Pyramidal lobe‐dominant papillary thyroid carcinoma—A rare entity with important clinical implications

• Published in: Clinical case reports Vol. 11; no. 5; pp. e7189 - n/a
• Main Authors: Messias, Henrique, Sequeira, Maria Luísa, Nogueira, Ricardo, Zagalo, Carlos, Martins, Mariluz, Gomes, Pedro
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-05-2023; John Wiley and Sons Inc; Wiley
• Subjects: Case Report; Case reports; Cellular biology; Cysts; Editing; Family medical history; Hospitals; Lalouette pyramid; Lymphatic system; Medical imaging; Medical prognosis; Metastasis; Ostomy; papillary thyroid carcinoma; pyramidal lobe of thyroid; Supervision; Surveillance; thyroid; Thyroid cancer; Thyroidectomy; Tracheotomy; Ultrasonic imaging; Writing; Lalouette pyramid; thyroid cancer; thyroid; papillary thyroid carcinoma; pyramidal lobe of thyroid
• ISSN: 2050-0904; 2050-0904
• DOI: 10.1002/ccr3.7189

Papillary thyroid carcinoma (PTC) primarily located in the pyramidal lobe of the thyroid gland is extremely rare, therefore the clinical and pathological features are not well understood. The authors describe a case of PTC of the pyramidal lobe, in a 77‐year‐old woman who underwent en bloc total thyroidectomy with pyramidal lobe, hyoid bone and cervical lymph node excision. In line with the present case, current literature reports a greater presence of worse prognostic factors, namely extrathyroidal extension, advanced T stage or presence of cervical lymph node metastasis. Recently, a new classification has been suggested—Upper Neck Papillary Thyroid Cancer (UPTC)—which encompasses these carcinomas, Delphi ganglion metastases and thyroglossal duct cyst carcinomas, with potential clinical and therapeutic implications, particularly the need for orthotopic thyroidectomy. Also, the complete excision of the pyramidal lobe during thyroidectomy may influence the success of radioactive iodine therapy and the patient's follow‐up surveillance.
Pyramidal lobe papillary thyroid carcinoma appears to behave differently from other locations in the thyroid gland in its clinical presentation (proposed a new classification of Papillary Carcinoma of the Upper Neck (UPTC)) and association with more adverse prognostic features.