Clinical Approach to Well-differentiated Thyroid Cancers by Frederick L. Greene, Andrzej L. Komorowski

By Frederick L. Greene, Andrzej L. Komorowski

The administration of sufferers with thyroid cancers is a continually altering box as a result of various advancements in diagnostics and treatment. This ebook presents clinicians with up to date details at the present administration of sufferers via all levels in their thyroid ailment: from prognosis of thyroid nodules via staging, quantity and means of surgical procedure to adjuvant remedies, and follow-up schemes.

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16 J. Ryś and J. Wysocka Fig. 10 Papillary thyroid carcinoma. Classic type with typical papillary arrangements (histological slide, HE stain) Fig. 11 Papillary thyroid carcinoma. Classic type with typical papillary arrangements (histological slide, HE stain) 2 Pathology of Differentiated Thyroid Cancers 17 Prognosis Most PTCs are characterized by an excellent prognosis—the 10-year survival rate is >90 %; in the case of young patients it can even be >98 %. Follicular Carcinoma By definition it is a malignant epithelial tumour which shows a follicular differentiation (follicle formation) and lack of the characteristic nuclear features of papillary carcinoma.

Notice the infiltration of normal thyroid tissue outside the tumour capsule (histological slide, HE stain) 2 Pathology of Differentiated Thyroid Cancers 19 Fig. 14 Widely invasive follicular thyroid carcinoma. 4 Histological variants of follicular thyroid carcinoma (FTC) and their different prognoses. ) Variants of follicular carcinoma Encapsulated FTC with microscopic capsular invasion (no vascular invasion is present) = minimally invasive follicular carcinoma Encapsulated FTC with angioinvasion (capsular invasion is present or absent) Widely invasive follicular carcinoma Oncocytic Clear cell Mucinous variant FTC with signet-ring cells Prognosis Very low probability (<5 % of cases) of metastases, recurrence or tumourassociated mortality Metastases, recurrences or tumourassociated mortality in 5–30 % of cases Metastases, recurrences or tumourassociated mortality in 50–55 % of cases Nodal metastases in approximately 30 % of cases Not known Not known Not known beyond the capsule.

6 % versus 3 %). 7 %, and overall accuracy of 69–97 %. Inadequate specimens may be sampled in 10–20 % of cases, possibly due to non-standardization of techniques. Side-effects or complications are few. Bleeding may occur, but this is usually minor, even in patients who are on anticoagulants. The procedure is performed in the outpatient clinic; the patient lies supine with the head extended. This is achieved by removing the pillow. Local anaesthetic (1 % lidocaine hydrochloride) can be injected subcutaneously at the appropriate area, which is necessary if several aspirations are to be undertaken.

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