Question

Psammoma bodies or microcalcification in dissected lymph nodes in papillary thyroid carcinoma?

Many textbooks say psammoma bodies or calcification in dissected lymph nodes in papillary carcinoma of thyroid implies the possible tumor cell metastasis to the lymph nodes.

However there is no description mentioning the calcification or counting the lymph nodes with calcification as metastasized lymph nodes when staging the case. How do you deal with this matter? Do you count them or just ignore them?

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All Answers (6)

  • Jaimanti Bakshi · Postgraduate Institute of Medical Education and Research
    Microcalcifications in dissected lymph nodes in papillary thyroid cancer are not a common feature however they may be present in some cases. We dont count them as criteria for metastasis in lymph nodes and we look for other features suggesting metastasis.
  • Yosep Chong · Catholic University of Korea
    I have seen two such cases only today in my surgical reading. And Many textbook say the tumor cells can be found in few microns away from the calcification and even if the tumor cells are not found, there is a high probability that the calcification could be an evidence for tumor metastasis. However, none of them ever mentioned how to deal with such findings. Is there any one who can comment on how to make a study plan to estimate the significance of this finding in staging the papillary cancer in relation to patient prognosis or survival?
  • Effat Omar · Universiti Teknologi MARA
    This is a very interesting question. I am a practising pathologist for the last 10 years, plus I also had worked on thyroid tumours. In my experience, it is not common to see psammoma bodies in the metastatic lymph node of PTC, however, I agree with you that if there are calcifications, we should look hard for any metastasis.
    I am currently involved in a project where we use CAT scan to look for calcification in another disease (also for possible relation to the survival and prognosis). Perhaps you could do the same for the PTC lymph nodes?
  • Maher Sughayer · King Hussein Cancer Center
    The presence of psamoma bodies is an alert to look hard for the mets but wheather that or the presence of small or micro mets would affect the prognosis is not clear. The best approach is to disregard them in the lymph nodes if no clear mets are present after careful search or deeper levels.
  • Pasqualino Malandrino · University of Catania
    Psammoma bodies may be present in the thyroid tissue also without any evidence of thyroid cancer, for instance in chronic lymphocitic thyroiditis. Thus I believe that the only presence of psammoma bodies in the lymph nodes is not a sufficient criteria suggesting the occurrence of node metastases.
  • Saif Al-Sobhi · King Faisal Specialist Hospital and Research Centre
    It is sign of lymph nodes involvement by metastatic cells
    So I will do neck dissection for that side of the neck
    The prognosis may be affected by lymph nodes Metz

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