OCCULT PAPILLARY THYROID MICROCARCINOMA DISCOVERED
DURING THYROIDECTOMY FOR BENIGN GOITRE
Fausto Fama’, MG Berry, Cecile Linard, Maria Antonietta Gioffre’-Florio,
Arnaud Piquard, Olivier Saint-Marc
University Hospital of Messina, Italy
Centre Hospitalier Régional d’Orléans, France
Introduction Patients and Methods
Papillary thyroid microcarcinoma Between January and November 2004, a prospective and
(PTMC) is a malignant differentiated randomised study of thyroid surgical techniques was performed in
thyroid cancer with a size ≤1 cm in the a French regional hospital. During this study of 200 consecutive
greatest dimension (according to the total thyroidectomies for benign multinodular goitre, 22 (11%)
World Health Organization histological patients were affected by an occult PTMC, although all pre-
classification). Generally it is clinically operative ultrasounds were negative.
occult but with a favourable prognosis.
Increasing PTMC detection is related to
refinements of diagnostic pathological
Results
techniques.
The patients were 20 females with a mean age of 53 years
(range 29-75) and 2 males with a mean age of 58.5 years (58-
18
59). There were 29 microcarcinomas with a mean size tumour of
3.8 mm (0.5-10). Tumour localisation was: 18 tumours in the
16
middle, 6 in the superior pole, 4 in the inferior pole and 1 in the
14 isthmus. In 7 cases PTMC was bifocal and in 3 cases associated
12
with a papillary carcinoma. Three cervical lymphadenectomies
(central and lateral compartment) were performed. In only 1
10
case was lymph node involvement found. No distant metastases
8 were found. In all cases, simple multinodular goitre was found,
6
but in 8 cases a chronic lymphocytic thyroiditis was also found.
Radioiodine (RAI) treatment, with a dose of 100 mCi, was
4
performed in 7 cases, whether associated to a papillary
2 carcinoma, or capsular infiltration or multifocality.
0
Superior pole Middle isthmus Inferior pole
Tumour localisation
Discussion
PTMC may be detected by ultrasound screening and ultrasound-guided fine needle aspiration biopsy (FNAB). On
occasion, the initial clinical presentation may be cervical nodes in the absence of primary tumour, with a poor
prognosis. For clinical PTMC a cervical node dissection is mandatory. More frequently PTMC represents an
incidental pathological finding with multifocality and, frequently, bilaterality. Supplementary RAI is recommended
when occult PTMC size is over 5 mm and with multifocality. Accurate screening and a more aggressive
management is required, in regions close to nuclear power generator, such as Orleans.
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