Follicular thyroid carcinoma (FTC) is a malignant epithelial tumour showing follicular cell differentiation and lacking the diagnostic nuclear features of papillary thyroid carcinoma (PTC) [
This was a retrospective review from January 1994 to December 2013.
The study was conducted in the Department of Pathology, Korle-Bu Teaching Hospital (KBTH), the largest referral hospital in Ghana. This department receives cases from the Korle-Bu teaching hospital, hospitals within the Accra Metropolis, and the surrounding towns and Districts.
All the histology request forms, the histology reports, and the corresponding histology slides of all thyroid malignancies diagnosed in our institution from January 1994 to December 2013 were reviewed. Data were collected on the demographic features and the histopathological characteristics of TCs diagnosed during the period of review. Data were entered into a statistical data base and analysed using SPSS software version 23.0 (Chicago) and Graph pad prism version 5.00 (
The relative proportions of thyroid malignancies over the period of study were calculated.
The annual trend of follicular thyroid cancers (FTCs) over the period 1994–2013 was determined.
Descriptive statistics were computed for the ages (mean, standard deviation) of all patients included in the study.
The clinicopathological characteristics of follicular thyroid cancer including the types of surgical specimens were described. Comparisons were made between females and males using Fischer’s exact test.
The histological subtypes FTC and their proportions were determined.
The results were presented in frequency tables and a histogram.
The data used to prepared this manuscript will be made available on demand.
All histologically confirmed thyroid malignancies were included.
Poorly fixed specimens and cases with incomplete records were excluded
Over the period of study, a total of 220 thyroid malignancies were diagnosed, of which 77 (35.0%) were follicular thyroid cancers (FTCs), second to papillary thyroid carcinoma 116 (52.7%).
Annual Trend in FTC for the period 1994–2013.
The ages of patients diagnosed with FTC range from 10 to 77 years with mean age of 46.7 years (SD = 15.7) and a modal age group of 50–59 years 22 (28.6%), Figure
Age characteristics of patients diagnosed with thyroid cancers.
There were 47 (61.0%) and 30 (39.0%), with a female to male ratio of 1.5 : 1. The ages of female with FTCs ranged from 10 to 77 with a mean age of 46.9 (SD = 17.3) and a modal age group being women aged 60 years and above (27.7%), Figure
Demographic characteristics and the clinical presentation of FCTs in females and males.
Female ( | Male ( | | |
---|---|---|---|
| |||
≤19 | 3 (6.4) | 0 (0.0) | 0.277 |
20–29 | 8 (17.0) | 5 (16.7) | 1.000 |
30–39 | 5 (10.6) | 2 (6.7) | 0.699 |
40–49 | 7 (14.9) | 8 (26.7) | 0.245 |
50–59 | 11 (23.4) | 11 (36.7) | 0.301 |
≥60 | 13 (27.7) | 4 (13.3) | 0.168 |
| |||
Anterior neck swelling | 42 (89.4) | 26 (86.7) | 0.730 |
Pathological fracture | 0 (0.0) | 2 (6.7) | 0.149 |
Bone pain | 2 (4.3) | 1 (3.3) | 1.000 |
Soft tissue swelling | 3 (6.3) | 1 (3.3) | 1.000 |
| |||
1 | 8 (25.8) | 5 (22.7) | 1.000 |
2 | 2 (6.5) | 4 (18.2) | 0.201 |
3 | 4 (12.9) | 6 (27.3) | 0.175 |
≥4 | 17 (52.7) | 7 (31.8) | 0.315 |
| |||
Total thyroidectomy | 22 (46.8) | 14 (46.7) | 1.000 |
Near total thyroidectomy | 5 (10.6) | 4 (13.3) | 0.730 |
Lobectomy | 12 (25.6) | 4 (13.3) | 0.256 |
Biopsy | 8 (17.0) | 7 (23.3) | 0.562 |
Neck dissection | 0 (0.0) | 1 (1.3) | 0.390 |
The commonest symptom of TCs in both females (91.3%) and males (86.7%) was anterior neck swelling (
Histological subtypes and distant spread of FTCs at the time of histological diagnosis in females and males.
Female ( | Male ( | | |
---|---|---|---|
| |||
Conventional | 38 (80.9) | 18 (60.0) | 0.066 |
Hurthle cell | 5 (10.6) | 8 (26.7) | 0.116 |
Insular | 1 (2.1) | 1 (3.3) | 1.000 |
| 1 (2.1) | 2 (6.7) | 0.557 |
Encapsulated | 1 (2.1) | 0 (0.0) | 1.000 |
Uncertain malignant potential | 1 (2.1) | 1 (3.3) | 1.000 |
Total | 47 (100.0) | 30 (100.0) | |
| 9 (19.1) | 7 (23.3) | 0.775 |
Lymph node | 4 (44.4) | 2 (28.6) | 0.633 |
Bony involvements | 1 (11.1) | 4 (57.2) | 0.106 |
(i) Femur | 0 (0.0) | 1 (14.3) | 1.000 |
(ii) Clavicle | 0 (0.0) | 1 (14.3) | 1.000 |
(iii) Cervical vertebrae | 1 (11.1) | 1 (14.3) | 0.400 |
(iv) Rib | 0 (0.0) | 1 (14.3) | 0.000 |
Forehead (swelling) | 1 (11.1) | 0 (0.0) | 1.000 |
Neck muscle | 2 (22.2) | 1 (14.3) | 1.000 |
Dural mater | 1 (11.1) | 0 (0.0) | 1.000 |
Total | 9 (100.0) | 7 (100.0) |
A total of 9 (19.1%) of the female have their cancer spread outside the thyroid gland at diagnosis, mostly involving cervical lymph nodes 4 (44.4%), (
During the period under review, follicular thyroid cancer (FTC) was the second thyroid cancer, accounting for 35.0% of all the thyroid malignancies. This is in keeping with previous studies in Ghana [
Furthermore, the high (35.0%) relative proportions of FTC among TCs in the current study differ from the 13–17% quoted in some literature [
There was a gradual rise in the incidence of FTC during the period under review. The author has no specific explanation for this trend. This may however be a reflection of the general rise in the incidence of thyroid malignancies globally in recent years [
In this study, FTC was commoner in females with the female to male ratio of 1.5 : 1. Follicular thyroid cancers like other thyroid malignancies for an unknown reason are found by studies to be female predominant [
The commonest clinical presentation of FTCs was an enlarged palpable anterior neck swelling (95.7%), in keeping with studies across the globe [
Conventional FTC was commoner in the females (
The prognosis is general described as being favourable [
The study found a relative proportion of TFCs of 35.0%, with a gradual rise in the trend over the period of study. Patients presented very late with huge thyroid gland enlargement. The female to male ratio was 1.5 : 1. Approximately, 20.8% had extraglandular spread at the time of histological diagnosis.
The data used to prepare this manuscript will be made available on demand.
Permission to conduct and publish this work was obtained from the Head of Department of Pathology (Professor RK Gyasi), School of Biomedical Sciences, College of Health Sciences, University of Ghana Legon.
The author declares that they have no conflicts of interest.
The author thanks the staff of the Department of Pathology whose work generated the data. He would also like to thank in a special way the Dean of the School of Medicine and Health Sciences, the University for Development Studies, Tamale, for reading through the final manuscript and offering his comments and correction.