Review Question - QID 104667

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Thyroid Cancer Classification Papillary QID: 104667 (M1.ON.14.27)

QID 104667 (Type "104667" in App Search)

A 27-year-old female presents to her physician with a palpable thyroid nodule. Iodine uptake testing shows that the nodule has decreased iodine uptake compared with the rest of the thyroid gland. A fine-needle aspiration is performed and the physician calls telling the patient that she has a neoplasm of the thyroid. Which of the following diagnoses is the most likely?

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Papillary carcinoma

59%

89/150

Medullary carcinoma

14/150

Follicular carcinoma

25%

38/150

Anaplastic carcinoma

5/150

Hurthle cell carcinoma

4/150

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This patient likely has a thyroid malignancy. In this setting papillary carcinoma is the most likely diagnosis and is the most common type of thyroid cancer.

Papillary carcinoma of the thyroid is the most common form of thyroid cancer. It typically presents in young women and has an excellent prognosis. It forms from the cells that produce thyroid hormone- follicular cells. These are often initially diagnosed on routine examination when a nodular thyroid gland is found. Further evaluation with fine-needle aspiration will make the definitive diagnosis. This cancer tends to spread through the lymphatics and treatment can vary based on the extent of metastasis at the time of diagnosis. Overall, the survival for papillary thyroid cancer is excellent.

Knox reviews the literature on the evaluation of thyroid nodules. She states that this is a common finding in the general population. An initial TSH and ultrasound can help triage the evaluation towards fine needle aspiration or immediate biopsy. All thyroid nodules require further evaluation due to risk of malignancy.

Ito et al. performed a retrospective analysis to understand the effect of young age on papillary carcinoma of the thyroid. They found that although survival is inversely related with age, patients presenting at a younger age tended to have larger and more aggressive nodules.

Illustration A displays a cold nodule in radio iodine uptake testing.

Illustration B displays the histologic appearance of papillary carcinoma of the thyroid.

Incorrect Answers:
Answer 2: Medullary carcinoma is a cancer of the parafollicular cells that produce calcitonin. It is the second most common type of thyroid cancer.
Answer 3: Follicular carcinoma is also a cancer of the cells that produce thyroid hormone; however, it is the third most common type of thyroid cancer and is differentiated from papillary carcinoma by its genetic makeup.
Answer 4: Anaplastic carcinoma is the rarest but most malignant form of thyroid cancer.
Answer 5: Hurthle cell carcinoma is a sub-type of follicular carcinoma.