Metastatic Follicular Thyroid Carcinoma and the Primary Thyroid Gross Examination: Institutional Review of Cases from 19
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Metastatic Follicular Thyroid Carcinoma and the Primary Thyroid Gross Examination: Institutional Review of Cases from 1990 to 2015 Krzysztof Glomski 1,2 & Vania Nosé 1,2 & William C. Faquin 1,2,3 & Peter M. Sadow 1,2,3
# Springer Science+Business Media New York 2017
Abstract The diagnosis of follicular-patterned carcinomas, including follicular thyroid carcinoma, oncocytic (Hürthle cell) carcinoma, and the encapsulated follicular variant of papillary thyroid carcinoma, requires evidence of capsular and/or vascular invasion. With minimally invasive carcinomas classified often within less than a millimeter of tissue segregating them from adenomas and non-invasive follicular thyroid neoplasms with papillary-like nuclear features, opinions vary internationally over how much of the capsule to submit in order to deem it well enough represented, considering that even if grossly entirely submitted in microcassettes, without leveling through each tissue block, the capsule is truly never entirely examined microscopically. Here, we retrospectively examine submission practices and outcomes at a single, high-volume institution over a 25-year period. Our results indicate that the vast majority of lesions with poor outcomes are those with wide invasion, and tumors lacking gross evidence of capsular perturbation rarely lead to recurrence or metastasis, an unsurprising result that should prompt re-evaluation of our grossing methods and approach to follicular-patterned tumors in a time of cost restraint, molecular diagnostics, and low biological potential of encapsulated, circumscribed neoplasia of the thyroid.
* Peter M. Sadow [email protected] 1
Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
2
Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
3
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
Keywords Follicular thyroid carcinoma . Capsule . Capsular invasion
Introduction Follicular thyroid carcinoma (FTC) is the second most common epithelial-derived malignancy of the thyroid, accounting for approximately 3–15% of total thyroid cancer incidence [1, 2]. Carcinoma is determined by the presence of capsular and/ or vascular invasion [3], but assessing for invasion is subjective [3–6]. Follicular-patterned neoplasms of the thyroid, including adenomatous nodules, follicular adenomas (FA), noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), follicular thyroid carcinomas, and the follicular variant of papillary thyroid carcinomas (FVPTC), lack hallmark morphologic features of classical papillary thyroid carcinomas (PTC), most conspicuously papillary architecture to accompany nuclear features of PTC [4, 5]. Follicular-patterned carcinomas are invasive, either through their fibrous capsules or into blood vessels within or outside of their lesional capsules, or both [3, 7]. The distinction between minimally invasive and widely invasive carcino
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