Surgical approach to encapsulated follicular variant of papillary thyroid carcinoma: a report of three cases

Yıl 2008, Cilt: 18 Sayı: 6, 384 - 388, 20.12.2008

Ahmet Eyibilen İbrahim Aladağ Mehmet Güven Reşit Doğan Köseoğlu

Öz

The diagnosis of follicular variant of thyroid papillary carcinoma is often difficult with fine-needle aspiration biopsy since this variant contains both benign and malignant follicular structures. The encapsulated follicular variant poses even more difficulty for diagnosis. It is usually agreed that this variant has similar clinical behavior to that of classic thyroid papillary carcinoma. However, some recent cases have been shown to have an aggressive course, leading to controversy as to the type of surgery. We presented three female patients whose results of fine-needle aspiration biopsy were not malignant, but postoperative histopathologic diagnosis was made as encapsulated follicular variant. One patient underwent thyroid lobectomy for a single thyroid nodule, and two patients underwent subtotal thyroidectomy. Upon histologic diagnosis of encapsulated follicular variant, total thyroidectomy was performed in two patients. Encapsulated follicular variant should be borne in mind in patients with a benign fineneedle aspiration biopsy result.

Anahtar Kelimeler

Biopsy, fine-needle, carcinoma, papillary, follicular, thyroid neoplasms, thyroidectomy/methods

Tiroid papiller karsinomunun kapsüllü folliküler varyantında cerrahi yaklaşım: Üç olgu sunumu

Öz

Tiroid bezi papiller karsinomlarının folliküler varyan- tında benign ve malign özellikleri taşıyan folliküllerin bir arada bulunması nedeniyle, ince iğne aspirasyon biyopsisinde yanlış tanı sıktır. Tiroid bezi papiller kar- sinomunun folliküler varyantının kapsüllü formunda ise tanısal zorluk daha çoktur. Bu lezyonların klinik seyrinin klasik varyant gibi yavaş ilerlediği, hatta daha ılımlı olduğu söylenmektedir. Ancak, son yıllar- da agresif seyirli olgular da bildirilmiştir. Bu nedenle, cerrahi tedavinin şekli de tartışılmaktadır. Bu yazı- da, ince iğne aspirasyon biyopsi sonuçları malign olmayan ve ameliyat sonrası histolojik incelemede kapsüllü folliküler varyant tanısı konan üç kadın hasta sunuldu. Bir hastaya tek nodül olduğu için tiroid lobek- tomi, ikisine de subtotal tiroidektomi yapıldı. Ameliyat sonrasında histolojik inceleme sonucunda kapsüllü folliküler varyant tanısı konması üzerine, iki hastaya total tiroidektomi yapıldı. Tiroid ince iğne aspirasyon biyopsisi sonucu malign olan olgularda bu varyanta dikkat çekmek amaçlandı

Anahtar Kelimeler

Biyopsi, ince iğne, karsinom, papiller, folliküler, tiroid neoplazileri, tiroidektomi/yöntem

Kaynakça

• LiVolsi VA. Papillary neoplasms of the thyroid. Pathologic and prognostic features. Am J Clin Pathol 1992;97:426-34.
• Kesmodel SB, Terhune KP, Canter RJ, Mandel SJ, LiVolsi VA, Baloch ZW, et al. The diagnostic dilemma of follicular variant of papillary thyroid carcinoma. Surgery 2003;134:1005-12.
• Wu HH, Jones JN, Grzybicki DM, Elsheikh TM. Sensitive cytologic criteria for the identification of follicular variant of papillary thyroid carcinoma in fine-needle aspiration biopsy. Diagn Cytopathol 2003; 29:262-6.
• Chan JK. Strict criteria should be applied in the diag- nosis of encapsulated follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2002;117:16-8.
• Baloch ZW, LiVolsi VA. Encapsulated follicular variant of papillary thyroid carcinoma with bone metastases. Mod Pathol 2000;13:861-5.
• Baloch ZW, Gupta PK, Yu GH, Sack MJ, LiVolsi VA. Follicular variant of papillary carcinoma. Cytologic and histologic correlation. Am J Clin Pathol 1999;111:216-22.
• Renshaw AA, Gould EW. Why there is the tendency to “overdiagnose” the follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2002;117:19-21.
• Logani S, Gupta PK, LiVolsi VA, Mandel S, Baloch ZW. Thyroid nodules with FNA cytology suspicious for fol- licular variant of papillary thyroid carcinoma: follow- up and management. Diagn Cytopathol 2000;23:380-5.
• Lin HS, Komisar A, Opher E, Blaugrund SM. Follicular variant of papillary carcinoma: the diagnostic limita- tions of preoperative fine-needle aspiration and intra- operative frozen section evaluation. Laryngoscope 2000; 110:1431-6.
• Goodell WM, Saboorian MH, Ashfaq R. Fine-needle aspiration diagnosis of the follicular variant of papil- lary carcinoma. Cancer 1998;84:349-54.
• Shemen LJ, Chess Q. Fine-needle aspiration biopsy diagnosis of follicular variant of papillary thyroid can- cer: therapeutic implications. Otolaryngol Head Neck Surg 1998;119:600-2.
• Sabel MS, Staren ED, Gianakakis LM, Dwarakanathan S, Prinz RA. User of fine-needle aspiration biopsy and frozen section in the management of the solitary thy- roid nodule. Surgery 1997;122:1021-6.
• Sobrinho-Simoes M, Preto A, Rocha AS, Castro P, Maximo V, Fonseca E, et al. Molecular pathology of well-differentiated thyroid carcinomas. Virchows Arch 2005;447:787-93.
• Castro P, Rebocho AP, Soares RJ, Magalhaes J, Roque L, Trovisco V, et al. PAX8-PPARgamma rearrange- ment is frequently detected in the follicular variant of papillary thyroid carcinoma. J Clin Endocrinol Metab 2006;91:213-20.
• Finley DJ, Arora N, Zhu B, Gallagher L, Fahey TJ 3rd. Molecular profiling distinguishes papillary carcinoma from benign thyroid nodules. J Clin Endocrinol Metab 2004;89:3214-23.
• Burningham AR, Krishnan J, Davidson BJ, Ringel MD, Burman KD. Papillary and follicular variant of papil- lary carcinoma of the thyroid: Initial presentation and response to therapy. Otolaryngol Head Neck Surg 2005; 132:840-4.
• Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic fac- tors, treatment, and survival. Cancer 2003;97:1181-5.
• Lugli A, Terracciano LM, Oberholzer M, Bubendorf L, Tornillo L. Macrofollicular variant of papillary carci- noma of the thyroid: a histologic, cytologic, and immu- nohistochemical study of 3 cases and review of the literature. Arch Pathol Lab Med 2004;128:54-8.
• Vickery AL Jr. Thyroid papillary carcinoma. Pathological and philosophical controversies. Am J Surg Pathol 1983;7: 797-807.
• Punthakee X, Palme CE, Franklin JH, Zhang I, Freeman JL, Bedard YC. Fine-needle aspiration biopsy findings suspicious for papillary thyroid carcinoma: a review of cytopathological criteria. Laryngoscope 2005;115:433-6.
• Hunt JL, Dacic S, Barnes EL, Bures JC. Encapsulated follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2002;118:602-3.
• Chan JKC. The author’s reply; encapsulated follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2002;118:605.
• Albores-Saavedra J, Gould E, Vardaman C, Vuitch F. The macrofollicular variant of papillary thyroid carcinoma: a study of 17 cases. Hum Pathol 1991;22:1195-205.
• Mizukami Y, Nonomura A, Michigishi T, Ohmura K, Noguchi M, Ishizaki T. Diffuse follicular variant of papillary carcinoma of the thyroid. Histopathology 1995;27:575-7.