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Pathology · Endocrine: thyroid carcinoma
Sample itemA 72-year-old woman has a rapidly enlarging, hard neck mass for 3 weeks with hoarseness and dysphagia. Biopsy shows pleomorphic spindle and giant cells with numerous mitoses and necrosis. Which statement about the tumour is correct?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. It is an aggressive undifferentiated carcinoma with a median survival of months
Anaplastic thyroid carcinoma occurs in the elderly, often arising from a longstanding goitre or differentiated carcinoma, and invades locally with a dismal prognosis. TP53 mutations are common. It does not concentrate radioactive iodine.
Option by option
A. It arises from parafollicular C cells and secretes calcitonin
Medullary carcinoma arises from C cells and secretes calcitonin.
B. It is a well-differentiated tumour with a 95% 10-year survival
Papillary carcinoma has excellent long-term survival, unlike this lesion.
C. It is cured by radioactive iodine after thyroidectomy
Anaplastic tumours lose iodine uptake so radioiodine is ineffective.
D. It is an aggressive undifferentiated carcinoma with a median survival of months (correct)
Correct. Anaplastic carcinoma is rapidly fatal, with survival measured in months.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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