Papillary thyroid carcinoma

Papillary thyroid carcinoma 

Updated: 01/26/2023

© Jun Wang, MD, PhD

General features
  • Most common thyroid carcinoma
  • Usually young women
  • Risk factors
Ionizing radiation
Radioactive material
Hashimoto’s thyroiditis
  • May be Familial
  • Diagnosed cytologically (fine needle aspiration, FNA) or histologically
  • Usually excellent prognosis
  • Indicators for poor prognosis: tall cell, columnar or diffuse sclerosing variants; vascular invasion; poorly differentiated areas
Clinical features
  • Painless nodule or mass in neck or cervical node
Radiologic features
  • Usually cold on scan
Pathological features
  • Most important morphological clue: nuclear features including clear chromatin, inclusion, grooves, etc
  • Solid, white, firm, often multifocal, encapsulated or infiltrative
  • May have calcification
  • Papillae or follicles lined by follicular cells with overlapping nuclei
  • Finely dispersed optically clear chromatin (also called ground-glass, Orphan-Annie nuclei)
  • Eosinophilic intranuclear inclusions (represent cytoplasmic invaginations)
  • Nuclear longitudinal grooves
  • Further classified according to architectural pattern and/or morphology of tumor cells: follicular variant, tall cell variant, etc
  • Follicular variant
Follicular architecture
Cells with nuclear feature of papillary carcinoma
Higher frequency of RAS mutation
Less mutation of RET-PTC, BRAF
Marker
  • Positive for thyroglobulin, TTF1
  • Negative for calcitonin
Molecular abnormality
  • RET-PTC
  • BRAF
  • NTRK1
  • RAS: follicular variant
Treatment
  • Total thyroidectomy
  • Radioiodine
  • Thyrotropin suppression



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