Med Bull Sisli Etfal Hosp. 2006; 40(1): 41-49

Papillary thyroid microcarcinomas in nodular goiter

Mehmet Uludað¹, Gürkan Yetkin¹, Bülent Çitgez¹, Banu Yýlmaz², Adnan Iþgör³, Abut Kebudi^4
1Second Department of General Surgery, Þiþli Etfal Training and Research Hospital, Istanbul, Turkey
²Pathology Laboratory, Þiþli Etfal Training and Research Hospital, Istanbul, Turkey
³Haliç University, Istanbul, Turkey
⁴Department of General Surgery, Maltepe University, Faculty of Medicine, Istanbul, Turkey

Objective: To evaluate the papillay microcarcinoma incidence and the treatment options in the patients that we operated for nodular goiter.

Study design: The datas for 215 patients who has been examined with the diagnosis of nodular goiter and has been operated in our clinic in the period of 2002-2004 were rewiewed retrospectively
Results: In the 215 patients a total of 15 papillary thyroid micro- carcinoma was detected and the incidence was %6.98. The mean age of the patients who has a tumor was 46.5 and 13 of them were women (%86.7). The mean diameter of the tumors was 0.41cm (0.1 -lcm). Extrathyroidal and capsular invasion was observed in the %13.3 of the patients. %6.6 of the tumors were multifocal and in %6.6 of them cervical lenf node metastase was found. The surgical procedures that were administered to these patients were I lobectomy, 6 total thyroidectomy,I near total thyroidectomy and in 7 cases total lobectomy plus subtotal lobectomy was made. In 3 of these patients completion thyroidectomy was necessary because of risk factors. In the mean fallow up of 22,6 months recurrence or mortality was not encountered.
br> Conclusions: Since the papillary thyroid microcarcinomas have a good prognose in the incidental cases which were found in subtotal thyroidectomy patients we recommend fallow up without additional treatment.In the cases who has risk factors related to the tumor our opinion is to perform a total thyroidectomy in order to achieve a safe oncological fallow up.

Keywords: incidental thyroid cancer, micropapillary thyroid cancer, thyroidectomy

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Noduler guatrda papiller tiroit mikrokarsinomlarý

Mehmet Uludað¹, Gürkan Yetkin¹, Bülent Çitgez¹, Banu Yýlmaz², Adnan Iþgör³, Abut Kebudi^4
1Þiþli Etfal Eðitim ve Araþtýrma Hastanesi, 2. Genel Cerrahi Kliniði, Ýstanbul
²Þiþli Etfal Eðitim ve Araþtýrma Hastanesi, Patoloji Laboratuvarý, Ýstanbul
³Haliç Üniversitesi, Ýstanbul
⁴Maltepe Üniversitesi, Týp Fakültesi Genel Cerrahi Anabilim Dalý

Amaç: Noduler guatr tanýsý ile öpere ettiðimiz hastalardaki papiller mikrokarsinom insidansým ve tedavi seçimlerini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Kliniðimizde 2002-2004 tarihleri arasýnda klinik olarak noduler guatr tanýsý ile araþtýrýlýp, operasyon uygulanan 215 hastanýn verileri retrospektif olarak deðerlen¬dirildi.
Bulgular: 215 olguda toplam 15 tiroit papiller mikrokanseri saptanmýþ olup, insidans % 6.98’di. Tümörlü hastalarýn yaþ ortalamasý 46.5 olup, 13’ü (% 86.7) kadýndý. Tümör çapý ortalama 0.41 (0.1-1) cm’di. % 13.3 kapsüler invazyon ve ekstratiroidal yayýlým, % 6.6 multisentrite, %6.6 servikal lenf bezi metastazý saptandý. 1 lobektomi, 6 total tiroidektomi, 1 totale yakýn tiroidektomi uygulandý. 7 olguda ise total lobektomi+ subtotal lobektomi uygulandý. Bunlardan 3‘imde risk faktörü olduðu için tamamlayýcý tiroidektomi uygulandý. Ortalama 22,6 aylýk takipte nüks ve mortalite saptanmadý.
Sonuçlar: Tiroit papiller mikrokarsinomlannm iyi seyirlerinden dolayý, insidental saptanan subtotal tiroidektomili olgularda risk faktörleri yok ise ek tedaviye gerek olmadan olgularýn takip edilebileceði kanýsýndayýz. Subtotal tiroidektomili olgularda iýýsidental saptanan ve tümör ile ilgili risk faktörü olan olgularda onkolojik ve güvenli takip açýsýndan tiroidektominin totale tamamlanmasý gerektiði kanýsýndayýz.

Anahtar Kelimeler: insidental tiroit kanseri, mikropapiller tiroit kanseri, tiroidektomi

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