Endocrine Abstracts

Objective: Papillary thyroid carcinoma is the most common malignant tumor of the thyroid, the diffuse sclerosing variant is however very rare and represents between 0.7 and 6.7% of all papillary thyroid carcinomas. We propose through this poster to study its clinical, epidemiological, therapeutic and prognostic characteristics.

Matherials and methods: We report two cases of diffuse papillary sclerosing carcinoma of the thyroid, collected at the ENT and CCF service of the Farhat Hached University Hospital of Sousse.

Results: The 2 patients were a man aged 38 years old and a women aged 55 years old with a family history of papillary thyroid carcinoma. The reasons for consultation were right superclavicular swelling that had been present for 5 months in the man and right jugulocarotid adenopathy that had been present for 4 months in the woman. Cervical ultrasonography revealed a 2 cm right supraclavicular adenopathy containing fine microcalcifications and multiple microcalcifications were noted in the right lobe of the thyroid which contained a 10 mm nodule fully calcified in men and a suspicious nodule classified EUtirads 5 of 33 mm in women. Both patients underwent total thyroidectomy with dissection of the bilateral central lymph node and homolateral lateral one. Extemporaneous examination revealed papillary carcinoma in the female patient, whereas it was in favor of benign in the male patient. The final histological examination showed a papillary carcinoma in its diffuse sclerosing variant with sub-millimetric microscopic foci of epithelial malignant tumor proliferation, disseminated throughout the right lobe of the thyroid in men and infiltrating both thyroid lobes and peri-thyroid fat in women, as well as multiple endolymphatic emboli and lymph node metastases in the mediastinum-recurrent, jugulocarotid and supraclavicular. The postoperative period was dominated by the appearance of transient hypoparathyroidism. Both patients received additional treatment with radio-active iodine. The evolution was good. The decline was 12 months.

Conclusion: The diffuse sclerosing variation of papillary carcinoma is an uncommon histological form distinguished by its locally aggressive nature and deceptive clinical appearance. Its therapy must be complete.