Ann Surg Treat Res.  2017 Mar;92(3):123-128. 10.4174/astr.2017.92.3.123.

Clinical characteristics of papillary thyroid carcinoma arising from the pyramidal lobe

• Yoon SG
• Yi JW
• Seong CY
• Kim JK
• Kim SJ
• Chai YJ
• Choi JY
• Lee KE

• KMID: 2377553
• DOI: http://doi.org/10.4174/astr.2017.92.3.123

Abstract

PURPOSE
Papillary thyroid carcinoma (PTC) arising from the pyramidal lobe is rare; therefore, clinicopathologic evaluation is lacking. In addition, the rate of occult malignancy in the pyramidal lobe after thyroid surgery is unclear. This study is to evaluate the clinical characteristics of PTCs that involve the pyramidal lobe.
METHODS
The study enrolled 1,107 patients who underwent thyroid surgery for PTC at Seoul National University Hospital from 2006 to 2015. Pyramidal lobe status in pathologic reports was clear in all cases. "Pyramidal lobe-dominant PTC" was defined as single pyramidal lobe cancer or multifocal cancer with larger pyramidal lobe tumor. "Incidental pyramidal lobe PTC" was defined as occult cancer identified after thyroidectomy or as multifocal cancer with smaller pyramidal lobe tumor.
RESULTS
Ten patients were included in the pyramidal lobe-dominant PTC group. The mean age was 58 ± 12.5 years, and the mean tumor size was 0.7 ± 0.7 cm. Cervical lymph node metastasis was found in 5 patients (50%). Three patients had microscopic lymphatic invasion, and 7 had advanced American Joint Comitee on Cancer (AJCC) stage disease (5 with stage III and 2 with stage IV). Compared with conventional PTC (n = 1,058), pyramidal lobe-dominant PTC was significantly associated with lymphatic invasion (P = 0.031) and advanced AJCC stage (P = 0.022). The prevalence of incidental pyramidal lobe PTC was 3.56%.
CONCLUSION
Pyramidal lobe PTC is relatively small in size; however, the rate of extrathyroidal extension and lymph node metastasis is high. Preoperative evaluation of nodal status is important, and the extent of surgery should be determined in accordance with the preoperative diagnosis.

Keyword

Thyroid; Pyramidal; Papillary thyroid carcinoma; Lymphatic metastasis; Thyroid neoplasms

MeSH Terms

Diagnosis
Humans
Joints
Lymph Nodes
Lymphatic Metastasis
Neoplasm Metastasis
Prevalence
Seoul
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy

Figure

• 

  Fig. 1 (A) Pyramidal lobe papillary thyroid carcinoma identified during surgery. (B) Gross specimen of pyramidal lobe thyroid carcinoma.

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