Is familial papillary thyroid microcarcinoma more aggressive than sporadic form?
Cho Rok LeeSeulkee ParkSang‐Wook KangJandee LeeJong Ju JeongKee‐Hyun NamWoong Youn ChungCheong Soo Park
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Abstract:
With the increasing incidence of papillary thyroid microcarcinoma (PTMC), familial papillary thyroid microcarcinoma (FPTMC) is now recognized more frequently. However, the biological behavior of FPTMC is poorly understood. The aim of this study was to investigate the prevalence of FPTMC and its biological aggressiveness.Between March 2006 and July 2010, 2,414 patients underwent primary surgical therapy for PTMC and 149 (6.2%) were further classified as FPTMC. To determine the biological aggressiveness of FPTMC, we compared the clinicopathological features and prognosis between FPTMC and sporadic PTMC (SPTMC).The male-to-female ratio was higher in FPTMC than in sporadic papillary thyroid microcarcinoma (SPTMC: 1:4.5 vs. 1:7.2, P = 0.041). The central lymph node (LN) metastasis rate was significantly higher in FPTMC than in SPTMC (36.2% vs. 24.2%, P = 0.002). The local recurrence rate was also higher in FPTMC than in SPTMC (4.5% vs. 0.6%, P < 0.001). We identified familial occurrence in 6.2% of cases of PTMC. FPTMC is associated with a high rate of central LN metastasis and local recurrence.These findings suggest that close follow-up can be beneficial in FPTMC patients to detect local recurrence.Keywords:
Distant metastasis
Thyroglobulin
Thyrotropin receptor
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Purpose: American Thyroid Association's guidelines (2015) recommend that papillary thyroid carcinomas (PTCs) ≤4 cm without extrathyroidal extension (ETE) and clinical lymph node metastasis (cLNM) can be treated by a unilateral procedure if a slightly higher risk of locoregional recurrence is accepted.The aim of the present study is to evaluate impact of minimal ETE (mETE) on locoregional recurrence in PTCs ≤4 cm without cLNM.Methods: The medical records of patients who underwent thyroidectomy for PTC ≤4 cm between January 1, 2007 and December 31, 2013 were retrospectively reviewed.Patients who had PTC with gross ETE and/or cLNM were excluded.-Patientswith papillary thyroid microcarcinoma (PTMC) without ETE (group I; n=381) were compared with three other groups of patients: PTC 1-4 cm without ETE (group II; n=150); PTC ≤1 cm with mETE (group III; n=186); and PTC 1-4 cm with mETE (group IV; n=121).Mean follow-up period was 72.2±26.4months.Results: Multiplicity, bilaterality, LNM, and total thyroidectomy were more common in group III and IV.Five-year disease-free survival (DFS) was 100%, 97.9%, 95.9%, and 94.9% in group I, II, III, and IV, respectively.DFS rates were significantly higher in group I compared to the other groups (P<0.01).There were no significant differences among group II, III, and IV.Conclusion: Compared to PTMC without ETE, mETE in PTC ≤4 cm without cLNM may be associated with more aggressive biological behavior and increased risk of recurrence, although the increments may be relatively small.
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甲状腺癌是头颈部最常见的恶性肿瘤，近年来发病率迅速增长，甲状腺乳头状癌是其中最常见的类型，其临床特点是极易发生淋巴结转移（lymph node metastasis，LNM），且与术后复发及预后密切相关，手术是处理侧颈LNM的首选治疗方案，精准的术前评估和个体化的手术方案是手术成功的基础。超声检查、细针穿刺、CT检查是目前术前评估侧颈LNM与否和范围的常用措施。然而，目前侧颈淋巴清扫的具体范围仍存在很大争议，如何在进行最大限度地减少肿瘤残留或复发的同时降低手术带来的不必要的创伤是下一步研究的关键，以免因过度手术和手术不足导致的无效医疗。.
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Supplementary Data from Gene Expression Profiling of Papillary Thyroid Carcinoma Identifies Transcripts Correlated with <i>BRAF</i> Mutational Status and Lymph Node Metastasis
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Abstract Background Lateral lymph node metastasis (LLNM) is common in patients with papillary thyroid cancer (PTC), usually occurring after central lymph node metastasis (CLNM). However, some patients experience LLNM without first developing CLNM. This study aimed to identify the risk factors for developing LLNM without CLNM. Methods We retrospectively reviewed 421 patients diagnosed with PTC who underwent lobectomy or total thyroidectomy with central and ipsilateral lateral lymph node dissection. We collected clinicopathological data and used univariate and multivariate logistic regression analyses to determine the risk factors associated with LLNM without CLNM. Results The LLNM without CLNM frequency was 18.3% (77/421). Univariate analyses demonstrated that age over 55 years, primary tumor in the upper portion of the thyroid, the number of central lymph node (CLN) and LLNM, primary tumor size, and the summed size of multi‐foci tumors smaller than 1 cm were significantly associated with LLNM without CLNM ( p < 0.05). Multivariate analysis revealed that LLNM without CLNM was more likely to occur in patients aged ≥55 years (odds ratio [OR], 2.309; 95% confidence interval [CI], 1.133–4.704; p = 0.021), and primary tumor in the upper portion of the thyroid (OR, 0.524; 95% CI, 0.295–0.934; p = 0.028). Conclusion The lymph node metastasis pattern in patients with PTC is not constant. Therefore, surgeons should evaluate the lateral lymph nodes, especially in patients older than 55 years or when the primary tumor is in the upper portion of the thyroid.
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Solid variant is a rare and poorly characterized variant of papillary thyroid carcinoma. In this study we analyzed 20 primary cases of the solid variant of papillary carcinoma found in a series of 756 papillary carcinomas operated at the Mayo Clinic between 1962 and 1989. The criteria for classification included predominantly (>70%) solid growth pattern of primary tumor, retention of cytologic features typical of papillary carcinoma, and absence of tumor necrosis. For each case of the solid variant, a control case of classical papillary carcinoma matched by age, sex, tumor size, and length of follow-up was selected. The follow-up ranged from 6 to 32 years. Two patients with the solid variant of papillary carcinoma (10%) died from disease 7 and 10 years after initial surgery, while another two patients (10%) are alive with lung metastases. In contrast, the control group had no cases with distant metastases or death from disease. Molecular analyses showed a similar prevalence of RET/PTC rearrangements in both groups. In conclusion, the solid variant of papillary carcinoma is associated with a slightly higher frequency of distant metastases and less favorable prognosis than classical papillary carcinoma. However, it should be distinguished from poorly differentiated thyroid carcinoma, which has a reported lower survival rate compared with the solid variant of papillary carcinoma.
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Polymorphous low-grade adenocarcinoma is a rare salivary gland tumor with lower rate of local and regional metastasis and rare distant metastasis. The prognosis is relatively good. This paper reported a case of palatal polymorphous low-grade adenocarcinoma with cervical lymph node and distant metastasis, and discussed clinical characteristics, differential diagnosis, treatment, prognosis based on literature review.
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