title: Our experience with papillary thyroid microcancer.
abstract: BACKGROUND
  Papillary thyroid microcarcinoma (PTMC) describes a focus of papillary thyroid cancer that is less than 1 cm in size. These tumors are frequently found on histopathological examination of thyroid specimens, operated upon for an indication other than suspected malignancy.
  
  
  METHODS
  From 2005 to 2012, 94 of 1300 thyroidectomy specimens in our institution were found to have PTMC. Of these, 77 were isolated PTMC while the others were associated with other differentiated cancers. We studied their clinicopathologic features, treatment and long-term outcome.
  
  
  RESULTS
  There were 18 men and 59 women (the male: female ratio was 1:3), their mean age was 44 ± 10.5 years (range: 18-72 years). Multinodular goiter was the most common indication for surgery. Malignancy was suspected in only 31.4% cases. The mean tumor size was 4.1 ± 2.3 mm. Nearly 17% cases had slightly larger tumors measuring >6 but <10 mm. Multifocal tumor was found in 44.1% of cases and among these, multifocal disease restricted to a single lobe was found in 19.5%. Eleven patients (14.2%) had cervical lymph node metastasis, 3 (3.9%) had extra thyroid tumor extension and 2 (2.6%) had evidence of vascular invasion. One patient (1.3%) presented with bone metastasis. Majority of the patients (79.2%) underwent total thyroidectomy with or without lymph node dissection. Sixteen patients (20.7%) who had initially undergone hemithyroidectomy went on to have completion thyroidectomy. Twenty nine patients (36.8%) also received radioactive iodine. The mean duration of follow-up was 20.2 ± 13.5 months. On follow-up one patient developed cervical lymph node recurrence and one died due to a second malignancy.
  
  
  CONCLUSIONS
  PTMC is often found as an incidental finding on the thyroidectomy specimen. Sometimes they present with regional lymph node metastasis and very rarely with distant metastasis. They have a good prognosis similar to papillary thyroid carcinoma.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Anulekha Mary
authors.initials: AM
authors.lastname: John
authors.affiliation: Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Jacob
authors.affiliation: Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Regi
authors.initials: R
authors.lastname: Oommen
authors.affiliation: Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sheila
authors.initials: S
authors.lastname: Nair
authors.affiliation: Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Aravindan
authors.initials: A
authors.lastname: Nair
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Simon
authors.initials: S
authors.lastname: Rajaratnam
keywords: Micro papillary cancer; papillary thyroid micro cancer; thyroid micro cancer