Advertisement

A Case of Papillary Carcinoma of the Thyroid with Minimal Extrathyroidal Extension

  • Banu Bilezikçi
  • Seyfettin Ilgan
Chapter

Abstract

Authors present a case with papillary thyroid carcinoma showing minimal extrathyroidal extension (ETE). The ETE, which is defined as tumor extension beyond the thyroid gland in surrounding tissues, is one of the major determinants of accurate staging. Though it is considered as a prognostic parameter in all guidelines, the evaluation and interpretation of microscopic ETE remain problematic due to the thyroid gland’s anatomical features. By TNM classification (seventh edition), differentiated thyroid carcinoma with ETE is designated by T3 (minimal invasion, invasion into the sternothyroid muscle or perithyroid tissues), T4a (extended invasion), or T4b (more extensive unresectable invasion) according to the degree of tumor involvement. Though outcomes from gross ETE are worse than those from microscopic ETE, both are recognized as risk factors on prognosis and recurrence rate.

Keywords

Thyroid cancer Extrathyroidal extension Prognosis Recurrence 

References

  1. 1.
    Lloyd R, De Lellis RPH. World Health Organization classification of tumours: pathology and genetics of tumours of the endocrine organs. 3rd ed. Lyon: IARC Press International Agency for Research on Cancer; 2004.Google Scholar
  2. 2.
    Amin MB, Edge SB, Greene FL, Compton CC, Gershenwald JE, Brookland RK, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.Google Scholar
  3. 3.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.  https://doi.org/10.1089/thy.2015.0020.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mete O, Rotstein L, Asa SL. Controversies in thyroid pathology: thyroid capsule invasion and extrathyroidal extension. Ann Surg Oncol. 2010;17:386–91.  https://doi.org/10.1245/s10434-009-0832-7.CrossRefPubMedGoogle Scholar
  5. 5.
    Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA. Extrathyroidal extension is associated with compromised survival in patients with thyroid cancer. Thyroid. 2017;27:626–31.  https://doi.org/10.1089/thy.2016.0132.CrossRefPubMedGoogle Scholar
  6. 6.
    Komorowski RA, Hanson GA. Occult thyroid pathology in the young adult: an autopsy study of 138 patients without clinical thyroid disease. Hum Pathol. 1988;19:689–96.CrossRefGoogle Scholar
  7. 7.
    Seethala RR, Asa SL, Carty SE, Hodak SP, McHugh JB, Richardson MS, et al. Protocol for the examination of specimens from patients with carcinomas of the thyroid gland. Northfield: College of American Pathologists; 2016. p. 1–22.Google Scholar
  8. 8.
    Wang LY, Ghossein R, Palmer FL, Nixon IJ, Tuttle RM, Shaha AR, et al. Microscopic positive margins in differentiated thyroid cancer is not an independent predictor of local failure. Thyroid. 2015;25:993–8.  https://doi.org/10.1089/thy.2015.0141.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Edge SB, Byrd DR, Carducci MA, Compton CC, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2009.Google Scholar
  10. 10.
    Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136:1310–22.CrossRefGoogle Scholar
  11. 11.
    Shindo ML, Caruana S, Kandil E, McCaffrey JC, Orloff LA, Porterfield JR, et al. Management of invasive well-differentiated thyroid cancer an American Head and Neck Society consensus statement. Head Neck. 2014;36:1379–90.  https://doi.org/10.1002/hed.23619.CrossRefPubMedGoogle Scholar
  12. 12.
    Yin DT, Yu K, Lu RQ, Li X, Xu J, Lei M. Prognostic impact of minimal extrathyroidal extension in papillary thyroid carcinoma. Medicine (Baltimore). 2016;95:e5794.  https://doi.org/10.1097/MD.0000000000005794.CrossRefGoogle Scholar
  13. 13.
    Radowsky JS, Howard RS, Burch HB, Stojadinovic A. Impact of degree of extrathyroidal extension of disease on papillary thyroid cancer outcome. Thyroid. 2014;24:241–4.  https://doi.org/10.1089/thy.2012.0567.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim KJ, Hong SW, Lee YS, Kim BW, Lee SC, Chang HS, et al. Tumor margin histology predicts tumor aggressiveness in papillary thyroid carcinoma: a study of 514 consecutive patients. J Korean Med Sci. 2011;26:346–51.  https://doi.org/10.3346/jkms.2011.26.3.346.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Shimamoto K, Satake H, Sawaki A, Ishigaki T, Funahashi H, Imai T. Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol. 1998;29:4–10.CrossRefGoogle Scholar
  16. 16.
    Park JS, Son KR, Na DG, Kim E, Kim S. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol. 2009;192:66–72.  https://doi.org/10.2214/AJR.07.3731.CrossRefPubMedGoogle Scholar
  17. 17.
    Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009;193:871–8.  https://doi.org/10.2214/AJR.09.2386.CrossRefPubMedGoogle Scholar
  18. 18.
    Kim H. Preoperative prediction of the extrathyroidal extension of papillary thyroid carcinoma with ultrasonography versus MRI: a retrospective cohort study. Int J Surg. 2014;12:544–8.  https://doi.org/10.1016/j.ijsu.2014.03.003.CrossRefPubMedGoogle Scholar
  19. 19.
    Rim JH, Chong S, Ryu HS, Chung BM, Ahn HS. Feasibility study of ultrasonographic criteria for microscopic and macroscopic extra-thyroidal extension based on thyroid capsular continuity and tumor contour in patients with papillary thyroid carcinomas. Ultrasound Med Biol. 2016;42:2391–400.  https://doi.org/10.1016/j.ultrasmedbio.2016.06.014.CrossRefPubMedGoogle Scholar
  20. 20.
    Kim SS, Lee BJ, Lee JC, Kim SJ, Lee SH, Jeon YK, et al. Preoperative ultrasonographic tumor characteristics as a predictive factor of tumor stage in papillary thyroid carcinoma. Head Neck. 2011;33:1719–26.  https://doi.org/10.1002/hed.21658.CrossRefPubMedGoogle Scholar
  21. 21.
    Kwak JY, Kim EK, Youk JH, Kim MJ, Son EJ, Choi SH, et al. Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid. 2008;18:609–14.  https://doi.org/10.1089/thy.2007.0345.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee CY, Kim SJ, Ko KR, Chung KW, Lee JH. Predictive factors for extrathyroidal extension of papillary thyroid carcinoma based on preoperative sonography. J Ultrasound Med. 2014;33:231–8.  https://doi.org/10.7863/ultra.33.2.231.CrossRefPubMedGoogle Scholar
  23. 23.
    Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114:1050–7; discussion 1057–1058.PubMedGoogle Scholar
  24. 24.
    Hotomi M, Sugitani I, Toda K, Kawabata K, Fujimoto Y. A novel definition of extrathyroidal invasion for patients with papillary thyroid carcinoma for predicting prognosis. World J Surg. 2012;36:1231–40.  https://doi.org/10.1007/s00268-012-1518-z.CrossRefPubMedGoogle Scholar
  25. 25.
    Park JH, Lee YS, Kim BW, Chang HS, Park CS. Skip lateral neck node metastases in papillary thyroid carcinoma. World J Surg. 2012;36:743–7.  https://doi.org/10.1007/s00268-012-1476-5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Banu Bilezikçi
    • 1
  • Seyfettin Ilgan
    • 2
  1. 1.Department of PathologyGüven HospitalAnkaraTurkey
  2. 2.Department of Nuclear MedicineGüven HospitalAnkaraTurkey

Personalised recommendations