Papillary Carcinoma

• more common in young females

• Risks: radiation exposure, Gardner's syndrome

• 30% palpable regional nodes (70% occult nodes)

• Histopathology: papillary and follicular structures, psammoma bodies (calcific), intranuclear vacuoles ("Orphan Annie" eyes), multicentric

• Prognosis: 95% 5-year survival; poor prognostic indicators include tumors >1.5 cm or extracapsular spread (cervical metastases have increased cervical recurrence rates without affecting survival)

1. total or near total thyroidectomy (multicentric)

2. lobectomy and isthmusectomy (hemithyroidectomy) with radioactive iodine (I131)may be considered if <1.5 cm or in younger patients

3. modified neck dissection (MND) for palpable nodes only (elective neck dissection [END] has not been shown to improve survival)

4. thyroid suppression therapy

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