Follicular thyroid cancer

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Follicular thyroid cancer
Other namesFollicular thyroid carcinoma
ENT surgery, oncology

Follicular thyroid cancer accounts for 15% of thyroid cancer and occurs more commonly in women over 50 years of age. Thyroglobulin (Tg) can be used as a tumor marker for well-differentiated follicular thyroid cancer. Thyroid follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.

Cause

Associated mutations

Approximately one-half of follicular thyroid carcinomas have mutations in the

peroxisome proliferator-activated receptor γ 1 (PPARγ1), a nuclear hormone receptor contributing to terminal differentiation of cells. The PAX8-PPARγ1 fusion is present in approximately one-third of follicular thyroid carcinomas, specifically those cancers with a t(2;3)(q13;p25) translocation, permitting juxtaposition of portions of both genes.[1] This subtype may potentially be treated with pioglitazone, a thiazolidinedione-class drug that potentiates PPARγ to boost insulin sensitivity.[2] Tumors tend to carry either a RAS mutation or a PAX8-PPARγ1 fusion, and only rarely are both genetic abnormalities present in the same case.[1] Thus, follicular thyroid carcinomas seem to arise by two distinct and virtually nonoverlapping molecular pathways.[1]

Hurthle cell variant

Micrograph of a Hurthle cell neoplasm.

Hurthle cell thyroid cancer is often considered a variant of follicular cell carcinoma.[3][4]
Hurthle cell forms are more likely than follicular carcinomas to be bilateral and multifocal and to metastasize to lymph nodes. Like follicular carcinoma, unilateral hemithyroidectomy is performed for non-invasive disease, and total thyroidectomy for invasive disease.

Diagnosis

It is difficult to correctly diagnose follicular neoplasms (FNs) on fine-needle aspiration cytology (FNAC) because it shares many cytological features with other mimicking lesions.[5]

Classification

It is impossible to distinguish between follicular adenoma and

fine needle aspiration cytology (FNAC) suggests follicular neoplasm, thyroid lobectomy should be performed to establish the histopathological diagnosis. Features sine qua non for the diagnosis of follicular carcinoma are capsular invasion and vascular invasion by tumor cells. Still, focuses of the capsular invasion should be carefully evaluated and discriminated from the capsular rupture due to FNA
penetration resulting in WHAFFT (worrisome histologic alterations following FNA of thyroid).

HMGA2 has been proposed as a marker to identify malignant tumors.[6]

Treatment

Treatment is usually surgical, followed by radioiodine.

Initial treatment

Finding disease recurrence

Some studies have shown that thyroglobulin (Tg) testing combined with neck

Thyroid stimulating hormone (TSH). In both cases, a low iodine diet regimen must also be followed to optimize the takeup of the radioactive iodine dose. Low dose radioiodine of a few millicuries is administered. Full body nuclear medicine scan follows using a gamma camera. Scan doses of radioactive iodine may be I131 or I123
.

Recombinant human TSH, commercial name

Thyrogen, is produced in cell culture from genetically engineered hamster
cells.

Prognosis

The overall

5-year survival rate for follicular thyroid cancer is 91%, and the 10-year survival rate is 85%.[8]

By overall

5-year survival rate of 100% for stages I and II, 71% for stage III, and 50% for stage IV.[9]

Compared to other variants of Follicular cell derived thyroid cancer, bone metastases are commonly associated with follicular carcinoma. In the present study a high rate of bone metastases of 34% was observed.[10]

References

  1. ^
    ISBN 978-1-4160-2973-1
    . 8th edition.
  2. ^ https://academic.oup.com/jcem/article/103/4/1277/4822913. Retrieved 2023-06-11. {{cite web}}: Missing or empty |title= (help)
  3. PMID 18070728
    .
  4. ^ Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. "Thyroid and Parathyroid Cancers" Archived 2010-02-28 at the Wayback Machine in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach Archived 2013-10-04 at the Wayback Machine. 11 ed. 2008.
  5. PMID 29374960
    .
  6. PMID 17943974
    .
  7. S2CID 19818345
    .
  8. ISBN 978-3-540-22309-2
    . (Note:Book also states that the 14% 10-year survival for anaplastic thyroid cancer was overestimated
  9. ^ cancer.org > Thyroid Cancer By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).
  10. PMID 29456936
    .

External links
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