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Columnar variant? Spread?


I had a total thyroidectomy on 7/25 and the path results are:

"Histologic type: Papillary Carcinoma
Focality: Unifocal
Tumor laterality: left central lobe
Tumor size: 1.0 cm
Lymph-vascular invasion: not identified
Extrathyroidal extension: not identified
Margins: uninvolved
Stage: T1a, N0, MX

Lymph node, Left Paratraceal/pretracheal Lymph Node Resection: Five of Five negative for malignancy

Microscopic description:
TP, FS3, A through V: Sections show portions of thyroid parenchyma.  Within there is an identified lesion showing both papillary structures and follicular structures lined by a columnar to cuboidal epithelium.  The cell nuclei show areas of nuclear clearing.  There are associated psammoma bodies in areas.  Surrounding the lesion there is a fairly fibrous capsular material.  The tumor extends into the capsule in areas and into thyroid parenchyma.  While the capsular tissue involves the blue-inked margin of excision, actual tumor cells do not.

W though Y: Sections show a nodular portion of benign thyroid parenchyma.  Although, none of the lymph node shows metastatic malignancy, one of them shows isolated psammoma bodies.  Multiple levels through this lymph node shows no metastatic papillary carcinoma.  There are 5 lymph nodes in total."


1. Based on "Within there is an identified lesion showing both papillary structures and follicular structures lined by a columnar to cuboidal epithelium,"  can it be concluded that my thyroid cancer is of the columnar variant?  I am worried about this because I have read that columnar variants are more aggressive and have worse outcomes.

2. My endo referred to the quoted part in 1 and that the tumor was not encapsulated, to conclude that my cancer is a bit more aggressive.  She also said that I may not need RAI or if I did it will be 29 millicuries.  Because my cancer is more aggressive, would it be OK to skip RAI?

3. Is the cancer well-differentiated?  Could you comment on my prognosis?

Thank you!!
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I would send the slides for expert opinion to see if this qualifies for columnar-variant PTC.  Dr. Livolsi at U Penn (if that is possible) is one of the best in the world for surgical pathology second opinions.  If it is this variant, I would give RAI (30-50mCi probably adequate if everything else is as reported and the lymph nodes not involved).  This appears to have been caught early, so prognosis is good.
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Avatar universal
To add to the above information, I am 42 yo male.
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Avatar universal
Dr. Lupo,

Thank you so much for your response.

Before starting the process for the second opinion, I was informed by the pathologist who analyzed my tissue that my cancer was classic papillary and not columnar.  I am relieved about that and I am not pursuing second opinion.

I have two more questions (sorry for all of this).

1.  This is regarding the one lymph node that has psammoma bodies.  Based on the statement in the report above, "Multiple levels through this lymph node shows no metastatic papillary carcinoma," could it be certainly concluded that this one lymph node is cancer free?  I am in no way doubting the pathologist, I am just wanting your opinion.

2.  Given that my cancer is now categorized as classic papillary, could I be considered at low-risk?  If so, would I be a candidate for RAI?

Thank you again for your time in this matter.  It helps a lot.

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