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Histopathologic and immunohistochemical characterization of a primary
papillary thyroid carcinoma in the lateral cervical lymph node.
Exp Mol Pathol. 2007 Feb;82(1):91-4.
Lymph nodes in
the neck are known to occasionally contain benign epithelial
inclusions and can be rare primary site of various tumors usually
occurring in other organs. Papillary thyroid carcinoma in the lateral
neck lymph node with co-existing ectopic thyroid inclusions has not
been reported previously. A 41-year-old male patient, who had normal
thyroid function and no history of neck irradiation, was seen with a
slowly enlarging mass in the right lateral neck. At surgery the
cervical mass was found to be separate from the thyroid proper without
any attachments in between. Papillary thyroid carcinoma and
co-existing thyroid inclusions were identified within the lateral
cervical lymph node. Immunohistochemistry detected strong and diffuse
cytoplasmic positivity with antibodies against CK19 and CK903 in
papillary thyroid carcinoma. Benign thyroid follicles within the lymph
node were only weakly and focally stained. Thorough examination
confirmed no malignancy in the total thyroidectomy specimen.
Furthermore, small foci of metastatic papillary carcinoma were
identified in two ipsilateral lymph nodes from neck dissection
specimen. These findings suggest development of primary papillary
thyroid carcinoma from malignant transformation of benign intranodal
thyroid inclusions.
Papillary thyroid carcinoma with lymph node metastases.Growth
Factors. 2007;25 (1): 41-9.
Papillary thyroid
cancer (PTC) is the most frequently occurring human thyroid cancer
with good prognosis following appropriate treatment. Lymph node (LN)
metastases are the main way through which PTC spread cancer cells. The
mechanisms underlying PTC with local invasion, LN metastases and
distant metastases are not well investigated. Tumor secrete cytokines,
such as vascular endothelial growth factor (VEGF)-C and -D bind to
VEGF receptors on lymphatic endothelial cells and induce proliferation
(budding) from nearby lymphatic capillaries and growth of new
lymphatic capillaries. About one-third of patients can be diagnosed at
the time of surgical findings. Different image studies, such as
ultrasonography with fine needle aspiration cytology, scintigraphic
localization and positron emission tomography were reported to detect
LN metastases. Important factors in predicting LN metastases are
vascular invasion, male gender, absence of tumor capsule, and
perithyroid involvement. Tumor recurrence in LN after primary
treatment of PTC had an independent and highly significant negative
effect on survival in patients over 45 year-old. Recombinant adeno-associated
virus-mediated gene transfer of sVEGFR3-Fc is a feasible therapeutic
scheme for blocking lymphogenous metastasis. In conclusion, aggressive
surgical procedures performed by experienced surgeons or postoperative
radioactive iodine therapy to minimize local recurrence of LN for PTC
patients with high risk.
Risk Factors for Recurrence to the Lymph Node in
Papillary Thyroid Carcinoma Patients without Preoperatively Detectable
Lateral Node Metastasis: Validity of Prophylactic Modified Radical
Neck Dissection.World
J Surg. 2007 Sep 22;
BACKGROUND:
Although papillary carcinoma usually shows mild characteristics, it
metastasizes and shows recurrence to the lymph node in high
incidences. Of the two representative lymph node compartments to which
papillary carcinoma metastasizes, the central compartment can be
routinely dissected via the surgical incision made for thyroidectomy.
However, the routine application of prophylactic lateral node
dissection (modified radical neck dissection [MND]) remains
controversial. In this study, we investigated risk factors for lymph
node recurrence of papillary carcinoma to determine the appropriate
application of prophylactic MND. METHODS: We investigated risk factors
for lymph node recurrence in 1,231 patients without preoperatively
detectable lateral node metastasis who underwent thyroidectomy,
central node dissection, and prophylactic MND for papillary carcinoma
between 1987 and 1995. RESULTS: The incidence of lateral node
metastasis and the number of metastatic lateral nodes significantly
increased with carcinoma size. The lymph node disease-free survival (LN-DFS)
was also significantly worse in carcinoma with a maximal diameter
greater than 3 cm. Massive extrathyroid extension, male gender, and
age 55 years or older also reflected a poorer LN-DFS. The 10-year
LN-DFS rates of patients with carcinoma having two and three or four
of these features were low at 88.5% and 64.7%, respectively, although
the rates of those with carcinoma having no or only one characteristic
were better than 95%. CONCLUSIONS: Prophylactic MND is recommended for
cases of papillary carcinoma demonstrating two or more of the
following four characteristics; male gender, age 55 years or older,
maximal tumor diameter larger than 3 cm, and massive extrathyroid
extension.
Prognostic factors for persistent or recurrent disease of papillary
thyroid carcinoma with neck lymph node metastases and/or tumor
extension beyond the thyroid capsule at initial diagnosis.J
Clin Endocrinol Metab. 2005
Oct;90(10):5723-9.
CONTEXT: Reliable
prognostic factors are needed in papillary thyroid cancer patients to
adapt initial therapy and follow-up schemes to the risks of persistent
and recurrent disease. OBJECTIVE AND SETTINGS: To evaluate the
respective prognostic impact of the extent of lymph node (LN)
involvement and tumor extension beyond the thyroid capsule, we studied
a group of 148 consecutive papillary thyroid cancer patients with LN
metastases and/or extrathyroidal tumor extension. Initial treatment,
performed at the Institut Gustave Roussy between 1987 and 1997,
included in all patients a total thyroidectomy with central and
ipsilateral en bloc neck dissection followed by radioactive iodine
ablation. RESULTS: Uptake outside the thyroid bed, demonstrating
persistent disease, was found on the postablation total body scan
(TBS) in 22% of the patients. With a mean follow-up of 8 yr, eight
patients (7%) with a normal postablation TBS experienced a recurrence.
Ten-year disease-specific survival rate was 99% (confidence interval,
97-100%). Significant risk factors for persistent disease included the
numbers of LN metastases (>10) and LN metastases with extracapsular
extension (ECE-LN >3), tumor size (>4 cm), and LN metastases location
(central). Significant risk factors for recurrent disease included the
numbers of LN metastases (>10), ECE-LN (>3), and thyroglobulin level
measured 6-12 months after initial treatment after T4 withdrawal.
CONCLUSION: We highlight an excellent survival rate and suggest risk
classifications of persistent and recurrent disease based on the
numbers of LN metastases and ECE-LN, LN metastases location, tumor
size, and thyroglobulin level.
Clinical study on papillary thyroid carcinoma presenting with lymph
node metastasis.Nippon
Jibiinkoka Gakkai Kaiho. 2004 Aug;107(8):750-5.
Papillary thyroid
carcinoma (PTC) may metastasize to cervical lymph nodes. It is,
however, uncommon for a palpable neck node alone to lead to the
diagnosis of this disease when it is not apparent at presentation.
Standard treatment for such cases has not yet been established. We
retrospectively analyzed clinical courses in 8 patients with thyroid
papillary carcinoma presenting with palpable lymph node metastasis at
Hokkaido University Hospital between 1990 and 2003. Three had high
thyrogloblin in cervical cystic lesions, leading to the diagnosis of
PTC with lymph node metastasis. In 4, PTC was diagnosed by
pathological examination of cervical lymph nodes initially diagnosed
as lateral cervical cysts. Preoperative examination did not indicate
PTC within the gland in any case. All 8 were alive at the last visit
after follow-up from 23 to 150 months (mean: 78 months). Total
thyroidectomy was done on 4 and thyroid lobectomy on 3. Pathological
examination of resected thyroid glands confirmed multifocal papillary
carcinoma from 4 mm to 15 mm in diameter. Six underwent unilateral
neck dissection and 1 chose bilateral dissection. The other patient
received no additional surgery on either the thyroid or neck after the
single enlarged lymph node initially diagnosed as a lateral cervical
cyst was resected. Postoperative radioiodine treatment was done in 2
undergoing total thyroidectomy. Recurrence in the cervical area were
observed in 1 whose neck dissection was insufficient. Based on these
observations, we concluded that patients who undergo thyroid lobectomy
and adequate neck dissection may enjoy longer survival than those
treated with total thyroidectomy without sacrificing thyroid and
parathyroid function. We therefore propose a prospective study on the
effectiveness of thyroid lobectomy with neck dissection including
positive nodes in patients with occult PTC presenting with lymph node
metastasis.
Papillary microcarcinoma of the thyroid-Prognostic significance of
lymph node metastasis and multifocality.Cancer.
2003 Jul 1;98(1):31-40.
BACKGROUND: It is
known that patients with papillary microcarcinoma (PMC) of the thyroid
gland have a very favorable prognosis. The rising incidence of PMC
among papillary thyroid carcinoma (PTC) necessitates the
identification of prognostic factors and the formulation of treatment
protocols. METHODS: The authors conducted a retrospective analysis of
203 patients with PMC who were diagnosed on or before 1999 and were
treated at the Department of Clinical Oncology, Queen Elizabeth
Hospital, Hong Kong. RESULTS: The cause specific survival,
locoregional (LR) failure free survival, and distant metastases
failure free survival rates at 10 years were 100%, 92.1%, and 97.1%,
respectively. Five patients had lung metastases; 2 patients died of
their metastases 12.9 years and 14.8 years after diagnosis, and 3
patients achieved clinical remission after radioiodine (RAI)
treatment. Twelve patients had LR recurrences. Patients with LR
recurrence were highly salvageable with a combination of surgery, RAI
treatment, and external radiotherapy; all but one (who refused
treatment) were alive without disease at last follow-up. Multivariate
analyses did not reveal any independent prognostic factor for
survival. The risk of cervical lymph node (LN) recurrence increased
6.2-fold (P = 0.01) and 5.6-fold (P = 0.02) when LN metastases and
multifocal disease were present at diagnosis. RAI ablation reduced the
LN recurrence rate to 0.27 (P = 0.04). The presence of LN metastasis
increased the rate of distant metastasis 11.2-fold (P = 0.03). Age was
not a significant factor in predicting disease recurrence or survival.
Subdivision by tumor sizes </= 5 mm and > 5 mm did not affect the
outcome, but no patient with tumors <or= 5 mm had mortality related to
PMC. CONCLUSIONS: Despite the overall excellent prognosis for patients
with PMC, PMC was associated with a 1.0% disease-related mortality
rate, a 5.0% LN recurrence rate, and a 2.5% distant metastasis rate.
Therefore, the treatment of patients with PMC should be no different
from the treatment of patients with conventional PTC: i.e., complete
surgery with consideration for RAI and/or external radiation therapy
if poor prognostic factors are present.
Papillary carcinoma of the thyroid: development of the
histological criteria for diagnosis. Study of 29 cases and review of
the literature.
Ann Pathol.
1988;8(3):211-9.
Papillary
carcinoma (PAP) is the most frequent malignant tumour of the thyroid.
PAP and follicular carcinoma of the thyroid are two biologically
different tumours, without any intermediate or mixed form. Therefore
the differentiation between PAP and follicular carcinoma is essential.
The histological diagnosis of PAP is based upon several criteria, the
most important being the papillae, the "ground glass" nuclei, and the
psammoma bodies. The value of the "ground glass" nuclei in the
diagnosis of PAP has been particularly emphasized in the last 10
years. The need to take into account all the diagnostic histological
criteria of PAP is necessary in the definition of the different
variants of PAP, particularly its follicular variant. We report 28
cases of PAP and one case of insular carcinoma, the latter probably
originating from a PAP. "Ground glass" nuclei often associated with
"grooved nuclei", were identified in the paraffin sections of 7 PAP.
One case was classified as a follicular variant of PAP. Psammoma-bodies
were seen in 6 PAP. Eleven PAP were less than 1 cm in diameter (microPAP).
One microPAP presented with important lymph node metastases and blood
vessels' involvement; 2 others microPAP arose in a vesicular adenoma.
Six PAP were entirely encapsulated, without any lymph node metastasis
or vessel invasion. Six PAP presented with lymph node metastases
associated with lymphatic and/or blood vessels invasion. Lymphatic and
blood vessel invasion was seen more often in association with PAP
extending to the thyroid capsule. The histological classification and
prognostic criteria are discussed and compared with those previously
described in the literature.
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