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2 - Treatment of incidental papillary microcarcinoma in patients whom underwent thyroidectomy because of multinodular goiter
Bülent Çitgez, Mehmet Uludağ, Gürkan Yetkin, Sinan Karakoç, İsmail Akgün, Fevziye Kabukçuoğlu, Hamdi Özşahin
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 pre-diagnosed patients to prevent to skip papillary microcarcinoma and a second surgery.
Keywords: Papillary microcarcinoma, multinodular goiter, total thyroidectomy
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