The Clinical Management of a Patient with Insular Thyroid Carcinoma
Thyroid and Parathyroid Diseases: A Case-Based Guide, Springer International Publishing Ag, ss.365-370, 2018
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2018
- Doi Numarası: 10.1007/978-3-319-78476-2_58
- Yayınevi: Springer International Publishing Ag
- Sayfa Sayıları: ss.365-370
- Anahtar Kelimeler: Distant metastasis, Insular carcinoma, Poorly differentiated thyroid carcinoma, Radioiodine therapy, Worse prognosis
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Insular carcinoma is a rare tumor that was first described as a unique histological subtype of thyroid cancer, in 1984. The World Health Organization (WHO) classified insular carcinoma as a separate existence and as a larger group of poorly differentiated thyroid carcinomas, in 2004. It was described as a thyroglobulin producing non-papillary non-follicular thyroid carcinoma, and it possesses an intermediate behavior between well-differentiated (papillary and follicular carcinoma) and anaplastic thyroid carcinomas with regard to both histological features and biologic aggressiveness. Insular carcinomas represent 0.4-6.2% of all thyroid carcinomas. Despite its rarity, it represents the main cause of death from non-anaplastic follicular cell-derived thyroid cancers. Distant metastasis and lymph node metastasis are most frequent, and moreover, 20% of patients with insular carcinoma have distant metastasis at the time of diagnosis. In patients with insular carcinoma, radioiodine uptake ability of primary tumor and distant metastasis is more than 80%. The current approach of management is total thyroidectomy followed by radioiodine therapy and close follow-up. In the view of the fact that worse prognosis, multidisciplinary approach combining surgery, bone-directed agents, and external radiation therapy concomitant with radioiodine therapy may provide treatment success and significant improvement in progression-free survival.