pathology results

[shellyb341]

I had a rt side hemithyroidectomy and the results came back positive for papillary carcinoma with follicular variant.  I had 2 nodules, the 1st one measured 1.1cm
Tumor focality: multifocal, ipsilateral
histologice type: pap with follicular variant
architecture: clasical:follicular
classical cytomorphology
margins are involved by carcinoma-distance of invasive carc. to closest margin 1.0 cm
tumor is totally encapsulated
tumor capsular invasion: present, widely invasive
lymph node-vascular invasion is not identified (doc told me the lymph nodes looked good)

the second tumor: .9cm
architecture:follicular
margins uninvolved by carcinoma, 1.0mm closest distance
totally encapsulated
tumor capsular invasion: present, minimal
pathologic staging:  p T(m)1, NX, MX
additonal findings:  focal thyroiditis, parathyroid within normal limits

Micro:  Two sperical encapsulated tumors show char. cytology of papillary carc. generally showing a preserved follicular architecture.  Small papillary growths are identified in the larger tumor.  Both tumors show extension into the partially calcified capsule with at least focal extracapsular extension and are located with 1.0mm of inked surgical margins.  No transected carcinnoma is identified.  Elsewhere the thyroid gland exhibits normal arch. with scattered minimal foci of lympohoid infiltrates.  There is a .4cm histologically unremarkable parathryoid gland.

I then had a completion thyroidectomy and the left lobe came back clean.

My question is should I have the RAI, I'm leaning towards yes due to the "widely invasive" tumor capsular invasion.  I trust my doctor, he recommends that I do the RAI, I'm also getting a second opinion.  I'm just looking for another one.  I've read also about risk for other cancers can increase with the RAI.  But does the risk of recurrence out weigh that?

It's just alot to take in and I want to feel positive with my decision.  Any help you can give me would be greatly appreciated.

[shellyb341]

ok, thanks very much.

[Mark Lupo, M.D.]

Extracapsular invasion does not necessarily mean extension beyond the thyroid - would ask the pathologist to be specific on this (but it was called T1, suggesting not extending to extrathyroidal tissue - which would be T3).
Not sure what they are trying to say with the other comment.

[shellyb341]

Also forgot to mention that the report also said "Elsewhere the thyroid has normal appearing dark red finely granular cut sections although there are apparent focal calcifications in the superior lobe".  I'm not sure what that means?  Thanks for helping.

[shellyb341]

Thanks so much for the information!  One more question-does extracapsular invasion mean extra-thyroidal extension?  It gets really confusing with it saying totally encapsulated but with extracapsular invasion.  Thanks again!

[Mark Lupo, M.D.]

If there is extra-thyroidal extension, then yes.  Also there is multifocality with the dominant tumor measuring more than 1cm (1.1cm in this case).  So current guidelines would suggest probable benefit with RAI.  Would consider carefully the dose.  Depending on the extra-thyroidal extension -- ie, if only minimal then lower RAI dose (50mCi after thyrogen prep) if more invasive or there is known microscopic residual disease in the neck then a higher dose (100mCi after thyrogen prep).  

This is only a rough guideline based on information presented.