Thyrod cancerdiagnosis and management.pptVIP

Thyroid cancer diagnosis and management 4C1 RI 李士寬 09-2 曾廖站 78F, 5192444 1.Thyroid cancer, follicular carcinoma, with multiple lung metastasis and skull metastasis s/p total thyroidectomy parathyroidectomy 2. Obstructive pneumonitis 3. Urinary tract infection with fungus infection Neck mass noted for 20+ years , significant weight loss(8kg loss in 2 months) from 96/2 96/4: admission at 中國附醫 CXR: trachea deviated to left side multiple lung mass over bilateral lung fieldCT: one 6.6x5.2x4.5 cm mass lesion containing calcification and necrotic component with treachea and esophagus deviation and multiple lung masses Bone scan: left parietal-occipital region of the skull Thyroid needle biopsy: follicular carcinoma 07/21 OP: Total thyroidectomy + parathyroidectomy Operation Finding 1. Enlarged, hard, irregular, shape; yellowish, white tumor; 8X7X6cm over R’t thyroid with invasion to paraspinal muscle. Parathyroid origin was likely 2. 4X2X2cm L’t thyroid with one 1X1cm hard tumor inside Thyroid cancer 1.5% of all cancer Papillary carcinoma(75-85% of cases) Follicular carcinoma(10-20%) Medullary carcinoma(5%) Anaplastic carcinoma(5%) Papillary thyroid carcinoma Most often in the twenties to forties. Incidence rinse: 1935 (1.3/100,000 for women and 0.2/100,000 for men) 1991 (5.8/100,000 for women and 2.5/100,000 for men) Cause: (1)R/T to children with head and neck benign disease between 1910 and 1960 (2) increased detection of small papillary cancers Papillary thyroid carcinoma Pathogenesis : Activation of receptor tyrosine kinases (RET/PTC, TRK, MET) →Produce chimeric proteins with tyrosine kinase activity Clinical presentation: Most: asymptomatic thyroid nodule , discovered by fine needle aspiration biopsy. Advanced disease: hoarseness,dysphagia,cough, or dyspnea Minority: lung metastasis Papillary thyroid carcinoma Pathologic features: unencapsulated , calcified psammoma bodies Good prognosis: micropapillary encapsulated, sol