| Papillary thyroid cancer | |
|---|---|
| Classification and external resources | |
 Papillary thyroid carcinoma. |
|
| ICD-10 | C73. |
| ICD-9 | 193 |
| OMIM | 603744 |
| eMedicine | med/2464 |
| MeSH | D013964 |
Papillary thyroid cancer is the most common type of thyroid cancer.[1] It occurs more frequently in women and presents in the 30-40 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck.
Contents |
Markers
Thyroglobulin can be used as a tumor marker for well-differentiated papillary thyroid cancer.[2][3] HBME-1 staining may be useful for differentiating papillary carcinomas from follicular carcinomas; in papillary lesions it tends to be positive.[4]
Pathology
- Characteristic Orphan Annie eye nuclear inclusions (nuclei with uniform staining, which appear empty)[5] and psammoma bodies on light microscopy. The former is useful in identifying the follicular variant of papillary thyroid carcinomas.[6]
- Lymphatic spread is more common than hematogenous spread
- Multifocality is common
- The so-called Lateral Aberrant Thyroid is actually a lymph node metastasis from papillary thyroid carcinoma.[7]
- Papillary microcarcinoma is a subset of papillary thyroid cancer defined as measuring less than or equal to 1cm. [8]. The highest incidence of papillary thyroid microcarcinoma in autopsy series was reported by Harach et al. in 1985, who found 36 of 101 consecutive autopsies were found to have an incidental microcarcinoma [9]. Michael Pakdaman et al. report the highest incidence in a retrospective surgical series at 49.9% of 860 cases [10]. Management strategies for incidental papillary microcarcinoma on ultrasound (and confirmed on FNAB) range from total thyroidectomy with radioactive iodine ablation to observation alone. Harach et al. suggest using the term "occult papillary tumor" to avoid giving patients distress over having cancer.It was Woolner et al. who first arbitrarily coined the term "occult papillary carcinoma" in 1960, to describe papillary carcinomas ≤ 1.5cm in diameter.[11]
Prognosis
There are at minimum 13 known scoring systems for prognosis; among the more often used are:
- AGES - Age, Grade, Extent of disease, Size
- AMES - Age, Metastasis, Extent of disease, Size
- MACIS - Metastasis, Age at presentation, Completeness of surgical resection, Invasion (extrathyroidal), Size[12] (this is a modification of the AGES system). It is probably the most reliable staging method available.
- TNM - Tumor, node, metastasis. Remarkable about the TNM grading for (differentiated) thyroid carcinoma is that the scoring is different according to age.
Treatment
Surgical treatment:
- Minimal disease (diameter up to 1.0 centimeters) - hemithyroidectomy (or unilateral lobectomy) and isthmectomy may be sufficient. There is some discussion whether this is still preferable over total thyroidectomy for this group of patients.
- Gross disease (diameter over 1.0 centimeters) - total thyroidectomy, and central compartment lymph node removal is the therapy of choice. Additional lateral neck nodes can be removed at the same time if an ultrasound guided FNA and thyrobulin TG cancer washing was positive on the pre-operative neck node ultrasound evaluation.
Arguments for total thyroidectomy are:
- Reduced risk of recurrence, if central compartment nodes are removed at the original surgery.
- Papillary carcinoma is a multifocal disease (hemithyroidectomy may leave disease in the other lobe)
- Ease of monitoring with thyroglobulin (sensitivity for picking up recurrence is increased in presence of total thyroidectomy, and ablation of remnant normal thyroid by low dose radioiodine 131 after following a low iodine diet (LID).
- Ease of detection of metastatic disease by thyroid and neck node ultrasound.
Thyroid total body scans are less reliable at finding recurrence than TG and ultrasound.
Additional images
.jpg) Micrograph of papillary thyroid carcinoma demonstrating prominent papillae with fibrovascular cores. H&E stain. |
.jpg) Micrograph showing that the papillae in papillary thyroid carcinoma are composed of cuboidal cells. H&E stain. |
.jpg) Micrograph (high power view) showing nuclear changes in papillary thyroid carcinoma (PTC), which include groove formation, optical clearing, eosinophilic inclusions and overlapping of nuclei. H&E stain. |
.jpg) Micrograph (high power view) of PTC demonstrating nuclear clearing and overlapping nuclei. H&E stain. |
 Micrograph of metastatic papillary thyroid carcinoma to a lymph node. H&E stain. |
 Micrograph of papillary thyroid carcinoma, tall cell variant - high magnification. H&E stain. |
 Micrograph of papillary thyroid carcinoma, tall cell variant - intermediate magnification. H&E stain. |
References
- ^ Hu MI, Vassilopoulou-Sellin R, Lustig R, Lamont JP. "Thyroid and Parathyroid Cancers" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
- ^ Lin JD (2007). "Thyroglobulin and human thyroid cancer". Clin Chim Acta 388: 15. doi:. PMID 18060877.
- ^ Tuttle RM, Leboeuf R, Martorella AJ (2007). "Papillary thyroid cancer: monitoring and therapy". Endocrinol. Metab. Clin. North Am. 36 (3): 753–78, vii. doi:. PMID 17673127.
- ^ Papotti M, Rodriguez J, De Pompa R, Bartolazzi A, Rosai J (April 2005). "Galectin-3 and HBME-1 expression in well-differentiated thyroid tumors with follicular architecture of uncertain malignant potential". Mod. Pathol. 18 (4): 541–6. doi:. PMID 15529186.
- ^ "Papillary Carcinoma of Thyroid (Hi Pow)". University of Connecticut Health Center. http://esynopsis.uchc.edu/eAtlas/Endo/1802.htm. Retrieved 2008-09-14.
- ^ Yang GC, Liebeskind D, Messina AV (2001). "Ultrasound-guided fine-needle aspiration of the thyroid assessed by Ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to six-year follow-up". Thyroid 11 (6): 581–9. doi:. PMID 11442006.
- ^ Escofet X, Khan AZ, Mazarani W, Woods WG (2007). "Lessons to be learned: a case study approach. Lateral aberrant thyroid tissue: is it always malignant?". J R Soc Health 127 (1): 45–6. doi:. PMID 17319317.
- ^ Shaha AR (2007). "TNM classification of thyroid carcinoma.". World J Surg 31 (5): 879–87. doi:. PMID 17308849.
- ^ Harach HR, Franssila KO, Wasenius VM (1985). "Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study.". Cancer 56 (3): 531–8. doi:. PMID 2408737.
- ^ Pakdaman MN, Rochon L, Gologan O, Tamilia M, Garfield N, Hier MP, Black MJ, Payne RJ (2008). "Incidence and histopathological behavior of papillary microcarcinomas: Study of 429 cases.". Otolaryngol Head Neck Surg 139 (5): 718–22. doi:. PMID 18984270.
- ^ LEWIS B. WOOLNER, M.D., MARK L. LEMMON, M.D.{dagger}, OLIVER H. BEAHRS, M.D., B. MARDEN BLACK, M.D. and F. RAYMOND KEATING, JR., M.D. OCCULT PAPILLARY CARCINOMA OF THE THYROID GLAND: A STUDY OF 140 CASES OBSERVED IN A 30-YEAR PERIOD* Journal of Clinical Endocrinology & Metabolism Vol. 20, No. 1 89-105 doi:10.1210/jcem-20-1-89 PMID: 13845950 [PubMed - OLDMEDLINE]
- ^ "New York Thyroid Center: Prognosis Staging for Thyroid Cancer". http://cpmcnet.columbia.edu/dept/thyroid/staging.html. Retrieved 2007-12-22.
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