Follicular thyroid cancer pathophysiology

	Follicular thyroid cancer Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Follicular thyroid cancer arises from follicular cells of thyroid, which are secretory cells that are normally involved in production and secretion of thyroid hormones, thyroxine (T4) and triiodothyronine (T3). Genes involved in the pathogenesis of follicular thyroid cancer include RAS, PAX8/PPARγ, and PTEN.

Follicular thyroid cancer is the second most common type of cancer. It constitutes about 15% of thyroid cancers.

Follicular thyroid cancer 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 carcinoma tends to metastasize to the lungs and bone via the bloodstream.
Follicular thyroid cancer metastasizes to lymph nodes late in the course of the disease, with only 5 - 10% of patients having nodal metastases at the time of diagnosis.
Hematogenous spread is however much more common with 20% of the patients having distant hematogenous metastases at at the time of diagnosis.
A Hürthle cell (also known as Askanazy cell) is an oncocytic cell in the thyroid that is often associated with Hashimoto's thyroiditis as well as follicular thyroid cancer.^[1]

PAX8/PPARγ (translocation) associated with PAX8-associated nuclear transcription signaling pathways. PAX8 is responsible for the follicular cell differentiation.

IDH1 (mutation) assciated with IDH1-associated metabolic pathways signaling pathways.

Phosphatase and tensin homologue suppressor gene and the phosphatidylinositol 3-kinase pathway are also involved in the pathogenesis of follicular thyroid tumor.
P53 (protein), c-myc, c-fos, and the thyrotropin (TSH) receptor are some other factors involved in the pathogenesis of follicular thyroid cancer.
MicroRNAs namely miR-192, miR-197, miR-328, and miR-346 have increased expression in follicular cell carcinoma.

It is not possible 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 th histopathological diagnosis.
On microscopic examination, trabecular, solid, follicular tumor cells that invade tumor capsule or surrounding vascular structures are found.

↑ Aytug, Serhat (June 13, 2006). "Hurthle Cell Carcinoma". eMedicine. Check date values in: |date= (help)