Treatment of incidental papillary microcarcinoma in patients whom underwent thyroidectomy because of multinodular goiter

Objective: Multinodular goiter (MNG) is the most frequent indication for thyroid surgery in our country which is endemic for goiter. In this study we aimed to examine the cases that were operated for MNG, and diagnosed as “incidental papillary microcarcinoma” with the pathological examination.
Methods: A total of 362 patients that were operated for benign MNG between June 2006 and January 2010 were evaluated retrospectively. The patients with unilateral nodules were excluded from the study. The cases that were known to have tumor preoperatively, that were asked for frozen examination pathologically after fine needle aspiration biopsy (FNAB), > 1cm of tumor diameter postoperatively, and papillary microcarcinomas that accompany to tumors that are > 1cm were also excluded from the study. The demographic characteristics,
histopathologic results, and postoperative treatments of the patients with papillary microcarcinoma pathological diagnose were evaluated.
Results: A total of 347 patients were treated with total thyroidectomy, and 15 patients were operated with near-total thyroidectomy. At the histopathological examination, 14 (4%) patients were diagnosed with papillary microcarcinoma. All of 14 patients were women. The mean age was 58,07 (36-73). The mean tumor diameter was 3,7 (1-8) mm. Only one case had capsule invasion and, at the same case, multicentricity was detected. The other cases had no additional surgical treatment becasue they had total thyroidectomy. All cases had supression treatment; only one case had capsule invasion and was multifocal, therefore this case was treated with radioisotope treatment.
Conclusion: Although the papillary microcarcinoma had a fairly good clinical course, it may cause distant metastases rarely. We think that the total thyroidectomy is the appropriate treatment of choice in MNG prediagnosed patients to prevent to skip papillary microcarcinoma and a second surgery.

Multinodüler guatr nedeniyle tiroidektomi uygulanan hastalarda insidental papiller tiroid mikrokarsinom olgularýmýz ve tedavisi

Amaç: Multinodüler guatr (MNG), endemik guatr bölgesi olan ülkemizde en sýk tiroid operasyon endikasyonudur. MNG nedeniyle opere edilen ve patoloji incelemelerinde insidental papiller mikrokarsinom saptanan olgularý incelemeyi amaçladýk.
Yöntem: Haziran 2006 ile Ocak 2010 tarihleri arasýnda selim nedenlerle operasyona alýnan 362 hasta retrospektif olarak deðerlendirildi. Tek taraflý nodülü olan hastalar çalýþma dýþý býrakýldý. Preoperatif tümör olduðu bilinen ve ince iðne aspirasyon biopsi (ÝÝAB) sonucunda patolog tarafýndan frozen istenen, postoperatif 1 cm’den büyük olan ve 1 cm’den büyük tümöre eþlik eden papiller mikrokarsinomlar çalýþma dýþý tutuldu. Patolojik tanýsý papiller mikrokarsinom gelen hastalarýn demografik özellikleri, histopatolojik sonuçlarý ve postoperatif tedavileri
incelendi.
Bulgular: Toplam 347 hastaya total tiroidektomi, 15 hastaya totale yakýn tiroidektomi uygulandý. Histopatolojik incelemede 14 (%4) hastada papiller mikrokarsinom saptandý. 14 hastanýn tümü kadýndý. Yaþ ortalamasý 58,07 (36-73) olarak saptandý. Tümör ortalama boyutu 3,7 mm (1-8) olarak hesaplandý. Sadece bir olguda kapsül invazyonu ve ayný olguda multifokalite saptandý. On dört olguda total tiroidektomi uygulandýðýndan ek bir cerrahi giriþim planlanmadý. Tüm olgulara supresyon tedavisi uygulanýrken sadece bir olguya kapsül invazyonu ve multifokal olmasý nedeniyle radyoizotop ablasyon (RAI) tedavisi uygulandý.
Sonuç: Papiller mikrokarsinomun klinik seyri çok iyi olabilmesine raðmen, nadiren uzak metastazlarla saptanabilirler. Papiller mikrokarsinomun atlanmamasý ve ikinci bir cerrahi giriþimi engellemek için MNG ön tanýsý olan hastalarda total tiroidektominin uygun bir tedavi olduðunu düþünmekteyiz.