Surgical Management of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma. Experience in 25 Patients

  • Claudio SpinelliEmail author
  • Silvia Strambi
  • Sohail Bakkar
  • Andrea Nosiglia
  • GianMarco Elia
  • Alessia Bertocchini
  • Chiara Calani
  • Matteo Leoni
  • Riccardo Morganti
  • Gabriele Materazzi
Original Scientific Report



To delineate the clinicopathologic features and biologic behavior of the diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) and to report its outcome.


The clinical records of 25 patients who had surgery for DSV-PTC from 2004 to 2017 were retrospectively analyzed. Comparisons were made to similar studies in the literature reporting ≥8 cases and a cohort of classical PTC.


There were 20 females and 5 males with an average age of 23 years (range 10–39 years). Bilateral disease occurred in 80% of cases. The mean size of the dominant mass was 4.2 ± 1.92 cm. In 92% of cases, therapeutic neck dissection was performed. Male sex significantly correlated with a higher yield of positive lymphadenopathy (p = 0.045). 62% of patients had recurrent disease. Recurrence significantly correlated with male sex, the number of metastatic lymph nodes (cutoff: 22 lymph nodes), and multifocality (p = 0.044, p ˂ 0.008, p ˂ 0.003, respectively). However, it did not correlate with the age at presentation. No disease-specific mortality occurred after an average follow-up of 77 months (range 12–168 months). The two comparisons made demonstrated a statistically significant greater tendency of the current series of DSV-PTC toward more aggressive clinicopathologic features and biologic behavior. No differences in overall survival were observed.


The DSV-PTC should be considered a high-risk PTC that mandates an aggressive therapeutic strategy with the intent of optimizing disease-free survival.


Author contributions

Corresponding author CS studied the concept and design and contributed to data interpretation, drafting, final approval, and accountability for all aspects of the work. LF was involved in data collection and interpretation, drafting, final approval, and accountability for all aspects of the work. SB was involved in data interpretation, drafting, critical revision, final approval, and accountability for all aspects of the work. GE, AB, CC, ML, RM, and SS were involved in data collection and interpretation, final approval, and accountability for all aspects of the work.


This study was not funded by any grant.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This work was approved by the Ethical Committee at the University of Pisa, Pisa, Italy.

Informed consent

Informed consent was waived due to the retrospective nature of the study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Claudio Spinelli
    • 1
    Email author
  • Silvia Strambi
    • 1
  • Sohail Bakkar
    • 2
  • Andrea Nosiglia
    • 1
  • GianMarco Elia
    • 1
  • Alessia Bertocchini
    • 1
  • Chiara Calani
    • 1
  • Matteo Leoni
    • 1
  • Riccardo Morganti
    • 3
  • Gabriele Materazzi
    • 4
  1. 1.Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical PathologyUniversity of PisaPisaItaly
  2. 2.Department of Surgery, Faculty of MedicineThe Hashemite UniversityZarqaJordan
  3. 3.Department of Clinical and Experimental Medicine, Section of StatisticsUniversity of PisaPisaItaly
  4. 4.Division of Endocrine Surgery, Department of Surgical PathologyUniversity of PisaPisaItaly

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