Nodal metastasis in well-differentiated follicular carcinoma of the thyroid: Its incidence and clinical significance

Hirokawa,Mitsuyoshi; Ito,Yasuhiro; Kuma,Seiji; Takamura,Yuuki; Miya,Akihiro; Kobayashi,Kaoru; Miyauchi,Akira

doi:10.3892/ol_00000154

Nodal metastasis in well-differentiated follicular carcinoma of the thyroid: Its incidence and clinical significance

Authors:
- Mitsuyoshi Hirokawa
- Yasuhiro Ito
- Seiji Kuma
- Yuuki Takamura
- Akihiro Miya
- Kaoru Kobayashi
- Akira Miyauchi
View Affiliations

Affiliations: Department of Diagnostic Pathology, Kuma Hospital, Chuo-ku, Kobe 650-0011, Japan. mhirokawa@kuma-h.or.jp
Published online on: September 1, 2010 https://doi.org/10.3892/ol_00000154
Pages: 873-876

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The clinical significance of nodal metastasis in well-differentiated follicular carcinoma (WD-FC) of the thyroid remains a controversial issue. This study aimed to clarify clinical and pathological characteristics of WD-FC with nodal metastasis, based on the new WHO classification. We examined 249 WD-FC cases diagnosed between 1983 and 2004 in our hospital. Poorly differentiated follicular carcinoma was not included in this study. Of the 249 WD-FC cases, 9 (3.6%) revealed nodal metastasis. The incidences of nodal metastasis in minimally invasive and widely invasive cases were 2.0 and 9.8%, respectively. In four patients, nodal metastasis was detected in the ipsilateral lymph nodes during the initial surgery. A total of 6 patients presented with nodal metastasis 2-10 years after the initial operation, and 3 patients with bilateral and large nodal metastases were relatively young. No patients succumbed to the carcinoma. Primary lesions of WD-FC with nodal metastasis were microscopically conventional, and there were no findings predicting nodal metastasis. We hypothesized that the incidence of nodal metastasis in WD-FC, based on the new WHO classification, was lower compared with previous reports. Younger individuals may be at a higher risk of large bilateral nodal metastasis. The presence of nodal metastasis did not affect the long-term outcome of follicular carcinoma.

View Figures

View References

1	DeLellis RA, Lloyd RV, Heitz PU and Eng C: WHO Classification of Tumours, Pathology and Genetics of Tumours of Endocrine Organs. IARC Press; Lyon: pp. 67–72. 2004
2	Crile G Jr, Pontius KI and Hawk WA: Factors influencing the survival of patients with follicular carcinoma of the thyroid gland. Surg Gynecol Obstet. 160:409–413. 1985.PubMed/NCBI
3	Witte J, Goretzki PE, Dieken J, Simon D and Roher HD: Importance of lymph node metastases in follicular thyroid cancer. World J Surg. 26:1017–1022. 2002. View Article : Google Scholar : PubMed/NCBI
4	Lin JD, Liou MJ, Chao TC, Weng HF and Ho YS: Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases. Endocr Relat Cancer. 6:109–115. 1999. View Article : Google Scholar : PubMed/NCBI
5	Shaha AR, Loree TR and Shah JP: Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery. 118:1131–1136. 1995. View Article : Google Scholar : PubMed/NCBI
6	Shaha AR, Shah JP and Loree TR: Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg. 172:692–694. 1996. View Article : Google Scholar : PubMed/NCBI
7	Segal K, Arad A, Lubin E, Shpitzer T, Hadar T and Feinmesser R: Follicular carcinoma of the thyroid. Head Neck. 16:533–538. 1994. View Article : Google Scholar : PubMed/NCBI
8	Chow SM, Law SC, Au SK, Leung TW, Chan PT, Mendenhall WM and Lau WH: Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute. Head Neck. 24:670–677. 2002. View Article : Google Scholar : PubMed/NCBI
9	Hughes CJ, Shaha AR, Shah JP and Loree TR: Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck. 18:127–132. 1996. View Article : Google Scholar : PubMed/NCBI
10	Ghossein R: Problems and controversies in the histopathology of thyroid carcinomas of follicular cell origin. Arch Pathol Lab Med. 133:683–691. 2009.PubMed/NCBI
11	Suster S: Thyroid tumors with a follicular growth pattern, problems in differential diagnosis. Arch Pathol Lab Med. 130:984–988. 2006.PubMed/NCBI
12	Asa SL: The role of immunohistochemical markers in the diagnosis of follicular-patterned lesions of the thyroid. Endocr Pathol. 16:295–309. 2005. View Article : Google Scholar : PubMed/NCBI
13	Fletcher CDM: Diagnostic Histopathology of Tumors. 2nd edition. Churchill Livingstone; London: pp. 979–993. 2000
14	Rezk S and Khan A: Role of immunohistochemistry in the diagnosis and progression of follicular epithelium-derived thyroid carcinoma. Appl Immunohistochem Mol Morphol. 13:256–264. 2005. View Article : Google Scholar : PubMed/NCBI
15	Sakamoto A: Definition of poorly differentiated carcinoma of the thyroid: the Japanese experience. Endocr Pathol. 15:307–311. 2004. View Article : Google Scholar : PubMed/NCBI
16	Albores-Saavedra J and Carrick K: Where to set the threshold between well differentiated and poorly differentiated follicular carcinomas of the thyroid. Endocr Pathol. 15:297–305. 2004. View Article : Google Scholar : PubMed/NCBI
17	Rosai J: Poorly differentiated thyroid carcinoma, introduction to the issue, its landmarks, and clinical impact. Endocr Pathol. 15:293–296. 2004. View Article : Google Scholar : PubMed/NCBI
18	Lang W, Choritz H and Hundeshagen H: Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings. Am J Surg Pathol. 10:246–255. 1986.PubMed/NCBI
19	Pilotti S, Collini P, Mariani L, Placucci M, Bongarzone I, Vigneri P, Cipriani S, Falcetta F, Miceli R, Pierotti MA and Rilke F: Insular carcinoma, a distinct de novo entity among follicular carcinomas of the thyroid gland. Am J Surg Pathol. 21:1466–1473. 1997. View Article : Google Scholar : PubMed/NCBI
20	Natsugoe S, Aiko T and Shimazu H: A detailed histological study on occult metastasis of the lymph nodes. Jpn J Surg. 21:528–532. 1991. View Article : Google Scholar : PubMed/NCBI
21	Rao RS, Parikh HK, Deshmane VH, Parikh DM, Shrikhande SS and Havaldar R: Prognostic factors in follicular carcinoma of the thyroid, a study of 198 cases. Head Neck. 18:118–124. 1996. View Article : Google Scholar : PubMed/NCBI