma, Wilms tumor, rhabdomyosarcoma, Ewing's sarcoma, medulloblastoma, retinoblastoma, and lymphoma. For each tumor, the document outlines characteristics such as common age of diagnosis, clinical features, histopathological appearance under the microscope, immunohistochemistry profiles, genetics where relevant, and important prognostic factors. Differential diagnosis of these small round blue cell tumors in children is provided for accurate diagnosis and treatment.
This document discusses the role of immunohistochemistry (IHC) in diagnosing soft tissue tumours. It begins by defining soft tissue and the WHO classification of soft tissue tumours. IHC is an important ancillary technique that can be used to identify discrete tissue components using antigen-antibody binding. The document outlines the IHC protocol and discusses various markers that can help diagnose different types of soft tissue tumours, including markers for fibroblastic, adipocytic, vascular, neural, osseous and cartilaginous tumours. Specific markers and the tumours they are useful for identifying are provided. The document emphasizes that IHC should be used along with other techniques as markers sometimes show cross-reactivity.
This document discusses immunohistochemistry (IHC), which combines immunology, histology, and chemistry to identify tissue antigens using antibodies. IHC allows identification of cell types and origins. The document outlines the principles and history of IHC, the IHC process, common markers used to identify tissues like epithelial, mesenchymal and hematopoietic tissues. Examples of IHC use in identifying lung cancer subtypes, gastrointestinal cancers, breast cancer subtypes, and lymphoma subtypes are provided. In summary, the document provides a comprehensive overview of the field of immunohistochemistry.
Bethesda system for reporting thyroid cytologyariva zhagan
The document discusses the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), which provides a standardized classification system for thyroid fine needle aspiration (FNA) results. The BSRTC aims to improve communication between clinicians by establishing uniform diagnostic terminology. It categorizes FNA results as non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, suspicious for malignancy, or malignant. The document outlines the criteria for each category and risk of malignancy. It notes recent enhancements in the 2017 version of BSRTC, including recalculated risk of malignancy and the
Cervical cancer is one of the most common cancers among women worldwide, with over 500,000 new cases annually. Developing countries account for 86% of cases. Risk factors include HPV infection, smoking, number of children, contraceptive use, and a weakened immune system. Histologically, cervical cancer includes squamous cell carcinoma and adenocarcinoma. Precancerous lesions are classified as CIN (cervical intraepithelial neoplasia) grades 1-3 based on nuclear abnormalities and maturation alterations. Molecular markers like p16 and Ki-67 help with diagnosis. Rare variants include basaloid, verrucous, and lymphoepithelioma-like carcinomas. Accurate
This document provides an overview of salivary gland tumors. It discusses that salivary gland tumors are heterogeneous and most are benign. The majority originate in the parotid glands. Pleomorphic adenoma is the most common benign tumor and occurs most often in the parotid glands. The document describes the histopathology and classification of various salivary gland tumors including pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. It also discusses the genetics and hypothesized cells of origin for different salivary gland neoplasms.
The data on thyroid tumors in the fourth edition of the World Health Organization (WHO) classification of endocrine tumors published in 2017 contain significant revisions.
These revisions of the 2004 WHO classification were based on new knowledge about pathology, clinical behavior, and most importantly the genetics of the thyroid tumors.
Presentation dr rahul seminar (2)[1387]rahulraj956
This document discusses the role of fine needle aspiration cytology (FNAC) in evaluating salivary gland neoplasms. It begins with an introduction noting that salivary gland FNAs present challenges due to the wide range of possible lesions. It then covers normal salivary gland morphology, indications and contraindications for FNAC, advantages, technical considerations, complications, and classification of salivary gland lesions according to the WHO. Specific benign and malignant lesions are discussed in detail, including characteristics on cytology and differential diagnoses. Imaging is also shown demonstrating features of various lesions. In summary, the document provides a comprehensive overview of utilizing FNAC to evaluate salivary gland masses.
Renal pathology lecture 4 Tumors of kidney and urinary tract. Sufia Husain 2020Sufia Husain
This document provides an overview of tumors of the kidney and urinary tract. It begins by outlining the objectives and key topics to be covered, which include benign kidney tumors, renal cell carcinoma, Wilms tumor, and transitional cell and squamous carcinomas of the bladder. The document then covers these topics in detail over several sections, describing the histology, risk factors, clinical features, and characteristics of each tumor type. The major tumor types discussed are renal oncocytoma, angiomyolipoma, renal cell carcinoma (clear cell and papillary subtypes), Wilms tumor, and transitional cell neoplasms of the bladder.
This document provides information on cysts and tumors of the salivary glands. It discusses that salivary gland tumors represent 2-4% of head and neck neoplasms and are classified as benign or malignant. 70% originate in the parotid gland, with 75% of parotid tumors being benign. Salivary gland diseases are classified as neoplastic or non-neoplastic. Non-neoplastic diseases include developmental, infectious, obstructive, functional and metabolic disorders. Salivary gland neoplasms show histologic diversity and classifications include benign, malignant, soft tissue and hematolymphoid tumors. Tumor progression is a multistep process involving genetic changes that can result
This document provides information on cysts and tumors of the salivary glands. It discusses that salivary gland tumors represent 2-4% of head and neck neoplasms and are classified as benign or malignant. 70% originate in the parotid gland, with 75% of parotid tumors being benign. Salivary gland diseases are classified as neoplastic or non-neoplastic. Non-neoplastic diseases include developmental, infectious, obstructive, functional and metabolic disorders. Salivary gland neoplasms show histologic diversity and classifications include benign, malignant, soft tissue and hematolymphoid tumors. Tumor progression is a multistep process involving genetic changes that can result
This document provides information on fine needle aspiration cytology (FNAC) findings for different types of breast cancers and lesions. It describes the typical cellular appearance and characteristics seen on FNAC for normal breast tissue, ductal carcinoma, lobular carcinoma, medullary carcinoma, mucinous carcinoma, tubular carcinoma, and metaplastic carcinoma. It also outlines the Scarff-Bloom-Richardson grading system used to assess breast cancer prognosis based on histopathological analysis of tumor cells and tissue structure.
Ovarian cancer is a major cause of morbidity and mortality in gynecological patients. They often present late with pressure symptoms caused by their large size. The most common type is high grade serous carcinoma. Treatment involves surgical staging and debulking followed by chemotherapy with carboplatin, which is the standard treatment. Prognosis is poor due to lack of effective screening, and most cases are diagnosed at advanced stages, with overall 5-year survival rates ranging from 5-30% for stages III and IV.
This document summarizes various types of pancreatic tumours. It describes pancreatic ductal adenocarcinoma as the most common exocrine pancreatic cancer, accounting for 85% of cases. Risk factors and clinical features are provided. Other exocrine tumours discussed include acinar cell carcinoma, cystic pancreatic neoplasms such as microcystic cystadenoma and mucinous cystadenoma. Neuroendocrine tumours such as insulinomas are also summarized. Rare tumour types like anaplastic carcinoma, giant cell tumour and intraductal papillary mucinous neoplasms are described.
Ca ovary staging(AJCC 8th Edition& FIGO 2014) and classificationDr.Bhavin Vadodariya
Pathological classification of ovary in details.
Principles of Staging in Ca Ovary.
Staging according to AJCC 8th edition & Figo 2014.
Summary of changes in 8th Edition AJCC
This document discusses molecular approaches and updates in the classification of thyroid neoplasms. It covers:
1. Changes in the WHO classification, emphasizing a molecular-based classification of thyroid tumors including follicular cell-derived and C-cell derived neoplasms.
2. Key driver mutations in different thyroid tumors including BRAF, RAS, RET, NTRK, and others.
3. The importance of immunohistochemistry and molecular testing to classify tumors and guide treatment. Tests for BRAF, RAS, TRK, ALK, and PTEN are highlighted.
4. Specific tumor types are discussed like papillary thyroid carcinoma, follicular thyroid adenoma and carcinoma, and
This document discusses the different types and management approaches for thyroid cancer. It covers:
1. Thyroid cancers are classified into groups A and B based on differentiation and prognosis. Papillary thyroid cancer is the most common type, while anaplastic is very rare and aggressive.
2. Diagnostic workup involves ultrasound, fine needle aspiration biopsy, and staging tests if cancer is detected. FNAB results are classified from C1 to C6 indicating likelihood of malignancy.
3. Treatment depends on cancer type and stage. For lower risk papillary cancer, surgery may involve hemithyroidectomy followed by histopathology. Higher risk cancers receive more aggressive surgical and adjuvant treatment.
This document discusses ovarian cancer, including its epidemiology, risk factors, pathology, diagnosis, screening, staging, and treatment. It notes that ovarian cancer is the 5th leading cause of cancer death in women in the US. The majority of cases are diagnosed at an advanced stage due to asymptomatic early disease. Epithelial ovarian cancer accounts for approximately 80% of cases and arises from the ovarian surface epithelium. Risk factors include family history, BRCA mutations, and factors that reduce ovulation. Prognosis is correlated with stage at diagnosis, with 5-year survival rates of 45% overall but only 10-28% for advanced stage disease.
Histopathological Interpretation of Breast Cancer.pptxMunmun Kulsum
This lecture was prepared while opening of 'Breast Clinic' in Department of surgery , Cumilla Medical college Hospital, Cumilla, Bangladesh. This was delivered by Dr. Umme Kulsum Munmun, as a resource person in the seminar regarding opening of breast clinic.
This document provides information about testicular pathology, including epididymitis, orchitis, and testicular tumors. It discusses the normal histology of the testis and epididymis. It describes the causes and pathology of epididymitis and orchitis, including non-specific, granulomatous, gonorrhea and tuberculosis types. It then covers the classification and features of testicular tumors, separating them into germ cell tumors and sex cord stromal tumors. Within germ cell tumors it discusses seminoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma and mixed germ cell tumors.
Recent updates and reporting of testicular tumors Dr.Argha BaruahArgha Baruah
1) The document discusses recent updates to the classification and reporting of testicular tumors, including changes to the WHO 2016 classification and TNM staging system.
2) Key pathological findings to report include the presence of GCNIS, serum tumor markers, invasion of rete testis, hilar soft tissue, tunica vaginalis, epididymis, and lymphovascular invasion.
3) Adequate sampling from areas of possible extratesticular extension is important for accurate pathological assessment and staging of testicular tumors.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
2. New WHO 2022 classification of thyroid neoplasms
Several new
categories:
for clearer
understanding
Cell of origin
Pathologic
features
Molecular
classification
Biological
behaviour
WHO 2017 classification of thyroid neoplasms
Architecture
Morphology
Nuclear feature
3. WHO classification of tumors of thyroid gland
(2017)
WHO classification of tumors of thyroid gland
(2022)
Not included Developmental abnormalities
Thyroglossal duct cyst
Other congenital thyroid anomalies
Follicular adenoma
Variant of Follicular adenoma
Included under Hürthle( Oncocytic) cell tumors
Follicular cell-derived neoplasm
Benign tumors
Thyroid follicular nodular disease
Follicular adenoma
Follicular adenoma with papillary architecture
Oncocytic adenoma of the thyroid
Hyalinizing trabecular tumor Low-risk neoplasm
Hyalinizing trabecular tumor
4. Other encapsulated follicular-patterned thyroid
tumors
Follicular tumor of uncertain malignant potential
Well-differentiated tumor of uncertain malignant
potential
Non-invasive follicular thyroid neoplasm with
papillary-like nuclear features (NIFTP)
Low-risk neoplasm
Thyroid tumor of Uncertain malignant potential
Follicular tumor of uncertain malignant
potential
Well-differentiated tumor of uncertain
malignant potential
Non-invasive follicular thyroid neoplasm with
papillary-like nuclear features (NIFTP)
WHO classification of tumors of thyroid gland
(2017)
WHO classification of tumors of thyroid gland
(2022)
5. 2017 WHO…………… 2022 WHO………
Follicular thyroid carcinoma (FTC), NOS
_________________________________________________
Papillary thyroid carcinoma
_________________________________________________
Variant of PTC
_________________________________________________
Hurthle (oncocytic) cell carcinoma
_________________________________________________
Poorly differentiated thyroid carcinoma
_________________________________________________
Anaplastic thyroid carcinoma
Malignant neoplasm
Follicular thyroid carcinoma
Papillary thyroid carcinoma
Invasive encapsulated follicular variant of papillary
carcinoma
Oncocytic carcinoma of thyroid
Follicular derived carcinoma high grade
A. Differentiated high grade carcinoma
B. Poorly differentiated thyroid carcinoma
Anaplastic follicular cell-derived thyroid carcinoma
Squamous cell carcinoma Included under Anaplastic follicular cell derived thyroid
carcinoma
Medullary thyroid carcinoma
_________________________________________________
Mixed medullary and follicular thyroid carcinoma
Thyroid C cell-derived carcinoma
Medullary thyroid carcinoma
________________________________________________
Mixed medullary and follicular cell-derived thyroid
carcinoma
6. 2017 WHO…………… 2022 WHO………
Mucoepidermoid carcinoma
______________________________________________
Mucinous carcinoma
______________________________________________
Not included
Salivary gland type carcinoma of thyroid
Mucoepidermoid carcinoma
Subtype of Mucoepidermoid carcinoma
Secretory carcinoma of salivary gland type
Sclerosing mucoepidermoid carcinoma with
eosinophilia
______________________________________________
Variant of PTC
Thyroid tumor of uncertain histogenesis
Sclerosing mucoepidermoid carcinoma with eosinophilia
Cribriform morular thyroid carcinoma
Ectopic thymoma
______________________________________________
Spindle epithelial tumor with thymus like differentiation
______________________________________________
Intrathyroid thymic carcinoma
______________________________________________
Malignant Teratoma – Germ cell tumor
Thymic tumors within the thyroid
Thymoma family
Spindle epithelial tumor with thymus like elements
Thymic carcinoma family
______________________________________________
Embryonal thyroid neoplasm- Thyroblastoma
7.
8. Chan Kwon Jung et al.Update from the 2022 WHO classification of thyroid tumor
9. Developmental abnormalities
Thyroglossal Duct cyst (TGDC):
• Essential diagnostic criteria: Perihyoidal
(at or just below hyoid)
• Desirable diagnostic criteria: midline
lesion; respiratory or squamous lined cyst
with associated thyroid follicular
epithelium.
Other congenital thyroid abnormalities
• Agenesis/hemigenesis/ectopic
thyroid/hypoplasia Thyroid dysgenesis
• Dyshormogenetic goiter: due to inborn
defects in any of proteins indispensable
for thyroid hormone synthesis
https://tumourclassification.iarc.who.int/chapters/53
10. 2017 WHO 4th edition Single Benign Lesion – Follicular Adenoma
Follicular cell-derived neoplasms
1.Benign tumors
a. Thyroid follicular nodular disease
b. Follicular adenoma
c. Follicular adenoma with papillary architecture
d. Oncocytic adenoma of the thyroid
11. Thyroid Follicular nodular disease (FND)
• Different thyroid lesions included in this entity:
Multinodular goitre
Hyperplastic nodule
Nodular hyperplasia
Adenomatous nodule
Adenomatous hyperplasia
Colloid nodules
Colloid goitre
Diffuse goitre
Adenomatoid hyperplasia
These nodules are FREQUENTLY BUT NOT ALWAYS CLONAL
Foci of malignant transformation can occur within the
nodules
12. FND- Gross- Thyroid gland enlarged with variable size multiple nodules
Zubair W. Baloch et al. Overview of the 2022 WHO classification of Thyroid neoplasm
13. Colloid rich macrofollicular nodule
Colloid nodule with Sanderson’s
pollsters
Nodule with microfollicular pattern
Multiple nodules with variable
delineation and encapsulation
Calcification
14. Follicular thyroid adenoma with papillary architecture
• In Previous Edition this entity was classified as variant of follicular adenoma.
• Genetic alterations :
70% cases Activating TSHR mutation
30% cases GNAS/EZH1 mutation
Molecular alteration activation of adenyl cyclase increase cAMP
stimulation and proliferation of thyroid follicle
• 15-60% of patients present with symptoms of hyperthyroidism
V/S FA RAS Mutation
15. FA with papillary architecture
Encapsulated
Non invasive
Centripetal
intrafollicular
papillary
architecture
Lack nuclear
feature of PTC
Zubair W. Baloch et al. Overview of the 2022 WHO classification of Thyroid neoplasm
16. Oncocytic adenoma of the thyroid
Term ‘Hürthle cell” misnomer and
is discouraged (Karl Hürthle
described C cells)
• 4th ed- Separate category Oncocytic
cell tumors
• Genomics different from FA
Alterations in the mitochondrial
genome
Copy number variations
Benign, non-invasive, encapsulated,
follicular-cell-derived neoplasm
composed of >75% oncocytic cells
17. LOW RISK NEOPLASM
• Borderline tumor morphologically and clinically intermediate between benign and
malignant tumors.
• Side effect of complete thyroidectomy
• Side effect of RAI
• Healthcare cost
Histologically classified
a. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features
b. Thyroid tumor of uncertain malignant potential
c. Hyalinizing trabecular tumor
The term TUMOR is used to reduce the risk of overtreatment.
2017 WHO HTT was described as seperate entity.
2022 WHO HTT combined together with NIFTP and UMP to form one category.
18. NIFTP
2022 WHO Subtypes
• Subcentimeter NIFTP: ≤ 1 cm in size
( In <2mm size it is difficult to access capsular invasion and papillary architure)
• Oncocytic NIFTP: NIFTP with at least 75% oncocytic cells
21. Thyroid tumors of uncertain malignant potential
• The definition of UMP is same
Well-differentiated thyroid tumours with follicular architecture
Encapsulated/unencapsulated
Well circumscribed
Invasion remains questionable after thorough sampling and exhaustive examination
• Subtypes:
Follicular tumour of uncertain malignant potential (FT-UMP): Lack nuclear feature of PTC.
Well-differentiated tumour of uncertain malignant potential (WDT-UMP) : Nuclear feature of PTC
present.
23. Capsular or vascular invasion
Present Questionable Absent
Nuclear
Features of
PTC
Present Invasive encapsulated
follicular variant of PTC
Well differentiated
tumor of uncertain
malignant potential
(WT-UMP)
Non-invasive
follicular thyroid
neoplasm with
papillary-like
nuclear features
(NIFTP)
Questionable Well differentiated
carcinoma, NOS
Absent Follicular carcinoma Follicular tumor of
uncertain malignant
potential (FT-UMP)
Follicular adenoma
24. Zubair W. Baloch et al. Overview of the 2022 WHO classification of Thyroid neoplasm
25. Hyalinizing trabecular tumor
• 4 edition – Separate entity
• 5 edition - Follicular cell-derived Low risk neoplasm. (Rare distant metastasis and rare lymph
node metastasis)
• Architecture Trabeculae of enlongated/polygonal cells with intrabecular hyaline material
• Hyaline material PAS + , Diastase resistant, congo red – negative and immunoreactive for
collagen IV
• PTC like nuclear feature
• Specific genetic alteration- Not identified in other thyroid tumor
PAX::GLIS3 M/C
PAX8::GLIS1
These fusion leads to overexpression of GLIS gene Causes upregulation of extracellular matrix
related gene including collagen gene
• HTT diagnosis confirmation MIB1 (characteristic membranous statining)+ Follicular marker
(thyroglobulin, PAX8 and TTF1)
27. Follicular cell-derived neoplasms
3. Malignant neoplasms
a. Follicular thyroid carcinoma
b. Invasive encapsulated follicular variant papillary carcinoma
c. Papillary thyroid carcinoma
d. Oncocytic carcinoma of the thyroid
e. Follicular-derived carcinoma, high grade
f. Anaplastic follicular cell-derived thyroid carcinoma
28. Invasive encapsulated follicular variant papillary carcinoma
(IEFVPC)
• Separate entity and not part of other subtypes of PTC.
• Because -
• 1} Different biological behaviour (rare nodal spread)
• 2} Different molecular profile (RAS-like mutation)
RAS like mutation ( v/s Infiltrative follicular carcinoma can show BRAFV600E
mutation)
• Subtype(s)
Minimally invasive encapsulated FVPTC capsular invasion only
Encapsulated angioinvasive FVPTC Invasion of vessels.
1. Within the tumour capsule or beyond
2. Intravascular tumour attached to the vessel wall, or admixed with fibrin or covered
by endothelium
Widely invasive FVPTC Grossly apparent invasive growth & extensive vascular
invasion
30. Papillary thyroid carcinoma
• Term “variant” has been replaced by “subtype”:
Consistency with other WHO tumor classification schemes
Avoid confusion with the molecular diagnostic term “genetic
variant(s)
31. PTCs measuring ≤ 1.0 cm: “PTC-microcarcinoma”:
should NOT be considered as a distinct subtype (size does not indicate a specific histologic
subtype & can display aggressive pathological and clinical behaviour)
32. CRITERIA FOR TALL CELL VARIANT OF PTC IS REDEFINED
4 th edition – Tall cells 2 to 3 times tall as they are wide.
5 th Editon- Tall cell must have atleast 3 times height as they are wide and shows dense eosinophilic
cytoplasm
33. Follicular-derived carcinomas, high grade
2022 WHO introduced criteria to diagnose thyroid carcinoma having prognosis
intermediate between favourable outcome and poor outcome.
34. 1. Differentiated high-grade thyroid carcinoma Retain architectural and/or
cytological properties of well differentiated histiotypes of follicular cell derivation
2. Poorly differentiated thyroid carcinoma Histologically poorly differentiated-
solid, trabecular and insular growth pattern
35.
36.
37.
38. Anaplastic follicular cell-derived thyroid carcinoma
• New: Squamous cell
carcinoma has been included
in Anaplastic carcinoma:
(ATC, squamous cell
carcinoma pattern)
Similar poor overall survival
Frequent BRAF V600E
mutations
Express PAX8 and TTF1 –
follicular origin
39. Jung C K et al. Update from the 2022 WHO classification of thyroid tumor: A standardized diagnostic approach
40. Jung C K et al. Update from the 2022 WHO classification of thyroid tumor: A standardized diagnostic approach
41. Medullary carcinoma thyroid : grading
• Histologic grading schemes have been validated -
Impacts on overall survival, disease-specific survival, local recurrence free survival, and
distant metastasis free survival.
• The International Medullary Thyroid carcinoma grading scheme:
High-grade MTCs Tumours with at least one of the following 3 features:
1. Mitotic count ≥5 per 2 mm2
2. Ki67 proliferation index ≥5%, and/or
3. Tumour necrosis ( Tumor necrosis can be focal generously sample the tumor)
42.
43. New 2022 WHO classification scheme of thyroid neoplasm
Salivary gland-type carcinomas of the thyroid
1. Mucoepidermoid carcinoma of thyroid
2. Secretory carcinoma of salivary gland type
Thyroid tumors of uncertain histogenesis
1. Sclerosing mucoepidermoid carcinoma with eosinophilia
2. Cribriform morular thyroid carcinoma
Thymic tumors within the thyroid
1. Thymoma family
2. Spindle epithelial tumor with thymus-like elements
3. Thymic carcinoma family
Embryonal thyroid neoplasms
1. Thyroblastoma
44. Mucoepidermoid carcinoma
• Histogenesis:
Squamous metaplasia
Ectopic salivary gland
tissue
• Pathogenesis: MAML2
rearrangement
• Indolent behaviour,
favourable outcome
NEW: Mucinous carcinoma of the thyroid: very rare incorporated as subtype of MEC
Indicating one extreme with glandular differentiation, signet ring features and accumulation of
extracellular mucin among neoplastic cells.
45. Secretory carcinoma of salivary gland type
• Incorporated in new WHO classification of thyroid tumor
• Morphologically and genetically similar to its mammary and salivary gland counterparts
• Does not share the histological and immunophenotypical features of differentiated
follicular cell–derived carcinomas
• Age: slightly older than at salivary sites (mean=61.5 years)
• More aggressive course than that of other locations, with locoregional recurrences and
distant metastasis in upto 30% cases
46. Secretory Carcinoma – Mammary analogue of
secretory carcinoma
• Architecturemicrocystic, tubular,
and solid
• Tumor cells eosinophilic to
vacuolated cytoplasm with
abundant eosinophilic bubbly
luminal secretions
• Nuclei cleared and ovoid with
prominent nucleoli
• IHC diffuse Positive GATA3,
mammaglobin and S100
negative TTF1, thyroglobulin and
PAX8
48. New 2022 WHO classification scheme of
thyroid neoplasm
Thyroid tumors of uncertain histogenesis
1. Sclerosing mucoepidermoid carcinoma with
eosinophilia
2. Cribriform morular thyroid carcinoma
2017 WHO classification scheme of thyroid
neoplasm
1.Separate entity
2.Variant of PTC
49. Sclerosing mucoepidermoid carcinoma with eosinophilia
(SMECE)
• 4th edition- Classified as separate entity.
• 5th edition – classified under tumor of uncertain histiogenesis.
• Mean age: 55 years
• M:F= 1:13
• Origin Ultimobranchial body/solid cell nest.
• Lack MAML2 rearrangements and BRAF mutation
• Uncertain Histogenesis
50.
51. Cribriform-morular thyroid carcinoma (CMTC)
• Originally classified as a subtype of papillary carcinoma because of the presence of
papillae and in some instances diagnostic nuclear features
• REMOVED FROM PAPILLARY VARIANT BECAUSE-
Distinct molecular profile: no BRAF and rare RAS mutations
Genetic alteration – Wnt/beta-catenin pathway (APC mutation- M/C)
• Usually multifocal and/or bilateral in familial adenomatous polyposis (FAP), while
sporadic cases appear as a solitary nodule
• Almost exclusively occurs in young women (mean age= 28 years)
52.
53. New 2022 WHO classification scheme of
thyroid neoplasm
Thymic tumors within the thyroid
1. Thymoma family
2. Spindle epithelial tumor with thymus-like
elements
3. Thymic carcinoma family
2017 WHO classification scheme of
thyroid neoplasm
1. Ectopic thymoma
2. Spindle epithelial tumor with thymus-like
differentiation
3. Intrathyroid thymic carcinoma
54. Thymic tumors within the thyroid
• Postulated to develop from branchial pouch remnants differentiating along the thymic
line
• No major changes in new WHO classification
• Term “Ectopic thymoma”: discouraged
55. New 2022 WHO classification scheme
of thyroid neoplasm
Embryonal thyroid neoplasms
1. Thyroblastoma
2017 WHO classification scheme of
thyroid neoplasm
Malignant teratoma
56. Thyroblastoma
• Embryonal high-grade thyroid neoplasm.
• Predilection for females (3: 1)
• Median age of 43 years (range: 17 to 65 years)
• Presents as rapidly growing mid-cervical thyroid mass diffusely infiltrating one or both
thyroid lobes and extending into perithyroid tissue
• Pathogenesis: arise due to somatic mutations in the DICER1 gene
• Highly aggressive course with >50% of patients dying at a median follow-up of 11.5
months
57. Thyroblastoma
• Three cellular components:
fetal-type primitive-appearing thyroid follicles (TTF1+/PAX8+/focal thyroglobulin+)
Primitive small round to oval cells (SALL 4 +)
Surrounded by a primitive spindle cell stroma of variable cellularity arranged into
fascicles,(usually SMA, desmin and myogenin +)
• Foci of cartilage are seen in half of cases
58. Primitive small round cells Fetal type thyroid cells Primitive stromal component
Jung C K et al. Update from the 2022 WHO classification of thyroid tumor: A standardized diagnostic approach
59. References:
1. Baloch, Zubair W et al. “Overview of the 2022 WHO Classification of Thyroid
Neoplasms.” Endocrine pathology vol. 33,1 (2022): 27-63. doi:10.1007/s12022-022-
09707-3
2. Jung CK, Bychkov A, Kakudo K. Update from the 2022 World Health
Organization Classification of Thyroid Tumors: A Standardized Diagnostic
Approach. Endocrinol Metab (Seoul). 2022 Oct;37(5):703-718. doi:
10.3803/EnM.2022.1553. Epub 2022 Oct 4. PMID: 36193717; PMCID:
PMC9633223.
3. https://tumourclassification.iarc.who.int/chapters/53