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

Affiliations
  • 1Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. kyueunlee@snu.ac.kr
  • 2Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 4Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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.


Reference

1. Milojevic B, Tosevski J, Milisavljevic M, Babic D, Malikovic A. Pyramidal lobe of the human thyroid gland: an anatomical study with clinical implications. Rom J Morphol Embryol. 2013; 54:285–289. PMID: 23771071.
2. Braun EM, Windisch G, Wolf G, Hausleitner L, Anderhuber F. The pyramidal lobe: clinical anatomy and its importance in thyroid surgery. Surg Radiol Anat. 2007; 29:21–27. PMID: 17146601.
Article
3. Geraci G, Pisello F, Li Volsi F, Modica G, Sciume C. The importance of pyramidal lobe in thyroid surgery. G Chir. 2008; 29:479–482. PMID: 19068184.
4. Ogawa C, Kammori M, Onose H, Yamada E, Shimizu K, Yamada T. Follicular carcinoma arising from the pyramidal lobe of the thyroid. J Nippon Med Sch. 2009; 76:169–172. PMID: 19602825.
Article
5. Lee YS, Kim KJ, Kim BW, Chang HS, Park CS. Recurrence of papillary thyroid carcinoma in a remnant pyramidal lobe. ANZ J Surg. 2011; 81:304.
Article
6. Ha TK, Kim DW, Park HK, Jung SJ. Papillary thyroid microcarcinoma in a thyroid pyramidal lobe. Ultrasonography. 2014; 33:303–306. PMID: 25116459.
Article
7. Santrac N, Besic N, Buta M, Oruci M, Djurisic I, Pupic G, et al. Lymphatic drainage, regional metastases and surgical management of papillary thyroid carcinoma arising in pyramidal lobe--a single institution experience. Endocr J. 2014; 61:55–59. PMID: 24077221.
8. Zizic M, Faquin W, Stephen AE, Kamani D, Nehme R, Slough CM, et al. Upper neck papillary thyroid cancer (UPTC): a new proposed term for the composite of thyroglossal duct cyst-associated papillary thyroid cancer, pyramidal lobe papillary thyroid cancer, and Delphian node papillary thyroid cancer metastasis. Laryngoscope. 2016; 126:1709–1714. PMID: 26691539.
Article
9. Cengiz A, Sakı H, Yürekli Y. Scintigraphic evaluation of thyroid pyramidal lobe. Mol Imaging Radionucl Ther. 2013; 22:32–35. PMID: 24003394.
Article
10. Zivic R, Radovanovic D, Vekic B, Markovic I, Dzodic R, Zivaljevic V. Surgical anatomy of the pyramidal lobe and its significance in thyroid surgery. S Afr J Surg. 2011; 49:110. 112. 114 passim. PMID: 21933507.
11. Ryu JH, Kim DW, Kang T. Pre-operative detection of thyroid pyramidal lobes by ultrasound and computed tomography. Ultrasound Med Biol. 2014; 40:1442–1446. PMID: 24613558.
Article
12. Park JY, Kim DW, Park JS, Kang T, Kim YW. The prevalence and features of thyroid pyramidal lobes as assessed by computed tomography. Thyroid. 2012; 22:173–177. PMID: 22224818.
Article
13. Kim DW, Jung SL, Baek JH, Kim J, Ryu JH, Na DG, et al. The prevalence and features of thyroid pyramidal lobe, accessory thyroid, and ectopic thyroid as assessed by computed tomography: a multicenter study. Thyroid. 2013; 23:84–91. PMID: 23031220.
Article
14. Hartl DM, Al Ghuzlan A, Chami L, Leboulleux S, Schlumberger M, Travagli JP. High rate of multifocality and occult lymph node metastases in papillary thyroid carcinoma arising in thyroglossal duct cysts. Ann Surg Oncol. 2009; 16:2595–2601. PMID: 19565286.
Article
15. Heshmati HM, Fatourechi V, van Heerden JA, Hay ID, Goellner JR. Thyroglossal duct carcinoma: report of 12 cases. Mayo Clin Proc. 1997; 72:315–319. PMID: 9121176.
Article
16. Weiss SD, Orlich CC. Primary papillary carcinoma of a thyroglossal duct cyst: reREFERENCES port of a case and literature review. Br J Surg. 1991; 78:87–89. PMID: 1998873.
17. Plaza CP, Lopez ME, Carrasco CE, Meseguer LM, Perucho Ade L. Management of well-differentiated thyroglossal remnant thyroid carcinoma: time to close the debate? Report of five new cases and proposal of a definitive algorithm for treatment. Ann Surg Oncol. 2006; 13:745–752. PMID: 16538412.
Article
18. Doshi SV, Cruz RM, Hilsinger RL Jr. Thyroglossal duct carcinoma: a large case series. Ann Otol Rhinol Laryngol. 2001; 110:734–738. PMID: 11510730.
19. Miccoli P, Minuto MN, Galleri D, Puccini M, Berti P. Extent of surgery in thyroglossal duct carcinoma: reflections on a series of eighteen cases. Thyroid. 2004; 14:121–123. PMID: 15068626.
Article
20. Pribitkin EA, Friedman O. Papillary carcinoma in a thyroglossal duct remnant. Arch Otolaryngol Head Neck Surg. 2002; 128:461–462. PMID: 11926928.
Article
21. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992; 164:658–661. PMID: 1463119.
Article
22. Hay ID, Grant CS, Bergst ralh EJ, Thompson GB, van Heerden JA, Goellner JR. Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 1998; 124:958–964. PMID: 9854569.
Article
23. Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer. 2005; 103:2269–2273. PMID: 15856429.
Article
24. Witt RL. Initial surgical management of thyroid cancer. Surg Oncol Clin N Am. 2008; 17:71–91. PMID: 18177801.
Article
25. Attie JN, Moskowitz GW, Margouleff D, Levy LM. Feasibility of total thyroidectomy in the treatment of thyroid carcinoma: postoperative radioactive iodine evaluation of 140 cases. Am J Surg. 1979; 138:555–560. PMID: 484783.
26. Zeuren R, Biagini A, Grewal RK, Randolph GW, Kamani D, Sabra MM, et al. RAI thyroid bed uptake after total thyroidectomy: A novel SPECT-CT anatomic classification system. Laryngoscope. 2015; 125:2417–2424. PMID: 25891354.
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr