15/11/2025
Post
25 বছরের মেয়ে, জীবন শুরু হতে না হতেই, ক্যান্সার নামক মরণ ব্যাধি রোগ গলায় বাসা বেঁধেছে
Dx:Follicular Thyroid Carcinoma with Neck metastasis
Operation : Total Thyroidectomy with central neck clearance with Selective neck dissection
Structure Explanation :::::
Thyroid Carcinoma (FTC)
>Definition
A malignant tumour of thyroid follicular epithelial cells, characterized by capsular and/or vascular invasion.
> >Key Diagnostic Point:
FC cannot be diagnosed by FNAC.
Diagnosis requires histopathology showing invasion.
>Epidemiology
More common in females (40–60 yrs)
More frequent in iodine-deficient regions
Accounts for 10–15% of thyroid cancers
>Pathogenesis
Follicular cells → genetic mutations (e.g., RAS, PAX8–PPARγ translocation) → tumor grows and invades capsule/vessels.
>Types
1. Minimally invasive
Only capsular invasion
Better prognosis
2. Widely invasive
Extensive vascular/capsular invasion
Worse prognosis
3. Hurthle cell carcinoma (variant)
More aggressive
Poorer uptake of radioactive iodine
>>Clinical Features
Solitary thyroid nodule
Firm, smooth, painless swelling
Slowly progressive
Often euthyroid (normal thyroid function)
Symptoms of metastasis (common due to blood spread)
Bone pain / pathological fractures
Lung symptoms (cough, dyspnea)
Spread (Very Important)
➡️ Hematogenous spread (unlike papillary carcinoma which spreads lymphatically)
Common metastatic sites:
Bone (lytic lesions)
Lungs
Liver (less common)
Investigations
1. FNAC
Shows “follicular neoplasm” → cannot differentiate adenoma vs carcinoma
2. Ultrasound
Solitary, solid, hypoechoic nodule
May have halo (capsule)
3. Histopathology (Diagnostic)
Capsular invasion
Vascular invasion
Uniform follicular cells
>>>Management
Surgery
Total thyroidectomy (standard)
Hemithyroidectomy may be considered in minimally invasive low-risk cases
Post-operative treatment
Radioactive Iodine (RAI) ablation for most patients
TSH suppression with levothyroxine
Lifelong follow-up with thyroglobulin levels and imaging
>>Prognosis
10-year survival ~ 85–90% for minimally invasive
Lower for widely invasive and Hurthle cell variants
Prognosis depends on:
Age > 45 years
Tumor size
Vascular invasion
Dr.Robiul islam Rony
Assistant Professor
Dept. Of ENT & Head Neck Surgery
Kumudini Women's Medical College
Mirjapur, Tangail
Alhamdulillah
15/11/25
