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Metastatic Minimally Invasive (Encapsulated) Follicular and Hurthle Cell Thyroid Carcinoma: A Study of 34 Patients

Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Modern Pathology (Impact Factor: 6.36). 03/2000; 13(2):123-30. DOI: 10.1038/modpathol.3880023
Source: PubMed

ABSTRACT Most studies that have examined minimally invasive, encapsulated, follicular carcinoma (FC) or Hurthle cell carcinomas (HCs) have contained only a few metastatic neoplasms. We studied 34 patients with a single, minimally invasive, metastatic FC or HC and compared them with 38 patients with similar, nonmetastatic FCs or HCs. The numbers of incomplete capsular penetration (neoplasm into but not through the capsule), complete capsular penetration (neoplasm through the capsule), and vascular invasion foci were quantified. The median number (three), range, and distribution of complete capsular penetration and vascular invasion foci were similar in the nonmetastatic and metastatic carcinomas. All of the metastatic FCs and HCs had at least one vascular invasion or complete capsular penetration focus. Sixty-two percent of the metastatic carcinomas had two to four complete capsular penetration foci, and 60% had two to four vascular invasion foci. Two metastatic neoplasms had incomplete capsular penetration but had one and two vascular invasion foci, respectively. One tumor had no vascular invasion but had four complete capsular penetration foci. No metastatic neoplasms had incomplete capsular penetration only. There were no differences in the number of vascular invasion or complete capsular penetration foci between metastatic and nonmetastatic FCs and HCs and between metastatic FCs and HCs. Most metastatic neoplasms had vascular space invasion and complete capsular penetration. The number of complete capsular penetration or vascular invasion foci was not associated with the initial site of metastasis or the interval between the surgery and the metastasis.

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    • "Indeed, although several studies have suggested that patients with MI-FTC and no vascular invasion might benefit from a more conservative treatment (e.g., thyroid lobectomy) [2] [15] [16] [21] [24], we retain that a more aggressive approach (i.e., total thyroidectomy in all the patients) could be suitable. This approach has the advantage to facilitate follow-up and the detection of occult distant metastases that could occur at presentation even in patients with MI-FTC without vascular invasion [3] [8] [15] [25] [26] "
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    ABSTRACT: Follicular thyroid carcinoma classically accounts for 10–32% of thyroid malignancies. We determined the incidence and the behaviour of follicular thyroid carcinoma in an endemic goitre area. A comparative analysis between minimally invasive and widely invasive follicular thyroid carcinoma was performed. The medical records of all patients who underwent thyroidectomy from October 1998 to April 2012 for thyroid malignancies were reviewed. Those who had a histological diagnosis of follicular carcinoma were included. Among 5203 patients, 130 (2.5%) were included. Distant metastases at presentation were observed in four patients. Sixty-six patients had a minimally invasive follicular carcinoma and 64 a widely invasive follicular carcinoma. In 63 patients an oxyphilic variant was registered. Minimally/widely invasive ratio was 41/26 for usual follicular carcinoma and 25/38 for oxyphilic variant (P < 0.05). Patients with widely invasive tumors had larger tumors (P < 0.001) and more frequently oxyphilic variant (P < 0.05) than those with minimally invasive tumours. No significant difference was found between widely invasive and minimally invasive tumors and between usual follicular carcinoma and oxyphilic variant regarding the recurrence rate (P = NS). The incidence of follicular thyroid carcinoma is much lower than classically retained. Aggressive treatment, including total thyroidectomy and radioiodine ablation, should be proposed to all patients.
    The Scientific World Journal 03/2014; 2014:952095. DOI:10.1155/2014/952095 · 1.73 Impact Factor
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    ABSTRACT: Das leitliniengerechte Therapiekonzept des follikulären Schilddrüsenkarzinoms (FTC) bestand bisher in einer totalen Thyreoidektomie mit Lymphknotendissektion und Radiojodtherapie. In Anbetracht des geringen Malignitätspotenzials scheint beim minimal-invasiven follikulären Schilddrüsenkarzinom (MIFTC) ein eingeschränkt radikales Operationsverfahren adäquat. Das MIFTC ist allerdings in der Literatur eine inhomogene Gruppe und unterschiedlich definiert. Daher hat Rosai im Jahr 2005 eine klinisch prognoseorientierte Klassifikation vorgeschlagen, die auf dem Ausmaß von Kapsel- und Gefäßinvasion beruht: das MIFTC mit ausschließlicher Kapselinvasion und mit limitierter Gefäßinvasion (≤3), das gekapselte FTC mit ausgedehnter Gefäßinvasion (>3) und das weit invasive FTC mit grob invasivem Wachstum. Voraussetzung für die Diagnose MIFTC ist die Aufarbeitung des gesamten gekapselten follikulären Knotens oder von mindestens 10Tumorblöcken der Tumorkapsel; der Pathologie kommt somit eine wesentliche therapierelevante Rolle zu. Aufgrund der exzellenten Prognose stellt die Hemithyreoidektomie für das MIFTC mit ausschließlicher Kapselinvasion ein adäquates Operationsverfahren dar, bei limitierter Gefäßinvasion ist es ebenso in Erwägung zu ziehen, unterliegt jedoch noch einer klinischen Prüfung. Es besteht keine Indikation zur Durchführung einer systematischen Lymphadenektomie. Current treatment guidelines for follicular thyroid carcinoma (FTC) recommend total thyroidectomy, lymphadenectomy and radioiodine ablation. Considering the low malignant potential of minimally invasive follicular thyroid carcinoma (MIFTC), a limited radical therapeutic procedure may be adequate. MIFTC is an intensely discussed group of tumors and a review of the literature reveals disagreement among experts concerning the criteria for a distinct definition. Therefore, in 2005 Rosai proposed a clinically more significant classification of FTC based on the extent of capsular and vascular invasion: MIFTC with capsular invasion only, with limited (≤3) vascular invasion, encapsulated FTC with extensive (>3) vascular invasion and broadly invasive FTC with extensive invasive growth. For the diagnosis of MIFTC a complete investigation of the encapsulated follicular lesion should be performed by the pathologist and examination of at least 10 tissue blocks is mandatory. Due to the excellent prognosis hemithyroidectomy constitutes an adequate therapeutic approach in MIFTC with capsular invasion only and may also be considered for MIFTC with limited vascular invasion. There are no indications for systematic lymphadenectomy. SchlüsselwörterMinimal-invasives follikuläres Schilddrüsenkarzinom-Kapselinvasion-Gefäßinvasion-Limitierte Radikalität-Hemithyroidektomie KeywordsMinimally invasive follicular thyroid carcinoma-Capsular invasion-Vascular invasion-Limited radicality-Hemithyroidectomy
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    ABSTRACT: Diss. med. Zürich. Literaturverz.
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