1. All of the following are true about anaplastic carcinoma thyroid except:
a. Women are more commonly affected.
b. It is painful.
c. Ulcerations are seen.
d. Lymph node involvement not seen.
2. All of the following are true about anaplastic carcinoma thyroid except:
a. Giant cells are present.
b. Anaplastic tumours arise from well-differentiated tumours.
c. Tracheostomy should be routinely performed.
d. Neoadjuvant chemotherapy prolongs survival.
Answers:
1. (d)
Women are more commonly affected, and the majority of tumors present in the seventh and eighth decade of life. The typical patient has a long-standing neck mass, which rapidly enlarges and may be painful. Associated symptoms such as dysphonia, dysphagia, and dyspnea are common. The tumor is large and may be fixed to surrounding structures or may be ulcerated with areas of necrosis. Lymph nodes usually are palpable at presentation.
2. (c)
Diagnosis is confirmed by FNAB revealing characteristic giant and multinucleated cells.
On gross inspection, anaplastic tumors are firm and whitish in appearance. Microscopically, sheets of cells with marked heterogeneity are seen. The three main histologic growth patterns are spindle cell, squamoid, and pleomorphic giant cell. Tumors may show a predominance of one pattern or a mixture
of various patterns. Foci of more differentiated thyroid tumors, either follicular or papillary, may be seen, suggesting that anaplastic tumors arise from more well-differentiated tumors.
Tracheostomy should be avoided as long as possible unless there is impending airway loss. Adjuvant radiation with should be offered to patients with a good performance status and no metastatic disease who desire aggressive management. Cytotoxic chemotherapy (with some combination of a taxane, anthracycline, and platinum) is typically given concurrently and has been associated with prolonged survival, although these agents are also being used in a neoadjuvant fashion particularly in patients with unresectable disease.
a. Women are more commonly affected.
b. It is painful.
c. Ulcerations are seen.
d. Lymph node involvement not seen.
2. All of the following are true about anaplastic carcinoma thyroid except:
a. Giant cells are present.
b. Anaplastic tumours arise from well-differentiated tumours.
c. Tracheostomy should be routinely performed.
d. Neoadjuvant chemotherapy prolongs survival.
Answers:
1. (d)
Women are more commonly affected, and the majority of tumors present in the seventh and eighth decade of life. The typical patient has a long-standing neck mass, which rapidly enlarges and may be painful. Associated symptoms such as dysphonia, dysphagia, and dyspnea are common. The tumor is large and may be fixed to surrounding structures or may be ulcerated with areas of necrosis. Lymph nodes usually are palpable at presentation.
2. (c)
Diagnosis is confirmed by FNAB revealing characteristic giant and multinucleated cells.
On gross inspection, anaplastic tumors are firm and whitish in appearance. Microscopically, sheets of cells with marked heterogeneity are seen. The three main histologic growth patterns are spindle cell, squamoid, and pleomorphic giant cell. Tumors may show a predominance of one pattern or a mixture
of various patterns. Foci of more differentiated thyroid tumors, either follicular or papillary, may be seen, suggesting that anaplastic tumors arise from more well-differentiated tumors.
Tracheostomy should be avoided as long as possible unless there is impending airway loss. Adjuvant radiation with should be offered to patients with a good performance status and no metastatic disease who desire aggressive management. Cytotoxic chemotherapy (with some combination of a taxane, anthracycline, and platinum) is typically given concurrently and has been associated with prolonged survival, although these agents are also being used in a neoadjuvant fashion particularly in patients with unresectable disease.
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