Metastases from occult thyroid carcinoma.An autopsy study from Hiroshima and Nagasaki, Japan

Abstract

In an autopsy series in Hiroshima and Nagasaki, Japan, cervical lymph node dissections were performed in 128 autopsy cases in which occult papillary thyroid carcinoma had been found, and metastatic carcinoma was demonstrated in 20 cases (16%). These 20 cases with metastatic carcinoma, and an additional 25 occult papillary thyroid carcinomas previously known to have metastases, were compared with the 108 cases which had lymph node dissections negative for metastatic thyroid carcinoma. Significantly increased lymph node metastases occurred in association with the following changes in the the thyroid gland: multiple tumor foci, larger tumor size, greater tumor invasiveness, more than 50% papillary differentiation, and tumor psammoma bodies. Metastases were significantly more frequent in men than in women. In 5 of the 25 additional cases, only the cervical lymph node metastases and no tumor in the thyroid glands were found at routine autopsy. Special thyroid reexamination revealed the small primary carcinomas. In this autopsy series, no thyroid follicle inclusions have been found in cervical lymph nodes in the absence of a primary thyroid carcinoma. The metastases were generally occult, and sometimes multiple, contralateral, and bilateral. In the entire autopsy series, only one occult thyroid carcinoma was the cause of death; 517 other persons with occult papillary carcinoma of the thyroid reached the end of their lifespan without awareness or manifestation of the presence of the tumor.

Papillary microcarcinoma of the thyroid—Prognostic significance of lymph node metastasis and multifocality

“…We found that multifocality was correlated with LN metastasis at presentation, which also was noticed in an autopsy study by Sampson et al 4 We also confirmed that multifocality predicted for LR recurrence, as reported by Baudin et al 7 Older age at presentation is a universally identified poor prognostic factor for patients with PTC. [32][33][34][35][36][37][38] However, we found that older age did not affect the outcome of patients with PMC adversely, as also observed in the study by Yamashita et al 8 Whether this is related to intrinsic biologic differences or to the overwhelming importance of other factors, like LN status, multifocality, and treatment factors, remains an open question for further studies.…”

“…16 Lymph node (LN) metastases were detected in 3.1-18.2% of patients. 14,15 Marked geographic differences in incidence rates were noted: 1% in Brazil, 12 13% in Hong Kong (unpublished data from Queen Elizabeth Hospital), 11.3-28.4% in Japan, 4,13,17 1.5% in Greece, 18 and 35.6% in Finland. 15 Based on the high incidence in autopsy studies in Finland, this common incidental finding was viewed as a normal finding, and tumors that measured Յ 5 mm were considered tumor instead of carcinoma to avoid unnecessary surgeries.…”

Symptomatic versus Asymptomatic Papillary Thyroid Microcarcinoma: A Retrospective Analysis of Surgical Outcome and Prognostic Factors.

“…And Sampson [4] reported that among a total of 391 autopsies from the Hiroshima-Nagasaki series, 111 cadavers had PMC. Many world-wide autopsy series have also shown a surprisingly high prevalence of PMC, ranging from 6 to 28%, without any significant differences in prevalence related to sex or age [5][6][7][8], whereas it is known that the prevalence of clinically evident thyroid cancer is only about 0.1% to 0.05% of the general population [36,37].…”

Nodular Metastatic Lung Tumor from Thyroid Carcinoma

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] In addition, autopsy studies reported two cases with occult pulmonary metastasis (>10 mm in diameter) from thyroid cancer. 18,19) The 16 cases, who were antemortem diagnosed, were female in all cases, and the thyroid cancer was papillary carcinoma in all but one case-a case of follicular carcinoma. 10) In four of the cases, the patients presented with pulmonary metastasis after thyroidectomy, as was observed in our case.…”