The purpose of this study is to evaluate which clinicopathologic factors are associated with central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC). A total of 402 cases of PTC were divided into two groups: CNLM (+) and CLNM (-). In univariate analysis, CLNM showed correlation with sex, tumor size, multifocality, bilaterality, extrathyroid extension, and distance from the capsule. In multivariate analysis, male gender, >1 cm of tumor size, multifocallity and extrathyroid extension were significant risk factors for CLNM. Findings of this study suggest that clinicians should pay attention to the above mentioned significant risk factors when examining lymph node (LN) for deciding LN dissection.

Macrofollicular variant of papillary thyroid carcinoma (MFV-PTC) is a rare variant of papillary carcinoma. The tumors are easily misdiagnosed as benign due to their macrofollicular structures with bland-looking cytologic findings. The author experienced a rare case of MFV-PTC with pelvic bone metastasis 10 years after initial surgery. The patient was a 55-year-old female with a history of right thyroid lobectomy. The encapsulated nodule consisted of variable sized follicles with no nuclear atypia. The initial diagnosis was a nodular hyperplasia. She had recently suffered from pelvic discomfort due to metastasizing thyroid carcinoma. The thyroid was reevaluated and revised as MFV-PTC.

Marked neutrophilia associated with neoplasia is a relatively rare finding and has been considered as a paraneoplastic manifestation. Thyroid cancer seldom presents with paraneoplastic leukocytosis. We report on a case of a 69-year-old man who presented with paraneoplastic leukocytosis seven months after undergoing total thyroidectomy and I-131 therapy for treatment of papillary thyroidcarcinoma. We found neither bone marrow involvement of malignant cells nor hematologic malignancy. Based on elevated levels of serum granulocyte colony-stimulating factor, we concluded that the cause was paraneoplastic leukocytosis. Another interesting point was the anaplastic transformation in the pleural metastatic site. It usually occurs in the intrathyroid or regional lymph node.