World Journal of Surgery

, Volume 30, Issue 5, pp 759–766 | Cite as

Papillary Microcarcinoma: Is There Any Difference between Clinically Overt and Occult Tumors?

  • Chung-Yau LoEmail author
  • Wai-Fan Chan
  • Brian Hung-Hin Lang
  • King-Yin Lam
  • Koon-Yat Wan



Papillary microcarcinoma (PMC) is a subtype of papillary thyroid carcinoma (PTC) associated with excellent prognosis. However, clinical and biologic behaviors of PMC may vary considerably between tumors that are clinically overt and those that are occult.

Materials and Methods

From 1964 to 2003, 185 of 628 patients with PTC were identified as having PMC, based on tumor size ≤1 cm. There were 110 overt and 75 occult PMCs detected based on clinical presentation. The clinicopathologic features, treatment, and long-term outcome of PMCs were evaluated and compared between the two groups.


There were 37 men and 148 women with a median age of 45 years (range: 11–84 years). The median tumor size was 6.2 mm. Thirty-eight (21%) patients presented with cervical nodal metastases. Three (1.6%) had distant metastases and 5 (2.7%) underwent incomplete resection. Bilateral procedures were performed for 129 patients (70%) and 53 (29%) received postoperative I131treatment. During a mean follow-up of 8.2 years, 4 patients died of the disease and 13 developed recurrence. Clinically overt PMCs were significantly larger, were more likely to be multifocal, and more likely to lead to bilateral thyroidectomy. Extrathyroidal or lymphovascular invasion, nodal metastases, I131ablation, high-risk tumors, and postoperative recurrence occurred in overt PMC only. Patients with nodal metastases had a decreased survival and an increase in locoregional recurrence.


Despite a relatively good prognosis in PMC, a distinction should be made between clinically overt and occult PMCs in which clinically overt PMC should be managed according to tumor risk profile and clinical presentation.


Papillary Thyroid Carcinoma Locoregional Recurrence Cervical Lymph Node Metastasis Occult Tumor Extrathyroidal Invasion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hedinger CE, Williams ED, Sobin LH. Histological typing of thyroid tumours. In Hedinger CE, editor. International Histological Classification of Tumors, vol 11, Berlin, Springer-Verlag, 1988:7–68Google Scholar
  2. 2.
    Ross DS. Nonpalpable thyroid nodules: managing an epidemic. J Clin Endocrinol Metab 2002;87:1938–1940CrossRefPubMedGoogle Scholar
  3. 3.
    Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87:1941–1946CrossRefPubMedGoogle Scholar
  4. 4.
    Bramley MD, Harrison BJ. Papillary microcarcinoma of the thyroid gland. Br J Surg 1996;83:1674–1683PubMedGoogle Scholar
  5. 5.
    Piersanti M, Ezzat S, Asa SL. Controversies in papillary microcarcinoma of the thyroid. Endocr Pathol. 2003;14:183–191CrossRefPubMedGoogle Scholar
  6. 6.
    Allo MD, Christiansen W, Koivunen D. Not all “occult” papillary microcarcinomas are “minimal.” Surgery 1988;104:971–976PubMedGoogle Scholar
  7. 7.
    Woolner LB, Lemmon ML, Beahrs OH, et al. Occult papillary thyroid carcinoma of the thyroid gland: a study of 140 cases observed in a 30 year period. J Clin Endocrinol Metab 1960;20:89–105PubMedGoogle Scholar
  8. 8.
    Hay IH, Grant CS, van Heerden, et al. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 1992;112:1139–1147Google Scholar
  9. 9.
    Wada N, Duh Q-Y, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas. Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg 2003;237:399–407CrossRefPubMedGoogle Scholar
  10. 10.
    Sugitani I, Yanagisawa A, Shimizu A, et al. Clinicopathologic and immunohistochemical studies of papillary thyroid carcinoma presenting with cervical lymphadenopathy. World J Surg 1998;22:731–737CrossRefPubMedGoogle Scholar
  11. 11.
    Baudin E, Travagli JP, Ropers J, et al. Microcarcinoma of the thyroid gland. The Gustave-Roussy Institute experience. Cancer 1998;83:553–559CrossRefPubMedGoogle Scholar
  12. 12.
    Rodriguez JM, Moreno A, Parilla P, et al. Papillary thyroid microcarcinoma: clinical study and prognosis. Eur J Surg 1997;163:255–259PubMedGoogle Scholar
  13. 13.
    Cady B, Rossi R, Silverman M, et al. Further evidence of the validity of risk group definition in differentiated thyroid carcinoma. Surgery 1985;98:1171–1178PubMedGoogle Scholar
  14. 14.
    DeGroot LJ, Kaplan EL, McCormick M, et al. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endcorinol Metab 1990;71:414–424CrossRefGoogle Scholar
  15. 15.
    UICC (International Union Against Cancer). TNM Classification of Malignant Tumours, 5th Edition, Sobin LH, Wittekind C, editors. New York; Wiley, 1997Google Scholar
  16. 16.
    Hay ID, Bergstralh EJ, Goellner JR, et al. 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;114:1050–1058PubMedGoogle Scholar
  17. 17.
    Kaplan EL, Meier P. Nonparameteric estimation from incomplete observation. J Am Stat Assoc 1958;53:457–481Google Scholar
  18. 18.
    Shattuck TM, Westra WH, Ladenson PW, et al. Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma. N Engl J Med 2005;352:2406–2412CrossRefPubMedGoogle Scholar
  19. 19.
    Pellegriti G, Scollo C, Lumera G, et al. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab 2004;89:3713–3720CrossRefPubMedGoogle Scholar
  20. 20.
    Chow SM, Law SCK, Chan JKC, et al. Papillary microcarcinoma of the thyroid prognostic significance of lymph node metastasis and multifocality. Cancer 2003;98:31–40CrossRefPubMedGoogle Scholar
  21. 21.
    Sampson RJ, Oka H, Key CR, et al. Metastases from occult thyroid carcinoma: an autopsy study from Hiroshima and Nagasaki Japan. Cancer 1970;25:803–811PubMedGoogle Scholar
  22. 22.
    Frauenhoffer CM, Patchetsky AS, Cobanoglu A. Thyroid carcinoma, a clinical and pathologic study of 125 cases. Cancer 1979;43:2414–2421PubMedGoogle Scholar
  23. 23.
    Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003;13:381–387CrossRefPubMedGoogle Scholar
  24. 24.
    Ito Y, Tomoda C, Uruno T, et al. Papillary microcarcinoma of the thyroid: how should it be treated ? World J Surg 2004;28:1115–1121CrossRefPubMedGoogle Scholar
  25. 25.
    Pearce EN, Braverman LE. Editorial: Papillary thyroid microcarcinoma outcomes and implications for treatment. J Clin Endocrinol Metab 2004;89:3710–3712CrossRefPubMedGoogle Scholar
  26. 26.
    Loh KC, Greenspan FS, Gee L, et al. Pathologic tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients. J Clin Endocrinol Metab 1997;82:3533–3562CrossRefGoogle Scholar
  27. 27.
    Lo CY, Chan WF, Lam KY, Wan KY. Optimizing the treatment of AMES high risk papillary thyroid carcinoma. World J Surg 2004;28:1103–1109CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Chung-Yau Lo
    • 1
    Email author
  • Wai-Fan Chan
    • 1
  • Brian Hung-Hin Lang
    • 1
  • King-Yin Lam
    • 2
  • Koon-Yat Wan
    • 3
  1. 1.Department of SurgeryUniversity of Hong Kong Medical Centre, Queen Mary HospitalPokfulamChina
  2. 2.Discipline of PathologySchool of Medicine, Griffith UniversityAustralia
  3. 3.Department of Clinical OncologyUniversity of Hong Kong Medical Centre, Queen Mary HospitalPokfulamChina

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