Kliničko-patološke osobitosti papilarnog mikrokarcinoma štitnjače [Clinical and pathological characteristics of papillary microcarcinoma of the thyroid gland]

Džepina, Davor (2010) Kliničko-patološke osobitosti papilarnog mikrokarcinoma štitnjače [Clinical and pathological characteristics of papillary microcarcinoma of the thyroid gland]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

In this study, we made retrospective analysis of clinical and pathological data from 714 patients with papillary thyroid cancer, presented and operated at the Department of ENT/Head and Neck Surgery, Sisters of Charity University Hospital, Zagreb, during the period from 1980 to 2008. All patients were operated with total thyreoidectomy with or without some type of lymph node neck dissection (paratracheal or lateral). There were 321 cases of papillary microcarcinoma (tumors less than or equal to 1 centimeter). We investigated the clinical and pathological characteristics of papillary microcarcinoma and compared this group with tumors larger than 1 centimeter. In comparison with their larger counterparts, groups >1-2 cm and >1-3 cm, microcarcinomas showed statistically less frequent aggressive behaviour, multicentric focuses, and less affinity for regional metastatic dissemination. Male gender and age less than 45 years were identified as unfavorable parameters of papillary microcarcinoma. In males, microcarcinoma had similar characteristics as larger tumours. Patients with coexisting Hashimoto thyreoiditis showed better behaviour according to our chosen clinical and pathological parameters. Multivariant analysis revealed intraglandular dissemination in contralateral lobe, male gender as an independent risk factor for developing metastasis. Nodular goiter has been identified as a protective parameter for metastasis. Even though our study identified microcarcinoma as tumour with better clinical and pathological characteristics than larger tumours, we can conclude that papillary thyroid microcarcinoma behaves in many ways similar to its larger counterparts and therefore recommend a similar clinical approach to them consequently.

Abstract in Croatian

U ovom radu retrospektivno je analiziran kliničko-patološki materijal 714 pacijenata s papilarnim karcinomom operiranih na Klinici za otorinolaringologiju i kirurgiju glave i vrata Kliničke bolnice „Sestre milosrdnice“ u Zagrebu u razdoblju od 1980. do 2008. godine. U skupini mikrokarcinoma svrstan je 321 pacijent. U usporedbi s papilarnim karcinomima većih veličina te skupinama >1-2 cm i >1-3 cm koje čine druge najčešće veličine, mikrokarcinom je pokazao statistički značajno manju agresivnost prema definiranim kriterijima, značajno manje multicentričnih žarišta tumora, kao i manju sklonost regionalnom metastaziranju. Muški spol i životna dob mlađa od 45 godina pokazani su kao značajni čimbenik nepovoljnih karakteristika papilarnog mikrokarcinoma. U muškog spola mikrokarcinom je pokazao slične karakteristike kao i papilarni karcinomi ostalih veličina. Pacijenti s udruženom dijagnozom mikrokarcinoma i limfocitnog tireoiditisa imali su povoljnije kliničko-patološke karakteristike u usporedbi s mikrokarcinomima bez udružene dijagnoze. Multivarijantnom analizom kao vodeći čimbenik rizika za pojavu metastaziranja pokazan je intraglandularni rasap u kontralateralni režanj te muški spol, a kao protektivni čimbenik pokazana je udružena dijagnoza multinodularna struma. Premda statistički značajno povoljniji od papilarnih karcinoma ostalih veličina, mikrokarcinom se u velikom broju slučajeva ponašao agresivno, pokazao žarišta multicentričnosti te pojave metastaza na vratu. Iz navedenih razloga mikrokarcinom možemo smatrati tumorom sličnih bioloških karakteristika te kliničko-patološkog ponašanja kao i bilo koji drugi papilarni karcinom.

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