Skip to main content

Papillary Thyroid Carcinoma

  • Chapter
  • First Online:
Atlas of Thyroid Ultrasonography

Abstract

The most common histological type of thyroid cancer is papillary thyroid carcinoma, range: 65–88%. Typical US features are marked hypoechogenicity, microcalcifications, “taller-than-wide shape”, irregular margins, and intranodular hypervascularity. Ultrasound findings of papillary thyroid carcinoma are shown in various sizes and nodules forms or with others concomitant diseases. It is presented as microcarcinoma (Sect. 15.1), small solitary nodule ≤2 cm (Sect. 15.2), medium-sized and large nodules >4 cm (Sect. 15.3); can be multifocal (Sect. 15.4) or with extrathyroidal extension (Sect. 15.8). Often it occurs in concomitant Hashimoto’s thyroiditis (Sect. 15.5), less often in Graves’ disease or Amiodarone-induced thyrotoxicosis (Sect. 15.6). Rare is coexistence with a parathyroid adenoma (Sect. 15.7). Papillary thyroid carcinoma affects children and adolescents too (Sect. 15.9). To see: Sect. 15.1—4 cases, 15 pictures, Sect. 15.2—10 cases, 41 pictures, Sect. 15.3—7 cases, 37 pictures, Sect. 15.4—3 cases, 18 pictures, Sect. 15.5—7 cases, 25 pictures, Sect. 15.6—2 cases, 10 pictures, Sect. 15.7—1 case, 4 pictures, Sect. 15.8—2 cases, 10 pictures, Sect. 15.9—3 cases, 19 pictures.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE, et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol Biomarkers Prev. 2009;18(3):784–91.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hughes DT, Haymart MR, Miller BS, Gauger PG, Doherty GM. The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid. 2011;21(3):231–6.

    Article  PubMed  Google Scholar 

  4. Hay ID, Hutchinson ME, Gonzalez-Losada T, McIver B, Reinalda ME, Grant CS, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008;144(6):980–7. discussion 987–8.

    Article  PubMed  Google Scholar 

  5. Mazzaferri EL. Management of low-risk differentiated thyroid cancer. Endocr Pract. 2007;13(5):498–512.

    Article  PubMed  Google Scholar 

  6. Qu N, Zhang L, Ji QH, Chen JY, Zhu YX, Cao YM, et al. Risk factors for central compartment lymph node metastasis in papillary thyroid microcarcinoma: a meta-analysis. World J Surg. 2015;39(10):2459–70.

    Article  PubMed  Google Scholar 

  7. Karatzas T, Vasileiadis I, Kapetanakis S, Karakostas E, Chrousos G, Kouraklis G. Risk factors contributing to the difference in prognosis for papillary versus micropapillary thyroid carcinoma. Am J Surg. 2013;206(4):586–93.

    Article  PubMed  Google Scholar 

  8. 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):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wang Y, Li L, Wang YX, Feng XL, Zhao F, Zou SM, Hao YZ, et al. Ultrasound findings of papillary thyroid microcarcinoma: a review of 113 consecutive cases with histopathologic correlation. Ultrasound Med Biol. 2012;38(10):1681–8.

    Article  PubMed  Google Scholar 

  10. Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992–2006. Thyroid. 2011;21(2):125–34.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ito Y, Miyauchi A, Kobayashi K, Miya A. Prognosis and growth activity depend on patient age in clinical and subclinical papillary thyroid carcinoma. Endocr J. 2014;61(3):205–13.

    Article  PubMed  Google Scholar 

  12. Tsushima Y, Miyauchi A, Ito Y, Kudo T, Masuoka H, Yabuta T, et al. Prognostic significance of changes in serum thyroglobulin antibody levels of pre- and post-total thyroidectomy in thyroglobulin antibody-positive papillary thyroid carcinoma patients. Endocr J. 2013;60(7):871–6.

    Article  CAS  PubMed  Google Scholar 

  13. Falvo L, Catania A, D’Andrea V, Marzullo A, Giustiniani MC, De Antoni E. Prognostic importance of histologic vascular invasion in papillary thyroid carcinoma. Ann Surg. 2005;241(4):640–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Conzo G, Docimo G, Pasquali D, Mauriello C, Gambardella C, Esposito D, et al. Predictive value of nodal metastases on local recurrence in the management of differentiated thyroid cancer. Retrospective clinical study. BMC Surg. 2013;13(Suppl 2):S3.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Grant CS. Recurrence of papillary thyroid cancer after optimized surgery. Gland Surg. 2015;4(1):52–62.

    PubMed  PubMed Central  Google Scholar 

  16. Chow SM, Law SC, Au SK, Leung TW, Chan PT, Mendenhall WM, et al. Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute. Head Neck. 2002;24(7):670–7.

    Article  PubMed  Google Scholar 

  17. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, Peters H, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab. 2013;98(2):564–70.

    Article  CAS  PubMed  Google Scholar 

  18. Kim JH, Kim NK, Oh YL, Kim HJ, Kim SY, Chung JH, et al. The validity of ultrasonography-guided fine needle aspiration biopsy in thyroid nodules 4 cm or larger depends on ultrasonography characteristics. Endocrinol Metab (Seoul). 2014;29(4):545–52.

    Article  Google Scholar 

  19. Popowicz B, Klencki M, Lewiński A, Słowińska-Klencka D. The usefulness of sonographic features in selection of thyroid nodules for biopsy in relation to the nodule’s size. Eur J Endocrinol. 2009;161(1):103–11.

    Article  CAS  PubMed  Google Scholar 

  20. Napolitano G, Romeo A, Vallone G, Rossi M, Cagini L, Antinolfi G, et al. How the preoperative ultrasound examination and BFI of the cervical lymph nodes modify the therapeutic treatment in patients with papillary thyroid cancer. BMC Surg. 2013;13(Suppl 2):S52.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Noguchi S, Noguchi A, Murakami N. Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer. 1970;26(5):1053–60.

    Article  CAS  PubMed  Google Scholar 

  22. Machens A, Hinze R, Thomusch O, Dralle H. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26(1):22–8.

    Article  PubMed  Google Scholar 

  23. Tam AA, Özdemir D, Çuhacı N, Başer H, Aydın C, Yazgan AK, et al. Association of multifocality, tumor number, and total tumor diameter with clinicopathological features in papillary thyroid cancer. Endocrine. 2016;53(3):774–83.

    Article  CAS  PubMed  Google Scholar 

  24. Zhu F, Shen YB, Li FQ, Fang Y, Hu L, Wu YJ. The effects of Hashimoto thyroiditis on lymph node metastases in unifocal and multifocal papillary thyroid carcinoma: a retrospective Chinese cohort study. Medicine (Baltimore). 2016;95(6):e2674.

    Article  CAS  Google Scholar 

  25. Al Afif A, Williams BA, Rigby MH, Bullock MJ, Taylor SM, Trites J, et al. Multifocal papillary thyroid cancer increases the risk of central lymph node metastasis. Thyroid. 2015;25(9):1008–12.

    Article  PubMed  Google Scholar 

  26. So YK, Kim MW, Son YI. Multifocality and bilaterality of papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol. 2015;8(2):174–8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. AMA Arch Surg. 1955;70(2):291–7.

    Article  CAS  PubMed  Google Scholar 

  28. Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. A study of surgical cases among Japanese, and white and African Americans. Cancer. 1995;76(11):2312–8.

    Article  CAS  PubMed  Google Scholar 

  29. Jeong JS, Kim HK, Lee CR, Park S, Park JH, Kang SW, et al. Coexistence of chronic lymphocytic thyroiditis with papillary thyroid carcinoma: clinical manifestation and prognostic outcome. J Korean Med Sci. 2012;27(8):883–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lee JH, Kim Y, Choi JW, Kim YS. The association between papillary thyroid carcinoma and histologically proven Hashimoto’s thyroiditis: a meta-analysis. Eur J Endocrinol. 2013;168(3):343–9.

    Article  CAS  PubMed  Google Scholar 

  31. Anderson L, Middleton WD, Teefey SA, Reading CC, Langer JE, Desser T, et al. Hashimoto thyroiditis: Part 2, sonographic analysis of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis. AJR Am J Roentgenol. 2010;195(1):216–22.

    Article  PubMed  Google Scholar 

  32. Gul K, Dirikoc A, Kiyak G, Ersoy PE, Ugras NS, Ersoy R, et al. The association between thyroid carcinoma and Hashimoto’s thyroiditis: the ultrasonographic and histopathologic characteristics of malignant nodules. Thyroid. 2010;20(8):873–8.

    Article  PubMed  Google Scholar 

  33. Durfee SM, Benson CB, Arthaud DM, Alexander EK, Frates MC. Sonographic appearance of thyroid cancer in patients with Hashimoto thyroiditis. J Ultrasound Med. 2015;34(4):697–704.

    Article  PubMed  Google Scholar 

  34. Ohmori N, Miyakawa M, Ohmori K, Takano K. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto’s thyroiditis. Intern Med. 2007;46(9):547–50.

    Article  PubMed  Google Scholar 

  35. Lee J, Nam KH, Chung WY, Soh EY, Park CS. Clinicopathologic features and treatment outcomes in differentiated thyroid carcinoma patients with concurrent Graves’ disease. J Korean Med Sci. 2008;23(5):796–801. doi:10.3346/jkms.2008.23.5.796.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Taneri F, Kurukahvecioglu O, Ege B, Yilmaz U, Tekin EH, Cifter C, et al. Clinical presentation and treatment of hyperthyroidism associated with thyroid cancer. Endocr Regul. 2005;39(3):91–6.

    PubMed  Google Scholar 

  37. Van Sande J, Lejeune C, Ludgate M, Munro DS, Vassart G, Dumont JE, et al. Thyroid stimulating immunoglobulins, like thyrotropin activate both the cyclic AMP and the PIP2 cascades in CHO cells expressing the TSH receptor. Mol Cell Endocrinol. 1992;88(1–3):R1–5.

    Article  PubMed  Google Scholar 

  38. Viglietto G, Romano A, Manzo G, Chiappetta G, Paoletti I, Califano D, et al. Upregulation of the angiogenic factors PlGF, VEGF and their receptors (Flt-1, Flk-1/KDR) by TSH in cultured thyrocytes and in the thyroid gland of thiouracil-fed rats suggest a TSH-dependent paracrine mechanism for goiter hypervascularization. Oncogene. 1997;15(22):2687–98.

    Article  CAS  PubMed  Google Scholar 

  39. Stocker DJ, Burch HB. Thyroid cancer yield in patients with Graves’ disease. Minerva Endocrinol. 2003;28(3):205–12.

    CAS  PubMed  Google Scholar 

  40. Cappelli C, Braga M, De Martino E, Castellano M, Gandossi E, Agosti B, et al. Outcome of patients surgically treated for various forms of hyperthyroidism with differentiated thyroid cancer: experience at an endocrine center in Italy. Surg Today. 2006;36(2):125–30.

    Article  PubMed  Google Scholar 

  41. Inaba H, Suzuki S, Takeda T, Kobayashi S, Akamizu T, Komatsu M. Amiodarone-induced thyrotoxicosis with thyroid papillary cancer in multinodular goiter: case report. Med Princ Pract. 2012;21(2):190–2.

    Article  PubMed  Google Scholar 

  42. Saad A, Falciglia M, Steward DL, Nikiforov YE. Amiodarone-induced thyrotoxicosis and thyroid cancer: clinical, immunohistochemical, and molecular genetic studies of a case and review of the literature. Arch Pathol Lab Med. 2004;128(7):807–10.

    PubMed  Google Scholar 

  43. Hong HS, Lee EH, Jeong SH, Park J, Lee H. Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol. 2015;16(2):419–29.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wagner B, Begic-Karup S, Raber W, Schneider B, Waldhäusl W, Vierhapper H. Prevalence of primary hyperparathyroidism in 13387 patients with thyroid diseases, newly diagnosed by screening of serum calcium. Exp Clin Endocrinol Diabetes. 1999;107(7):457–61.

    Article  CAS  PubMed  Google Scholar 

  45. Morita SY, Somervell H, Umbricht CB, Dackiw AP, Zeiger MA. Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Surgery. 2008;144(6):862–6. discussion 866–8.

    Article  PubMed  Google Scholar 

  46. Heizmann O, Viehl CT, Schmid R, Müller-Brand J, Müller B, Oertli D. Impact of concomitant thyroid pathology on preoperative workup for primary hyperparathyroidism. Eur J Med Res. 2009;14(1):37–41.

    PubMed  PubMed Central  Google Scholar 

  47. Milas M, Mensah A, Alghoul M, Berber E, Stephen A, Siperstein A, et al. The impact of office neck ultrasonography on reducing unnecessary thyroid surgery in patients undergoing parathyroidectomy. Thyroid. 2005;15(9):1055–9.

    Article  PubMed  Google Scholar 

  48. Linos DA, van Heerden JA, Edis AJ. Primary hyperparathyroidism and nonmedullary thyroid cancer. Am J Surg. 1982;143(3):301–3.

    Article  CAS  PubMed  Google Scholar 

  49. Ulanovski D, Feinmesser R, Cohen M, Sulkes J, Dudkiewicz M, Shpitzer T. Preoperative evaluation of patients with parathyroid adenoma: role of high-resolution ultrasonography. Head Neck. 2002;24(1):1–5.

    Article  PubMed  Google Scholar 

  50. Nozeran S, Duquenne M, Guyetant S, Rodien P, Rohmer V, Ronceray J, et al. Diagnosis of parathyroid cysts: value of parathyroid hormone level in puncture fluid. Presse Med. 2000;29(17):939–41.

    CAS  PubMed  Google Scholar 

  51. Price DL, Wong RJ, Randolph GW. Invasive thyroid cancer: management of the trachea and esophagus. Otolaryngol Clin North Am. 2008;41(6):1155–68.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP. Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg. 1995;170(5):467–70.

    Article  CAS  PubMed  Google Scholar 

  53. McCaffrey TV, Bergstralh EJ, Hay ID. Locally invasive papillary thyroid carcinoma: 1940–1990. Head Neck. 1994;16(2):165–72.

    Article  CAS  PubMed  Google Scholar 

  54. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992;164(6):658–61.

    Article  CAS  PubMed  Google Scholar 

  55. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941–6.

    Article  CAS  PubMed  Google Scholar 

  56. Kobayashi K, Hirokawa M, Yabuta T, Fukushima M, Kihara M, Higashiyama T, et al. Tumor thrombus of thyroid malignancies in veins: importance of detection by ultrasonography. Thyroid. 2011;21(5):527–31.

    Article  PubMed  Google Scholar 

  57. Gross M, Mintz Y, Maly B, Pinchas R, Muggia-Sullam M. Internal jugular vein tumor thrombus associated with thyroid carcinoma. Ann Otol Rhinol Laryngol. 2004;113(9):738–40.

    Article  PubMed  Google Scholar 

  58. Chakravarthy VK, Rao ND, Chandra ST. Study of papillary carcinoma of thyroid with uncommon sites of metastasis. Indian J Otolaryngol Head Neck Surg. 2010;62(2):198–201.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Al-Jarrah Q, Abou-Foul A, Heis H. Intravascular extension of papillary thyroid carcinoma to the internal jugular vein: a case report. Int J Surg Case Rep. 2014;5(8):551–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Dikici AS, Yıldırım O, Er ME, Kılıç F, Tutar O, Kantarcı F, Mihmanlı I. A rare complication of the thyroid malignancies: jugular vein invasion. Pol J Radiol. 2015;80:360–3.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Sugimoto S, Doihara H, Ogasawara Y, Aoe M, Sano S, Shimizu N. Intraatrial extension of thyroid cancer: a case report. Acta Med Okayama. 2006;60(2):135–40.

    PubMed  Google Scholar 

  62. Moon WJ, Baek JH, Jung SL, Kim DW, Kim EK, Kim JY, et al. Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol. 2011;12(1):1–14.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Kamaya A, Tahvildari AM, Patel BN, Willmann JK, Jeffrey RB, Desser TS. Sonographic detection of extracapsular extension in papillary thyroid cancer. J Ultrasound Med. 2015;34(12):2225–30.

    Article  PubMed  Google Scholar 

  64. Gupta A, Ly S, Castroneves LA, Frates MC, Benson CB, Feldman HA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab. 2013;98(8):3238–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Ho WL, Zacharin MR. Thyroid carcinoma in children, adolescents and adults, both spontaneous and after childhood radiation exposure. Eur J Pediatr. 2016;175(5):677–83.

    Article  CAS  PubMed  Google Scholar 

  66. Babcock DS. Thyroid disease in the pediatric patient: emphasizing imaging with sonography. Pediatr Radiol. 2006;36(4):299–308.

    Article  PubMed  Google Scholar 

  67. Gow KW, Lensing S, Hill DA, Krasin MJ, McCarville MB, Rai SN, et al. Thyroid carcinoma presenting in childhood or after treatment of childhood malignancies: an institutional experience and review of the literature. J Pediatr Surg. 2003;38(11):1574–80.

    Article  PubMed  Google Scholar 

  68. Grigsby PW, Gal-or A, Michalski JM, Doherty GM. Childhood and adolescent thyroid carcinoma. Cancer. 2002;95(4):724–9.

    Article  PubMed  Google Scholar 

  69. Corrias A, Cassio A, Weber G, Mussa A, Wasniewska M, Rapa A, et al. Study Group for Thyroid Diseases of Italian Society for Pediatric Endocrinology and Diabetology (SIEDP/ISPED). Thyroid nodules and cancer in children and adolescents affected by autoimmune thyroiditis. Arch Pediatr Adolesc Med. 2008;162(6):526–31.

    Article  PubMed  Google Scholar 

  70. Skarpa V, Kousta E, Tertipi A, Anyfandakis K, Vakaki M, Dolianiti M, et al. Epidemiological characteristics of children with autoimmune thyroid disease. Hormones (Athens). 2011;10(3):207–14.

    Article  Google Scholar 

  71. Koibuchi H, Omoto K, Fukushima N, Toyotsuji T, Taniguchi N, Kawano M. Coexistence of papillary thyroid cancer and Hashimoto thyroiditis in children: report of 3 cases. J Ultrasound Med. 2014;33(7):1299–303.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Halenka, M., Fryšák, Z. (2017). Papillary Thyroid Carcinoma. In: Atlas of Thyroid Ultrasonography. Springer, Cham. https://doi.org/10.1007/978-3-319-53759-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-53759-7_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-53758-0

  • Online ISBN: 978-3-319-53759-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics