Metastatic Minimally Invasive (Encapsulated) Follicular and Hurthle Cell Thyroid Carcinoma: A Study of 34 Patients

Abstract

Most studies that have examined minimally invasive, encapsulated, follicular carcinoma (FC) or Hurthle cell carcinomas (HCs) have contained only a few metastatic neoplasms. We studied 34 patients with a single, minimally invasive, metastatic FC or HC and compared them with 38 patients with similar, nonmetastatic FCs or HCs. The numbers of incomplete capsular penetration (neoplasm into but not through the capsule), complete capsular penetration (neoplasm through the capsule), and vascular invasion foci were quantified. The median number (three), range, and distribution of complete capsular penetration and vascular invasion foci were similar in the nonmetastatic and metastatic carcinomas. All of the metastatic FCs and HCs had at least one vascular invasion or complete capsular penetration focus. Sixty-two percent of the metastatic carcinomas had two to four complete capsular penetration foci, and 60% had two to four vascular invasion foci. Two metastatic neoplasms had incomplete capsular penetration but had one and two vascular invasion foci, respectively. One tumor had no vascular invasion but had four complete capsular penetration foci. No metastatic neoplasms had incomplete capsular penetration only. There were no differences in the number of vascular invasion or complete capsular penetration foci between metastatic and nonmetastatic FCs and HCs and between metastatic FCs and HCs. Most metastatic neoplasms had vascular space invasion and complete capsular penetration. The number of complete capsular penetration or vascular invasion foci was not associated with the initial site of metastasis or the interval between the surgery and the metastasis.

Hemithyroidectomy for low-risk follicular carcinoma of the thyroid: results from a regional hospital

“…In contrast, there is no evidence to support the benefit of RAI for early or low-risk FTC. (22) Likewise, for MIFTC that developed metastasis, Goldstein et al (23) failed to demonstrate any correlation between histology type (follicular carcinoma vs.…”

Prognostic factors of recurrence in encapsulated Hurthle cell carcinoma of the thyroid gland

“…The mean age at diagnosis was 52 years, which is at variance with most studies on encapsulated follicular carcinomas, which report a mean age range of 42 years to 48 years. 4,10,12 A referral bias could have caused this difference in age at presentation because high-risk older patients are more likely to be sent to a major cancer center. Both old age and male gender were not found to worsen prognosis within EHC.…”

“…Seven decades later, the debate still continues regarding the exact prognostic impact of vascular invasion and specifically its relation with capsular invasion and what constitutes extensive vascular invasion. 16 In 2000, Goldstein et al 10 compared metastatic with nonmetastatic encapsulated follicular carcinomas (including a mixture of oncocytic and nononcocytic variant) and reported no difference in the number of foci of capsular or vascular invasion between metastatic and nonmetastatic tumors. In the current series, vascular invasion was by far the most pow- erful predictor of recurrence (P Ͻ.0001) in patients with EHC, whereas capsular invasion was not significantly associated with tumor recurrence.…”

Minimally invasive follicular thyroid carcinoma

“…Zahlreiche Arbeitsgruppen beobach ten beim MIFTC einen besonders güns tigen Verlauf ohne tumorbedingten To desfall [7,20,21,26,28,32,33,53] [22]. Mit der Anzahl der Gefäßinvasionen steigt auch das Risi ko zur Fernmetastasierung [29].…”

“…In der Sammelstatistik von Goldstein [22] wei sen die MIFTC mit Fernmetastasen ei ne durchschnittliche Tumorgröße von 4,6 cm auf, Machens und Dralle konn ten zeigen, dass vor allem Knochenme tastasen ab 4 cm Größe deutlich zuneh men [34].…”