During a routine health maintenance examination, a physician palpates an asymptomatic, firm nodule in the right anterior neck of an adult female patient. The patient denies any recent weight changes, palpitations, dysphagia, or hoarseness. Her vital signs are within normal limits.
Laboratory evaluation reveals a serum thyroid-stimulating hormone (TSH) level of (normal: ) and a free T4 of (normal: ).
A dedicated neck ultrasound demonstrates a solid, hypoechoic nodule in the right thyroid lobe with irregular margins and punctate microcalcifications. A subsequent fine-needle aspiration biopsy is performed, revealing clusters of cells that demonstrate pale, empty-appearing nuclei, prominent longitudinal nuclear grooves, and scattered laminated calcific spherules.
Based on the confirmed diagnosis, which of the following correctly pairs the predominant molecular pathogenesis of this patient's neoplasm with a principle of its clinical management?
- Activating somatic mutation of a serine/threonine protein kinase; definitive management primarily involves surgical resection.Answer
- BInactivating mutation of the TP53 tumor suppressor gene; a whole-body positron emission tomography scan must be obtained prior to surgical planning.
- CGermline point mutation of the RET proto-oncogene; prophylactic surgical intervention is recommended for all of her first-degree relatives.
- DMonoclonal autoantibodies stimulating the thyrotropin receptor; a radioactive iodine uptake scan is the preferred next step to evaluate for autonomy.
- ESomatic mutation of the RAS oncogene; an upfront diagnostic hemithyroidectomy should have been performed initially instead of a fine-needle aspiration.