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Chirurgia 2005 August;18(4):157-62

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: Italian

Incidental carcinoma of the thyroid: our experience

Valduga P., Zani B., Famà R., Dvornik G., Ciola M., Rossi M., Eccher C.


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Aim. The incidental carcinoma of the thyroid is an occasional neoplasm in patients thyroidectomized owing to benign pathology. They often are neoplasms whose size is smaller than 1 cm and are defined microcarcinomas by the World Health Organization (WHO). In literature there has been a particular discussion about the most advisable surgical treatment.
Methods. From 1997 to 2002, we observed 17 incidental carcinomas of the thyroid, with a frequency of 2.9% out of all thyroid operations and of 3.2% out of the operations due to benign pathology. The preoperative diagnosis was: multinodule goitre in 11 patients, thyroid nodules in 5 patients and Basedow disease in 1 patient. Eleven patients underwent a total thyroidectomy, 6 a lobe-isthmectomy: 3 of these latter had to undergo a total thyroidectomy owing to an incidental carcinoma >1 cm (1 case) or a multifocal microcarcinoma (2 cases). In one case we discovered a neoplasm in the removed thyroid residue.
Results. In total we observed 4 papillary carcinomas >1 cm (2 monofocal, 2 multifocal), 1 Hurtle cell carcinoma of 1.5 cm and 12 microcarcinomas (10 monofocal, 2 multifocal). Only one case of local relapse of a microcarcinoma of 1 cm occurred 2 years and 9 months after the operation.
Conclusion. While in incidental carcinoma of the thyroid >1 cm a total thyroidectomy is performed, the observation of small monofocal carcinomas following conservative treatment (lobectomy or lobe-isthmectomy) does not justify a radical surgery, which is correct in multifocal carcinomas. Total thyroidectomy has been performed in most of our cases due to the extension of the pathology. Therefore, only a few patients could undergo conservative treatment, which in selected cases, is successful. However, a careful postoperative follow-up is needed after a conservative treatment, since there is a potential risk of a long term, local, lymph-node recurrence.

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