Occult sclerosing carcinoma of the thyroid

A in the nonadenoinatous portion of nodular goiter was described by Graham in 1927.His observations were based on seven cases, in six ol which the lesion was less than 1 cin. in diameter.Similar growths were present in both lobes in one case.Incomplete excision of the lesion in one instance was followed by recurrence without metastasis.Graham called these tumors "adenocarcinoma not originating in adenoma" and expressed the opinion that "This appears to be the most favorable group of carcinomata of the thyroid, the malignancy being of a very low order."Hazard, Crile, and Dempsey, in 1949, published a series of twenty-five similar thyroid tumoi s.They concluded from their data that the lesions we1 e innocuous and suggested that they be designated as "nonencapsulated sclerosing tumors."In all their cases the tumors were lound in glands removed for diseases other than suspected neoplasm.Hyperthyroidism was the reason for operation in nineteen of the twenty-five patients.T h e lesions were generally less than 1 cm. in diameter, fibrous, and not sharply circumscribed.Histologically, they were predominantly papillary and densely fibrotic and occasionally contained foci of calcification.Extension of the tumor into the stronia of the gland never exceeded a few millimeters, but the authors stated that "tumor cells infiltrated about a capsular blood vessel and into a nerve in 2 instances."I n none of their patients was there clinical or pathological evidence of metastasis; however, only nine were followed for as long as ten years.Hazard and associates suggestcd that "until more is known of their natural history, they [the tumors] should not be regarded as true carcinoma."Thirty-two lesions of the thyroid, indistinguishable from "nonencapsulated sclerosing tii- rnors of the thyroid," were collected from the files 01 the Armed Forces Institute of Pathology and the Garfield Memorial Hospital.T e n 01 the lesions had produced metastases in cervical lymph nodes.