Papillary Carcinoma - Just Diagnosed

[AJ1234]

I received my path report and took out some of B since it only relates to chronic thyroiditis.  I'm concerned with the cancer and what should next steps and long-term follow up be.  Feel free to suggest anything I should ask my dr. as well.

TISSUE
A. Mass-Right Thyroid Mass, FS
B. Lobectomy-Left Thyroid Lobe

GROSS DESCRIPTION
A. The specimen consists of a portion of thyroid tissue. It measures 4.5 x 2.2 x approx. 1.5 cm. Sectioning through it reveals a nodule which has a variegated appearance that measures 1.2 cm in greatest dimension. The frozen section is submitted in cassette marked FS. An additional frozen portion of the tumor is in A1.  Another portion of the tumor is in A2. Section of what would be isthmus is in A3. Other section, which is approx. 1 cm from previously described nodule is in A4.

FROZEN
A. PAPILLARY CARCINOMA

MICROSCOPIC IMPRESSION
A.  The specimen consists of a thyroid lobe. It shows the presence of a papillary carcinoma of the thyroid. This is characterized by a classic histologic and cytologic picture. Nuclear creases and nuclear clearing are noted along with nuclear inclusions.  In the background is evidence of chronic thyroiditis with mixed inflammatory infiltrate.  The lesion is contained within the thyroid capsule. There is no capsular invasion. There is no lymph vascular invasion. The isthmus is free of tumor. This is a unifocal tumor.

FINAL PATHOLOGIC DIAGNOSIS A. PAPILLARY CARCINOMA OF THE THYROID
GREATEST DIMENSION: 1.2 CM, CLASSIC HISTOLOGY, UNIFOCAL, TUMOR CONFINED TO RIGHT LOBE
MARGINS UNINVOLVED, TUMOR CAPSULE, TOTALLY ENCAPSULATED, TUMOR CAPSULAR INVASION ABSENT, LYMPH VASCULAR INVASION ABSENT, EXTRATHYROIDAL EXTENSION NOT IDENTIFIED

[AJ1234]

Thanks for your response; I really appreciate it.  

I did have a total thyroidectomy on 2-3-10 after 10 years with Hashimoto's and approx. 9 mos. after finding the nodule on my right side.  We monitored it for most of last year due to irregular shape and calcification.  The FNA 6 mos. ago seemed ok but after another ultrasound and another FNA recommendation, we decided to do surgery.  I'm so glad we did and hopefully we caught it early.

What is the criteria for determining whether I-131 is appropriate?  It sounds like that's the path my dr. is leading me on since I'm currently off levothyroxine and taking cytomel.  Is the potential benefit of I-131 a grey area or would there definitely be no benefit to me at all?  I'm very concerned about lymph node spread even though none was found.  I'm only 30 and want to do all I can to minimize the chance of a reoccurence.  

[Mark Lupo, M.D.]

This is a 1.2cm single focus of a classic papillary cancer without any additional findings or risk factors (based on what you posted).  You have had a total thyroidectomy it seems and beyond keeping TSH in the low normal range, and following thyroglobulin panel and neck ultrasound, there is no additional treatment needed.  There is no clear benefit from I-131 radioactive iodine in this setting.