RUKMAN MECCA

Annual incidence 3.7 per 100 000 Male: Female - 3:1 Older pts more aggressive , worse prognosis Presentation Thyroid swelling -Enlarged cervical lymph nodes -Voice changes -Pain ,referred to ear

Papillary & Colloid-filled follicles Histology - papillary projections -pale empty nuclei ORPHAN ANNIE NUCLEI [on FNAC] -very seldom encapsulated Multiple foci- lymphatic spread , multicentric growth, good prognosis Extra thyroidal blood-borne mets

Young females Present as solitary nodule Thyroid swelling + significant lymph nodes

OCCULT CARCINOMA-pap ca less than 1.5 cm diameter , excellent prognosis Papillary microcarcinoma- pap ca<1cm

Long-standing multinodular goitres , rapidly growing Diagnosis-thyroid scan; [not wd FNAC] Hard with restricted mobility Blood-borne mets twice common Mortality-twice high Bone mets-flat bones ,warm & pulsatile

Macroscopically-encapsulated Microscopically-invasion of capsule & of vascular spaces Multiple foci & lymphatic mets rarely seen HURTHLE CELL TUMOUR-variant of follicular ca where oxyphil cells predominate -all are malignant,.multicentric -lymph node mets, poorer prognosis

PAPILLARY FOLLICULAR Male incidence 22 35 Lymph node mets 35 13 Blood vessel invasion 40 60 Recurrence rate 19 29 Overall mortality rate 11 24 Location of recurrent carcinoma Distant mets 45 75 Nodal mets 34 12 Local recurrence 20 12

LOW RISK GROUP -Men-40yrs & younger -women-50yrs&younger,wd no distant mets -older pts wd extrathyroid papillary & folliclar, wd minor capsular inv,<5cm diam, no distant mets HIGH RISK GROUP -All pts wd distant mets -older pts wd extrathyroid pap & foll,wd major capslar inv , >5cm diam , regardless of extend

AGES AMES

MACIS

Undifferentiated carcinoma Elderly women,60-70yrs Rapidly growing ,hard & irregular Blood-borne & lymphatic mets , poor prognosis Diagnosis-FNAC

Early infiltration of trachea-obstruction., needs decompression,isthmusectomy done Difficult to diff from lymphoma of thyroid Infiltration of carotids-BERRY SIGN POSITIVE Early fixity , nil resectability Radiotherapy-palliative

Tumours of parafolliclar C cells derived from neural crest High levels of serm calcitonin,>0.08ng/ml , levels falls after resection,but recurs Diarrhoea - 5-hydroxy triptamine & prostaglandins Blood-borne& lymphatic mets,worse prognosis Paraneoplastic syndromes-cushing & carcinoid.

2 Types: sporadic & familial sporadic-at any age

Familial -affects children & young adults MEN-2A syndrome[ medullary ca+ adrenal pheochromocytoma & hyperparathyroidism]

Marfanoid habitus+mucosal neuromas in lips, tongue,eyelids-sipple syndrome or MEN-2B

Older patients are commonly affected. Prognosis is good if no involement of cervical LN May be ass wd Hashimotos thyroiditis Either as primary lymphoma or as a part of gen lymphoma FNAC helps to diagnose Good response to radio & chemotherapy

TUMOUR TX-primary cannot be assessed T0-no evidence of primary T1-limited to thyroid,1cm or less T2-limited to thyroid,>1cm but<4cm T3-limited to thyroid,>4cm T4-extending beyond capusle,any size

NODES-

NX-cannot be assessed N0-no regional node mets N1-regional node mets METASTASISMX-cannot be assessed M0-no mets M1-mets present

STAGE:
1 : 2 : 3 :

Under 45yrs
anyT,anyN,M0 anyT,anyN,M1

Over 45yrs
T1,NO,M0 T2,N0,M0 or T3, M0 ,NO T4,N0,M0 or any T,N1,M0 anyT,any N,M1

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