Papillary carcinoma of the thyroid

Abstract

The clinical behavior and mortality rate of papillary carcinoma of the thyroid varies widely, and clinically insignificant microscopic foci of the disease are frequently found. Dietary iodine and radiation to the head and neck in childhood play a role in etiology. Needle aspiration cytology provides a highly accurate diagnosis. Ultrasound, radioactive iodine, and technetium scans are not specific and should only be used to complete diagnostic studies when aspiration cytology is negative for papillary carcinoma. The most important aspect of prognosis of an individual patient with papillary carcinoma of the thyroid is the age at which the disease is diagnosed, with an excellent prognosis, even in advanced primary disease or extensive lymph node involvement, in children and young adults. A multifactorial clinical risk group definition (AMES) is easy to use and reliably separates patients into low risk and high risk. Since 90% of patients with this disease rarely have metastases or late complications from the cancer, total or subtotal thyroidectomy is necessary in only 10% of cases for later use of postoperative radioactive iodine. More conservative surgical procedures are advised in low-risk patients. Papillary carcinoma incidentally found during operation for other conditions such as Graves disease or thyroiditis and reported first on the permanent pathology reports are always clinically insignificant and completely cured by removal; total thyroidectomy should be completely avoided. Postoperatively, thyroid hormone supplementation may be unnecessary after relatively conservative surgery in selected low-risk patients. Thyroid hormone must be maintained permanently after total or subtotal thyroidectomy.

A long-standing cystic lymph node metastasis from occult thyroid carcinoma—report of a case

“…Papillary carcinomas are the most common variety of thyroid malignancy. They account for 68 per cent to 74 per cent of all malignant thyroid tumours (Jensen et al, 1990;Candy, 1991). Twenty five per cent of papillary carcinomas were classified as occult thyroid carcinoma, because they were less than 1.5 cm in size (Hubert et al, 1980).…”

Epidemiology of Thyroid Cancer

“…Data on this postulated association are inconsistent (50,(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62). However, the data remain inconclusive (63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76), with reported cancer rates ranging from 0.06% (66) to as high as 8.7% (68) in glands affected by Graves' disease. Graves' disease has also been postulated to be associated with an increased incidence of thyroid cancer.…”

Towards Understanding the Molecular Basis of Thyroid Cancer

“…60 Likewise, the notion that thyroid carcinoma is more frequent in Graves' disease glands, and tends to be more aggressive, [65][66][67] has been challenged. 68,69 Several host factors which determine the outcome of thyroid cancer have been identified. These include patient age, tumor size, histologic appearance, local invasion, lymph node and distant metastases and DNA aneuploidy.…”