Papillary Microcarcinoma: AN Epidemiological, Clinical, therapeutic and Prognostic Study of 35 Cases

Abstract

Papillary microcarcinoma of the thyroid is defined as cancers having a diameter equal or inferior to 10 mm in the anatomopathological examination; The problematic of this pathology lies in its latent character, it is, thus, much more frequent than we thought or predicted. That is why, beyond specifying the epidemiological and clinical characteristics of papillary thyroid microcarcinoma, our ultimate goal was to determine the "gold standard" for the management of this entity.
 We carried out a descriptive retrospective study spread over 4 years including all cases of Papillary Microcarcinoma of the thyroid diagnosed within the department of ENT and Head and Neck Surgery of the medical center Mohammed VI in Marrakech; We collected 35 cases, and using their medical records we summarized their epidemiological, clinical and paraclinical data.
 None of our patients had a normal clinical examination, the palpation of our patients showed an isolated nodule in 20% of patients, the rest of our patients had clinically bilateral noticeable nodes. 80% of which were not clinically suspicious, and only three of our patients had palpable lymph nodes which was confirmed by the ultrasound, where the major suspicious character was their hypoechoic character ( 17 % were EU-TIRADS 5 ) With regard to surgical treatment, 28 of our patients (80%) underwent total thyroidectomy as a first step,4 patients underwent secondary totalization during the same operation after the extemporaneous examination came back positive for papillary microcarcinoma , 2 cases of remote loboisthmectomy after final histological examination showing papillary microcarcinoma , and one final case of totalization after extemporaneous examination of a superior right jugular lymph node with central necrosis. Neck dissection was performed in three cases. Postoperative outcomes were simple in all patients. Isotopic totalization by iodine 131 therapy was performed in four of our patients. Their indications were respectively: infiltrating tumor, extension to neighboring parenchyma, multifocality, lymph node metastasis. The survival rate of our series was 100%. The therapeutic protocol of papillary microcarcinoma is punctuated, to this day, with controversy, and faces a conservative attitude versus a radical one, it is the surgeon's duty to distinguish between the two attitudes.