The many appearances of papillary carcinoma of the thyroid

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The many gross and microscopic appearances of papillary carcinoma of the thyroid have provided some challenges to the field of taxonomy, but more importantly the challenge of correct diagnosis must be met if this cancer is to be properly treated. In most patients, papillary carcinoma is a controllable cancer with a distinctive biologic behavior. Ten- and 20-year survivals are the rule rather than the exception, and indeed when papillary carcinoma is properly treated, even longer periods of survival can be expected. The purpose of this report is to detail the gross and histologic patterns of the disease as they relate to the biologic behavior of this neoplastic group. The principal gross subtypes are summarized in Table 1.

In a series of 300 consecutive cases of papillary carcinoma of the thyroid collected from 1921 through 1960, there were 197 for which accurate gross descriptions or photographs were available for assessment. Approximately 78% of the carcinomas fell into the usual or diffuse variety, 12% qualified as small, 8% as encapsulated, and 2% as massive. No massive papillary carcinomas have been seen at the Cleveland Clinic since 1960, but there has been a slight increase in the percentage of small and encapsulated subtypes.

Papillary carcinoma is usually a nonencapsulated tumor mass sharply circumscribed from the adjoining thyroid parenchyma. The margins of the tumor mass may be bosselated or scalloped. It is not uncommon for the neoplasm to extend to the thyroid capsule which it usually does not violate. Typically, the lesions are tan . . .



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