Endocrine Abstracts

Objective: To study thyroid microcarcinomas in surgical samples obtained by thyroidectomy.

Material and methods: We studied 311 patients thyroidectomized for different thyroid diseases in 2007, histology being made in the Institute of Pathology Tg.Mures.

Results: Surgery was made for uni- and multinodular goiter in 278, for Graves-disease in 28, and for other forms of hyperthyro-i-dism in 5 cases. Thyroid cancer was diagnosed in 65 cases (20.9%), 53 being papillary carcinomas. Almost half (31 subjects – 47.7%) of these well-diffe-rentiated forms were microcarcinomas, and the main part of them (21 cases – 67.7%) were detected incidentally by histology. From the total of 21 incidental papillary thyroid microcarcinomas (PTMCs) 4 (19%) harbored potential aggressive behaviour (capsular invasion, multifocality, lymph node micrometastases, Whartin-like variant). From the 10 non-incidental PTMCs 8 were unifocal and 2 multi-focal, but these 2 multifocal PTMCs were diagnosed before surgery as unifocal forms, and other foci of 1–2 mm were detected histologically in the contralateral lobe only after total thyroidectomy. Half of the 10 PTMCs diagnosed noninci-den–tally by histology had potential aggressive behaviour. From all incidentalomas 17 were resolved by total thyroidectomy (±lymph node dissection) and 4 by hemithyroidectomy and isthmectomy (all 4 unifocal, but 1 with extrathyroidal extension).

Conclusions: Microcarcinomas presented 47.7% out of papillary thyroid cancers. Most of them were detected incidentally (67.7%). About 1/3 of all PTMCs (9 out of 31 cases, 29%) showed signs that suggest an aggressive evolution: 3 multifocal growth (1 Whartin-like variant), 2 extra-thyroi-dal extension, 2 regional lymph node micro-metastases, 2 trabecular histological variant. From the 21 incidentalomas 4 (19%), and out of the 10 nonincidental microcarcinomas 5 (50%) had aggressive behaviour.