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Papillary Microcarcinoma Of The Thyroid

William D. Drucker, R. Robbins
Published 2006 · Medicine

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Papillary thyroid carcinoma is the most common type of differentiated thyroid carcinoma [1]. The majority of these lesions are small [2]; those whose diameters measure £1 cm have been designated by the World Health Organization as papillary microcarcinoma of the thyroid (PMCT) [3]. In the older literature, they were frequently referred to as occult thyroid cancers since most were first discovered at autopsy; others, now usually designated as incidentalomas, were identified in operative specimens submitted for nonmalignant diseases of the thyroid [4]. One conclusion drawn from these discoveries is that PMCT seldom constitutes a clinically significant problem [5] and, therefore, may not require a therapeutic response. One group [6] has even proposed that solitary PMCT be renamed as “papillary microtumor” to reflect its benignity and to eliminate the emotionally charged diagnosis of cancer [6]. Today, many PMCTs are no longer occult or incidental, but are discovered in life and prior to head and neck surgery [7]. This change results from the expanded use of high resolution neck imaging [8] and from the expanding application of ultrasound-guided fine-needle aspiration biopsy (FNAB) of eventing thyroid nodules [9]. Despite the fact that not all PMCTs are without complications [10], the prognosis of PMCT remains excellent, and the disease is seldom fatal. Because of this, there is no consensus concerning the management of PMCT. Controversy persists regarding the extent of appropriate intervention or whether any intervention is necessary at all beyond follow-up. A review of the literature suggests, however, that reasonable guidelines can be developed to aid in decisionmaking. In this chapter, we will use the term incidental to refer to a PMCT found at autopsy or in an operative specimen removed for other than known thyroid malignancy. Non-incidental will refer to lesions diagnosed by palpation or by another technique such as ultrasound (US) prior to any therapeutic intervention. Occult PMCTs will refer to those that are unsuspected by history or physical examination but are known to exist because of some distant manifestation, usually a metastasis.
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