Thyroid carcinoma 1

13. CARCINOMA THYROID 

 a & b

      This is an uncommon cancer and the incidence 30-60 new cases per million population per year.

      In man there is convincing evidence regarding radiation exposure as an etiologic factor. Cancer seen in the young is usually of the differentiated variety in the old undifferentiated carcinoma is more common.

13.1 Differentiated Carcinoma

13.1.1 PAPILLARY CARCINOMA

      This occurs most often in those under the age of 40 years and accounts for more than 50% of all thyroid cancers and presents as a small hard slow growing nodule in the thyroid, and spreads most often to the cervical lymphnodes.

      Histopathologic examination shows the lining epithelium of the follicule arranged in papilary processes. On careful examination many show more than one focus of carcinoma in the thyroid. The metastasis in the lymphnodes also resemble thyroid with papillary formation
the follicule arranged in papilary processes. On careful examination many show more than one focus of carcinoma in the thyroid. The metastasis in the lymphnodes also resemble thyroid with papillary formation

FOLLICULAR CARCINOMA

      This carcinoma presents with a mass in the thyroid and occur ten years later (40-50 years). It appears as a follicular pattern on histopathologic examination and manifests its malignant nature in infiltrating into the blood vessels or the capsule of the tumour. Metastasis usually occur to bones and lungs by blood stream. There are no clinical feature to distinguish it except signsof local infiltration to structures (larynx; recurrent laryngeal nerve; carotid sheath).

13.2.1 TREATMENT Fig. 31.10a, 31.10b

      In cases where the diagnosis is established by aspiration cytology or biopsy, the treatment recommended is total thyroidectomy, this takes care of focal and multifocal origin of these carcinomas and also helps the future management of metastasis by radio iodide.

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