Advertisement

Analysis of Malignant Thyroid Neoplasms with a Striking Rise of Papillary Microcarcinoma in an Endemic Goiter Region

  • Alka Mary MathaiEmail author
  • K. Preetha
  • S. Valsala Devi
  • Sam Vicliph
  • Raja Pradeep
  • Aqib Shaick
Original Article
  • 24 Downloads

Abstract

According to National Cancer Registry Program, Thiruvananthapuram district of Kerala, has the highest relative frequency of thyroid carcinomas; nevertheless, limited data exist regarding its socio-demographic and clinico-pathological characteristics. The aims of the study were to assess the: (1) demographic characteristics, (2) histopathological features and the relative frequency of various thyroid carcinoma cases and papillary thyroid carcinoma (PTC) subtypes, (3) rising trend of papillary microcarcinomas, and (4) associated lesions. A retrospective study wherein 170 cases of thyroid malignancies reported in our single institution over a period of 8 years period was reviewed. PTC accounted for 97% cases, followed by medullary (n = 4; 2.4%) and follicular carcinoma (n = 1; 0.6%). There was female preponderance (p = 0.0379) with a lower median age in females (p = 0.0275). Among the PTCs, conventional type constituted 53.4% cases (n = 87), followed by microcarcinomas (n = 34; 20.9%), follicular variant (n = 28; 17.2%), and others 14 cases (8.5%). Thirty-three cases (19.4%) showed multifocality, 5 cases (2.9%) extra-thyroid extension, and 19 cases (11.2%) lymph node metastasis. Two cases developed recurrences and three cases, metastasis. The associated lesions were significantly higher in females (p = 0.0059); most common being multinodular goiter (MNG; n = 67; 41.1%), followed by Hashimoto thyroiditis (n = 44; 27%) and lymphocytic thyroiditis (n = 28; 17.2%); MNG being associated with follicular (p = 0.0129), and Hashimoto thyroiditis with conventional variant (p = 0.0475). The frequency of microcarcinomas significantly increased in the past 4 years (p = 0.0291) and was associated with MNG (p = 0.0055), Hurthle cell nodule (p = 0.0315) and absent lymph node metastasis (p = 0.0147). The primary treatment modality was total thyroidectomy. Papillary microcarcinoma cases increased significantly in the past 4 years and were significantly associated with MNG and Hurthle cell nodule. It is challenging to distinguish the various PTC subtypes as recognition of these histological variants warrants better patient management.

Keywords

Thyroid malignancies Papillary thyroid carcinoma Variants Microcarcinoma Associated lesions 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors have no conflicts of interest or funding to disclose.

Human and Animal Rights Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R (2013) Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013:1–10CrossRefGoogle Scholar
  2. 2.
    Harach HR, Williams ED (1995) Thyroid cancer and thyroiditis in the goitrous region of Salta, Argentina, before and after iodine prophylaxis. Clin Endocrinol (Oxf) 43(6):701–706CrossRefGoogle Scholar
  3. 3.
    Yeo MK, Bae JS, Oh WJ, Park GS, Jung CK (2014) Macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases. Endocr Pathol 25(3):265–272PubMedCrossRefGoogle Scholar
  4. 4.
    De Lilles RA, Lloyd RV, Heitz PU, Eng C (2004) WHO classification of tumors: pathology and genetics of tumors of endocrine organs, 3rd edn. IARC Press, LyonGoogle Scholar
  5. 5.
    Lam AK, Lo CY, Lam KS (2005) Papillary carcinoma of thyroid: a 30-yr clinicopathological review of the histological variants. Endocr Pathol 16(4):323–330PubMedCrossRefGoogle Scholar
  6. 6.
    Lloyd RV, Buehler D, Khanafshar E (2011) Papillary thyroid carcinoma variants. Head Neck Pathol 5(1):51–56PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Lee JH, Shin JH, Lee HW, Oh YL, Hahn SY, Ko EY (2015) Sonographic and cytopathologic correlation of papillary thyroid carcinoma variants. J Ultrasound Med 34(1):1–15PubMedCrossRefGoogle Scholar
  8. 8.
    Al-Brahim N, Asa SL (2006) Papillary thyroid carcinoma: an overview. Arch Pathol Lab Med 130(7):1057–1062PubMedGoogle Scholar
  9. 9.
    Dorairajan N, Pandiarajan R, Yuvaraja S (2002) A descriptive study of papillary thyroid carcinoma in a teaching hospital in Chennai, India. Asian J Surg 25(4):300–303PubMedCrossRefGoogle Scholar
  10. 10.
    Girardi FM, Barra MB, Zettler CG (2013) Variants of papillary thyroid carcinoma: association with histopathological prognostic factors. Braz J Otorhinolaryngol 79(6):738–744PubMedCrossRefGoogle Scholar
  11. 11.
    Abboud B, Sader Ghorra C, Rassy M, El Naderi S, Trak-Smayra V, Abadjian G et al (2015) Epidemiological study of thyroid pathology in a University Hospital. Acta Chir Belg 115(6):414–417PubMedCrossRefGoogle Scholar
  12. 12.
    Albores-Saavedra J, Wu J (2006) The many faces and mimics of papillary thyroid carcinoma. Endocr Pathol 17(1):1–18PubMedCrossRefGoogle Scholar
  13. 13.
    Silver CE, Owen RP, Rodrigo JP, Rinaldo A, Devaney KO, Ferlito A (2011) Aggressive variants of papillary thyroid carcinoma. Head Neck 33(7):1052–1059PubMedCrossRefGoogle Scholar
  14. 14.
    Castro P, Fonseca E, Magalhães J, Sobrinho-Simões M (2002) Follicular, papillary, and “hybrid” carcinomas of the thyroid. Endocr Pathol 13(4):313–320PubMedCrossRefGoogle Scholar
  15. 15.
    Selzer G, Kahn LB, Albertyn L (1977) Primary malignant tumors of the thyroid gland: a clinicopathologic study of 254 cases. Cancer 40(4):1501–1510PubMedCrossRefGoogle Scholar
  16. 16.
    Girardi FM, Barra MB, Zettler CG (2015) Predictive factors for lymph node metastasis in solitary papillary thyroid carcinomas: a retrospective study. Pathol Oncol Res. 21(1):59–64PubMedCrossRefGoogle Scholar
  17. 17.
    Girardi FM, Barra MB, Zettler CG (2015) Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010. Braz J Otorhinolaryngol 81(5):541–548PubMedCrossRefGoogle Scholar
  18. 18.
    Kaliszewski K, Wojtczak B, Strutyńska-Karpińska M, Łukieńczuk T, Forkasiewicz Z, Domosławski P (2016) Incidental and non-incidental thyroid microcarcinoma. Oncol Lett 12(1):734–740PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Vlassopoulou V, Vryonidou A, Paschou SA, Ioannidis D, Koletti A, Klonaris N et al (2016) No considerable changes in papillary thyroid microcarcinoma characteristics over a 30-year time period. BMC Res Notes 9:252PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    John AM, Jacob PM, Oommen R, Nair S, Nair A, Rajaratnam S (2014) Our experience with papillary thyroid microcancer. Indian J Endocrinol Metab 18(3):410–413PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Gürleyik E, Gurleyik G, Karapolat B, Onsal U (2016) Incidental papillary thyroid microcarcinoma in an endemic goiter area. J Thyroid Res. doi: 10.1155/2016/1784397 PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Roti E, degli Uberti EC, Bondanelli M, Braverman LE (2008) Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol 159(6):659–673PubMedCrossRefGoogle Scholar
  23. 23.
    Zhang LY, Liu ZW, Liu YW, Gao WS, Zheng CJ (2015) Risk factors for nodal metastasis in cN0 papillary thyroid microcarcinoma. Asian Pac J Cancer Prev 16(8):3361–3363PubMedCrossRefGoogle Scholar
  24. 24.
    Pyo JS, Sohn JH, Kang G (2016) Detection of tumor multifocality is important for prediction of tumor recurrence in papillary thyroid microcarcinoma: a retrospective study and meta-analysis. J Pathol Transl Med 50(4):278–286PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Lin YS, Wu HY, Yu MC, Hsu CC, Chao TC (2016) Patient outcomes following surgical management of multinodular goiter: does multinodularity increase the risk of thyroid malignancy? Medicine (Baltimore) 95(28):e4194CrossRefGoogle Scholar
  26. 26.
    Harach HR, Escalante DA, Onativia A, Lederer Outes J, Saravia Day E, Williams ED (1985) Thyroid carcinoma and thyroiditis in an endemic goitre region before and after iodine prophylaxis. Acta Endocrinol (Copenh) 108(1):55–60CrossRefGoogle Scholar
  27. 27.
    Harach HR, Escalante DA, Day ES (2002) Thyroid cancer and thyroiditis in Salta, Argentina: a 40-yr study in relation to iodine prophylaxis. Endocr Pathol 13(3):175–181PubMedCrossRefGoogle Scholar
  28. 28.
    Williams ED, Doniach I, Bjarnason O, Michie W (1977) Thyroid cancer in an iodide rich area: a histopathological study. Cancer 39(1):215–222PubMedCrossRefGoogle Scholar
  29. 29.
    Kilfoy BA, Zheng T, Holford TR, Han X, Ward MH, Sjodin A et al (2009) International patterns and trends in thyroid cancer incidence, 1973–2002. Cancer Causes Control 20(5):525–531PubMedCrossRefGoogle Scholar
  30. 30.
    Harach HR, Ceballos GA (2008) Thyroid cancer, thyroiditis and dietary iodine: a review based on the Salta, Argentina model. Endocr Pathol 19(4):209–220PubMedCrossRefGoogle Scholar
  31. 31.
    Girardi FM, Barra MB, Zettler CG (2015) Papillary thyroid carcinoma: does the association with Hashimoto’s thyroiditis affect the clinicopathological characteristics of the disease? Braz J Otorhinolaryngol 81(3):283–287PubMedCrossRefGoogle Scholar
  32. 32.
    Ezaki H, Ebihara S, Fujimoto Y, Iida F, Ito K, Kuma K et al (1992) Analysis of thyroid carcinoma based on material registered in Japan during 1977–1986 with special reference to predominance of papillary type. Cancer 70(4):808–814PubMedCrossRefGoogle Scholar
  33. 33.
    Pillai S, Gopalan V, Smith RA, Lam AK (2015) Diffuse sclerosing variant of papillary thyroid carcinoma—an update of its clinicopathological features and molecular biology. Crit Rev Oncol Hematol 94(1):64–73PubMedCrossRefGoogle Scholar
  34. 34.
    La Vecchia C, Malvezzi M, Bosetti C, Garavello W, Bertuccio P, Levi F et al (2015) Thyroid cancer mortality and incidence: a global overview. Int J Cancer 136(9):2187–2195PubMedCrossRefGoogle Scholar
  35. 35.
    Colović M, Matić S, Kryeziu E, Tomin D, Colović N, Atkinson HD (2007) Outcomes of primary thyroid non-Hodgkin’s lymphoma: a series of nine consecutive cases. Med Oncol 24(2):203–208PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • Alka Mary Mathai
    • 1
    Email author
  • K. Preetha
    • 1
  • S. Valsala Devi
    • 1
  • Sam Vicliph
    • 2
  • Raja Pradeep
    • 2
  • Aqib Shaick
    • 2
  1. 1.Department of PathologySree Uthradom Thirunal Academy of Medical SciencesThiruvananthapuramIndia
  2. 2.Department of SurgerySree Uthradom Thirunal Academy of Medical SciencesThiruvananthapuramIndia

Personalised recommendations