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Thyroid by Mind Map: Thyroid

1. Solitary Masses

1.1. Palpably discrete swelling in thyroid

1.2. Female > Male (4:1)

1.3. localized, non-neoplastic or benign

2. Neoplasms

2.1. Bengin

2.1.1. well-encapsulated

2.1.2. expansile growth pattern

2.1.3. Types

2.1.3.1. Follicular adenomas

2.1.3.1.1. discrete, solitary mass

2.2. Malignant

2.2.1. Uncommon but good prognosis

2.2.2. Types

2.2.2.1. Papillary (85%)

2.2.2.1.1. Rearrangements of the tyrosine kinase receptors RET or NTRK1 or activating point mutations in BRAF.

2.2.2.1.2. > Women (25-50)

2.2.2.1.3. un-encapsulated, infiltrative and may be multifocal

2.2.2.1.4. Risk factor: exposure to ionizing radiation

2.2.2.1.5. Features: 1. Papillary structures 2. Psammoma bodies 3. Grooved nuclei 4. Orphan Annie nuclei 5. Pseudoinclusions

2.2.2.2. Follicular (15%)

2.2.2.2.1. Mutations in RAS (oncogenes)

2.2.2.2.2. > Women (40-60)

2.2.2.2.3. More frequent in areas with dietary iodine deficiency

2.2.2.2.4. Metastasis: most commonly in the lung or bones.

2.2.2.2.5. Features: 1. Solitary encapsulated 2. closely packed small follicles 3. Degenerative changes (central fibrosis and foci of calcification) sometimes present.

2.2.2.3. Medullary (5%)

2.2.2.3.1. Familial medullary thyroid carcinomas occur in multiple endocrine neoplasia type 2 (MEN-2) RET (protooncogene mutation)

2.2.2.3.2. Derived from the C-cells, neuroendocrine tumor, secretes calcitonin

2.2.2.3.3. Features: 1. sporadic neoplasms originate in one lobe, bilaterality and multicentricity are common in familial cases. 2. necrosis and haemorrhage, firm, pale gray to tan, and infiltrative.

2.2.2.4. Anaplastic (<5%)

2.2.2.4.1. Inactivating point mutations in the p53 (tumor suppressor) gene

2.2.2.4.2. rapid growth rate, Lethal (100%)

2.2.2.4.3. older age group > 65 year

2.2.2.4.4. Undifferentiated tumors Can be arising from papillary carcinoma

2.2.2.4.5. Features: Highly anapaestic cells, Large, pleomorphicgiant cells, occasional osteoclast-like multinucleate giant cells, Spindle cells with a sarcomatous appearance, Mixed spindle and giant cells.