Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: clinical behaviour and surgical management.

OBJECTIVES: Papillary thyroid microcarcinomas (PTM) have not yet an agreed clinical management. The Authors compared PTMs with papillary thyroid carcinoma of larger size (LPTC) and incidental and not-incidental carcinomas. MATERIALS AND METHODS: Review of clinical data of 67 patients (54 women, 13 men) prospectively stored in a standardised way in an electronic patient record system. RESULTS: There were 36 cases of microcarcinoma (53.7%). Differences were not significant between PTM and LPTC groups as to patients personal data, TNM and MACIS staging, nodal involvement (8.3% vs 19.3%) and multifocality (25% vs 38.7%) while capsular invasion was significantly higher in LPTC (25% vs 54.8%). Nineteen incidental tumors were detected at pathological examination and they were all microcarcinomas. They were smaller than the remaining 17 not-incidental microcarcinomas but showed a similar clinical behaviour. There were not cancer related deaths nor recurrences in the follow up period in any group. CONCLUSIONS: Despite the excellent prognosis of PTM, a subset of these tumours shows aggressive biological and clinical features, like nodal or capsular invasion and multifocality. Actually, with the exclusion of size, they do not show any relevant difference from differentiated thyroid carcinoma of larger size. Since predictive cytogenetic markers are still missing, their treatment should then be the same as for conventional thyroid cancers.

[Clinical significance of thyroid nodule calcification]. / Significato clinico delle calcificazioni nei noduli tiroidei.

To confirm the predictive value of calcifications in thyroid nodules as a risk factor for malignancy and to detect specific aspects for tumours, in a set of 175 patients--30 papillary carcinoma (PC) and 145 multinodular goiters (MNG) with dominant nodule--calcifications were detected by ultrasound scan. Calcifications were significantly more frequent in PC than in MNG (40% vs 20.7% p < 0.05) but their considered characteristics (size, number, position, location in the gland, sonographic features of the nodule) did not show any particular difference between PC and MNG. The frequency of calcifications in our series was higher in older patients (mean age 58.7 +/- 13.3 vs 51.1 +/- 12.7 in patients without calcifications, p < 0.001) and this could imply that their onset is time-dependent. Calcifications can be a useful indicator of enhanced risk, to be considered in the overall process of surgical decision making.

Warthin's tumor of parotid gland: treatment of a retroneural lesion by enucleation.

The papilliferous cystadenomas lymphomatosum or Warthin's tumor is a relatively rare and generally benign neoformation whose incidence is second only to the pleomorfic adenoma. 84% of all Warthin's tumor strikes the parotid gland. We report the two cases that come to our observation paying particular attention to the second one in which occurred a synchronous bilateral manifestation, a rarity in the clinical circle. We want to highlight that enucleation should be the preferred treatment in most cases due to extremely small dimension of Warthin's tumor. Moreover it is possible to perform this kind of surgical treatment even in the case of a retroneural lesion without causing any damage to the facial nerve and its main branches. As regards complications and sequelae we noticed neither a permanent nor a temporary injury of the facial mimicry and sensibility.