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Papillary Thyroid Carcinoma, Variants, and Related Tumors

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The Bethesda System for Reporting Thyroid Cytopathology

Abstract

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid, accounting for approximately 85% of all cancers at this site. PTC usually presents clinically as a thyroid nodule, often discovered incidentally on routine examination; less commonly, patients present with metastatic disease in the neck lymph nodes. PTC spreads via lymphatics to the regional lymph nodes and, less frequently, to the lungs. PTC is much more common in women and has a well-documented association with prior radiation exposure to the neck. It generally carries a good prognosis; death secondary to PTC is rare.

A malignant thyroid FNA diagnosis accounts for about 5% of all thyroid FNAs, the majority of them PTCs. When a definite diagnosis of PTC is made by FNA, 94–96% prove to be PTC on histologic follow-up. Conventional PTCs are notable histologically for numerous papillae lined by cuboidal to low columnar neoplastic follicular cells with characteristic nuclear features. PTC has many histological variants, however, and these have a spectrum of corresponding cytomorphologic characteristics. At the molecular level, the most important event is activation of the MAPK pathway, resulting from RET/PTC gene rearrangements and activating mutations of RAS and BRAF. The standard treatment is lobectomy or near-total thyroidectomy, sometimes followed by radioactive iodine.

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Author information

Authors and Affiliations

  1. Department of Clinical Pathology, Geneva University Hospitals, 1 Rue Michel Servet, Geneva, 1211, Switzerland

    Marc P. Pusztaszeri

  2. Department of Pathology, McGill University Health Center, Glen site, Montreal, PQ, Canada

    Manon Auger

  3. Department of Pathology, University of Virginia, Charlottesville, VA, USA

    Edward B. Stelow

  4. Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Grace C. H. Yang

  5. Department of Pathology, Englewood Hospital Medical Center, Englewood, NJ, USA

    Miguel A. Sanchez

  6. Department of Pathology and Laboratory Medicine, Perelman School of Medicine/University of Pennsylvania, Philadelphia, PA, USA

    Virginia A. LiVolsi

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  1. Marc P. Pusztaszeri
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  2. Manon Auger
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  3. Edward B. Stelow
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  4. Grace C. H. Yang
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  5. Miguel A. Sanchez
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  6. Virginia A. LiVolsi
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Correspondence to Marc P. Pusztaszeri .

Editor information

Editors and Affiliations

  1. Department of Pathology, The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Syed Z. Ali

  2. Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA

    Edmund S. Cibas

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Pusztaszeri, M.P., Auger, M., Stelow, E.B., Yang, G.C.H., Sanchez, M.A., LiVolsi, V.A. (2018). Papillary Thyroid Carcinoma, Variants, and Related Tumors. In: Ali, S., Cibas, E. (eds) The Bethesda System for Reporting Thyroid Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-60570-8_8

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  • DOI: https://doi.org/10.1007/978-3-319-60570-8_8

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  • Print ISBN: 978-3-319-60569-2

  • Online ISBN: 978-3-319-60570-8

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