Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients

Katoh, Ryohei; Sasaki, Jun; Kurihara, Hideo; Suzuki, Koichi; Iida, Yoji; Kawaoi, Akira

doi:10.1002/1097-0142(19920915)70:6<1585::aid-cncr2820700623>3.0.co;2-z

Cited by 160 publications

(84 citation statements)

References 14 publications

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“…Thyroid gland has a rich network of intraglandular lymphatics that intercommunicate between lobes through the isthmus and drain to the cervical lymph nodes. 4 Intraglandular metastasis and cervical lymph node metastasis occur through these rich lymphatic networks. Multivariate analysis showed isolated glands and lateral tubular growth to be independent risk factors for lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Unique patterns of tumor growth related with the risk of lymph node metastasis in papillary thyroid carcinoma

et al. 2010

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Although many attempts have been made to predict the occurrence of lymph node metastases from papillary thyroid carcinoma, there are currently no reliable means to accurately predict cervical nodal metastasis. In this study, we present a novel prediction system for the lymph node metastasis based on the histological and cyclin D1 staining features. The frequency of lymph node metastases from a series of 210 papillary thyroid carcinomas was analyzed according to the clinicopathological variables, cyclin D1 staining patterns and BRAF V600E mutation in tumor tissue. A total of 113 (54%) patients had lymph node metastasis. Cyclin D1 was constantly expressed at the invasive tumor front and revealed well-defined isolated glands of tumor cells in the extratumoral region (isolated glands) and laterally spreading tubular growth along the fibrous septa around the invasive front of the tumor (lateral tubular growth). Upon univariate analysis, an age of less than 45 years (Po0.001), tumor size of 10 mm or more (Po0.001), non-follicular variant (P ¼ 0.005), invasive growth pattern (P ¼ 0.007), extrathyroid extension (P ¼ 0.006), isolated glands (Po0.001), lateral tubular growth (Po0.001) and tumor multiplicity (P ¼ 0.005) predicted lymph node metastasis, whereas BRAF V600E mutation did not. Upon multivariate analysis, age (P ¼ 0.001, odds ratio (OR) ¼ 5.146), tumor size (P ¼ 0.034, OR ¼ 3.119), isolated glands (Po0.001, OR ¼ 21.042) and lateral tubular growth (Po0.001, OR ¼ 24.652) were found to be strong independent predictors of lymph node metastasis. Cyclin D1 staining of papillary thyroid carcinoma is very useful for identifying the intrathyroidal spreading or multifocality of the tumors. Tumor growth patterns verified by cyclin D1 staining can be used for the identification of papillary thyroid carcinomas with metastatic potential.

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Section: Discussionmentioning

confidence: 99%

“…3 Papillary thyroid carcinoma tends to metastasize to the cervical lymph nodes during the early stages of the disease. 4,5 Cervical lymph node metastases are found in 30-90% of patients at the time of diagnosis. 5 Nodal metastases increase the risk of loco-regional recurrence and cancer-specific mortality in older patients (445 years) and distant metastases.…”

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confidence: 99%

Unique patterns of tumor growth related with the risk of lymph node metastasis in papillary thyroid carcinoma

et al. 2010

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“…In PTCs %2 cm, the impact of multicentricity on tumor outcome is still debated. Indeed, in some studies it has been significantly correlated with disease relapse (Baudin et al 1998, Chow et al 2003, Pellegriti et al 2004, whereas in other series the association with the outcome has been found to be marginal, indicating that a more aggressive treatment is not required in case of multiple foci (Kato et al 1992, Mazzaferri & Jhiang 1994. In the present series, multicentricity was associated with a worst outcome in tumors of group B, whereas no significance was found at the multivariate analysis performed on all tumors %2 cm.…”

Section: Discussionmentioning

confidence: 99%

Outcome predictors and impact of central node dissection and radiometabolic treatments in papillary thyroid cancers ≤2 cm

Perrino

Vannucchi

Vicentini

et al. 2009

Endocrine-Related Cancer

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The incidence of papillary thyroid cancer (PTC) is rapidly growing, the recorded increase being mainly related to tumors %2 cm. The re-classification of tumors O1 and %2 cm limited to the thyroid from the T2 to the T1 category triggered some concerns about their best management. In order to identify possible predictors of disease outcome, several clinico-pathological features were analyzed by uni-and multivariate analyses in a retrospective consecutive series of 251 PTCs %2 cm. Moreover, since 37% of cases were submitted to prophylactic central compartment node dissection (CLND, VI-VII levels) and radioiodine ablation was performed only when the tumor had an extrathyroidal extension, the impact of these therapeutic tools on the final outcome was evaluated. Among all outcome predictors analyzed, only lymph node metastases and extracapsular invasion were strongly associated with persistence/recurrence. It is worth noting that neither age nor tumor size was a significant indicator of the outcome. Interestingly, as far as the therapeutic interventions are concerned, CLND was strongly associated with remission, whereas radioiodine ablation did not influence the outcome. In conclusion, present results confirm the prognostic influence of node metastases and extra-thyroidal invasion, indicating the need for aggressive treatment in tumors extending beyond the capsule. On the contrary, all pT1N0 tumors, regardless of the diameter, the number of intrathyroidal foci, and the age can be effectively treated only by surgery. The major impact of prophylactic CLND on prognosis suggests to routinely associate it to total thyroidectomy in cases with a preoperative diagnosis of malignancy.

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“…At this point it is also worth considering the question of multicentricity of childhood DTC. In general, thyroid cancer and especially its papillary histotype appear as multiple foci (Katoh et al 1992 and recent reports (Sugg et al 1998) indicate that these foci may be polyclonal. It is generally accepted that juvenile DTC is more frequently multicentric, although detailed comparisons are hampered by technical differences.…”

Section: Characteristics and Natural History Of Juvenile Dtcmentioning

confidence: 99%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

171

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients

Cited by 160 publications

References 14 publications

Unique patterns of tumor growth related with the risk of lymph node metastasis in papillary thyroid carcinoma

Unique patterns of tumor growth related with the risk of lymph node metastasis in papillary thyroid carcinoma

Outcome predictors and impact of central node dissection and radiometabolic treatments in papillary thyroid cancers ≤2 cm

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

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