Tülay ÖZTÜRK, Müge TUNÇYÜREK, ÖZER MAKAY, SÜHA SÜREYYA ÖZBEK, Gülgün Demirpolat KAVUKÇU, Recep Gökhan İÇÖZ, YEŞİM ERTAN, ALİ VERAL, DENİZ NART, Mehmet Mahir AKYILDIZ

Follicular variant of papillary thyroid carcinoma: Gray-scale and Doppler sonographic features

Amaç: Bu çalışmanın amacı, kapsülsüz formları da dahil olmak üzere tiroid papiller karsinom folliküler varyantının (TPKFV) farklı formlarının sonografik özelliklerini sunmaktır. Başka bir amaç ise bu nadir tümörün önceki çalışmalarda incelenmemiş olan renkli Doppler ultrasonografi (RDUS) özelliklerini analiz etmektir. Gereç ve Yöntem: TPKFV tanısı alan 22 tiroid nodülü çalışmaya dahil edildi . Nodüllerin sonografik ve Doppler özellikleri retrospektif olarak analiz edildi. İntranodüler kanlanma paterni sınıflandırıldı. Perinodüler ve/veya intranodüler kanlanma varlığı "araba tekerleği" görünümü olarak tanımlandı. Bulgular: Nodüllerin boyutu 6-55 mm arasında değişmekteydi. Nodüllerin çoğu tamamen solid (%77.3), izoekoik (%59.1) veya hipoekoik (%31.8), oval şekilli (%72.7), iyi sınırlı (%68.2) ve periferik hipoekoik haloluydu (%68.2). Nodüllerin yüzde %31'i mikrolobüle sınırlı lobule şekilli veya belirsiz sınırlı düzensiz şekilliydi. Enkapsüle TPKFV formların iyi sınırlı ve periferik hipoekoik halolu olduğu görülürken infiltratif formların ise tam tersi özellikler gösterdiği saptandı. Nodüllerin %72.7'sinde kalsifikasyon saptanmadı. 14 nodülde (%66.7) perinodüler ve ağırlıklı olarak periferik intranodüler kanlanma paterni gözlenmiş olup bu patern infiltratif TPKFV formlardan farklı olarak enkapsüle TPKFV formların çoğunda görülen dominant kanlanma paternidir. Sonuç: Ağırlıklı olarak solid iç yapıda olan, benign sonografik özellikler ve nodüler kanlanma paterni gösteren büyük boyutlu tiroid nodüllerinde TPKFV tanısı, her zaman düşünülmelidir.

Aim: The aim of this study was to present the sonographic characteristics of follicular variant of papillary thyroid carcinoma (FVPTC) related to different forms of the thyroid nodules, including those without a capsule. Another purpose was to analyze the color Doppler ultrasonography (CDUS) features of this unique tumor, which have not been intensively studied in previous works. Materials and Methods: Twenty-two thyroid nodules diagnosed with FVPTC were included in this study. The sonographic and Doppler features of the nodules were analyzed retrospectively. The intranodular pattern of vascularity was categorized with regard to the presence of perinodular and/or intranodular vascular signals, as well as a "spoke-and-wheel" appearance. Results: The length of the nodules varied from 6 to 55 mm. Most of nodules were purely solid (77.3%), isoechoic (59.1%) or hypoechoic (31.8%) and had an oval shape (72.7%), well-defined margins (68.2%) and a peripheral hypoechoic halo (68.2%). Thirty-one percent of the nodules had a lobulated shape with microlobulated margins or an irregular configuration with ill-defined margins. Encapsulated FVPTCs had a peripheral hypoechoic halo and welldefined margins, whereas infiltrative cases exhibited the opposite characteristics. No calcification was observed in 72.7% of the nodules. Perinodular and predominantly peripheral intranodular hypervascularity was observed in 14 nodules (66.7%) and was the dominant pattern of vascularity in most of the encapsulated FVPTCs, unlike the infiltrative FVPTCs. Conclusion: Diagnosis of FVPTC should always be considered when large thyroid nodules with predominantly solid echo-texture and other sonographic features that suggest benignity and nodular hypervascularity are observe.

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