WordNet

suggestive of a thyroid disorder; "thyroid personality"
of or relating to the thyroid gland; "thyroid deficiency"; "thyroidal uptake" (同)thyroidal
any malignant tumor derived from epithelial tissue; one of the four major types of cancer
of or relating to or constituting a follicle

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甲状腺 / 甲状腺の
がん,がん腫

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/05 17:40:02」(JST)

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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. Follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.

Classification

It is impossible to distinguish between follicular adenoma and carcinoma on cytological grounds. If 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).

Follicular carcinoma tends to metastasize to lung and bone via the bloodstream.
Papillary thyroid carcinoma commonly metastasizes to cervical lymph nodes.

HMGA2 has been proposed as a marker to identify malignant tumors.^[1]

Treatment

Treatment is usually surgical, followed by radioiodine.

Initial treatment

If follicular cells are found on cytological testing, it is common to carry out hemithyroidectomy to distinguish between follicular adenoma and follicular carcinoma on histopathological examination, proceeding to completion thyroidectomy and postoperative radioiodine ablation where carcinoma is confirmed. This way total thyroidectomy is not carried out unnecessarily.
Thyroidectomy is invariably followed by radioiodine treatment at levels from 50 to 200 millicuries following two weeks of a low iodine diet (LID). Occasionally treatment must be repeated if annual scans indicate remaining cancerous tissue. Some physicians favor administering the maximum safe dose (calculated based on a number of factors), while others favor administering smaller doses, which may still be effective in ablating all thyroid tissue. I-131 is used for ablation of the thyroid tissue.
- Minimally invasive thyroidectomy has been used in recent years in cases where the nodules are small.^[2]

Finding disease recurrence

Some studies have shown that thyroglobulin (Tg) testing combined with neck ultrasound is more productive in finding disease recurrence than full- or whole-body scans (WBS) using radioactive iodine. However, current protocol (in the USA) suggests a small number of clean annual WBS are required before relying on Tg testing plus neck ultrasound. When needed, whole body scans consist of withdrawal from thyroxine medication and/or injection of recombinant human 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.

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.

Prognosis

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

By overall cancer staging into stages I to IV, follicular thyroid cancer has a 5-year survival rate of 100% for stages I and II, 71% for stage III, and 50% for stage IV.^[6]

Associated mutations

Approximately one-half of follicular thyroid carcinomas have mutations in the Ras subfamily of oncogenes, most notably HRAS, NRAS, and KRAS.^[7] Also, a chromosomal translocation specific for follicular thyroid carcinomas is one between paired box gene 8 (PAX-8), a gene important in thyroid development, and the gene encoding 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.^[7] Tumors tend carry either a RAS mutation or a PAX8-PPARγ1 fusion, and only rarely are both genetic abnormalities present in the same case.^[7] Thus, follicular thyroid carcinomas seem to arise by two distinct and virtually nonoverlapping molecular pathways.^[7]

References

^ Belge G, Meyer A, Klemke M, et al. (2008). "Upregulation of HMGA2 in thyroid carcinomas: A novel molecular marker to distinguish between benign and malignant follicular neoplasias". Genes Chromosomes Cancer 47 (1): 56–63. doi:10.1002/gcc.20505. PMID 17943974.
^ Hegazy MA, Khater AA, Setit AE, et al. (2007). "Minimally invasive video-assisted thyroidectomy for small follicular thyroid nodules". World J Surg 31 (9): 1743–50. doi:10.1007/s00268-007-9147-7. PMID 17653588.
^ Kushchayeva Y, Duh QY, Kebebew E, D'Avanzo A, Clark OH (2007). "Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with Hurthle cell or follicular thyroid cancer". Am J Surg 195 (4): 457–62. doi:10.1016/j.amjsurg.2007.06.001. PMID 18070728.
^ Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. "Thyroid and Parathyroid Cancers" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
^ Numbers from National Cancer Database in the US, from Page 10 in: F. Grünwald; Biersack, H. J.; Grںunwald, F. (2005). Thyroid cancer. Berlin: Springer. ISBN 3-540-22309-6. (Note:Book also states that the 14% 10-year survival for anaplastic thyroid cancer was overestimated
^ cancer.org > Thyroid Cancer By the American Cancer Society. In turn citing: AJCC Cancer Staging Manual (7th ed).
^ ^a ^b ^c ^d Chapter 20 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.

UpToDate Contents

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1. 濾胞性甲状腺癌の概要 overview of follicular thyroid cancer
2. 甲状腺結節の診断的アプローチおよび治療 diagnostic approach to and treatment of thyroid nodules
3. 分化型甲状腺癌：マネージメントの概要 differentiated thyroid cancer overview of management
4. 小児における甲状腺結節および癌 thyroid nodules and cancer in children
5. 分化型甲状腺癌：外科的治療 differentiated thyroid cancer surgical treatment

English Journal

Differential protein expression and oncogenic gene network link tyrosine kinase ephrin B4 receptor to aggressive gastric and gastroesophageal junction cancers.

Liersch-Löhn B1,2, Slavova N2, Buhr HJ2,3, Bennani-Baiti IM4.
International journal of cancer. Journal international du cancer.Int J Cancer.2016 Mar 1;138(5):1220-31. doi: 10.1002/ijc.29865. Epub 2015 Oct 15.
Transmembrane tyrosine-kinase Ephrin receptors promote tumor progression and/or metastasis of several malignancies including leukemia, follicular lymphoma, glioma, malignant pleural mesothelioma, papillary thyroid carcinoma, sarcomas and ovarian, breast, bladder and non-small cell lung cancers. They
PMID 26414866

Cytodiagnosis of distant metastases from follicular thyroid carcinoma.

Gupta P1, Bardia A1, Rajwanshi A1, Nijhawan R1, Srinivasan R1, Gupta N1, Nahar Saikia U2, Dey P1.
Diagnostic cytopathology.Diagn Cytopathol.2016 Feb;44(2):108-12. doi: 10.1002/dc.23412. Epub 2015 Dec 10.
INTRODUCTION: Follicular carcinoma of the thyroid is second most common primary malignancy of the thyroid gland after papillary carcinoma and metastasis is uncommonly seen in these patients.AIMS AND OBJECTIVES: To describe the cytomorphologic features for the accurate diagnosis of distant metastases
PMID 26663523

miR-4299 mediates the invasive properties and tumorigenicity of human follicular thyroid carcinoma by targeting ST6GALNAC4.

Miao X1, Jia L2, Zhou H3, Song X4, Zhou M1, Xu J1, Zhao L2, Feng X2, Zhao Y1.
IUBMB life.IUBMB Life.2016 Feb;68(2):136-44. doi: 10.1002/iub.1467. Epub 2015 Dec 30.
Altered sialylation is closely associated with tumor progression and invasiveness. Micro-RNAs endogenous regulators of gene expression have been implicated in human thyroid carcinoma invasiveness. The objective of this study is to examine the alterations of miR-4299 and ST6GALNAC family in human fol
PMID 26715099

Japanese Journal

Pathology : Follicular Thyroid Carcinoma Characterized by Abundant Stromal Components with Chondroid and Osseous Metaplasia in a Dog

KOBAYASHI Ryosuke,YAMADA Naoaki,KITAMORI Takashi [他]
The journal of veterinary medical science 76(8), 1161-1164, 2014-08
NAID 40020197951

症例報告皮膚転移巣より診断に至った甲状腺濾胞癌の1例

平井郁子,崎山とも,木花光 [他]
臨床皮膚科 68(4), 333-337, 2014-04
NAID 40020064079

甲状腺乳頭癌と橋本病の鑑別について

佐野太亮,布引治,岩井重寿,澤田浩秀,青野早姫,天間友理香,能瀬衣沙子,宮下奈都美,猪俣啓子,山下弘幸,覚道健一
神戸常盤大学紀要 (7), 69-74, 2014-03-31
… Introduction: Thyroid fine-needle cytology is the first line clinical method for thyroid nodule to select patients for surgery, because papillary carcinoma has diagnostic characteristics in cytology, such as nuclear enlargement, nuclear grooves and nuclear inclusions. …
NAID 110009781981

Related Pictures

Pathology Outlines - Follicular carcinoma Thyroid - Follicular Carcinoma - NUS Pathology File:Follicular thyroid carcinoma -- very low mag.jpg - Wikimedia Commons Follicular carcinoma - Thyroid - MyPathologyReport.ca Follicular thyroid cancer - Wikipedia

★リンクテーブル★

リンク元	「甲状腺濾胞癌」
関連記事	「follicular」「thyroid」

「甲状腺濾胞癌」

Follicular thyroid cancer
	Follicular adenoma of the thyroid
Classification and external resources
Specialty	oncology
ICD-10	C73
ICD-9-CM	193
OMIM	188470
eMedicine	med/804
MeSH	D013964