Papillary carcinoma of the thyroid
This is an adenocarcinoma of the thyroid gland. They usually present below 45 years, with a female to male ratio of 3:1 and are more common in patients exposed to ionising radiation. In form they tend to be non-encapsulated, infiltrative masses.
In most cases, the defining feature is the nuclear changes consisting of:
- Cell nuclei large with clear areas (intra-nuclear inclusions). Where the inclusions occupy most of the nucleus, these are sometimes termed "orphan Annie" nuclei because they resemble the eyes of this newspaper cartoon character.
- Nuclear grooves
- Epithelial papillary projections are present in the classical form, but there are variants where this is absent (e.g. follicular variant where the architecture appears follicular).
- Calcified spherules may be present due to degeneration of the papillary projections into psammoma bodies.
- via lymphatics, early
- goitre / thyroid lump
- lump may be situated anterolaterally (lateral aberrant thyroid) and in this case is actually an involved lymph node.
- total thyroidectomy
- high dose thyroxine (aiming for complete suppression of TSH)
- +/- radio-iodine
- B-RAF inhibitors
- excellent, grows slowly; however, certain variant associated with poor prognosis, e.g. tall cell and columnar variants.
- not worsened by lymph node involvement at diagnosis
- 90% survival at 10 years