Follicular Adenoma and Carcinoma of the Thyroid Gland

McHenry, Christopher R.; Phitayakorn, Roy

doi:10.1634/theoncologist.2010-0405

Cited by 190 publications

(160 citation statements)

References 66 publications

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“…Although there may be factors indicating neoplastic change in fine needle aspirates, follicular carcinoma is defined as a tumour that invades the capsule, a feature that cannot be identified on cytological evaluation rendering these cancers indistinguishable from thyroid adenomas using cytopathology. The standard treatment of choice is therefore diagnostic hemithyroidectomy, which requires no further surgery in adenomatous lesions, but is usually followed by completion hemithyroidectomy, radioiodine ablation and suppression of TSH in the majority of invasive follicular carcinomas (McHenry & Phitayakorn 2011, Perros et al 2014, Pitoia & Miyauchi 2015. Raised serum TSH levels have been demonstrated in patients with follicular carcinoma compared with those with benign follicular disease (Kunt et al 2015).…”

Section: Genetic Factorsmentioning

confidence: 99%

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

Nieto¹,

Boelaert²

2016

Endocrine-Related Cancer

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Differentiated thyroid cancer is the most common endocrine malignancy and the incidence is increasing rapidly worldwide. Appropriate diagnosis and post-treatment monitoring of patients with thyroid tumours are critical. Fine needle aspiration cytology remains the gold standard for diagnosing thyroid cancer, and although there have been significant refinements to this technique, diagnostic surgery is often required for patients suspected to have malignancy. Serum thyroid-stimulating hormone (TSH) is higher in patients with malignant thyroid nodules than in those with benign disease, and TSH is proportionally increased in more aggressive tumours. Importantly, we have shown that the pre-operative serum TSH concentration independently predicts the presence of malignancy in subjects presenting with thyroid nodules. Establishing the use of TSH measurements in algorithms identifying high-risk thyroid nodules in routine clinical practice represents an exciting, cost-efficient and non-invasive approach to optimise thyroid cancer diagnosis. Binding of TSH to receptors on thyrocytes stimulates a number of growth promoting pathways both in normal and malignant thyroid cells, and TSH suppression with high doses of levothyroxine is routinely used after thyroidectomy to prevent cancer recurrence, especially in high-risk tumours. This review examines the relationship between serum TSH and thyroid cancer and reflects on the clinical potential of TSH measurements in diagnosis and disease monitoring.

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Section: Genetic Factorsmentioning

confidence: 99%

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

Nieto¹,

Boelaert²

2016

Endocrine-Related Cancer

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“…Until then, a patient with a follicular neoplasm should undergo a diagnostic thyroid lobectomy, which is definitive treatment for a benign follicular adenoma or a minimally invasive follicular cancer. [34] CONCLUSION: Follicular-patterned thyroid lesions are a common and challenging area of cytopathology. Follicular pattern in cytology is not characteristic of a particular diagnosis and constitutes a 'gray zone'.…”

Section: Discussionmentioning

confidence: 99%

Analyzing the ‘Gray Zone’ in Follicular Lesions of Thyroid

Sharma¹

2015

jemds

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BACKGROUND: Fine needle aspiration (FNA) is used as a gold standard for diagnosis of thyroid nodules. But, diagnostic efficacy of FNA declines sharply when follicular patterned lesions of thyroid are considered. Hence these lesions form a "gray zone" where a definite diagnosis on FNA is difficult. This article discusses the umbrella diagnosis of 'follicular lesions' on cytology, which largely comprises of four entities i.e., adenomatous goiter, follicular adenoma, follicular carcinoma, and the follicular variant of papillary thyroid carcinoma. AIMS: To assess the accuracy of FNAC in differentiating benign and malignant follicular patterned lesions so as to contribute to better patient care. MATERIALS AND METHODS: A retrospective analysis was conducted between 2009 and 2014 at our institution. Sixty two cases with diagnosis of 'follicular lesion' and 'follicular lesion with atypical cells' on FNA were included in the study. The cytological features were correlated with histopathology and the results tabulated. RESULTS: Sixty two cases with a FNA diagnosis of 'follicular lesion' or 'follicular lesion with atypical cells' was analyzed in the present study. The diagnosis of 'Follicular lesion' was noted in 46 cases and 'follicular lesion with atypical cells' in 16 cases. The histopathology diagnosis was adenomatous goiter in 35 cases, follicular adenoma in 16 cases, follicular carcinoma in four cases, and follicular variant of papillary carcinoma of thyroid (PTC) in seven cases. The malignancy rate in follicular pattern lesions (N=62) was 17.7% and neoplasia rate was 43.5%. In atypical or suspicious cases (N=16) the malignancy rate was 43.7% and the neoplasia rate was 68.7%. CONCLUSION: Follicular-patterned thyroid lesions remain a 'gray zone' and a challenge for cytopathologist. High malignancy rate in these patients supports the concept of giving an umbrella diagnosis of "follicular lesion" and advising excision of the nodule for histopathology to confirm the diagnosis or maintain close follow up.

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“…The histologic criteria used to distinguish benign from malignant neoplasm can be subtle especially in case of follicular neoplasm (4). The differential diagnosis of a thyroid nodule with a FNA biopsy consistent with follicular neoplasm is a follicular adenoma, adenomatous hyperplasia, follicular carcinoma, follicular variant of papillary carcinoma (5). A FNA biopsy specimen consistent with follicular neoplasm has a 15-30% risk of malignancy (6) .…”

Section: Discussionmentioning

confidence: 99%

“…There is a difference in the extent of surgery in terms of the probability of malignancy in the nodule. Thyroid lobectomy and isthmusectomy is the definite treatment for patients with a benign follicular adenoma and patients with minimally invasive follicular cancer whereas total thyroidectomy is necessary for invasive follicular carcinoma (5). Frozen section examination is not that helpful in intraoperative decision-making as it rarely distinguishes a follicular adenoma from a follicular carcinoma, which has been proven by various clinical trials (10).…”

Section: Discussionmentioning

confidence: 99%