Encapsulated vs Nonencapsulated

A doctor just told me that ALL papillary thyroid cancer in nonencapsulated. That's the first I have ever heard that. Facts, please

Report post

22 replies. Join the discussion

hello how are you. I was looking at my at my report.1 had pap car. in thyriod and metasticcar. in my nodes.and ny tumorswere partially encapulated good ? hope someone will chime in your friend.lol

Report post

My 1cm papillary thyroid carcinoma was partially encapsulated with minimal extrathyroidal extension into adjacent skeletal muscle and a parathyroid gland. My endo's comment about this finding was that it is rare to find a fully encapsulated PTC tumor so some invasion into local tissue at the unencapsulated area is quite common.

Report post

That's really interesting. Mine was pap. cancer follicular variant. One tumor was thinly encapsulated and the other was not encapsulated. I'm wondering what others' reports say.

Report post

Partially encapsulated. I am picturing this as growing out of the edge of the thyroid, as opposed to completely contained within the thyroid?

Report post

thank you @zheni have a great day.

Report post

@Zheni - my surgeon is awesome and took pictures of my thyoid gland with his iphone for me after he removed it and then emailed them to me. The 1cm tumor appears as a nodule with a small amount of tissue adhered to it. So even the parts contained within the capsule still appeared as a bulge on the surface of my thyroid gland. I am sure it is possible for the tumor to be completely contained within thyroid tissue as well. When the path report refers to "extrathyroidal extension" you know for sure that your tumor was not contained within the gland.

Report post

Hey Aries92,

This is a very interesting subject. From what I have learned, encapsulated vs. non-encapsulated is description used when discussing different aspects & areas of our papillary thyca tumored tissue. Discussing the encapsulation of the original tumor in the thyroid is different than the discussing the encapsulation of a distant tumor such as in a lymph node. It can be very confusing. Sometimes I think a physician may be talking specifically about the encapsulation of the thyroid where the cancer originated when the patient is inquiring or talking about the encapsulation of all the existing cancerous tissue in their body, including the metastasis... and vice-versa. And, I have learned encapsulation, depending upon the tissue or area, may refer to a "fibrous" or "thin" lining. I believe each case is so different, and that there are countless variations as to how our cancers develop or break through capsulations or metastasize.

I think I understand what your doctor said to you. But it might be more helpful to think of it as "all papillary thyroid cancer is potentially non-encapsulated or encapsulated." In my case, my thyroid gland's cancerous, tumored tissue obviously wasn't well encapsulated because it spread to nearby lymph nodes horizontally & then southward due to gravity. But, in a different type of capsulation, a few of my resulting tumored lymph nodes were well encapsulated... meaning the cancer was contained within its fibrous tissue. And thank goodness these few were because some were in very precarious locations "sitting on" or adjacent to other vital organs & tissues. However, I think most of my tumored lymph nodes were partially encapsulated... and that makes sense to me in my case because the cancer spread aggressively to many lymph nodes over a very long period of time throughout my upper body & neck before detection.

I am no doc obviously, but that has been my take on it thus far...

Best to you!!!

Report post

Hi all!

If papillary thyroid cells are encapsulated it means that it is papillary adenoma, which is NOT cancer. If it IS NOT encapsulated, it is papillary carcinoma, which is positive for cancer.

Hope this helps! Hugs!

Report post

I just had my thyroid removed 2 1/2 weeks ago and mine was encapsulated and had increased blood flow and tested positive for papillary cancer.

Report post

Probably the most critical issue that we face here is whether or not a tumor has (or had) extension beyond the thyroid gland, or--if you've already had a TT-- beyond the thyroid bed. That determination has extensive ramifications for RAI and beyond.

The following study suggests that there may not be any such thing as a thyroid capsule (what percentage of endocrinologists do you suppose know this?), in which case we and our various doctors will have to find a better way to talk about what's going on. Just one more another example of the complexity we need to deal with if we're going to understand what's happened and is happening to us.


Ann Surg Oncol. 2010 Feb;17(2):386-91. doi: 10.1245/s10434-009-0832-7. Epub 2009 Dec 1.
Controversies in thyroid pathology: thyroid capsule invasion and extrathyroidal extension.
Mete O, Rotstein L, Asa SL.
Source
Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada.

Abstract

INTRODUCTION AND DESIGN:
Endocrine pathologists, surgeons, and oncologists who manage patients with thyroid carcinomas confront many critical dilemmas. Controversies surrounding diagnostic criteria that distinguish benign from malignant thyroid follicular lesions have been brought to the attention of this community.
In this article, we confront another controversy, the definition of a thyroid "capsule" to clarify what constitutes extrathyroidal extension (ETE) and its clinical significance in the management of patients with differentiated thyroid carcinomas.

RESULTS AND CONCLUSION:
Our review of the anatomy of the thyroid gland confirms that this structure has No Defined Anatomical Fibrous Capsule. Moreover, the presence of adipose tissue within the thyroid gland and its pseudocapsule implies that thyroid tumor within fat tissue cannot be accepted as a criterion of ETE by that thyroid carcinoma. While invasion of skeletal muscle is a more reliable feature of ETE, at the isthmus, these fibers can be normally present within the gland, and this criterion does not have value. This implies that anatomical localization is a critical element in the determination of ETE. Clarification of such issues should be reflected in future revisions of the UICC/AJCC staging criteria to allow more rational management of patients with these increasingly common cancers.

Report post

Here's another question....how can they really tell if the cancer is just in the thyroid, if they never took lymph nodes out to test them?

Report post

My thoughts based on what a know about thyroid cancer and my knowledge of pathology as a veterinarian - if the thyroid gland is removed but no lymph nodes are removed for pathology, then there are still suspicious findings that raise the concern of cancer not being confined to the thyroid gland. The lack of complete encapsulation as we have been discussing as well as evidence of cancer cells in the lymphatic and blood vessels that are part of the thyroid gland are concerning. The variant can raise suspicion as some are more aggressive than others. At the time of surgery, the surgeon may be suspicious of spread to adjacent tissue based on the adherence or stickiness of the thyroid to the trachea, muscle, etc.

Often times the pathology report is used along with other findings (abnormal neck US, rising Tg, abnormal uptake on a diagnostic WBS) to make the final determination that there are cancer cells in other tissues. Even when some lymph nodes are removed and evaluated as negative for cancer, that does not mean that their is no cancer in any nodes. There are so many nodes it would be impossible to evaluate all of them.

In order to fully evaluate any individuals cancer, you need to look at the results of multiple tests and follow them over time. Sometimes everything looks clean immediately post-op but months down the road something shows up on an ultrasound or the Tg level rises or fails to decrease over time. This is why we are monitored so closely early on so we get the most accurate picture of what is happening in our bodies.

Report post

Thanks, Kathryn. Great info.

My pathology report refers specifically to the two microcarcinomas (tumors smaller than 1cm) when it uses the term "thinly encapsulated" for one of my tumors. The other simply says "None" with regard to a capsule. And I had other bilateral foci that were suspicious for cancer. Although it was contained within the thyroid itself, one was close to the margin.

Report post

You can't know for certain that there are no cancer cells in any nodes even if some were removed. Impossible to remove them all. I had 6 of 9 from a central dissection positive. While my ultrasound mapping looks good, it doesn't guarantee that I won't light up in nodes during my WBS. What bothers me is that the RAI will not deal with that - only a subsequent surgery. Which leads to the question, why isn't a prescan recommended first? Then if nodes need to be removed, get that done and then do the RAI. I know some get it done this way and I'm wondering why my docs do not feel this is the way to go.

Report post

Gale45 - i did not know that the RAI would not work on the nodes! I assumed it would work wherever thyca went while still iodine avid. This worries me.

Report post

Was a shocker to me, too. First I was told it would - then oncologist told me not so.

Report post

mine was non encapsulated, encapsulated is good

Report post

On removing nodes by the way - just saw my surgeon - he said if cells show up in lymph nodes they are not necessarily removed. Just watched as it could all mean nothing other than some cells hanging out there. If node changes, then removal is considered.

Report post

@Gale45 - I am a huge fan of the diagnostic WBS prior to RAI ablation. I had 6 negative nodes removed at surgery, a clean neck ultrasound prior to surgery, and undetectable resting and stimulated TG post-op and a path report that was not terribly exciting. I was 46 turning 47 at time of diagnosis so right on the edge of where age matters. Since my endo was on the fence about RAI ablation he ordered a diagnostic WBS which showed a postitve superior mediastinal lymph node and was the deciding factor for ablation.

The question with lymph nodes and successful ablation seems to depend on whether or not they are differentiated enough to be iodine avid. I would very much like to think if my cancerous nodes were iodine avid enough to take up both the tracer dose and the ablation dose then they should have been exposed to enough radiation to destroy them. My ablation was December 7. To date my Tg remains undetectable and my latest neck US still clean. Follow up WBS late August will tell the rest of the story.

My surgeon also discussed with me what would happen if the cancerous nodes persisted after ablation. He explained that jumping right into surgical removal is not always recommened. His comment was "cherry picking" cancerous nodes does not always make sense. There is a time to monitor and a time to remove.

I agree that surgical removal of cancerous nodes at the time of TT is ideal then follow up with RAI ablation to clean up the rest. However, if the nodes do not show up on the pre-op ultrasound or are not grossly suspicious looking to the surgeon, they stay put.

Report post

Saw my surgeon for a follow up today and he also said node removal if positive for cells not always necessary. Asked him about a pre scan and his reservation was that it sometimes blunts the cells making the actual RAI less effective than it would have been first off. So hard to know what to do ....

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Things you can do

Support ThyCa

Help ThyCa: Thyroid Cancer Survivors' Association reach its goals and support people like yourself by making a donation today.

Donate to  ThyCa: Thyroid Cancer Survivors' Association

Discussion topics

Help and information from ThyCa

Community leaders