Comparison of Histopathological Features of ‘Incidental’ and ‘Non-Incidental’ Papillary Thyroid Microcarcinomas
Keywords:
Thyroid microcarcinoma, peritumoral fibrosis, subcapsular location, infiltrative borders
Abstract
Background: Papillary thyroid microcarcinoma (Pm) is defined as a papillary carcinoma with size ≤ 10mm. On clinical and histological grounds, there are two presentations-‘incidental’ and ‘non-incidental’. Histopathological parameters like intratumoral/peritumoral fibrosis, multifocality, infiltrative borders, subcapsular location, lymphovascular emboli and histological type have been introduced in the reporting of Pm, besides the size which is considered an important prognostic/risk factor. Methods: The present study is a 5-year retrospective comparative study between the Pm which were incidentally detected, and those which had been previously diagnosed on fine needle aspiration/radiology or clinically suspicious of Pm. Result: The number of cases in both incidental (111) and non-incidental (110) Pm have been found to be comparable in the present study, which is attributable to meticulous grossing and extensive sampling of all thyroidectomy specimen. Size and multifocality has been significantly different between incidental and non-incidental Pm (p-value <0.05). The parameters like intratumoral/peritumoral fibrosis, infiltrative border and subcapsular location were significantly higher in larger sizes (>5mm) of non-incidental Pm (p-value <0.05). These parameters, however, were not found to be significant when analysed individually or with one another, between the two groups (p-value >0.05). In the incidental Pm of size ≤ 5mm, a good proportion of cases show these parameters, implicating their importance for further follow-up. Conclusion: Size and focality has been found to differ between incidental and non-incidental Pm. The histological parameters defined for Pm need to be followed up for a longer period to identify the prognostic significance, and their role in the different manifestation of incidental and non-incidental Pm.References
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2. DeLellis RA, Lloyd RV, Heitz PU, Eng C, eds. World Health Organization Classification of Tumours. Pathology and Genetics. Tumours of Endocrine Organs. Lyon, France: IARC PRess; 2004
3. Provenzale MA et al. ‘Incidental’ and ‘Non-incidental’ thyroid papillary microcarcinomas are two different entities. Eur J Endocrinol 2016;174:813-820
4. McDougall IR, Camargo CA. Treatment of micropapillary carcinoma of thyroid: where do we draw the line? Thyroid 2007;17:1093-1096
5. Mehanna H et al. Differences in the recurrence and mortality outcome rates of incidental and non-incidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J Clin Endocrinol Metabol 2014;99:2834-2843
6. Pazaitou-Panayiotou K, Capezzone M, Pacini F. Clinical features and therapeutic implications of papillary thyroid microcarcinoma. Thyroid 2007;17:1085-1092
7. Pellizzo MR et al. Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PMTC): a mono-institutional 12-year experience. Nucl Med Commun. 2004;25(6):547–62
8. Pellegriti G, Scollo C, Lumera G, Regalbuto C, Vigneri R, Belfiore A. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab. 2004; 89:3713–3720
9. Kumar SM, Mehta N, Steward DL, Nikiforov YE. Correlation between clinicopathologic features of papillary thyroid microcarcinomas and tumor behavior. Mod Pathol. 2006; 19:95A
10. Lim DJ, Baek KH, Lee YS, Park WC, Kim MK, Kang MI, Jeon HM, Lee JM, Yun-Cha B, Lee KW, et al: Clinical, histo-pathological, and molecular characteristics of papillary thyroid microcarcinoma. Thyroid 17: 883-888, 2007
11. Lombardi CP, Bellantone R, De Crea C, Paladino NC, Fadda G, Salvatori M and Raffaelli M: Papillary thyroid microcarcinoma: Extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 34: 1214-1221, 2010
12. Abdulmughni YA, Al-Hureibi MA, Al-Hureibi KA, Ghafoor MA, Al-Wadan AH and Al-Hureibi YA: Thyroid cancer in Yemen. Saudi Med J 25: 55-59, 2004
13. Kaliszewski K et al. Incidenal and non-incidental thyroid microcarcinoma. Oncology Letters 2016;12:734-740
14. Gurleyik E, Guryelik G, Karapolat B, Onsal U. Incidental Papillary thyroid microcarcinoma in an endemicgoitre area. J Thyoid Res 2016
15. Cappelli C, Castellano M, Braga M, Gandossi E, Pirola I, De Martino E, Agosti B and Rosei EA: Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus micro-carcinoma (PMC): A mono-institutional experience. J Surg Oncol 95: 555-560, 2007
16. Zhang X, Qian L. Ultrsonic features of papillary thyroid microcarcinoma and non-microcarcinoma. Experimental and therapeutic Medicine 2014;8:1335-1339
17. Kim DW et al. Sonographically based diagnosis of contralateral malignancy in pre-operative patients with papillary thyroid microcarcinoma. J Ultrasound Med 2015;34:789-795
18. Slijepcevic N et al. Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinoma in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease. BMC Cancer 2015;15:330-337
19. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T,Ito K, Takami H & Takanashi Y. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence, and optimal strategy for neck dissection. Annals of Surgery 2003 237 399–407
20. Pelizzo MR, Boschin IM, Toniato A, Pagetta C, Piotto A, Bernante P, Casara D, Pennelli G & Rubello D. Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience.Nuclear Medicine Communications 2004 25 547–552
21. Barbaro D, Simi U, Meucci G, Lapi P, Orsini P & Pasquini C. Thyroid papillary cancers: microcarcinoma and carcinoma, incidental cancers and non-incidental cancers – are they different diseases? Clinical Endocrinology 2005 63 577–581
22. Malandrino P et al. Papillary thyroid microcarcinoma: A comparative study of the characteristics and risk factors at presentation in two cancer registries. J Clin Endocrinol Metabl 2013;98(4):1427-1434
23. Lombardi C et al. Papillary thyroid microcarcinoma: Extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goitre area. World J Surg 2010;34:1214-21
24. Bradley NL, Wiseman SM. Papillary thyroid microcarcinoma:the significance of high risk features. Cancer 2017;17:142-146
25. Chow SM, Law SC, Chan JK, et al. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastases and multifocality. Cancer 2003;98:31–40
26. Niemeier LA et al. A combined molecular-pathological score improves risk stratification of thyroid papillary microcarcinoma. Cancer 2012;118(8):2069-2077
Published
2019-05-24
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