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Anaplastic thyroid cancer
62%
32/52
Follicular thyroid cancer
15%
8/52
Lymphoma
12%
6/52
Medullary thyroid cancer
0%
0/52
Papillary thyroid cancer
10%
5/52
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This patient has a symptomatic thyroid nodule concerning for malignancy in the setting of exposure to ionizing radiation for enlarged tonsils. Without histological evidence, the most likely etiology is papillary thyroid cancer.Papillary cancer accounts for 70 to 75% of all thyroid cancers. It spreads lymphatically and usually presents with local lymphadenopathy. Risk factors include exposure to ionizing radiation. Patients present with a symptomatic thyroid nodule and may be hyperthyroid if the nodule produces thyroid hormone. It carries a good prognosis with a close to 98% survival rate at 10 years with early diagnosis and treatment via resection with or without radiation therapy. Histology of the fine needle aspiration may reveal Orphan Annie nuclei and psammoma bodies with the cells organized in a papillary architecture.Coca-Pelaz et al. review the evidence regarding the diagnosis and treatment of papillary thyroid cancer. They discuss how most cases can be successfully managed with surgical excision. They recommend identification and aggressive treatment of rare aggressive variants.Figure/Illustration A shows a large, hypoechoic thyroid mass consistent with a solid thyroid nodule (red circle). These nodules are consistent with papillary thyroid cancer.Incorrect Answers:Answer 1: Anaplastic thyroid cancer accounts for less than 5% of all thyroid cancers and is associated with a poor prognosis. They are more common in elderly patients. Treatment is with surgical resection of tumor if the tumor is resectable.Answer 2: Follicular thyroid cancer accounts for 10% of all thyroid cancers. They spread hematogenously and cannot be diagnosed by fine needle biopsy but still carry a very favorable prognosis. Treatment is with surgical excisionAnswer 4: Medullary thyroid cancer accounts for 3 to 5% of all thyroid cancers. 10% percent are familial and 90% are sporadic. Familial cases are associated with multiple endocrine neoplasias 2a and 2b. Treatment is with surgical excision.Answer 5: Lymphoma in the thyroid accounts for less than 1% of all thyroid cancers. Most are non-Hodgkin lymphoma and generally affect women with or without a history of Hashimoto thyroiditis. It generally does not present with symptoms of hyperthyroidism.Bullet Summary:Papillary carcinoma is the most common thyroid cancer and is associated with exposure to ionizing radiation.
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