Internal Spreading of Papillary Thyroid Carcinoma: A Case Report and Systemic Review

Jin, Hui; Yan, Haiyu; Tang, Huamei; Zheng, Mingming; Wu, Chaojie; Li, Jun

doi:10.1155/2018/7618456

Cited by 6 publications

(7 citation statements)

References 10 publications

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“…These pathological features are strikingly similar to those observed in our case. In the reported case, two out of three harvested lymph nodes were positive for metastatic PTC but results of BRAF mutational analysis were not available ( 10 ).…”

Section: Discussionmentioning

confidence: 92%

A thyroid gland with over 30 foci of papillary thyroid carcinoma with activating BRAF V600E mutation

Pancer

Mitmaker

Ajise

et al. 2019

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Multifocal papillary thyroid carcinoma (PTC) is common and the number of tumor foci rarely exceeds ten. The mechanism of multifocal disease is debated, with the two main hypotheses consisting of either intrathyroidal metastatic spread from a single tumor or independent multicentric tumorigenesis from distinct progenitor cells. We report the case of a 46-year-old woman who underwent total thyroidectomy and left central neck lymph node dissection after fine-needle aspiration of bilateral thyroid nodules that yielded cytological findings consistent with PTC. Final pathology of the surgical specimen showed an isthmic dominant 1.5 cm classical PTC and over 30 foci of microcarcinoma, which displayed decreasing density with increasing distance from the central lesion. Furthermore, all malignant tumors and lymph nodes harbored the activating BRAF V600E mutation. The present case highlights various pathological features that support a mechanism of intraglandular spread, namely a strategic isthmic location of the primary tumor, radial pattern of distribution and extensive number of small malignant foci and BRAF mutational homogeneity. Learning points: Multifocal papillary thyroid carcinoma (PTC) is commonly seen in clinical practice, but the number of malignant foci is usually limited to ten or less. There is no clear consensus in the literature as to whether multifocal PTC arises from a single or multiple distinct tumor progenitor cells. Strategic location of the dominant tumor in the thyroid isthmus may favor intraglandular dissemination of malignant cells by means of the extensive lymphatic network. An important pathological finding that may be suggestive of intrathyroidal metastatic spread is a central pattern of distribution with a reduction in the density of satellite lesions with increasing distance from the dominant focus. PTCs originating from the isthmus with intraglandular metastatic dissemination behave more aggressively. As such, a more aggressive treatment course may be warranted, particularly with regard to the extent of surgery.

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Section: Discussionmentioning

confidence: 92%

A thyroid gland with over 30 foci of papillary thyroid carcinoma with activating BRAF V600E mutation

Pancer

Mitmaker

Ajise

et al. 2019

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…Intraglandular dissemination was defined as cancerous embolisms in the lymphatic vessels surrounding a major thyroid carcinoma, with features of heterotypic cells and psammoma bodies. 29 The aggressive pathologies included the hobnail variant, columnar cell variant, solid variant and tall cell variant.…”

Section: Methodsmentioning

confidence: 99%

<p>The Extent of Therapeutic Central Compartment Neck Dissection in Unilateral cT1N1a or cT2N1a Papillary Thyroid Carcinoma</p>

Liu¹,

Yang

Chen³

et al. 2020

CMAR

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Purpose Papillary thyroid carcinomas (PTCs) frequently metastasize to the central neck compartment. Therapeutic central compartment neck dissection (CCND) is a well-established treatment for PTC nodal metastases; however, the extent to which therapeutic CCND should be performed remains controversial. In this study, we investigated the predictive risk factors for contralateral paratracheal lymph node metastasis (LNM) in unilateral cT1N1a or cT2N1a PTC. Patients and Methods In this case–control study, which was conducted at a single center, demographic and pathological data from unilateral cT1N1a or cT2N1a PTC patients were collected from January 2017 to March 2019. All patients were treated with total thyroidectomy and bilateral CCND. Results Two hundred thirty-seven patients met the inclusion criteria. Forty-nine patients (20.7%) were diagnosed with positive lymph nodes in the contralateral paratracheal region. Male sex (p=0.003), T2 disease (21–40 mm) (p<0.001), inferior pole tumor (p=0.011), near isthmus tumor (p<0.001), aggressive pathology (p<0.001), intraglandular dissemination (p=0.009), pretracheal LNM (p<0.001), >5 metastatic lymph nodes (p<0.001) and extranodal invasion (p=0.003) were significantly associated with contralateral paratracheal LNM in univariate analysis. Multivariate analysis showed that male sex (p=0.005, OR=17.545), T2 disease (p=0.003, OR=34.317), inferior pole tumor (p=0.022, OR=8.289), near isthmus tumor (p=0.001, OR=40.229), aggressive pathology (p=0.027, OR=48.063), pretracheal LNM (p=0.002, OR=14.235) and >5 metastatic lymph nodes (p=0.025, OR=23.426) were independent risk factors for contralateral paratracheal LNM. Conclusion Male sex, T2 disease, a tumor located near the isthmus or inferior pole, aggressive pathology, pretracheal LNM and >5 metastatic lymph nodes were predictive factors for contralateral paratracheal LNM in unilateral cT1N1a or cT2N1a PTC. These data may be useful to identify targets for surveillance or develop therapeutic interventions for patients with CCND.

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“…Intraglandular dissemination meant that cancerous embolisms with heterotypic cells and psammoma bodies were found in the lymphatic vessels surrounding a major carcinoma. 21 Tall cell variant, solid variant, columnar cell variant and hobnail variant were included in aggressive pathology.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Effect of Tumor Location on the Risk of Bilateral Central Lymph Node Metastasis in Unilateral 1-4 cm Papillary Thyroid Carcinoma

Liu

Chen

et al. 2021

CMAR

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Purpose: Papillary thyroid carcinoma (PTC) has a high incidence of lymph node metastasis (LNM). Our aim was to determine whether tumor location is a useful feature to predict bilateral central lymph node metastasis (CLNM) in unilateral 1-4 cm PTC. Patients and Methods: Data on unilateral 1-4 cm PTC patients from 2016 to 2019 were collected retrospectively. The clinical and pathological characteristics of the tumors and lymph nodes were analyzed statistically. Results: The mean patient age was 49.1±12.3 (23-73) years, and the majority were women (n=1334, 75.4%). A total of 1767 patients were analyzed, and 256 (14.5%) had bilateral CLNM. Tumor location was an independent risk factor in predicting bilateral CLNM (p<0.001). The odds of bilateral CLNM were the highest in the near isthmus (OR 6.452, p<0.001). In a multivariate regression model adjusting for other risk factors, near-isthmus tumors had the highest risk of bilateral CLNM (OR 7.319, 95% CI: 3.844-13.933, p<0.001), followed by lower lobe tumors (OR 2.338, 95% CI: 1.315-4.155, p=0.004) and middle lobe tumors (OR 1.845, 95% CI: 1.035-3.291, p=0.038), compared to upper lobe tumors. Conclusion:Tumor location is an independent risk factor in predicting the risk of bilateral CLNM. Near-isthmus tumors carry the highest risk of bilateral CLNM.

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Internal Spreading of Papillary Thyroid Carcinoma: A Case Report and Systemic Review

Cited by 6 publications

References 10 publications

A thyroid gland with over 30 foci of papillary thyroid carcinoma with activating BRAF V600E mutation

A thyroid gland with over 30 foci of papillary thyroid carcinoma with activating BRAF V600E mutation

<p>The Extent of Therapeutic Central Compartment Neck Dissection in Unilateral cT1N1a or cT2N1a Papillary Thyroid Carcinoma</p>

Effect of Tumor Location on the Risk of Bilateral Central Lymph Node Metastasis in Unilateral 1-4 cm Papillary Thyroid Carcinoma

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