Management of papillary and follicular (differentiated) thyroid carcinoma - an update

Choudhury, Abdul Mobin; Shaikh, Abdul Alim

doi:10.3329/bjo.v16i2.6848

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…Excellent prognosis is seen in papillary carcinoma of thyroid (PTC) though approximately 10% of PTC patients undergo recurrences such as lymph node recurrence and lung metastasis 4 . Whereas majority of Follicular carcinoma of thyroid are minimally invasive with slight tumor capsular invasion alone and in case of medullary carcinoma the overall 5year survival of patients is 86%, though older age, advanced stage, the presence of lymph node metastasis at diagnosis were detected as poor prognostic factors 4,19 .…”

Section: Introductionmentioning

confidence: 99%

“…As management of thyroid carcinoma depends on tissue diagnosis and histological evidence 20 and plan of management differs significantly from different variety 19 ; hence, the study is aimed to evaluate the pattern of primary thyroid malignancy in a tertiary care hospital, which will help in early diagnosis and management planning for primary thyroid carcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Islam

Talukder

et al. 2020

J Dhaka Med Coll

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Background: Among the endocrine malignancies thyroid cancer is the most common. It constitutes a heterogeneous group of malignancies ranking it as the fifth most common cancer worldwide. On health as well as health system it has severe implication. Thyroid cancer incidence is rising most rapidly worldwide. Different thyroid malignancy requires different management strategy. Proper addressing and prompt management of different thyroid malignancies can lessen the suffering. Objective: The study aimed to evaluate the pattern of primary thyroid malignancy in a tertiary care hospital. Methods: The study was a hospital based descriptive cross sectional study and was conducted in Dhaka Medical College Hospital, Dhaka for one-year period following approval of this protocol. Patients suffering from primary thyroid carcinoma admitted in or attending the outpatient department (OPD) in the department of Otolaryngology and Head-Neck Surgery was approached for inclusion in the study. Written informed consent was taken from the subject and ethical issues were ensured. A total of 50 individual suffering from primary thyroid carcinoma calculated by sample size formula was selected by inclusion and exclusion criteria and data was collected by interview using a semi-structured questionnaire and by personal document analysis. Collected data was analyzed by the SPSS 20 for windows. This study reflects the pattern of primary thyroid malignancy in a tertiary care hospital in Bangladesh. Results: Mean age of the participants was 32.7 years with SD ± 13.8 years, Minimum age was 17 years and maximum age was 70 years. Majority of the patients (46%) were in the age group of 31- 40 years. Among the participants, 70% were female and 30% were male. The majority of the patients belong to Dhaka and Rangpur divisions (26% & 22% respectively) of which maximum patients were from rural area (70%). By occupation, maximum (22%) of the study subjects were businessman, maximum study subjects were below SSC (24%) and maximum patients (42%) had relatively low income per month. Half of the participants had habit of tobacco. All patients (100%) had presented with palpable thyroid swelling. Among the total participants 54% had lymphadenopathy, 10% had dysphagia, 4% had hoarseness of voice and 4% had lumpiness in throat. Only 2% of patients had the symptom of dyspnoea. No palpable lymph nodes were found in 46% followed by Single node lymphadenopathy 26%, multiple nodules in one side in 18%, bilateral lymphadenopathy 8% and 20% participants had Central compartment lymphadenopathy. USG findings of thyroid revealed Single solid nodule in 22.0%, Single cystic nodule in 16.0%, multiple mixed (solid + cystic) nodules in 62.0% cases. FNAC findings revealed Anaplastic carcinoma in 2.0%, Follicular neoplasm in 16.0% and Follicular variant of papillary carcinoma in 8.0%. Papillary carcinoma found in maximum 70.0% cases. No lymphoma found whereas medullary carcinoma found in 4.0% cases. Histopathological findings confirmed Anaplastic carcinoma in 4.0%, Follicular carcinoma in 16.0%, Follicular variant of papillary carcinoma in 8.0% and Papillary carcinoma 68.0% cases. By histopathological examination no lymphoma found whereas medullary carcinoma found in 4.0% cases. Only 24% participants had hypertension and 76% had DM as co-morbid diseases. Distant metastasis of carcinoma was not present in any of the participants. Conclusion: In this study, middle age group and female sex prevalent thyroid cancer. Geographical distribution also has an important role. Business, low educational level, low socioeconomic status and tobacco smoking are found the most important risk factors. Histopathologically papillary carcinoma was predominant followed by follicular carcinoma, follicular variant of papillary carcinoma, anaplastic carcinoma and medullary carcinoma. No lymphoma found. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 161-174

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Islam

Talukder

et al. 2020

J Dhaka Med Coll

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“…1 Butit is the commonest endocrine cancer accounting for 92%. 2 The annual incidence of thyroid cancer varies from 0.5 to10 per 100,000 populations worldwide.…”

Section: Introductionmentioning

confidence: 99%

Follicular Variant of Papillary Thyroid Carcinoma on the Basis of His-topathological and Immunohistochemical Diagnosis

Rahman¹,

Banu²,

Barua³

et al. 2017

Bangladesh Med Res Counc Bull

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A significant increase in incidence of papillary thyroid carcinoma (PTC) has been noticed in recent decades worldwide. This is due to advances in medical surveillance, increased use of ancillary tests, and a minor component due to over diagnosis of PTC. Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common variant of PTC and comprises about 23-41%. It is difficult to diagnose histologically when the distinctive nuclear features are either not well developed or present focally within the lesion. Several immunohistochemical markers (CD56, HMCK, GAL3, HBME-1 and CK19) either alone or combined in panels can be used to improve diagnostic accuracy. This study was aimed to differentiate FVPTC from other follicular patterned lesion of thyroid by histopathology and immunohistochemistry (IHC). A total of 50 histologically diagnosed cases of thyroid neoplasm were studied. The neoplastic cases included 40 cases of follicular variant papillary carcinoma (FVPC), 04 classic papillary carcinoma (PTC), 04 follicular carcinoma and 02 follicular adenoma. All cases were evaluated by IHC for the expression of CD56 and CK19 antibody. In case of FVPTC (n=40), 21 cases (52.5%) were CK19 positive and CD56 negative as expected. Both markers were found positive in 06 (15%) cases and CD56+ alone was found positive in 11 (27.5%) cases of FVPTC, and a finding that goes against the diagnosis of FVPTC. The histopathological slides of these cases were reviewed and findings were recorded. All cases (n=4) of classic PTC were CK19 positive and 03 (75%) cases were found CD56 negative. Diagnoses of thyroid follicular lesions are primarily based on histological and cytomorphological criteria. However, there was a subset of follicular patterned tumors like FVPTC which lack unequivocal features of malignancy. Immunohistochemistry can improve diagnostic accuracy but needs additional studies for controversial cases. It may be considered these lesions as differentiated tumor of uncertain malignant potential (WDT-UMP) to avoid the using term carcinoma. Additional studies are needed for establishing more precise morphologic criteria and for identifying useful markers for differentiating benign from borderline or malignant thyroid lesions.

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“…Due to limited resources, genetic tests were not conducted for the case reported in the present study. Almost all stages of FTC are treated with total or near-total thyroidectomy, iodine ablation and thyroid hormone suppression therapy (19). Similarly, aggressive management is recommended for patients with ITC, and the most appropriate treatment is total thyroidectomy followed by radioiodine therapy and close follow-up.…”

Section: Discussionmentioning

confidence: 99%

Insular thyroid carcinoma in the background of follicular thyroid carcinoma: A report of a rare case and mini‑review of the literature

Salih,

Abdullah,

Baba

et al. 2024

World Acad Sci J

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Follicular thyroid carcinoma (FTC) is a well-differentiated malignancy, while insular thyroid carcinoma (ITC) is a very rare and poorly differentiated tumor. The present study reports a case of ITC arising within the background of FTC. A 52-year-old housewife presented with an anterior neck swelling for a duration of 6 months. An ultrasound examination revealed a well-defined solid nodule measuring ~58x37x28 mm in the mid-lower third of the right thyroid lobe, and two small nodules of <3 mm in size in the left lobe. Fine needle aspiration cytology of the lesion led to the suspicion of follicular neoplasm. A right thyroid lobectomy was performed, and the histopathological examination revealed poorly differentiated insular carcinoma arising in the background of FTC. As a result of this diagnosis, a completion thyroidectomy was performed. ITC is a rare and highly aggressive thyroid malignancy that is morphologically and biologically regarded as an intermediate between fully differentiated and undifferentiated/anaplastic thyroid carcinomas. In comparison to patients solely with follicular carcinoma, patients with insular carcinoma are older, more often male, have larger tumor sizes, are at greater risk of metastasis, and have a lower survival rate. Poorly differentiated ITC with follicular carcinoma is a very rare and aggressive condition that could be managed by thyroidectomy followed by radioiodine therapy.

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Management of papillary and follicular (differentiated) thyroid carcinoma - an update

Cited by 4 publications

References 9 publications

Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Follicular Variant of Papillary Thyroid Carcinoma on the Basis of His-topathological and Immunohistochemical Diagnosis

Insular thyroid carcinoma in the background of follicular thyroid carcinoma: A report of a rare case and mini‑review of the literature

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