Compared with papillary thyroid carcinoma, the characteristic pattern of distant spread of follicular thyroid carcinoma is:

• A Predominantly lymphatic spread to jugular chain nodes
• B Haematogenous spread to bone and lung ✓
• C Direct invasion into the trachea and oesophagus as the main route
• D Perineural spread along the recurrent laryngeal nerve

Explanation

Follicular carcinoma characteristically invades vessels and disseminates haematogenously, giving bone (often lytic) and lung metastases, sometimes as the first presentation. Lymph node involvement is uncommon, unlike papillary carcinoma which spreads early to jugular chain nodes through lymphatics. This biological difference underlies why follicular lesions require lobectomy or total thyroidectomy for diagnosis, since capsular and vascular invasion can only be assessed histologically.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.