Anaplastic-thyroid-Ca-slides-050511

Anaplastic-thyroid-Ca-slides-050511 - ANAPLASTIC THYROID...

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ANAPLASTIC THYROID CANCER Sam J. Cunningham, MD, PhD Francis B. Quinn, Jr., MD UTMB Dept of Otolaryngology May 11, 2005
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Anaplastic Thyroid Cancer (APC) One of the most aggressive malignancies Survival measured in months Rare (2 per million per year) 1.6% of all thyroid cancers Often associated with well differentiated thyroid cancers (evidence of dedifferentiation, <1%) History Path Incidence declining IHC staining in ’80s Iodination of food More aggressive treatment on WDTC
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Clinical Presentation 60’s-70’s 55-77% female Most patients present with rapidly enlarging neck mass (mean size at presentation 8cm) Some incidentally discovered Local compressive symptoms Cervical lymphadenopathy in >40% 30% with TVC paralysis 90% with direct invasion 50% present with distant metastasis 75% develop distant mets during course of disease Lung 80%, Bone 6-15%, Brain 5-13%, Intestine
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Diagnosis FNA accurate in 90% Unencapsulated Tan-white Direct extension into soft tissues No radioactive iodine uptake CT to eval extent
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Pathology Microscopically 3 histologic patterns (no prognostic difference) Spindle Giant-cell Squamoid Previous nomenclature Small cell (lymphoma) Insular cell (morphology)
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Molecular Pathology NM23 deletion Metastasis suppressor gene P53 mutants found in 14% of all thyroid cancers-more commonly in APC Loss of genome stability
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Prognostic Factors Distant mets (Vankatesh): 8mos vs 3mos Acute symptoms, tumor >5cm, distant mets, leukocytosis (Sugitani): Multivariate analysis reveals each an independent risk factor Longer duration of symptoms, tumor <10cm, incidental findings within WDTC (Ojeda): better prognosis overall
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Treatment Surgery Radiation Chemotherapy Multimodality
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Surgery: Controversial Mayo Clinic: 50 year experience (134pts)
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Anaplastic-thyroid-Ca-slides-050511 - ANAPLASTIC THYROID...

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