Thyroid neoplasm

Thyroid neoplasm
Thyroid neoplasm
	Thyroid anatomy
Specialty	Oncology

Last updated March 06, 2024

Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma,^[1] or it can be a malignant neoplasm (thyroid cancer), such as papillary, follicular, medullary or anaplastic thyroid cancer.^[2] Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men.^[2]^[3] The estimated number of new cases of thyroid cancer in the United States in 2023 is 43,720 compared to only 2,120 deaths.^[4] Of all thyroid nodules discovered, only about 5 percent are cancerous, and under 3 percent of those result in fatalities.

Diagnosis

The first step in diagnosing a thyroid neoplasm is a physical exam of the neck area. If any abnormalities exist, a doctor needs to be consulted. A family doctor may conduct blood tests, an ultrasound, and nuclear scan as steps to a diagnosis. The results from these tests are then read by an endocrinologist who will determine what problems the thyroid has. Hyperthyroidism and hypothyroidism are two conditions that often arise from an abnormally functioning thyroid gland. These occur when the thyroid is producing too much or too little thyroid hormone respectively.^[4]

Thyroid nodules are a major presentation of thyroid neoplasms, and are diagnosed by ultrasound guided fine needle aspiration (USG/FNA) or frequently by thyroidectomy (surgical removal and subsequent histological examination). FNA is the most cost-effective and accurate method of obtaining a biopsy sample.^[5] As thyroid cancer can take up iodine, radioactive iodine is commonly used to treat thyroid carcinomas, followed by TSH suppression by high-dose thyroxine therapy.^{[ citation needed ]}

Nodules are of particular concern when they are found in those under the age of 20. The presentation of benign nodules at this age is less likely, and thus the potential for malignancy is far greater.^{[ citation needed ]}

Classification

Thyroid neoplasm might be classified as benign or malignant.^{[ citation needed ]}

Benign neoplasms

Thyroid adenoma is a benign neoplasm of the thyroid. Thyroid nodules are very common and around 80 percent of adults will have at least one by the time they reach 70 years of age. Approximately 90 to 95 percent of all nodules are found to be benign.^[4]

Malignant neoplasms

Thyroid cancers are mainly papillary, follicular, medullary or anaplastic thyroid cancer.^[2] Most patients are 25 to 65 years of age when first diagnosed; women are more affected than men.^[2]^[3] Nearly 80 percent of thyroid cancer is papillary and about 15 percent is follicular; both types grow slowly and can be cured if caught early. Medullary thyroid cancer makes up about 3 percent of this cancer. It grows slowly and can be controlled if caught early. Anaplastic is the most deadly and makes up around 2 percent. This type grows quickly and is hard to control.^[4] The classification is determined by looking at the sample of cells under a microscope and determining the type of thyroid cell that is present. Other thyroid malignancies include thyroid lymphoma, various types of thyroid sarcoma, smooth muscle tumors, teratoma, squamous cell thyroid carcinoma and other rare types of tumors.^[6]

Carcinoma of the thyroid with Ewing family tumor elements (CEFTE) disclosing solid nests of small cells with regular, round nuclei, and nests of papillary thyroid carcinoma (PTC) (a). This case is from a 17-year-old female patient with bilateral involvement of the thyroid by a malignant thyroid teratoma (b); the tumor discloses nests of small cells, rich stroma with chondroid appearance and an epithelial-tubular component. Mixed medullary and papillary thyroid carcinoma (c); the medullary thyroid carcinoma component stained positively for calcitonin mRNA while the PTC (follicular variant) component was negative (d). Intrathyroid thymic carcinoma (ITC) also known by the acronym (CASTLE) showing positivity for CD5 (inset) (e). Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a lobulated tumor composed of spindle cells and epithelioid cell component with glands, mucinous cysts, and/or squamous nests (f and g)^[7]
Follicular patterned medullary thyroid carcinoma (MTC) (a). In this other follicular patterned MTC (b), there are several calcifications simulating psammoma bodies (inset) and positivity for calcitonin (c). Intrathyroidal parathyroid tissue (d). The microscopic aspect of an intrathyroidal parathyroid adenoma is similar to eutopic parathyroid adenomas (e). Intrathyroidal parathyroid adenoma expressing chromogranin A (f) and PTH (g). Calcitonin-negative medullary thyroid carcinoma (h) showing positivity for CGRP (i). Paraganglioma (j) typically shows negativity for calcitonin and S100-positive sustentacular cells (inset)^[7]
Hyperfunctioning follicular adenoma typically shows follicles with papillary infoldings and bubbly, pale colloid with peripheral scalloping (a). Non-hyperfunctioning adenomas with papillary hyperplasia usually show a more predominantly papillary pattern without vacuolated cytoplasm and scalloping colloid (b). Rare hyperfunctioning follicular tumors (c) can show capsular and/or venous invasion (inset); the nuclei are very clear which may be associated to hyperfunctioning. The glomeruloid pattern in this follicular thyroid carcinoma (FTC) included follicles with round to oval tufts growing within, at times supported by a fibrovascular core mimicking the renal glomerulus (d and e); empty follicles were lined by columnar cells with marked pseudostratification, and positivity for CK18 was detected (f). FTC (g) with TTF1 expression (h) and very focal expression of thyroglobulin i^[7]
Lipid-rich follicular thyroid carcinoma (a) immunoreactive for thyroglobulin (b); the ultrastructural study evidenced numerous lipid vacuoles in the cytoplasm (ultrastructure) (c). Adenolipoma (lipoadenoma) in a patient with PTEN hamartoma tumor syndrome (d); there is negativity for PTEN protein in tumor cells while stromal cells (internal positive control) are positive (e)^[7]
Medullary thyroid carcinoma with papillary pattern (a). Solid variant of papillary thyroid carcinoma (b) with focal expression of thyroglobulin (c) and expression of T4 (d); in this case, TTF1 was diffusely expressed. Biphasic Hürthle cell (oncocytic) clear carcinoma in which the basal half of the cytoplasm is oncocytic, whereas the upper half is clear (e), due to the swelling of the mitochondria (ultrastructure) (f)^[7]
Metastatic carcinomas in the thyroid gland. Thyroid metastasis from lung adenocarcinoma (a, b). Some metastatic tumor cells (right) are positive for thyroglobulin due to diffusion artifact and should not be overinterpreted as positive (b). Metastatic clear cell renal carcinoma (c), metastatic renal cells are negative for thyroglobulin (d). Colonic adenocarcinoma metastatic to the thyroid gland (e); the thyroid tissue is positive for thyroglobulin while the metastatic adenocarcinoma is negative (f)^[7]
Mucinous thyroid carcinoma (a) showing abundant mucoid material mucicarmine positive (b); most tumor cells were positive for thyroglobulin (c). In this mucinous variant of follicular thyroid carcinoma (d), the follicles were distended and full of Alcian blue–positive mucinous material (e). Mucinous variant of papillary thyroid carcinoma (PTC) (f), the tumor showed ribbon, trabecular and/or follicular pattern, classic nuclear features of PTC and abundant mucoid stroma positively stained with Alcian blue (g)^[7]
Spindle cell variant of papillary thyroid carcinoma (PTC) showing spindle cells with typical PTC nuclei (a and b). Meningioma-like follicular adenoma (c and d), the typical arrangement of spindle to ovoid cells in a whorled pattern may give the impression one is dealing with a vascular tumor. Pericytic-like follicular adenoma (e) is characterized by a proliferation of spindle follicular cells concentrically arranged around vessels; the follicular nature of the tumor cells could be confirmed by the positivity for thyroglobulin (inset), thyroperoxidase, TTF1 and cytokeratins but negativity for calcitonin and CD31. PTC with fibromatosis/fasciitis-like stroma with both stromal and PTC component (f)^[7]
Squamous cell tumor examples that include extensive squamous metaplasia in PTC after fine needle aspiration biopsy (FNAB) (a), squamous cell carcinoma in the thyroid of putative secondary origin (b), and squamous cell carcinoma of the esophagus metastatic in the thyroid and diagnosed by FNAB (c). Mucoepidermoid carcinoma (d) composed by solid sheets of epithelial cells showing epidermoid cells and glandular spaces containing mucinous material positively stained with Alcian blue (e). Sclerosing mucoepidermoid carcinoma with eosinophilia showing epithelial cells richly infiltrated by eosinophils, lymphocytes, and plasma cells (f)^[7]
Columnar cell variant of papillary thyroid carcinoma (PTC) showing a combination of papillary and glandular-like patterns (a), marked nuclear pseudostratification, and less nuclear features of classic PTC (b). In the tall cell variant of PTC, the cytoplasm is deeply eosinophilic, and nuclear features of PTC are very prominent with irregular contours and common pseudoinclusions (c). Hobnail variant of PTC combining papillary (d), and micropapillary (e) structures lined by hobnail cells. “Teardrop” cells (f) and comet-like cells (inset). The cribriform-morular thyroid carcinoma exhibits a blending of cribriform, papillary, trabecular, and solid pattern with morules (g) and (h). Morules are strongly positive for CD10 (i). Tumor cells are reactive for estrogen receptors (j), and there is strong nuclear and cytoplasmic reactivity for β-catenin (k)^[7]
Tumor of the thyroid with solid cell nest features disclosing small cells of the main cell type (a) that express p63 (b) and cytokeratin 5 (c), in the absence of TTF1, calcitonin, and thyroglobulin expression. Hyalinizing trabecular tumor (d–f) is composed of trabeculae of elongated or polygonal cells admixed with abundant amounts of hyaline material negative for amyloid and positive for type IV collagen (f); Ki-67 is characteristically expressed in the cell membrane but not in the nuclei of the tumor cells (e). Follicular adenoma with signet ring cells (g and h), showing strong positivity for thyroglobulin (i)^[7]

Treatment

Treatment of a thyroid nodule depends on many things including size of the nodule, age of the patient, the type of thyroid cancer, and whether or not it has spread to other tissues in the body. If the nodule is benign, patients may receive thyroxine therapy to suppress thyroid-stimulating hormone and should be reevaluated in six months.^[2] However, if the benign nodule is inhibiting the patient's normal functions of life; such as breathing, speaking, or swallowing, the thyroid may need to be removed.^{[ citation needed ]} Sometimes only part of the thyroid is removed in an attempt to avoid causing hypothyroidism. There is still a risk of hypothyroidism though, as the remaining thyroid tissue may not be able to produce enough hormones in the long-run.^{[ citation needed ]}

If the nodule is malignant or has indeterminate cytologic features, it may require surgery.^[2] A thyroidectomy is a medium-risk surgery that can result in complications if not performed correctly. Problems with the voice, nerve or muscular damage, or bleeding from a lacerated blood vessel are rare but serious complications that may occur. After removing the thyroid, the patient must be supplied with a replacement hormone for the rest of their life. This is commonly a daily oral medication prescribed by their endocrinologist.^[8]

Radioactive iodine-131 is used in patients with papillary or follicular thyroid cancer for ablation of residual thyroid tissue after surgery and for the treatment of thyroid cancer. Patients with medullary, anaplastic, and most Hurthle cell cancers do not benefit from this therapy.^[2] External irradiation may be used when the cancer is unresectable, when it recurs after resection, or to relieve pain from bone metastasis.^[2]

Related Research Articles

The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans, it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the isthmus (pl.: isthmi). The thyroid gland is a butterfly-shaped gland located in the neck below the Adam's apple. Microscopically, the functional unit of the thyroid gland is the spherical thyroid follicle, lined with follicular cells (thyrocytes), and occasional parafollicular cells that surround a lumen containing colloid. The thyroid gland secretes three hormones: the two thyroid hormones – triiodothyronine (T₃) and thyroxine (T₄) – and a peptide hormone, calcitonin. The thyroid hormones influence the metabolic rate and protein synthesis and growth and development in children. Calcitonin plays a role in calcium homeostasis. Secretion of the two thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is secreted from the anterior pituitary gland. TSH is regulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus.

Multiple endocrine neoplasia is a condition which encompasses several distinct syndromes featuring tumors of endocrine glands, each with its own characteristic pattern. In some cases, the tumors are malignant, in others, benign. Benign or malignant tumors of nonendocrine tissues occur as components of some of these tumor syndromes.

Thyroglobulin (Tg) is a 660 kDa, dimeric glycoprotein produced by the follicular cells of the thyroid and used entirely within the thyroid gland. Tg is secreted and accumulated at hundreds of grams per litre in the extracellular compartment of the thyroid follicles, accounting for approximately half of the protein content of the thyroid gland. Human TG (hTG) is a homodimer of subunits each containing 2768 amino acids as synthesized.

An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure. Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner. Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.

This is a list of terms related to oncology. The original source for this list was the US National Cancer Institute's public domain Dictionary of Cancer Terms.

The International Classification of Diseases for Oncology (ICD-O) is a domain-specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.

Thyroid disease is a medical condition that affects the function of the thyroid gland. The thyroid gland is located at the front of the neck and produces thyroid hormones that travel through the blood to help regulate many other organs, meaning that it is an endocrine organ. These hormones normally act in the body to regulate energy use, infant development, and childhood development.

A Hürthle cell is a cell in the thyroid that is often associated with Hashimoto's thyroiditis as well as benign and malignant tumors. This version is a relatively rare form of differentiated thyroid cancer, accounting for only 3-10% of all differentiated thyroid cancers. Oncocytes in the thyroid are often called Hürthle cells. Although the terms oncocyte, oxyphilic cell, and Hürthle cell are used interchangeably, Hürthle cell is used only to indicate cells of thyroid follicular origin.

Hürthle cell neoplasm is a rare tumor of the thyroid, typically seen in women between the ages of 70 and 80 years old. When benign, it is called a Hürthle cell adenoma, and when malignant it is called a Hürthle cell carcinoma. Hürthle cell adenoma is characterized by a mass of benign Hürthle cells. Typically such a mass is removed because it is not easy to predict whether it will transform into the malignant counterpart of Hürthle cell carcinoma, which is a subtype of follicular thyroid cancer.

Anaplastic thyroid cancer (ATC), also known as anaplastic thyroid carcinoma, is an aggressive form of thyroid cancer characterized by uncontrolled growth of cells in the thyroid gland. This form of cancer generally carries a very poor prognosis due to its aggressive behavior and resistance to cancer treatments. The cells of anaplastic thyroid cancer are highly abnormal and usually no longer resemble the original thyroid cells and have poor differentiation.

Papillary thyroid cancer is the most common type of thyroid cancer, representing 75 percent to 85 percent of all thyroid cancer cases. It occurs more frequently in women and presents in the 20–55 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck. It is often well-differentiated, slow-growing, and localized, although it can metastasize.

Acinic cell carcinoma is a malignant tumor representing 2% of all salivary tumors. 90% of the time found in the parotid gland, 10% intraorally on buccal mucosa or palate. The disease presents as a slow growing mass, associated with pain or tenderness in 50% of the cases. Often appears pseudoencapsulated.

A thyroid adenoma is a benign tumor of the thyroid gland, that may be inactive or active as a toxic adenoma.

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

Medullary thyroid cancer is a form of thyroid carcinoma which originates from the parafollicular cells, which produce the hormone calcitonin. Medullary tumors are the third most common of all thyroid cancers and together make up about 3% of all thyroid cancer cases. MTC was first characterized in 1959.

Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. Cancer can also occur in the thyroid after spread from other locations, in which case it is not classified as thyroid cancer.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor that was previously classified as an encapsulated follicular variant of papillary thyroid carcinoma, necessitating a new classification as it was recognized that encapsulated tumors without invasion have an indolent behavior, and may be over-treated if classified as a type of cancer.

In CT scan of the thyroid, focal and diffuse thyroid abnormalities are commonly encountered. These findings can often lead to a diagnostic dilemma, as the CT reflects nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer.

Dr. Yuri Nikiforov is an American scientist who revolutionized the understanding of thyroid cancer, most recently winning a two-year battle in which the World Health Organization has agreed in 2017 to reclassify non-invasive thyroid tumors to non-cancerogenic liaisons. Those tumors typically have some, but not all, characteristics of cancer. The WHO has agreed to change the term for the tumors from Encapsulated Follicular Variant of Papillary Thyroid Carcinoma to Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features, or NIFTP. About 45,000 people a year are diagnosed with NIFTP in the world. The decision led to a change in protocol of medical treatment, which no longer required removal of the whole thyroid gland from such patients as well as ended the use of radioactive iodine, extending their life expectancy and quality of life. The patients still undergo surgery, in which their thyroid tumors are removed, typically with half, but not all, of the thyroid gland.

References

↑ Mitchell RS, Kumar V, Abbas AK, Fausto N (2007). "Chapter 20: The Endocrine System". Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN 978-1-4160-2973-1.
1 2 3 4 5 6 7 8 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.
1 2 Al-Zaher N, Al-Salam S, El Teraifi H (2008). "Thyroid carcinoma in the United Arab Emirates: perspectives and experience of a tertiary care hospital". Hematology/Oncology and Stem Cell Therapy. 1 (1): 14–21. doi: 10.1016/s1658-3876(08)50055-0 . PMID 20063523.
1 2 3 4 "Cancer of the Thyroid - Cancer Stat Facts". The Surveillance, Epidemiology, and End Results (SEER). U.S. National Cancer Institute.
↑ Schmitt FC (June 2010). "Thyroid cytology: is FNA still the best diagnostic approach?". International Journal of Surgical Pathology. 18 (3 Suppl): 201S–204S. doi:10.1177/1066896910370884. PMID 20484291. S2CID 937920.
↑ DeLellis RA, Lloyd RV, Heitz PU, Eng C, eds. (2004). Pathology and Genetics of Tumours of Endocrine Organs. World Health Organization Classification of Tumours. Vol. 8 (3rd ed.). Lyon, France: IARC Press. pp. 94–123. ISBN 978-92-832-2416-7.
1 2 3 4 5 6 7 8 9 10 11 Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M (September 2020). "Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers". Endocrine Pathology. 31 (3): 197–217. doi:10.1007/s12022-020-09638-x. PMC 7395918 . PMID 32632840.
"This article is licensed under a Creative Commons Attribution 4.0 International License"
↑ Hannoush ZC, Weiss RE (January 2016). "Thyroid Hormone Replacement in Patients Following Thyroidectomy for Thyroid Cancer". Rambam Maimonides Medical Journal. 7 (1): e0002. doi:10.5041/RMMJ.10229. PMC 4737508 . PMID 26886951.

External links

Thyroid Cancer Clinical Trials Page of the American Thyroid Association
Thyroid Cancer- National Cancer Institute
Diagnostic patient information

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[Kumar20-1] Mitchell RS, Kumar V, Abbas AK, Fausto N (2007). "Chapter 20: The Endocrine System". Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. ISBN 978-1-4160-2973-1.

[hu-2] 1 2 3 4 5 6 7 8 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.

[hemoncstem.net-3] 1 2 Al-Zaher N, Al-Salam S, El Teraifi H (2008). "Thyroid carcinoma in the United Arab Emirates: perspectives and experience of a tertiary care hospital". Hematology/Oncology and Stem Cell Therapy. 1 (1): 14–21. doi: 10.1016/s1658-3876(08)50055-0 . PMID 20063523.

[na-4] 1 2 3 4 "Cancer of the Thyroid - Cancer Stat Facts". The Surveillance, Epidemiology, and End Results (SEER). U.S. National Cancer Institute.

[pmid20484291-5] Schmitt FC (June 2010). "Thyroid cytology: is FNA still the best diagnostic approach?". International Journal of Surgical Pathology. 18 (3 Suppl): 201S–204S. doi:10.1177/1066896910370884. PMID 20484291. S2CID 937920.

[6] DeLellis RA, Lloyd RV, Heitz PU, Eng C, eds. (2004). Pathology and Genetics of Tumours of Endocrine Organs. World Health Organization Classification of Tumours. Vol. 8 (3rd ed.). Lyon, France: IARC Press. pp. 94–123. ISBN 978-92-832-2416-7.

[Cameselle-Teijeiro2020-7] 1 2 3 4 5 6 7 8 9 10 11 Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M (September 2020). "Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers". Endocrine Pathology. 31 (3): 197–217. doi:10.1007/s12022-020-09638-x. PMC 7395918 . PMID 32632840.
"This article is licensed under a Creative Commons Attribution 4.0 International License"

[8] Hannoush ZC, Weiss RE (January 2016). "Thyroid Hormone Replacement in Patients Following Thyroidectomy for Thyroid Cancer". Rambam Maimonides Medical Journal. 7 (1): e0002. doi:10.5041/RMMJ.10229. PMC 4737508 . PMID 26886951.

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v t e Tumours of endocrine glands
Pancreas	Pancreatic cancer Pancreatic neuroendocrine tumor α: Glucagonoma β: Insulinoma δ: Somatostatinoma G: Gastrinoma VIPoma
Pituitary	Pituitary adenoma: Prolactinoma ACTH-secreting pituitary adenoma GH-secreting pituitary adenoma Craniopharyngioma Pituicytoma
Thyroid	Thyroid cancer (malignant): epithelial-cell carcinoma Papillary Follicular/Hurthle cell Parafollicular cell Medullary Anaplastic Lymphoma Squamous-cell carcinoma Benign Thyroid adenoma Struma ovarii
Adrenal tumor	Cortex Adrenocortical adenoma Adrenocortical carcinoma Medulla Pheochromocytoma Neuroblastoma Paraganglioma
Parathyroid	Parathyroid neoplasm Adenoma Carcinoma
Pineal gland	Pinealoma Pinealoblastoma Pineocytoma
MEN	1 2A 2B