Does Every Classical Type of Well-differentiated Thyroid Cancer Have Excellent Prognosis? A Case Series and Literature Review

RESULTS

We evaluated 393 (9.08%) patients with thyroid malignancy. 348 (88.54%) of them were diagnosed as WDTC. There were 326 (82.95%) patients with PTC and 22 (5.59%) with FTC. In this homogenous group, we identified 14 (4.02%) patients with aggressive courses of the classical type of WDTC: 10 (2.87%) cases with PTC and 4 (1.14%) individuals with FTC. There were 11 (78.57%) females and 3 (21.43%) males. The mean ages of patients with PTC and FTC were 54.8 (±13.026) and 76.0 (±15.317), respectively (the difference was statistically significant). 11 (78.57%) patients were treated by total thyroidectomy with total or partial excision of the infiltrated adjacent structures. All of these patients received levothyroxine after thyroidectomy to suppress serum thyroid- stimulating hormone (TSH) level to prevent the growth of TC. All patients had the classical type of WDTC in their tumor specimens, and 12 (85.71%) individuals had lymph node metastases found during follow-up for recurrent disease (Figure 1A– D), and 1 (7.14%) patient had neck skin metastases 1 year after thyroidectomy. 5 (35.71%) patients died as a result of WDTC dissemination. Uncontrolled local disease and distant metastases were presented at the time of death. 4 (28.57%) patients died due to unrelated diseases. 5 (35.71%) patients are still alive (from 2 to 9 years after surgical treatment).

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Patients with the aggressive form of the classical type of PTC

10 patients with the aggressive form of the classical type PTC are summarized in Table 1. The median age at the time of surgery was 54.8 (range 31– 78 years), and 8 patients were females. 5 patients had multifocal tumors and 7 had extrathyroidal extension. 5 patients had nonradical surgery and 6 had lymph node metastases (Figure 1A– D). All 10 patients underwent RAI treatment. Nine patients had recurrent disease and 1 had vertebral column metastases (Figure 2C). The mean time to recurrence was 24 months (range 9– 38 months).

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Patients with the aggressive form of the classical type of FTC

4 patients with the aggressive form of the classical type FTC are summarized in Table 1. The median age at the time of surgery was 76.0 (range 69– 84 years), and 3 patients were females. 1 patient had multifocal tumor and 4 had extrathyroidal extension. 2 patients had nonradical surgery and 3 had lymph node metastases (Figure 1B,C; in one case, pN characteristic of the pTNM classification was not verified due to only one surgical biopsy performed). All 4 patients underwent RAI treatment. 3 patients had recurrent disease, 1 had vertebral column metastases (Figure 2A– D), and 1 had pulmonary metastases. The mean time to recurrence was 19 months (range 8– 39 months).

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