Would someone please help me understand this?

[BeeBee300]

I was diagnosed with papillary cancer 4 wks ago and just had a total thyroidectomy and right neck dissection.  My surgeon left over Christmas and I am scared and confused. Path report as follows:
MACROSCOPIC:The thyroid gland measures 62mm in transverse dimensions and 45mm superior to inferior and 10mm anterior to posterior. There is a tan firm nodular lesion identified measuring 10 x 10 x 10mm. Sectioning of the right thyroid gland reveals a pale tan mass measuring 20 x 15 x 10mm. This mass has focal cystic change. The rest of the thyroid tissue shows tan/smooth cut surface. The left thyroid and isthmus area shows tan and smooth cut surface.  No discrete lesion is identified.  MICROSCOPIC:Sections of the right lobe of the thyroid show a circumscribed hyalinised lesion occupying almost the entire length of the thyroid.  Within the hyalinised area, there are islands of papillary carcinoma of thyroid.  The lesion is quite close to the anterior surface and is present at the inked margin.  The sections of the left lobe show at least two seperate foci of papillary carcinoma within the thyroid parenchyma.  The isthmus shows no evidence of malignancy. The surrounding thyroid tissue shows extensive follicular thyroiditis.  There is no vascular or lymphatic permeation identified. There is a circumscribed follicular lesion present towards teh base of the right lobe.    SUMMARY:Papillary carcinoma of the thyroid involving both right and left lobes. The lesion extends to the anterior surface of the right lobe; two out of eight lymph nodes (out of a total of 24 removed) show metastatic papillary carcinoma.  Two parathyroid glands are indentified.

[Mark Lupo, M.D.]

This appears to be a multifocal papillary thyroid cancer measuring (?) up to 2cm - there are 2 positive lymph nodes.  This situation usually requires radioactive iodine - - so would talk to your doctor about arranging this.  Prognosis overall is very good.  

[BeeBee300]

Many thanks Dr Lupo, I appreciate your response.  I am somewhat confused by the sizing of the cancer as there appears to be two cancers in the right lobe, unless I am reading this incorrectly.  In the Macroscopic report they say a tan firm nodular lesion is idenftified measuring 10 x 10 x 10mm but they also say on sectioning that it is 20 x 15 x 10mm, so is there two or is it one and the same and it simply measures differently when cut.  Also, as the lesion is present at the inked margin does that mean that there is still some cancer left in my neck?

Also, they mention a circumscribed follicular lesion towards the base of the right lobe, is this a cancer?

Sorry for all the questions. My surgeon moved after Christmas to a new hospital and I don't know where to turn to next.
Many thanks!

[BeeBee300]

Many thanks Dr Lupo, I appreciate your response.  I am somewhat confused by the sizing of the cancer as there appears to be two cancers in the right lobe, unless I am reading this incorrectly.  In the Macroscopic report they say a tan firm nodular lesion is idenftified measuring 10 x 10 x 10mm but they also say on sectioning that it is 20 x 15 x 10mm, so is there two or is it one and the same and it simply measures differently when cut.  Also, as the lesion is present at the inked margin does that mean that there is still some cancer left in my neck?

Also, they mention a circumscribed follicular lesion towards the base of the right lobe, is this a cancer?

Sorry for all the questions. My surgeon moved after Christmas to a new hospital and I don't know where to turn to next.
Many thanks!

[Mark Lupo, M.D.]

This is hard to answer w/o looking at the pathology slides.
Depending on where you are, consider going for a second opinion (slides in hand) and have everything reviewed to make sure you know what the next step should be.

Consider a university setting or look on thyroid.org to find a thyroid specialist near you.