Papillary carcinoma of the thyroid

From Ganfyd

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.

Histology

Intra-nuclear occlusions.

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.

Spread

• via lymphatics, early

Examination

• goitre / thyroid lump
• lump may be situated anterolaterally (lateral aberrant thyroid) and in this case is actually an involved lymph node.

Treatment

• total thyroidectomy
• high dose thyroxine (aiming for complete suppression of TSH)
• +/- radio-iodine
• B-RAF inhibitors

Prognosis

• 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