engleski

Presentation of diffuse sclerosing variant of papillary thyroid carcinoma.

AIM: Evaluation of presentation of the diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). MATERIALS & METHODS: DSVPTC was diagnosed in 8 patients between 2002-2008 (1% of 838 pts treated for PTC in our department from 1970 to 2008). Seven were females and one male, aged 11 to 37 years (mean 22 years, median 20 years). RESULTS: All pts had autoimmune thyroid disease (AITD). The youngest pt was 11 year old girl with low growth velocity and severe hypothyroidism. Ultrasound examination showed typical presentation of chronic thyroidits, only discrete punctiform echoes were visible in the whole right lobe. Cytological finding from both lobes was lympocitic thyroidits. But, carcinoma was recognized by lymph nodes. On the right side of the neck some small lymph nodules showed pathological echostructure and CDFI showed pathological increased vascularisation. Fine needle guided biopsy revealed metastases of papillary carcinoma. Histology confirmed DSVPTC. Two small foci of tumour, 2 and 4 mm in diameter, were found in the right lobe and multiple pssamoma bodies in the whole right lobe with lymph node metastases on the right lateral side of the neck. One patient (17 year old girl) was treated because of hyperthyroidism, two had mild hypothyroidism and four were euthyroid. In one male patient tumour was presented in four months what was confirmed by previous ultrasound examination. None of the pts had nodules, US showed hypoechogenic structure of the thyroids, but scattered microcalcifications were visible in all pts as well as lymph node metastases. Diffuse usually bilateral involvement of the gland was presented histologically, micropapillary formations located within cleft-like spaces consistent with lymph vessels, large number of psammoma bodies, marked lymphocytic infiltration and fibrosis. Extrathyroidal extension was found in all pts (except one) as well as bilateral lymph node metastases. Lung metastases were found in only one pt (17 year old girl) by 131-I whole body scan. CONCLUSION: DSVPTC is rare and occurs in young pts with AITD. Previous studies have not comprehensively evaluated this variant of PTC. The question is: Is this variant of PTC a new entity or it was not verified as special variant of PTC, because of it’s rare appearance? The diagnosis of DSVPTC is difficult because there are no nodule in thyroid. Nowadays the diagnosis of this cancer is possible by ultrasound examination when scattered microcalcifictions are detected as well as lymph node metastases, especially in children and young patients with AITD.

Diffuse sclerosing variant of papillary thyroid carcinoma

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