All of the following are true about solitary thyroid nodule except:
a. unilateral cord palsy coexisting with an ipsilateral thyroid nodule is usually diagnostic of malignant disease.
b. Deep cervical lymphadenopathy along the internal jugular vein in association with a clinically suspicious swelling is almost diagnostic of papillary carcinoma.
c. The incidence of thyroid carcinoma in men is about three times that in women.
d. Papillary carcinoma is often associated with cyst formation.
Answer:
c
Flexible laryngoscopy has rendered indirect laryngoscopy obsolete and is widely used preoperatively to determine the mobility of the vocal cords. The presence of a unilateral cord palsy coexisting with an ipsilateral thyroid nodule of concern is usually diagnostic of malignant disease.
There are useful clinical criteria to assist in selection for operation according to the risk of neoplasia and malignancy. Hard texture alone is not reliable as tense cystic swellings may be suspiciously hard but a hard, irregular swelling with any apparent fixity, which is unusual, is highly suspicious. Evidence of RLN paralysis, suggested by hoarseness and a non- occlusive cough and confirmed by laryngoscopy, is almost pathognomonic. Deep cervical lymphadenopathy along the internal jugular vein in association with a clinically suspicious swelling is almost diagnostic of papillary carcinoma. In most patients, however, such features are absent but there are risk factors associated with sex and age. The incidence of thyroid carcinoma in women is about three times that in men, but a discrete swelling in a male is much more likely to be malignant than in a female and it is seldom justifiable to avoid removing such a swelling in a man. The risk of carcinoma is increased at either end of the age range and a discrete swelling in a teenager of either sex must be provisionally diagnosed as carcinoma. The risk increases as age advance beyond 50 years, more so in males.
Thyroid Cysts
Routine FNAC (or ultrasonography) shows that over 30% of clinically isolated swellings contain fluid and are cystic or partly cystic. Tense cysts may be hard and mimic carcinoma. Bleeding into a cyst often presents with a history of sudden painful swelling, which resolves to a variable extent over a period of weeks if untreated. Aspiration yields altered blood but reaccumulation is frequent. About 50% of cystic swellings are the result of colloid degeneration, or of uncertain aetiology because of an absence of epithelial cells in the lining.
Although most of the remainder is the result of involution in follicular adenomas (Figure 50.15), some 10–15% of cystic follicular swellings are histologically malignant (30% in men and 10% in women). Papillary carcinoma is often associated with cyst formation (Figure 50.16).
Most patients with discrete swellings, however, are women, aged 20–40 years, in whom the risk of malignancy, although significant, is low and the indications for operation are not clear cut.
Ultrasound is the most useful tool for assessing cysts. If there is no discernable solid element then the cyst is almost certainly benign and does not need to be further investigated.
If there is an associated solid element then consideration should be given to targeting that area with an ultrasound-guided FNAC.
Ref: Bailey and Love 27th edition
a. unilateral cord palsy coexisting with an ipsilateral thyroid nodule is usually diagnostic of malignant disease.
b. Deep cervical lymphadenopathy along the internal jugular vein in association with a clinically suspicious swelling is almost diagnostic of papillary carcinoma.
c. The incidence of thyroid carcinoma in men is about three times that in women.
d. Papillary carcinoma is often associated with cyst formation.
Answer:
c
Flexible laryngoscopy has rendered indirect laryngoscopy obsolete and is widely used preoperatively to determine the mobility of the vocal cords. The presence of a unilateral cord palsy coexisting with an ipsilateral thyroid nodule of concern is usually diagnostic of malignant disease.
There are useful clinical criteria to assist in selection for operation according to the risk of neoplasia and malignancy. Hard texture alone is not reliable as tense cystic swellings may be suspiciously hard but a hard, irregular swelling with any apparent fixity, which is unusual, is highly suspicious. Evidence of RLN paralysis, suggested by hoarseness and a non- occlusive cough and confirmed by laryngoscopy, is almost pathognomonic. Deep cervical lymphadenopathy along the internal jugular vein in association with a clinically suspicious swelling is almost diagnostic of papillary carcinoma. In most patients, however, such features are absent but there are risk factors associated with sex and age. The incidence of thyroid carcinoma in women is about three times that in men, but a discrete swelling in a male is much more likely to be malignant than in a female and it is seldom justifiable to avoid removing such a swelling in a man. The risk of carcinoma is increased at either end of the age range and a discrete swelling in a teenager of either sex must be provisionally diagnosed as carcinoma. The risk increases as age advance beyond 50 years, more so in males.
Thyroid Cysts
Routine FNAC (or ultrasonography) shows that over 30% of clinically isolated swellings contain fluid and are cystic or partly cystic. Tense cysts may be hard and mimic carcinoma. Bleeding into a cyst often presents with a history of sudden painful swelling, which resolves to a variable extent over a period of weeks if untreated. Aspiration yields altered blood but reaccumulation is frequent. About 50% of cystic swellings are the result of colloid degeneration, or of uncertain aetiology because of an absence of epithelial cells in the lining.
Although most of the remainder is the result of involution in follicular adenomas (Figure 50.15), some 10–15% of cystic follicular swellings are histologically malignant (30% in men and 10% in women). Papillary carcinoma is often associated with cyst formation (Figure 50.16).
Most patients with discrete swellings, however, are women, aged 20–40 years, in whom the risk of malignancy, although significant, is low and the indications for operation are not clear cut.
Ultrasound is the most useful tool for assessing cysts. If there is no discernable solid element then the cyst is almost certainly benign and does not need to be further investigated.
If there is an associated solid element then consideration should be given to targeting that area with an ultrasound-guided FNAC.
Ref: Bailey and Love 27th edition
No comments:
Post a Comment