‘Aggressive papillary’ thyroid microcarcinoma

Abstract

The objective of this study is to highlight the fact that papillary thyroid microcarcinoma can be aggressive, requiring therapeutic management similar to that of other differentiated thyroid cancers. This 8-year retrospective study concerned 187 surgical patients managed in an ENT and Head and Neck surgery department for thyroid cancer. 65 patients were found to have papillary microcarcinoma. 41 microcarcinomas were considered to be aggressive because of the presence of several risk factors such as larger than 5 mm, multifocal microcarcinomas, capsular effraction, vascular embolus, tumour extension beyond the thyroid parenchyma and metastatic lymphadenopathy. All patients with aggressive papillary microcarcinoma were treated by total thyroidectomy and (131)I. Ipsilateral recurrent laryngeal and lateral cervical lymph node dissections were performed in ten patients, ipsilateral cervical lymph node dissection was performed in six patients and bilateral recurrent laryngeal and lateral cervical lymph node dissections were performed in three patients. No recurrence or metastasis was observed (follow-up ranging from 6 months to 8 years). The optimal management of thyroid papillary microcarcinoma is still controversial. "Aggressive" papillary thyroid microcarcinoma is not rare and may justify aggressive treatment depending on the presence or absence of prognostic risk factors.

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype–phenotype correlation

“…6 In papillary thyroid microcarcinoma, nodal metastases have been reported in the range of 6-66.4% cases. 4,5,7,19,[22][23][24] In the present study, node dissection was performed in 70% (n ¼ 87) of the patients. Of these, 28% of patients had metastatic lymph nodes, and 88% of patients with nodal metastasis had microcarcinomas positive for the mutation.…”

“…6 Clinicopathological factors, eg, age more than 45 years, tumor size greater than 5 mm, male sex, multifocality, lymph nodes metastasis, and extrathyroidal extension have been reported to predict poor prognosis. 4,7,8 In recent years, a T1799A point mutation in the v-raf murine sarcoma viral oncogene homolog B1 (BRAF) resulting in a valine-to-glutamic acid switch at codon 600 (V600E) has emerged as a marker of aggressive behavior in papillary thyroid carcinoma. 9 A few studies have suggested that this mutation may predict aggressive behavior in papillary microcarcinoma too.…”

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

“…Two main difficulties arise from these modern guidelines: (i) a subset of these tumours progresses and metastasises (Roti et al 2006, Page et al 2009(ii) patients, when presented with a cancer diagnosis, often prefer comprehensive therapy, which leaves them with the best prognosis and the lowest risk of recurrence, often despite the potential cost of any associated treatment morbidity. Although current tumour staging systems are unable to guide therapy in papillary microcarcinomas, the potential for use of TSH to assist in assessing prognosis is appealing.…”

A Comparative Relationship Between Thyroid Gland And Body Weight: A Study in Foetuses of Different Ages

“…Most of the variations of the thyroid gland are due o a partial persistence of the median thyroglossal duct [4].We also observed a female fetus with agenesis of isthmus ith isolated lobes. Failure of the development of the ntire gland, or part of the gland, results in agenesis or emi agenesis, which may be unilateral or isthmic [6][7][8][9][10][11][12][13][14]Many workers claim that the absence of isthmus is uite rare in humans [7,8]. The frequency of the presence of pyramidal lobes could be a source of pitfalls in hyroidectomy during preoperative diagnosis on images [9].Braun et al [9] reported a pyramidal lobe was found to be present in 55% of the cadavers and it was found more frequently in men than in omen.…”