INCIDENTAL THYROID CANCER IN THE PYRAMIDAL LOBE & IMPLICATIONS FOR THYROIDECTOMY

Area of Science:

• Endocrinology
• Surgical Oncology
• Pathology

Background:

• Embryological remnants (ERs) are potential sites for thyroid pathology recurrence after thyroidectomy.
• Incomplete removal of ERs can complicate reoperations and management.
• The incidence of overt malignancy within ERs is low, but their role in disease recurrence is significant.

Purpose of the Study:

• To emphasize the necessity of complete ER removal during total thyroidectomy.
• To report the rare occurrence of incidental papillary microcarcinoma within ERs.
• To advocate for the routine removal of ERs as a standard surgical practice.

Main Methods:

• Review of literature on ERs and thyroidectomy outcomes.
• Case report of two patients with incidental papillary microcarcinoma in the pyramidal lobe (an ER).
• Analysis of the implications of residual ERs on patient management and surgical outcomes.

Main Results:

• Incidental papillary microcarcinoma in ERs, specifically the pyramidal lobe, has not been previously reported.
• Two cases of incidental papillary microcarcinoma within the pyramidal lobe were identified.
• Residual ERs can harbor malignancy and contribute to disease recurrence, necessitating careful intraoperative assessment.

Conclusions:

• Complete removal of ERs during total thyroidectomy is crucial for preventing disease recurrence.
• The presence of incidental papillary microcarcinoma in ERs underscores the importance of their thorough removal.
• Routine removal of ERs should be considered the standard of care in total thyroidectomy procedures.