Skip to main content
SpringerLink
Log in

Desmoplastic Stromal Reaction in Medullary Thyroid Cancer—An Intraoperative “Marker” for Lymph Node Metastases

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Medullary thyroid cancer (MTC) disseminates early to lymph nodes (LN). There is no pre- or intraoperative marker to exclude LN involvement and thereby avoid lateral neck dissection in LN-negative patients.

Materials and Methods

This study was intended to verify the observation that patients with MTC lacking desmoplastic stromal reaction (DSR) never have LN metastases. In 120 patients undergoing primary operation for sporadic MTC the prognostic value of DSR with respect to LN involvement was evaluated.

Results

Thirty-two (27%) of 120 tumors were DSR negative, and 88 (73%) were DSR positive. All 32 (100%) DSR-negative tumors were LN negative (N0), and all patients were biochemically cured. Of 88 DSR-positive tumors, 57 (65%) were staged N0, and 31 (36%) were staged N1(LN positive; Fisher’s exact test: P = 0.0001). In a comparison of the LN involvement to the DSR characteristics, 32 (36%) of the 89 N0 patients and none of the 31 N1 patients were DSR negative. The sensitivity of DSR in predicting N0 is 38% (95% confidence interval: CI 95% = 27 %–55%), the specificity is 100% (CI 95% = 88%–100%). The sensitivity and specificity for the parameter DSR to differentiate between N0 or N1 were 100% and 36%, respectively.

Conclusions

The desmoplastic stromal reaction appears to be an excellent intraoperative marker to predict LN involvement with a high specificity but low sensitivity. We therefore propose to avoid initial lateral neck dissection in MTC patients without DSR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg 1999;229:880–888

    Article  CAS  PubMed  Google Scholar 

  2. Cohen MS, Moley JF. Surgical treatment of medullary thyroid carcinoma. J Intern Med 2003;253:616–626

    Article  CAS  PubMed  Google Scholar 

  3. Scollo C, Baudin E, Travagli JP, et al. Rationale for central and bilateral lymph node dissection in sporadic and hereditary medullary thyroid cancer. J Clin Endocrinol Metab 2003;88:2070–2075

    Article  CAS  PubMed  Google Scholar 

  4. Mendelsohn G, Wells SA Jr, Baylin SB. Relationship of tissue carcinoembryonic antigen and calcitonin to tumor virulence in medullary thyroid carcinoma. Cancer 1984;54:657–662

    CAS  PubMed  Google Scholar 

  5. Kaserer K, Scheuba C, Neuhold N, et al. Sporadic versus familial medullary thyroid microcarcinoma: a histopathologic study of 50 consecutive patients. Am J Surg Pathol 2001;25:1245–1251

    Article  CAS  PubMed  Google Scholar 

  6. Fink M, Weinhäusel A, Niederle B, et al. Distinction between sporadic and hereditary medullary thyroid carcinoma (MTC) by mutation analysis of the RET proto-oncogene. “Study Group Multiple Endocrine Neoplasia Austria (SMENA).” Int J Cancer 1996;69:312–316

    Article  CAS  PubMed  Google Scholar 

  7. Sobin LH, Fleming ID. TNM Classification of Malignant Tumors, 5th edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer 1997;80:1803–1804

    Article  CAS  PubMed  Google Scholar 

  8. Scheuba C, Kaserer K, Weinhaeusl A, et al. Is medullary thyroid cancer predictable? A prospective study of 86 patients with abnormal pentagastrin tests. Surgery 1999;126:1089–1096

    Article  CAS  PubMed  Google Scholar 

  9. Voutilainen PE, Multanen M, Haapiainen RK, et al. Long term prognosis of medullary thyroid carcinoma in 39 patients. Ann Chir Gynaecol 2000;89:292–297

    CAS  PubMed  Google Scholar 

  10. Modigliani E, Cohen R, Campos JM, et al. Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d’etude des tumeurs a calcitonine. Clin Endocrinol (Oxf) 1998;48:265–273

    Article  CAS  Google Scholar 

  11. Tamagnini P, Iacobone M, Sebag F, et al. Lymph node involvement in macroscopic medullary thyroid carcinoma. Br J Surg 2005;92:449–453

    Article  CAS  PubMed  Google Scholar 

  12. Goudet P, Rogissart F, Petit JM, et al. Prognostic factors of survival in medullary cancers of the thyroid. Apropos of 51 cases. Clinical, biochemical and immunocytochemical study. Ann Chir 1996;50:23–29

    CAS  PubMed  Google Scholar 

  13. Busnardo B, Girelli ME, Simioni N, et al. Nonparallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma. Cancer 1984;53:1612–1619

    Google Scholar 

  14. Takahashi H, Okai Y, Paxton RJ, et al. Differential regulation of carcinoembryonic antigen and biliary glycoprotein by gamma-interferon. Cancer Res 1993;53:1612–1619

    CAS  PubMed  Google Scholar 

  15. Walker RA. The complexities of breast cancer desmoplasia. Breast Cancer Res 2001;3:143–145

    Article  CAS  PubMed  Google Scholar 

  16. Kodama T, Okamoto T, Fujimoto Y, et al. C cell adenoma of the thyroid: a rare but distinct clinical entity. Surgery 1988;104:997–1003

    CAS  PubMed  Google Scholar 

  17. Kodama T, Tamura M, Kanaji Y, et al. A case of calcitonin producing adenoma of the thyroid. Endocrinol Jpn 1984;31:63–70

    CAS  PubMed  Google Scholar 

  18. Franc S, Niccoli-Sire P, Cohen R, et al. Complete surgical lymph node resection does not prevent authentic recurrences of medullary thyroid carcinoma. Clin Endocrinol (Oxf) 2001;55:403–409

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria

    Christian Scheuba MD, Klaus Kaserer MD, Klaus Kaczirek MD, Reza Asari MD & Bruno Niederle MD

  2. Division of Clinical Pathology, Department of Pathology, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria

    Christian Scheuba MD, Klaus Kaserer MD, Klaus Kaczirek MD, Reza Asari MD & Bruno Niederle MD

Authors
  1. Christian Scheuba MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Kaserer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Klaus Kaczirek MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reza Asari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bruno Niederle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Scheuba MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scheuba, C., Kaserer, K., Kaczirek, K. et al. Desmoplastic Stromal Reaction in Medullary Thyroid Cancer—An Intraoperative “Marker” for Lymph Node Metastases. World J. Surg. 30, 853–859 (2006). https://doi.org/10.1007/s00268-005-0391-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0391-4

Keywords

Search

Navigation