The total number of prelaryngeal and pretracheal lymph node metastases: is it a reliable predictor of contralateral central lymph node metastasis in papillary thyroid carcinoma?

BACKGROUND: Central lymph node (CLN) metastasis in papillary thyroid carcinoma (PTC) is common and being able to predict CLN metastasis helps surgeons determine individualized therapy. However, the relationship between contralateral CLN metastasis and the total number of positive lymph nodes (LNs) in the combined prelaryngeal and pretracheal region remains unclear. This study aimed to investigate whether the total number of positive LNs in the combined prelaryngeal and pretracheal region has clinical significance as a predictor for contralateral CLN metastasis. METHODS: We prospectively enrolled 153 consecutive patients with unifocal PTC >1.0 cm without ultrasonographic evidence of nodal metastasis who underwent total thyroidectomy and prophylactic bilateral CLN dissection from July 2011-May 2013. Patients were divided into three groups according to the total number of positive LNs in the combined prelaryngeal and pretracheal region. RESULTS: Rates of metastasis to ipsilateral and contralateral central compartments in PTC >1.0 cm were 84.3% and 24.2%, respectively. Multivariate analysis showed that ≥3 positive LNs in the combined prelaryngeal and pretracheal region were an independent predictive factor of contralateral CLN metastasis (P < 0.001; odds ratio, 8.585). After a mean follow-up of 24.1 mo, none of these patients had a recurrence in the central or lateral compartment. CONCLUSIONS: Occult metastasis is highly prevalent in the ipsilateral central neck of patients with PTC >1.0 cm, and the total number of prelaryngeal and pretracheal LNs metastases may be a useful indicator to predict contralateral CLN metastasis in patients with unifocal PTC.

Granular cell tumor of the thyroid: Clinical and pathological characteristics of a rare case in a 14-year-old girl.

Granular cell tumors (GCTs) are soft tissue neoplasms that originate in the nervous system, which may arise anywhere in the body. However, GCTs are extremely uncommon in thyroid tumors, with a favorable prognosis. The diagnosis of GCTs is dependent on pathological and immunohistochemical analysis and at present, surgical resection is considered the only suitable treatment. Regular follow-up after surgery is an important way to monitor treatment outcome and recurrence. The present study describes a new pathological type of thyroid GCTs diagnosed by pathology and immunohistochemistry. A 14-year-old female was referred to the West China Hospital of Sichuan University (Chengdu, China), for thyroid incidentaloma. Laboratory examinations were within the normal range. Thyroid sonography demonstrated a solid hypoechoic mass in the right lobe of the thyroid. Fine needle aspiration cytology showed a suspicious malignant tumor and subsequently a total thyroidectomy was performed. Analysis of frozen sections, from obtained samples, did not facilitate a definite diagnosis. Finally, a thyroid benign granular tumor with atypical changes was diagnosed by postoperative pathology and immunohistochemistry. A 14-month post-operative follow-up showed that the patient experienced a stable recovery and had no signs of recurrence or metastasis. The case emphasizes that the diagnosis of thyroid granular cell tumors is predominantly based on postoperative morphology and immunophenotype. The clinical routine for the differential diagnosis may be due to: (i) neoplasms displaying a granular appearance mimicking granular cell tumors, or (ii) differential diagnosis in the pathological category of granular cell tumors. Further accumulation of such rare cases may be of clinical significance in aiding the diagnosis and treatment of GCTs.