Öz
Amaç: Bu çalışmanın amacı, kapsülsüz formları da dahil olmak üzere tiroid papiller karsinom folliküler varyantının (TPKFV) farklı formlarının sonografik özelliklerini sunmaktır. Başka bir amaç ise bu nadir tümörün önceki çalışmalarda incelenmemiş olan renkli Doppler ultrasonografi (RDUS) özelliklerini analiz etmektir.
Gereç ve Yöntem: TPKFV tanısı alan 22 tiroid nodülü çalışmaya dahil edildi (erkek/kadın: 17/5; ortalama yaş±SD: 42±16 yıl; yaş aralığı: 17-70). Nodüllerin sonografik ve Doppler özellikleri retrospektif olarak analiz edildi. İntranodüler kanlanma paterni sınıflandırıldı. Perinodüler ve/veya intranodüler kanlanma varlığı “araba tekerleği” görünümü olarak tanımlandı.
Bulgular: Nodüllerin boyutu 6-55 mm arasında değişmekteydi. Nodüllerin çoğu tamamen solid (%77.3), izoekoik (%59.1) veya hipoekoik (%31.8), oval şekilli (%72.7), iyi sınırlı (%68.2) ve periferik hipoekoik haloluydu (%68.2). Nodüllerin yüzde %31’i mikrolobüle sınırlı lobule şekilli veya belirsiz sınırlı düzensiz şekilliydi. Enkapsüle TPKFV formların iyi sınırlı ve periferik hipoekoik halolu olduğu görülürken infiltratif formların ise tam tersi özellikler gösterdiği saptandı. Nodüllerin %72.7’sinde kalsifikasyon saptanmadı. 14 nodülde (%66.7) perinodüler ve ağırlıklı olarak periferik intranodüler kanlanma paterni gözlenmiş olup bu patern infiltratif TPKFV formlardan farklı olarak enkapsüle TPKFV formların çoğunda görülen dominant kanlanma paternidir.
Sonuç: Ağırlıklı olarak solid iç yapıda olan, benign sonografik özellikler ve nodüler kanlanma paterni gösteren büyük boyutlu tiroid nodüllerinde TPKFV tanısı, her zaman düşünülmelidir.
Anahtar Kelimeler
Tiroid karsinomu papiller tiroid karsinomu karsinom folliküler variant Doppler
Kaynakça
- Jogai S, Adesina AO, Temmim L, Al-Jassar A, Amir T, Amanguno HG. Follicular variant of papillary thyroid carcinoma: A cytological study. Cytopathology 2004;15(4):212-6.
- Wreesmann VB, Ghossein RA, Hezel M, et al. Follicular variant of papillary thyroid carcinoma: Genoma-wide appraisal of a controversial entity. Genes Chromosomes Cancer 2004;40(4):355-64.
- Salajegheh A, Petcu EB, Smith RA, Lam AK. Follicular variant of papillary thyroid carcinoma: A diagnostic challenge for clinicians and pathologists. Postgrad Med J 2008;84(988):78-82.
- Liu J, Singh B, Tallini G, et al. Follicular variant of papillary thyroid carcinoma: A clinicopathologic study of a problematic entity. Cancer 2006;107(6):1255-64.
- Yang GC, Fried K, Yakoushina TV, Schreiner AM. Encapsulated follicular variant of papillary thyroid carcinoma: Fine-needle aspiration with ultrasound and histologic correlation of 41 cases. Acta Cytol 2013;57(1):26-32.
- Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 2008;247(3):762-70.
- Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: Re-evaluation with ultrasound. J Clin Ultrasound 1995;23(3):179-84.
- Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351(17):1764-71.
- Solbiati L, Charboneau JW, Reading CC, James EM, Hay ID. The Thyroid Gland. In: Rumack CM, Wilson SR, Charboneau JW, Levine D, editors. Diagnostic Ultrasound 4th ed. Philadelphia: Elsevier Mosby; 2011:708-49.
- Makay O, Icoz G, Gurcu B, et al. The ongoing debate in thyroid surgery: should frozen section analysis be omitted? Endocr J 2007;54(3):385-90.
- Yoon JH, Kim EK, Hong SW, Kwak JY, Kim MJ. Sonographic features of the follicular variant of papillary thyroid carcinoma. J Ultrasound Med 2008;27(10):1431-7.
- Ozdemir D, Ersoy R, Cuhaci N, et al. Classical and follicular variant papillary thyroid carcinoma: Comparison of clinical, ultrasonographical, cytological, and histopathological features in 444 patients. Endocr Pathol 2011;22(2):58-65.
- Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: Systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99(4):1253-63.
- Fukunari N, Nagahama M, Sugino K, Mimura T, Ito K, Ito K. Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. World J Surg 2004;28(12):1261-5.
- Müller HW, Schröder S, Schneider C, Seifert G. Sonographic tissue characterization in thyroid gland diagnosis. A correlation between sonography and histology. Klin Wochenschr 1985;63(15):706-10.
- Iared W, Shigueoka DC, Cristófoli JC, et al. Use of color Doppler ultrasonography for the prediction of malignancy in follicular thyroid neoplasms: Systematic review and meta-analysis. J Ultrasound Med 2010;29(3):419-25.
- Nicola HD, Szejnfeld J, Logullo AF, Wolosker AMB, Souza LRMF, Chiferi V Jr. Flow pattern and vascular resistive index as predictors of malignancy risk in thyroid follicular neoplasms. J Ultrasound Med 2005;24(7):897-904.
- Chen H, Zeiger MA, Clark DP, Westra WH, Udelsman R. Papillary carcinoma of the thyroid: Can operative management be based solely on fine-needle aspiration? J Am Coll Surg 1997;184(6):605-10.
- Tielens ET, Sherman SI, Hruban RH, Ladenson PW. Follicular variant of papillary thyroid carcinoma: A clinicopathologic study. Cancer 1994;73(2):424-31.
- Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration. Acta Cytol 1980;24(6):511-21.
- Kesmodel SB, Terhune KP, Canter RJ, et al. The diagnostic dilemma of follicular variant of papillary thyroid carcinoma. Surgery 2003;134(6):1005-12.
- Lin HS, Komisar A, Opher E, Blaugrund SM. Follicular variant of papillary carcinoma: The diagnostic limitations of preoperative fine-needle aspiration and intraoperative frozen section evaluation. Laryngoscope 2000;110(9):1431-6.
- Lang BH, Lo CY, Chan WF, Lam AK, Wan KY. Classical and follicular variant of papillary thyroid carcinoma: A comparative study on clinicopathologic features and long-term outcome. World J Surg 2006;30(5):752-8.
- Suster S. Thyroid tumors with a follicular growth pattern: Problems in differential diagnosis. Arch Pathol Lab Med 2006;130(7):984-8.
- Baloch ZW, Sack MJ, Yu GH, Li Volsi VA, Gupta PK. Fine needle aspiration of thyroid: an institutional experience. Thyroid 1998;8(7):565-9.
- Mehanna R, Murphy M, McCarthy J, et al. False negatives in thyroid cytology: Impact of large nodule size and follicular variant of papillary carcinoma Laryngoscope 2013;123(5):1305-9.
Öz
Aim: The aim of this study was to present the sonographic characteristics of follicular variant of papillary thyroid carcinoma (FVPTC) related to different forms of the thyroid nodules, including those without a capsule. Another purpose was to analyze the color Doppler ultrasonography (CDUS) features of this unique tumor, which have not been intensively studied in previous works.
Materials and Methods: Twenty-two thyroid nodules (male/female: 17/5; mean age±SD: 42±16 years; range: 17-70) diagnosed with FVPTC were included in this study. The sonographic and Doppler features of the nodules were analyzed retrospectively. The intranodular pattern of vascularity was categorized with regard to the presence of perinodular and/or intranodular vascular signals, as well as a “spoke-and-wheel” appearance.
Results: The length of the nodules varied from 6 to 55 mm. Most of nodules were purely solid (77.3%), isoechoic (59.1%) or hypoechoic (31.8%) and had an oval shape (72.7%), well-defined margins (68.2%) and a peripheral hypoechoic halo (68.2%). Thirty-one percent of the nodules had a lobulated shape with microlobulated margins or an irregular configuration with ill-defined margins. Encapsulated FVPTCs had a peripheral hypoechoic halo and well-defined margins, whereas infiltrative cases exhibited the opposite characteristics. No calcification was observed in 72.7% of the nodules. Perinodular and predominantly peripheral intranodular hypervascularity was observed in 14 nodules (66.7%) and was the dominant pattern of vascularity in most of the encapsulated FVPTCs, unlike the infiltrative FVPTCs.
Conclusion: Diagnosis of FVPTC should always be considered when large thyroid nodules with predominantly solid echo-texture and other sonographic features that suggest benignity and nodular hypervascularity are observe.
Anahtar Kelimeler
Thyroid carcinoma papillary thyroid carcinoma follicular variant Doppler
Kaynakça
- Jogai S, Adesina AO, Temmim L, Al-Jassar A, Amir T, Amanguno HG. Follicular variant of papillary thyroid carcinoma: A cytological study. Cytopathology 2004;15(4):212-6.
- Wreesmann VB, Ghossein RA, Hezel M, et al. Follicular variant of papillary thyroid carcinoma: Genoma-wide appraisal of a controversial entity. Genes Chromosomes Cancer 2004;40(4):355-64.
- Salajegheh A, Petcu EB, Smith RA, Lam AK. Follicular variant of papillary thyroid carcinoma: A diagnostic challenge for clinicians and pathologists. Postgrad Med J 2008;84(988):78-82.
- Liu J, Singh B, Tallini G, et al. Follicular variant of papillary thyroid carcinoma: A clinicopathologic study of a problematic entity. Cancer 2006;107(6):1255-64.
- Yang GC, Fried K, Yakoushina TV, Schreiner AM. Encapsulated follicular variant of papillary thyroid carcinoma: Fine-needle aspiration with ultrasound and histologic correlation of 41 cases. Acta Cytol 2013;57(1):26-32.
- Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology 2008;247(3):762-70.
- Takashima S, Fukuda H, Nomura N, Kishimoto H, Kim T, Kobayashi T. Thyroid nodules: Re-evaluation with ultrasound. J Clin Ultrasound 1995;23(3):179-84.
- Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351(17):1764-71.
- Solbiati L, Charboneau JW, Reading CC, James EM, Hay ID. The Thyroid Gland. In: Rumack CM, Wilson SR, Charboneau JW, Levine D, editors. Diagnostic Ultrasound 4th ed. Philadelphia: Elsevier Mosby; 2011:708-49.
- Makay O, Icoz G, Gurcu B, et al. The ongoing debate in thyroid surgery: should frozen section analysis be omitted? Endocr J 2007;54(3):385-90.
- Yoon JH, Kim EK, Hong SW, Kwak JY, Kim MJ. Sonographic features of the follicular variant of papillary thyroid carcinoma. J Ultrasound Med 2008;27(10):1431-7.
- Ozdemir D, Ersoy R, Cuhaci N, et al. Classical and follicular variant papillary thyroid carcinoma: Comparison of clinical, ultrasonographical, cytological, and histopathological features in 444 patients. Endocr Pathol 2011;22(2):58-65.
- Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: Systematic review and meta-analysis. J Clin Endocrinol Metab 2014;99(4):1253-63.
- Fukunari N, Nagahama M, Sugino K, Mimura T, Ito K, Ito K. Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. World J Surg 2004;28(12):1261-5.
- Müller HW, Schröder S, Schneider C, Seifert G. Sonographic tissue characterization in thyroid gland diagnosis. A correlation between sonography and histology. Klin Wochenschr 1985;63(15):706-10.
- Iared W, Shigueoka DC, Cristófoli JC, et al. Use of color Doppler ultrasonography for the prediction of malignancy in follicular thyroid neoplasms: Systematic review and meta-analysis. J Ultrasound Med 2010;29(3):419-25.
- Nicola HD, Szejnfeld J, Logullo AF, Wolosker AMB, Souza LRMF, Chiferi V Jr. Flow pattern and vascular resistive index as predictors of malignancy risk in thyroid follicular neoplasms. J Ultrasound Med 2005;24(7):897-904.
- Chen H, Zeiger MA, Clark DP, Westra WH, Udelsman R. Papillary carcinoma of the thyroid: Can operative management be based solely on fine-needle aspiration? J Am Coll Surg 1997;184(6):605-10.
- Tielens ET, Sherman SI, Hruban RH, Ladenson PW. Follicular variant of papillary thyroid carcinoma: A clinicopathologic study. Cancer 1994;73(2):424-31.
- Kini SR, Miller JM, Hamburger JI, Smith MJ. Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration. Acta Cytol 1980;24(6):511-21.
- Kesmodel SB, Terhune KP, Canter RJ, et al. The diagnostic dilemma of follicular variant of papillary thyroid carcinoma. Surgery 2003;134(6):1005-12.
- Lin HS, Komisar A, Opher E, Blaugrund SM. Follicular variant of papillary carcinoma: The diagnostic limitations of preoperative fine-needle aspiration and intraoperative frozen section evaluation. Laryngoscope 2000;110(9):1431-6.
- Lang BH, Lo CY, Chan WF, Lam AK, Wan KY. Classical and follicular variant of papillary thyroid carcinoma: A comparative study on clinicopathologic features and long-term outcome. World J Surg 2006;30(5):752-8.
- Suster S. Thyroid tumors with a follicular growth pattern: Problems in differential diagnosis. Arch Pathol Lab Med 2006;130(7):984-8.
- Baloch ZW, Sack MJ, Yu GH, Li Volsi VA, Gupta PK. Fine needle aspiration of thyroid: an institutional experience. Thyroid 1998;8(7):565-9.
- Mehanna R, Murphy M, McCarthy J, et al. False negatives in thyroid cytology: Impact of large nodule size and follicular variant of papillary carcinoma Laryngoscope 2013;123(5):1305-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2017 |
| Gönderilme Tarihi | 24 Temmuz 2016 |
| Yayımlandığı Sayı | Yıl 2017 |