Incidental carcinoma of the thyroid

Abstract

The diagnosis of incidental thyroid carcinoma in patients submitted to thyroidectomy for a benign disease is quite frequent. A retrospective analysis was performed on 455 patients submitted to surgical intervention in order to establish the incidence of this kind of carcinoma. Two hundred fifty-six patients (56%) were affected by benign disease (176 multinodular goiter, 12 uninodular goiter, 1 Plummer disease and 67 Basedow disease) and 202 (44%) by carcinoma. In 28 of 256 patients (11%), affected by benign disease, occurred a histological diagnosis of thyroid carcinoma, (10 papillary carcinoma, 1 follicular carcinoma, 29 papillary carcinoma follicular variant). In this study it's considered incidental thyroid carcinoma the one occurred in patients who never underwent Fine Needle Aspiration (FNA) and there were no suspicious features in all exams that may suggest the presence of carcinoma. Twenty-three of the 40 incidental carcinoma (57.5%) were microcarcinomas. Ten patients had a sincronous carcinoma. Actually, these patients are still in a follow up program and no recurrency of disease is occasionally observed. This study shows that the only way to put doubts on the real benignity of the disease is the fine needle aspiration; there are no other instruments that could identify the occurrence of the carcinoma. Moreover in the majority of cases the incidental carcinoma is a microcarcinoma, it doesn't reach significant volume, may be not centered by a FNA, but in most cases it's not really biologically aggressive.

Comparison of clinicopathological features in incidental and nonincidental papillary thyroid carcinomas in 308 patients

“…In our study, IPTCs were more common in female patients and the mean age of patients was 51.3 years, which was similar to the data reported in the meta-analysis. Some studies have stated that FVPTC was the most common histological variant in IPTCs [7,10,17,21], whereas other studies indicated that CVPTC was the most common variant in IPTCs [15,18], as in our study. One of the studies was performed in a nearby geographic region and reported similar results to our study by declaring the most common histology as CVPTC in IPTCs [18].…”

“…Prognosis of IPTCs has been reported to be more favourable than NIPTCs [11,21,22,24,35]. In the present study, clinicopathological features and the BRAF V600 mutation status as a probable prognostic factor were compared between IPTCs and NIPTCs, as well as in IPTCS according to primary tumour size with a cut-off value of 5 mm.…”

“…The prognosis of IPTCs has been the subject of several papers, particularly in terms of the presence or absence of a difference between IPTCs and nonincidental PTCs (NIPTCs). Accumulated data from the results of these studies revealed that IPTCs, in particular incidental microcarcinomas, have a more favourable prognosis than NIPTCs [11,19,21,22,23,24]. In addition, the molecular basis of IPTCs has been investigated in previous studies.…”

Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter

“…Our 12.1% rate is comparable to rates from other European countries, including Belgium, Italy (25,30,33) and Greece (17). Because Italy and Greece have no nuclear plants, we tend to exclude that our rate was influenced by the relative vicinity of our medical center and residence of patients to three nuclear plant units (82).…”

Incidental thyroid carcinomas. A retrospective study

“…The incidence also varies in relation to the histological type and the type of thyroid disease associated. Papillary forms would appear to be much more frequent than follicular ones (42).…”