Lymphatic drainage, regional metastases and surgical management of papillary thyroid carcinoma arising in pyramidal lobe – a single institution experience

Santrač, Nada; Bešič, Nikola; Buta, Marko; Oruci, Merima; Djurisic, Igor; Pupić, Gordana; Petrovic, Ljubica; Ito, Yasuhiro; Džodić, Radan

doi:10.1507/endocrj.ej13-0316

Cited by 24 publications

(25 citation statements)

References 26 publications

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“…Primary PTC arising from the pyramidal lobe is rare [4567]. Santrac et al [7] reported three cases of pyramidal lobe PTC over 10 years.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, only 5 case series have been reported worldwide [45678]. Thus, the clinical and pathological characteristics of pyramidal lobe PTC are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

“…A previous study reported the incidence of occult malignancy in the surgically resected pyramidal lobe as 2% [7]. Occult pyramidal lobe malignancy is important to endocrine surgeons, not only in terms of the decision to completely remove the thyroid tissue, but also with respect to remnant cancer in the operating field.…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe

Yoon

Seong

et al. 2017

Ann Surg Treat Res

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Purpose Papillary thyroid carcinoma (PTC) arising from the pyramidal lobe is rare; therefore, clinicopathologic evaluation is lacking. In addition, the rate of occult malignancy in the pyramidal lobe after thyroid surgery is unclear. This study is to evaluate the clinical characteristics of PTCs that involve the pyramidal lobe. Methods The study enrolled 1,107 patients who underwent thyroid surgery for PTC at Seoul National University Hospital from 2006 to 2015. Pyramidal lobe status in pathologic reports was clear in all cases. “Pyramidal lobe-dominant PTC” was defined as single pyramidal lobe cancer or multifocal cancer with larger pyramidal lobe tumor. “Incidental pyramidal lobe PTC” was defined as occult cancer identified after thyroidectomy or as multifocal cancer with smaller pyramidal lobe tumor. Results Ten patients were included in the pyramidal lobe-dominant PTC group. The mean age was 58 ± 12.5 years, and the mean tumor size was 0.7 ± 0.7 cm. Cervical lymph node metastasis was found in 5 patients (50%). Three patients had microscopic lymphatic invasion, and 7 had advanced American Joint Comitee on Cancer (AJCC) stage disease (5 with stage III and 2 with stage IV). Compared with conventional PTC (n = 1,058), pyramidal lobe-dominant PTC was significantly associated with lymphatic invasion (P = 0.031) and advanced AJCC stage (P = 0.022). The prevalence of incidental pyramidal lobe PTC was 3.56%. Conclusion Pyramidal lobe PTC is relatively small in size; however, the rate of extrathyroidal extension and lymph node metastasis is high. Preoperative evaluation of nodal status is important, and the extent of surgery should be determined in accordance with the preoperative diagnosis.

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“…Primary PTC arising from the pyramidal lobe is rare [4567]. Santrac et al [7] reported three cases of pyramidal lobe PTC over 10 years.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, only 5 case series have been reported worldwide [45678]. Thus, the clinical and pathological characteristics of pyramidal lobe PTC are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe

Yoon

Seong

et al. 2017

Ann Surg Treat Res

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“…Papillary carcinoma may originate from the pyramidal lobe or may represent intraglandular metastasis and be clinically apparent as a palpable, rigid mass, visible in the midline of the neck. Multifocal papillary carcinomas with foci in the pyramidal lobe were reported in 1-3% of patients [9]. Ogawa et al [5] reported a case of a minimally invasive follicular carcinoma arising from the apex of the pyramidal lobe.…”

Section: Discussionmentioning

confidence: 99%

“…This aggressive approach also increases the effectiveness of postoperative adjuvant radioiodine therapy (when indicated) by minimizing the residual mass of thyroid parenchyma. Finally, complete resection of the pyramidal lobe during total thyroidectomy facilitates postoperative surveillance of these patients by increasing the sensitivity of serum thyroglobulin measurements [3,4,9]. The surgeon should, therefore, be aware of the clinical anatomy of pyramidal lobe to recognize it properly during surgery and to achieve complete removal when a total/near total thyroidectomy is required, as in patients with differentiated thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

Pyramidal Lobe of the Thyroid: Anatomical Considerations of Importance in Thyroid Cancer Surgery

Sinos

Sakorafas

2015

Oncol Res Treat

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The pyramidal lobe is a remnant of the thyroglossal duct and is considered a normal component of the thyroid gland. The pyramidal lobe may be affected by the diseases that affect the rest of the thyroid parenchyma. A practicing endocrine surgeon should keep the anatomical variations of the pyramidal lobe in mind to achieve a completely total thyroidectomy, when indicated. This approach is especially important in thyroid cancer surgery, given the high incidence of multifocality of papillary thyroid cancer, the increased effectiveness of adjuvant radioiodine therapy following a really total thyroidectomy, and the increased sensitivity of serum thyroglobulin measurements during the follow-up of these patients.

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The prevalence and anatomy of the pyramidal lobe of the thyroid gland: A meta‐analysis with implications for thyroid surgery

et al. 2023

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The pyramidal lobe (PL), also known as the third lobe of the thyroid gland or lobe of Lalouette is an embryological remnant of the caudal end of the thyroglossal tract. The following meta‐analysis aims to provide a detailed analysis of the anatomical variations of the PL using the available data in the literature. Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched in order to find all studies considering the prevalence and anatomy of the PL of the thyroid gland. Finally, a total of 24 studies that met the required criteria and contained complete and relevant data were included in the present meta‐analysis. The pooled prevalence of the PL was found to be 42.82% (95% CI: 35.90%–49.89%). An analysis showed that the mean length was 23.09 mm (SE: 0.56). The mean width was found to be 10.59 mm (SE: 0.77). The pooled prevalence of the PL originating from the left lobe (LL) was established at 40.10% (95% CI: 28.83%–51.92%). In conclusion, we believe that this is the most accurate and up‐to‐date study regarding the complete surgical anatomy of the PL. The PL was prevalent in 42.82% of the cases, being slightly more prevalent in males (40.35%) than females (37.43%). The mean length and width of the PL were 23.09 mm and 10.59 mm, respectively. Our results should be taken into consideration when performing procedures on the thyroid gland, such as thyroidectomies. The presence of the PL can affect the completeness of this procedure and lead to postoperative complications.

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Lymphatic drainage, regional metastases and surgical management of papillary thyroid carcinoma arising in pyramidal lobe – a single institution experience

Cited by 24 publications

References 26 publications

Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe

Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe

Pyramidal Lobe of the Thyroid: Anatomical Considerations of Importance in Thyroid Cancer Surgery

The prevalence and anatomy of the pyramidal lobe of the thyroid gland: A meta‐analysis with implications for thyroid surgery

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