Thyroid malignancy/ Papillary thyroid carcinoma

Epidemiology
 Most common type of thyroid malignancy 70-80%
 Mean age: 30-50 years
 Female to male ratio: 2.5:1
 Risk factors: childhood radiation, first degree-relatives thyroid carcinoma, familial
syndromes: werner, cowden, carney complex, familial polyposis

Pathological classification
 PTC gross morphology: Hard, whitish, flat
 Histological morphology: microscopic calcification, necrosis, and cystic changes.
Papillary projection, psammoma bodies (microcalcification lumps of cells, caused by
sloughed papillary projections). Cuboidal cells with pale, abundant cytoplasm,
crowded nuclei that may demonstrate grooving and internuclear cytoplasmic inclusion
– Orphan Annie nuclei -

Diagnosis is made by characteristic nuclear cellular feature.

 Made by FNA cytology

- Classical papillary carcinoma
- Encapsulated follicular variant (10% of PTC) has excellent prognosis, why count
it as PTC variant? Cause it behave like PTC
- Columnar
- Hobnail
- Tall cell carcinoma

Clinical Features
Slow growing painless mass
Dysphagia
Dyspnea
Dysphonia

Localized:
Palpable thyroid nodule

Metastatic:
Painless lateral neck mass (detected before the primary lesion) – Lateral aberrant thyroid -

PTC with no metastasis - Prognosis is 10 years survival (for all stages) greater than 95%

Factors affecting the prognosis:

Age (most important prognostic factor)
Tumor size
Tumor extension

PTC metastasis site:

PTC with Lung metastasis – Prognosis 50% at 10 years
PTC with Brain metastasis – Prognosis median 1-year survival

The most common site for metastasis is the lung then bone then liver then brain.
Lymph node does not effect the prognosis unless the patient has lymph metastasis and he is
older than 45 (increases risk of death by 46%)

Lymph node metastasis is very common – most commonly cervical lymph node

Multifocality is associated with increase of risk of cervical nodal metastasis

Invasion of adjacent structure: esophagus, trachea, recurrent laryngeal nerve (RLN)