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Violetis O, Konstantakou P, Spyroglou A, Xydakis A, Kekis PB, Tseleni S, Kolomodi D, Konstadoulakis M, Mastorakos G, Theochari M, Aller J, Alexandraki KI. The Long Journey towards Personalized Targeted Therapy in Poorly Differentiated Thyroid Carcinoma (PDTC): A Case Report and Systematic Review. J Pers Med 2024; 14:654. [PMID: 38929875 PMCID: PMC11205159 DOI: 10.3390/jpm14060654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Poorly differentiated thyroid carcinoma (PDTC) has an intermediate prognosis between indolent well-differentiated thyroid carcinoma (TC) and anaplastic carcinoma. Herein, we present a case report with a PDTC component, along with a systematic review of the literature. CASE REPORT We report a case of a 45-year-old man diagnosed with a PDTC component, along with hobnail and tall-cell variant features positive for BRAFV600E mutation, after a total thyroidectomy and neck dissection. Radioactive iodine (RAI)-131 therapy was applied, but an early recurrence led to complementary surgeries. The anti-Tg rise, the presence of new lymph nodes, and the negative whole-bodyradioiodine scan were suggestive of a radioiodine-resistant tumor. Lenvatinib, sorafenib, dabrafenib/trametinib, cabozantinib and radiotherapy were all administered, controlling the tumor for a period of time before the patient ultimately died post-COVID infection. Systematic Review: We searched PubMed, Scopus, and WebofScience to identify studies reporting clinicopathological characteristics, molecular marker expression, and management of non-anaplastic TC with any proportion of PDTC in adult patients. Of the 2007 records retrieved, 82were included in our review (PROSPERO-ID545847). CONCLUSIONS Our case, together with the systematic review, imply that a combination of molecular-targetedtreatments may be safe and effective in patients with RAI-resistantBRAF-mutated advanced PDTC when surgery has failed to control tumor progression.
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Affiliation(s)
- Odysseas Violetis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Panagiota Konstantakou
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Ariadni Spyroglou
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Antonios Xydakis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | | | - Sofia Tseleni
- Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece;
| | - Denise Kolomodi
- European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Ekpa-Laiko Center, 11527 Athens, Greece;
- IATROPOLIS Private Medical Center, 11521 Athens, Greece
| | - Manousos Konstadoulakis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - George Mastorakos
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Maria Theochari
- Department of Oncology, Ippokrateio Athens General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Javier Aller
- Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Krystallenia I. Alexandraki
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
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Higgins KE, Sadow PM, Johnson DN, Wang P, Wanjari P, Cipriani NA. Columnar Cell Thyroid Carcinoma: A Heterogeneous Entity Demonstrating Overlap Between Papillary Thyroid Carcinoma and Follicular Neoplasms. Head Neck Pathol 2024; 18:39. [PMID: 38727854 PMCID: PMC11087446 DOI: 10.1007/s12105-024-01645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Columnar cell papillary thyroid carcinoma (CC-PTC) is a morphologic subtype of papillary thyroid carcinoma with a variable prognosis. It is characterized by neoplastic thyroid follicular-derived cells with pseudostratified columnar morphology arranged in papillary or follicular structures with supranuclear or subnuclear vacuoles. The molecular profile of this subtype has only recently come under scrutiny, with mixed results. The aim of this study is to further explore the morphologic, immunohistochemical, and genetic profile of CC-PTC, as well as to correlate these features with clinical outcomes. METHODS CC-PTC cases were identified from 3 institutions. Immunohistochemistry (ER, CDX2) and molecular testing (DNA and RNA sequencing) were performed. Clinicopathologic parameters and patient outcomes were recorded. RESULTS Twelve cases (2006-2023) were identified, all in adults (age 45-91). Two presented with disease outside the thyroid gland (neck and mediastinum) and two presented with distant metastasis. Four were high-grade differentiated thyroid carcinomas (necrosis or mitoses), one of which died of disease. Four were noninvasive or minimally invasive, one of which locally recurred. Three patients had lymph node metastases. ER and CDX2 were positive in 73% and 50%, respectively. Pathogenic mutations were found in TERT promoter (n = 3), RAS (n = 2), ATM, NOTCH1, APC, and ESR1, along with cases bearing AGK::BRAF fusion (n = 1), BRAF VE1 expression (n = 1), and NF2 loss (n = 1). CONCLUSIONS This study represents the largest molecularly defined cohort of non-oncocytic thyroid carcinomas with columnar cell morphology. These tumors represent a genetically and behaviorally heterogeneous group of neoplasms, some of which have RAS-like or follicular neoplasm-like genetics, some of which have BRAF-p.V600E-like or classic papillary thyroid carcinoma-like genetics, and some of which remain unclear. Noninvasive or minimally invasive tumors showed an indolent course compared to those with angioinvasion, gross extrathyroidal growth, or high-grade morphology. Consideration could be given to reclassification of this neoplasm outside of the subtyping of papillary thyroid carcinoma in light of its genetic diversity, distinct morphology, and clinical behavior more closely aligned with follicular thyroid neoplasms.
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Affiliation(s)
- Kathleen E Higgins
- College of Dentistry, The University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Peng Wang
- Division of Molecular Pathology, Department of Pathology, The University of Chicago, Chicago, USA
| | - Pankhuri Wanjari
- Division of Molecular Pathology, Department of Pathology, The University of Chicago, Chicago, USA
| | - Nicole A Cipriani
- Division of Anatomic Pathology, Department of Pathology, The University of Chicago, Chicago, USA.
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3
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Lee YK, Rovira A, Carroll PV, Simo R. Management of aggressive variants of papillary thyroid cancer. Curr Opin Otolaryngol Head Neck Surg 2024; 32:125-133. [PMID: 38116795 DOI: 10.1097/moo.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide a timely and relevant review of the latest findings and explore appropriate management of aggressive variants of papillary thyroid cancer (AVPTC). RECENT FINDINGS In general, AVPTCs tend to exhibit more invasive characteristics, a lack of responsiveness to radioiodine, increased occurrences of regional spreading, distant metastases and higher mortality rates. Meanwhile, each variant showcases unique clinical and molecular profiles. SUMMARY Given the elevated risk of recurrence postsurgery, a more aggressive strategy may be necessary when suspected preoperatively, particularly for those presenting with invasive features. Decision on the extent of surgical treatment and adjuvant therapy is individualized and made by experienced clinicians and multidisciplinary teams based on the clinical presentation, presence of aggressive features and molecular profile. Future studies on development of personalized medicine and molecular target therapy may offer tailored treatment options.
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Affiliation(s)
- Ying Ki Lee
- Department of Otorhinolaryngology - Head and Neck Surgery
| | - Aleix Rovira
- Department of Otorhinolaryngology - Head and Neck Surgery
| | - Paul V Carroll
- Department of Endocrinology and Thyroid Oncology Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ricard Simo
- Department of Otorhinolaryngology - Head and Neck Surgery
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Gazzeri R, Telera S, Galarza M, Sperduti I, Alfieri A. Prognostic scoring system for surgical treatment of intramedullary spinal cord metastases. J Clin Neurosci 2023; 118:90-95. [PMID: 37897816 DOI: 10.1016/j.jocn.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Although rare, intramedullary spinal cord metastases (ISCMs) are on the rise, most likely due to prolonged survival and improved outcomes as a result of the advances in cancer treatment for cancer patients. While the management of these lesions remains controversial, surgery for ISCM has recently been advocated for selected patients. We performed a retrospective analysis on 30 patients who were surgically treated for intramedullary spinal cord metastases in order to determine a preoperative prognostic scoring system to guide patient selection for surgical interventions. The scoring system was designed to decide between surgery or other therapeutic procedures. The five parameters selected and employed in the assessment system were: 1) patient's general condition, 2) age, 3) primary site of the cancer, 4) number of other extramedullary metastases and 5) severity of neurologic symptoms. Prognosis could not be predicted from a single parameter. These five factors were added together to give a prognostic score between 1 and 10. The average survival period of patients with a prognostic score between 1 and 3 points was 3 months; 11 patients with a score of 4 and 5 points had a mean survival of 7.63 months, while patients with a prognostic score between 6 and 10 was 14.8 months. According to our prognostic scoring system for surgical treatment of ISCM, surgery should be performed in those patients who score above 6 points, while radiotherapy/chemotherapy or palliative care is recommended for those who score between 1 and 3 points. A prognostic score of 4 and 5 represents a grey area where surgeons must use their judgment on whether to intervene either medically or surgically. This scoring system could facilitate decision-making in the management of patients with intramedullary spinal cord metastases.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Interventional and Surgical Pain Management Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
| | - Stefano Telera
- Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Isabella Sperduti
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alex Alfieri
- Neurosurgery, Kantonal Hospital Winterthur, Winterthur, Switzerland; Neurosurgery, Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus -Senftenberg, The Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany
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Lee JS, Lee JS, Yun HJ, Kim SM, Chang H, Lee YS, Chang HS, Park CS. Aggressive subtypes of papillary thyroid carcinoma smaller than 1 cm. J Clin Endocrinol Metab 2022; 108:1370-1375. [PMID: 36546348 DOI: 10.1210/clinem/dgac739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Tumor size is important in determining the range of surgery in papillary thyroid carcinomas (PTCs), especially those smaller than 1 cm. We aimed to analyze the features of small PTCs with aggressive subtypes based on histological characteristics. METHODS In this retrospective study, we reviewed the medical records of 11,570 patients with PTCs ≤ 1 cm who underwent thyroidectomy between January 2009 and December 2016. Aggressive subtypes included diffuse sclerosing, solid, tall cell, columnar cell, and hobnail subtypes. RESULTS Among the 11,570 patients with PTCs ≤ 1 cm, 177 aggressive PTC subtypes were identified. Propensity score matching revealed 110 tumors (62.1%) with extrathyroidal extension of aggressive PTC subtypes and 451 (51.1%) non-aggressive PTC subtypes (95% confidence interval [CI], 0.41-0.80, P < 0.001). Metastatic central and lateral neck lymph nodes constituted 3.06 ± 3.67 and 3.81 ± 5.39 of aggressive PTC subtypes and 1.22 ± 2.14 and 2.85 ± 3.79 of non-aggressive PTC subtypes, respectively (central neck nodes: 95% CI, 1.42-2.26, P < 0.001; lateral neck nodes: 95% CI, 2.9-5.90, P < 0.001). Seven patients with aggressive PTC subtypes (3.95%) and 12 with non-aggressive PTC subtypes (1.7%) exhibited recurrence. CONCLUSION Aggressive subtypes of small PTC tumors ≤ 1 cm exhibited more extrathyroidal extension and neck node metastasis. This study suggests that surgeons should consider the aggressive subtypes as important factors when deciding the range of surgery in PTCs smaller than 1 cm.
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Affiliation(s)
- Jin Seok Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Sung Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Goyang-si, Korea
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Pizzimenti C, Fiorentino V, Ieni A, Martini M, Tuccari G, Lentini M, Fadda G. Aggressive variants of follicular cell-derived thyroid carcinoma: an overview. Endocrine 2022; 78:1-12. [PMID: 35864338 DOI: 10.1007/s12020-022-03146-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The incidence of thyroid carcinoma has increased globally in the past years. Papillary thyroid carcinoma (PTC) is the most frequent neoplasm of the thyroid gland comprehending the 90% of the thyroid carcinoma and has an indolent clinical behaviour. However, some variants of follicular cell-derived thyroid carcinoma, including variants of classic of PTC, have been identified that show a more aggressive biological behaviour. An accurate diagnosis of these entities is crucial for planning a more aggressive treatment and improving patients' prognosis of patients. The aim of this review is to present the main clinical, histological, and molecular features of aggressive variants of follicular cell-derived thyroid carcinoma, and to provide useful histological parameters for determining the most suitable therapeutic strategy for patients affected by these forms. RESULTS Variants of classic PTC such as the diffuse sclerosing variant (DSV), the tall cell variant (TCV), the columnar cell variant (CCV), the solid/trabecular variant (STV) and the hobnail variant (HV), and other variants of follicular cell-derived thyroid carcinoma, such as poorly differentiated thyroid carcinoma (PDTC), and anaplastic thyroid carcinoma (ATC), are associated with aggressive behaviour. CONCLUSIONS The correct identification and diagnosis of aggressive variants of follicular cell-derived thyroid carcinoma is important, as they allow the clinician to adopt the most refined therapeutic strategies in order to the survival of the patients.
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Affiliation(s)
- Cristina Pizzimenti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98124, Messina, Italy.
| | - Vincenzo Fiorentino
- Department of Pathology, Foundation "Agostino Gemelli", University Hospital IRCCS, 00168, Rome, Italy
| | - Antonio Ieni
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, 98124, Messina, Italy
| | - Maurizio Martini
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, 98124, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, 98124, Messina, Italy
| | - Maria Lentini
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, 98124, Messina, Italy
| | - Guido Fadda
- Department of Human Pathology of the Adulthood and Developing Age "Gaetano Barresi", Section of Pathology, University of Messina, 98124, Messina, Italy
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Lee IA, Moon G, Kang S, Lee KH, Lee SM, Kim JK, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY. Predictive Factors Indicative of Hemithyroidectomy and Close Follow-Up versus Bilateral Total Thyroidectomy for Aggressive Variants of Papillary Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14112757. [PMID: 35681737 PMCID: PMC9179578 DOI: 10.3390/cancers14112757] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary This study evaluated the need for additional surgical treatment in patients diagnosed with aggressive variants of papillary thyroid cancer after lobectomy. With the increase in the frequency of early diagnosis, the detection of papillary thyroid cancer pathologically belonging to the aggressive variant is also increasing. Therefore, there is growing concern regarding the aggressive treatment of encapsulated aggressive variants of papillary thyroid cancer without invasive features. We suggest that close follow-up can be performed without any additional surgical treatment in patients with low-risk aggressive variants of papillary thyroid cancer incidentally detected after hemithyroidectomy. The patients should be provided sufficient consultation with clinicians. Abstract The diagnostic and treatment rates of early thyroid cancer have been increasing, including those of aggressive variants of papillary thyroid cancer (AVPTC). This study aimed to analyze the need for completion total thyroidectomy after lobectomy for clinically low-to-intermediate-risk AVPTC. Overall, 249 patients who underwent hemithyroidectomy (HT, n = 46) or bilateral total thyroidectomy (BTT, n = 203) for AVPTC between November 2005 and December 2019 at our single institution were examined. The average follow-up period was 14.9 years, with a recurrence rate of 4.3% and 10.8% in the HT and BTT groups, respectively. Multivariate Cox analysis revealed that palpable tumor on the neck during evaluation (HR, 2.7; 95% CI, 1.1–6.4; p = 0.025), clinical N1b (HR, 8.3; 95% CI, 1.1–63.4; p = 0.041), tumor size (cm) (HR, 1.3; 95% CI, 1.0–1.7; p = 0.036), gross extrathyroidal extension (HR, 3.1; 95% CI, 1.4–7.0; p = 0.007), and pathologic T3b (HR, 3.4; 95% CI, 1.0–11.4; p = 0.045) or T4a (HR, 6.0; 95% CI, 1.9–18.8; p = 0.002) were associated with an increased risk of recurrence. Incidentalomas identified during diagnosis had a significantly lower risk of recurrence (HR, 0.4; 95% CI, 0.2–0.9; p = 0.033). Close follow-up may be performed without completion total thyroidectomy for AVPTC found incidentally after HT.
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Affiliation(s)
- In A Lee
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Gilseong Moon
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Seokmin Kang
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Kang Hee Lee
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Sun Min Lee
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Jin Kyong Kim
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Cho Rok Lee
- Department of Surgery, Yongin Severance Hospital, Yongin-si 16995, Korea;
| | - Sang-Wook Kang
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Jong Ju Jeong
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
- Correspondence: ; Tel.: +82-02-2228-2136
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
| | - Woong Youn Chung
- Department of Surgery, College of Medicine, Severance Hospital, Yonsei University, Seoul 03722, Korea; (I.A.L.); (G.M.); (S.K.); (K.H.L.); (S.M.L.); (J.K.K.); (S.-W.K.); (K.-H.N.); (W.Y.C.)
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Anila KR, Pravanya PK, Thomas S, Sreekumar A, Jayasree K. Aggressive histopathological variants of papillary thyroid carcinoma, diagnostic challenge, and clinical significance—A case series. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_1028_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wong KS, Dong F, Telatar M, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, Doherty GM, Afkhami M, Barletta JA. Papillary Thyroid Carcinoma with High-Grade Features Versus Poorly Differentiated Thyroid Carcinoma: An Analysis of Clinicopathologic and Molecular Features and Outcome. Thyroid 2021; 31:933-940. [PMID: 33143568 DOI: 10.1089/thy.2020.0668] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Similar to poorly differentiated thyroid carcinoma (PDTC), papillary thyroid carcinoma with high-grade features (PTC HGF) demonstrates increased mitotic activity and/or necrosis; however, PTC HGF is excluded from the World Health Organization (WHO) definition of PDTC based on maintained nuclear features of PTC. Methods: Consecutive tumors that met criteria for PTC HGF, defined as tumors with maintained nuclear features of PTC and mitoses numbering 5 or more per 10 contiguous high-power fields and/or tumor necrosis, and PDTC (defined as per the WHO criteria) were identified. Clinicopathologic characteristics, follow-up data, and targeted next-generation sequencing results were compared between groups. Results: There were 15 PTC HGF and 47 PDTC. PTC HGF was associated with a higher rate of pT4 disease (53% vs. 13%, p = 0.0027) and lymph node metastases (73% vs. 38%, p = 0.049). The disease-specific survival was worse for patients with PTC HGF compared with those with PDTC using Kaplan-Meier estimation (p < 0.001) and was worse in subgroup analysis evaluating patients with widely invasive PDTC (i.e., those with a similar rate of pT4 disease) and PTC HGF (p = 0.040). PTC HGF had a higher BRAFV600E mutation rate (42% vs. 3%; p = 0.003), a trend toward more gene fusions (25% vs. 3%; p = 0.052), and a higher rate of relative gain of 1q (67% vs. 15%; p = 0.002) than PDTC. Conclusions: Our results demonstrate that PTC HGF are important to recognize based on their aggressive behavior. The molecular differences between PTC HGF and PDTC suggest that PTC HGF should be considered a distinct group from PDTC.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Fei Dong
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Milhan Telatar
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Erik K Alexander
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen Marqusee
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy L Cho
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew A Nehs
- Department of Surgery; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard M Doherty
- Department of Surgery; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Afkhami
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Justine A Barletta
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
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Janovitz T, Williamson DFK, Wong KS, Dong F, Barletta JA. Genomic profile of columnar cell variant of papillary thyroid carcinoma. Histopathology 2021; 79:491-498. [PMID: 33783022 DOI: 10.1111/his.14374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Columnar cell variant (CCV) is a rare papillary thyroid carcinoma subtype. The majority of CCV occur in older patients and are large, invasive tumours that pursue an aggressive clinical course. Rare well-circumscribed CCV occur in younger female patients and are comparatively indolent. METHODS AND RESULTS We retrospectively identified CCV with material available to perform targeted next-generation sequencing and correlated molecular results with clinicopathological features and outcome. Our cohort was comprised of nine CCV. Nearly all were aggressive tumours; however, one was predominantly well-circumscribed and arose in a thyroglossal duct cyst of a 26-year-old woman who had no evidence of disease at last follow-up. Seven (78%) cases demonstrated activating oncogenic driver alterations in BRAF, including BRAF V600E, an activating N486_P490del deletion, and BRAF-AGK fusions. Activating RAS mutations were seen in two (22%) cases. Additionally, three (33%) cases had TERT promoter mutations, four (44%) had loss of the tumour suppressor CDKN2A and one (11%) case had a loss of function TP53 mutation. Most cases (89%) also demonstrated copy number alterations, including recurrent gain of chromosome 1q (five cases) and losses of chromosome 9p (three cases) and 22q (four cases). The one case without secondary pathogenic mutations or copy number alterations was the tumour in the 26-year-old woman. CONCLUSIONS We found that CCV is primarily a BRAF-driven tumour, with most also harbouring secondary oncogenic mutations and multiple chromosomal gains and losses. Moreover, our findings suggest that molecular analysis could potentially be used to help risk stratify CCV.
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Affiliation(s)
- Tyler Janovitz
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Drew F K Williamson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Soares P, Póvoa AA, Melo M, Vinagre J, Máximo V, Eloy C, Cameselle-Teijeiro JM, Sobrinho-Simões M. Molecular Pathology of Non-familial Follicular Epithelial-Derived Thyroid Cancer in Adults: From RAS/BRAF-like Tumor Designations to Molecular Risk Stratification. Endocr Pathol 2021; 32:44-62. [PMID: 33651322 DOI: 10.1007/s12022-021-09666-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
This review addresses the impact of molecular alterations on the diagnosis and prognosis of differentiated thyroid carcinoma (DTC), including papillary, follicular, and well-differentiated carcinoma NOS, as well as oncocytic neoplasms. The molecular characterization of DTC is based upon the well-established dichotomy of BRAF-like and RAS-like designations, together with a remaining third group, less homogeneous, composed of non-BRAF-/non-RAS-like tumors. The role of BRAF V600E mutation in risk stratification is discussed in the clinico-pathological context, namely, staging and invasive features of classic papillary thyroid carcinoma (PTC) and histopathological variants carrying an excellent prognosis (microPTC) or a guarded prognosis, including the aggressive variants tall cell and hobnail cell PTCs. In follicular patterned tumors, namely, follicular thyroid carcinoma (FTC), with or without oncocytic features, the most prevalent molecular alteration are RAS mutations that do not carry prognostic significance. The only genetic alteration that has been proven to play a role in risk stratification of PTC and FTC is TERT promoter (TERTp) mutation.
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Affiliation(s)
- Paula Soares
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal.
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal.
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal.
| | - Antónia Afonso Póvoa
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4400-129, Vila Nova de Gaia, Portugal
| | - Miguel Melo
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar Universitário de Coimbra, 3004-561, Coimbra, Portugal
| | - João Vinagre
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
| | - Valdemar Máximo
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
| | - Catarina Eloy
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), University of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Manuel Sobrinho-Simões
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar E Universitário São João, 4200-139, Porto, Portugal
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12
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Gazzeri R, Telera S, Galarza M, Callovini GM, Isabella S, Alfieri A. Surgical treatment of intramedullary spinal cord metastases: functional outcome and complications-a multicenter study. Neurosurg Rev 2021; 44:3267-3275. [PMID: 33564982 DOI: 10.1007/s10143-021-01491-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/24/2022]
Abstract
Intramedullary spinal cord metastasis (ISCM) is a rare event in the course of advanced malignancy. Management of these lesions remains controversial. Recently, surgery for ISCM has been advocated for selected patients. We performed a retrospective analysis of the clinical course, complications, and outcome of 30 patients surgically treated for ISCM. Patients' age, histopathological diagnoses of primary cancer, tumor size, spinal location, and extramedullary tumor dissemination were collected. Preoperative functional status, pre- and postoperative neurological status, and extent of the tumor resection were also analyzed. Predominant tumor location was thoracic, followed by cervical and conus medullaris. Lung cancer constituted the majority of primary malignancies. In 9 cases, one of the indications for spinal surgery was to obtain a histopathological diagnosis. On admission, all patients presented with neurological symptoms suggestive of myelopathy. After surgery, 18 patients exhibited improvement of symptoms in terms of pain relief and partial recovery of motor and/or sensory deficits; 6 patients were unchanged, while 6 patients exhibited postoperative deterioration. Median survival time after surgery was 9.9 months. Age > 70 years old, presence of systemic metastases, preoperative neurological non functional status, and lung cancer as primary tumor were all factors associated with a worse survival prognosis. This study did not show a clear survival difference between gross total and subtotal ISCM tumor resection. Patients who underwent gross total resection had a worse functional outcome with respect to patients with only partial resection. Gross total resection with low morbidity must be the surgical target, but when not possible, subtotal resection and adjuvant therapy are a valid therapeutic option.
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Affiliation(s)
- Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy. .,Department of Neurosurgery, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy.
| | - Stefano Telera
- Department of Neurosurgery, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | | | - Sperduti Isabella
- Department of Biostatistics, IRCCS Istituto Nazionale Tumori "Regina Elena", Rome, Italy
| | - Alex Alfieri
- Neurosurgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Neurosurgery, Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany
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13
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Longheu A, Canu GL, Cappellacci F, Erdas E, Medas F, Calò PG. Tall Cell Variant versus Conventional Papillary Thyroid Carcinoma: A Retrospective Analysis in 351 Consecutive Patients. J Clin Med 2020; 10:jcm10010070. [PMID: 33379135 PMCID: PMC7794904 DOI: 10.3390/jcm10010070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this retrospective study was to investigate clinical and pathological characteristics of the tall cell variant of papillary thyroid carcinoma compared to conventional variants. Methods: The clinical records of patients who underwent surgical treatment between 2009 and 2015 were analyzed. The patients were divided into two groups: those with a histopathological diagnosis of tall cell papillary carcinoma were included in Group A, and those with a diagnosis of conventional variants in Group B. Results: A total of 35 patients were included in Group A and 316 in Group B. All patients underwent total thyroidectomy. Central compartment and lateral cervical lymph node dissection were performed more frequently in Group A (42.8% vs. 18%, p = 0.001, and 17.1% vs. 6.9%, p = 0.04). Angiolymphatic invasion, parenchymal invasion, extrathyroidal extension, and lymph node metastases were more frequent in Group A, and the data reached statistical significance. Local recurrence was more frequent in Group A (17.1% vs. 6.3%, p = 0.02), with two patients (5.7%) in Group A showing visceral metastases, whereas no patient in Group B developed metastatic cancer (p = 0.009). Conclusions: Tall cell papillary carcinoma is the most frequent aggressive variant of papillary thyroid cancer. Tall cell histology represents an independent poor prognostic factor compared to conventional variants.
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14
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Piciu A, Mester A, Rusu G, Piciu D. Challenges in the Correct Assessment of a Case of Aggressive Thyroid Carcinoma with Synchronous Breast Cancer: A Case Report and Review of the Literature of Essential Role of Radiopharmaceuticals. Curr Radiopharm 2020; 14:85-91. [PMID: 32988358 DOI: 10.2174/1874471013666200928105151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/22/2022]
Abstract
Thyroid carcinoma represents a complex pathology that can still be considered a medical challenge, despite having a better prognosis and life expectancy than most other neoplasms; also the scenario of multiple malignancies involving thyroid cancer is nowadays a common reality. MATERIALS AND METHODS We reviewed the literature regarding the aggressive presentation of synchronous thyroid and breast cancer. In the current paper, we report the case of a 59 years-old woman, diagnosed with invasive ductal breast carcinoma and papillary thyroid carcinoma, presenting a natural history of both aggressive synchronous tumors. At the moment of hospitalization, the diagnosis was breast carcinoma with multiple secondary lesions, suggestive of lung and bone metastases, and nodular goiter. RESULTS Searching the literature in PUBMED with the terms "thyroid carcinoma and synchronous breast carcinoma, we found 86 studies; introducing the term "aggressive," the result included 4 studies, among which, none showed to be relevant to the terms aggressive and synchronous. A similar search was done in SCOPUS finding 92 documents and after introducing the term aggressive, the number of papers was 8, none including the literature on synchronous aggressive metastatic thyroid and breast carcinoma. A majority of imaging diagnostic tools were used in this particular medical case in order to ensure the best potential outcome. The final diagnosis was papillary thyroid carcinoma with lung and unusual multiple bone metastases and synchronous invasive ductal breast carcinoma with subcutaneous metastases. CONCLUSION The case illustrates the challenges in the correct assessment of oncologic patients, despite the advances in medical imaging and technologies and underlines the essential role of nuclear medicine procedures in the diagnostic and therapy protocols.
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Affiliation(s)
- Andra Piciu
- Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Mester
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - George Rusu
- Department of Endocrine Tumors and Nuclear Medicine Institute of Oncology Ion Chiricuta 400015 Cluj-- Napoca, Romania
| | - Doina Piciu
- Department of Endocrine Tumors and Nuclear Medicine Institute of Oncology Ion Chiricuta 400015 Cluj-- Napoca, Romania
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15
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Coca-Pelaz A, Shah JP, Hernandez-Prera JC, Ghossein RA, Rodrigo JP, Hartl DM, Olsen KD, Shaha AR, Zafereo M, Suarez C, Nixon IJ, Randolph GW, Mäkitie AA, Kowalski LP, Vander Poorten V, Sanabria A, Guntinas-Lichius O, Simo R, Zbären P, Angelos P, Khafif A, Rinaldo A, Ferlito A. Papillary Thyroid Cancer-Aggressive Variants and Impact on Management: A Narrative Review. Adv Ther 2020; 37:3112-3128. [PMID: 32488657 PMCID: PMC7467416 DOI: 10.1007/s12325-020-01391-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction Aggressive variants of papillary thyroid cancer (PTC) have been described with increasing frequency. These variants include diffuse sclerosing variant, tall cell variant, columnar cell variant, solid variant, and hobnail variant. Methods We have performed a review of the more aggressive variants of PTC with respect to main characteristics, histological and molecular features, and the consequences that the knowledge of these variants should have in the treatment of the patients. Results At the present time, we do not know the prognostic value of these aggressive PTC variants. The extent of the surgical treatment and adjuvant therapy necessary should be decided on the basis of the extent of the tumor at presentation and the opinion of experienced clinicians. Conclusion These aggressive variants should be known by clinicians, to avoid underdiagnosis, and treated according to the latest recommendations in the literature.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Asturias, Spain.
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain.
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain
| | - Dana M Hartl
- Division of Surgical Oncology, Gustave Roussy Cancer Center and Paris-Sud University, Villejuif Cedex, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Zafereo
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Asturias, Spain
| | - Iain J Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, Scotland, UK
| | - Gregory W Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, São Paulo, Brazil
| | - Vincent Vander Poorten
- Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación-CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Ricard Simo
- Head and Neck Cancer Unit, Guy's and St Thomas' Hospital NHS Foundation Trust London, London, UK
| | - Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
| | - Peter Angelos
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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16
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Hernandez-Prera JC. The evolving concept of aggressive histological variants of differentiated thyroid cancer. Semin Diagn Pathol 2020; 37:228-233. [PMID: 32241577 DOI: 10.1053/j.semdp.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023]
Abstract
It is recommended by current clinical guidelines that pathologists identify and report aggressive histological variants of differentiated thyroid cancer (e.g., tall cell, columnar cell, and hobnail variants of papillary thyroid carcinoma; widely invasive follicular thyroid carcinoma). This review analyzes the historical evolution of these entities and highlights unresolved issues with respect to the diagnostic criteria for these tumors.
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Affiliation(s)
- Juan C Hernandez-Prera
- Department of Pathology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
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17
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Abstract
This article examines more uncommon thyroid entities, including anaplastic thyroid carcinoma, poorly differentiated thyroid carcinoma, rare papillary thyroid carcinoma variants, medullary thyroid carcinoma, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and multiple adenomatous nodules in the setting of Cowden syndrome. These entities were chosen based on their clinical significance and because they can be diagnostically challenging due to their morphologic diversity and overlap with other thyroid tumors. This article addresses the diagnostic features of each entity, focusing on how to avoid potential pitfalls and mimics while also highlighting the clinical implications of each diagnosis.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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18
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Does Aggressive Variant Histology Without Invasive Features Predict Overall Survival in Papillary Thyroid Cancer?: A National Cancer Database Analysis. Ann Surg 2019; 274:e276-e281. [PMID: 31599802 DOI: 10.1097/sla.0000000000003632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We aimed to clarify whether aggressive histology of papillary thyroid cancer (PTC) impacts overall survival (OS). SUMMARY BACKGROUND DATA Aggressive variants of PTC (AVPTC) are associated with invasive features. However, their behavior in the absence of these features is not well characterized. METHODS Patients treated from 2004 to 2015 for classic PTC (cPTC) or AVPTCs were identified from the National Cancer Database. Patients were further stratified based on presence of at least 1 invasive feature-extrathyroidal extension, multifocality, lymphovascular invasion, nodal or distant metastasis. Demographics, treatments, and OS were compared. RESULTS A total of 170,778 patients were included-162,827 cPTC and 7951 AVPTC. Invasive features were more prevalent in AVPTC lesions compared to cPTC (70.7% vs 59.7%, P < 0.001). AVPTC included tall cell/columnar cell (89.5%) and diffuse sclerosing (10.5%) variants. Patients with invasive features had worse OS irrespective of histology. Furthermore, when controlling for demographics, tumor size, and treatment variables in patients with noninvasive lesions, AVPTC histology alone was not associated with worse OS compared to cPTC (P = 0.209). In contrast, among patients who had at least 1 invasive feature, AVPTC histology was independently predictive of worse OS (P < 0.05) {TCV/Columnar hazard ratio [HR] 1.2; [95% confidence interval (CI) 1.1-1.3] and diffuse sclerosing HR 1.3; 95% CI 1.0-1.7]}. All invasive features, except multifocality, were independently associated with worse OS, with metastasis being the most predictive [HR 2.9 (95% CI 2.6-3.2) P < 0.001]. CONCLUSIONS In the absence of invasive features, AVPTC histology has similar OS compared to cPTC. In contrast, diffuse sclerosing and tall cell/columnar variants are associated with worse OS when invasive features are present.
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19
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Rossi ED, Faquin WC, Pantanowitz L. Cytologic features of aggressive variants of follicular-derived thyroid carcinoma. Cancer Cytopathol 2019; 127:432-446. [PMID: 31150164 DOI: 10.1002/cncy.22136] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 12/18/2022]
Abstract
Certain carcinomas of the thyroid gland behave aggressively resulting in increased patient morbidity and poor patient prognosis. The diagnosis of these aggressive thyroid cancer subtypes is sometimes challenging and subject to increased interobserver variability. This review deals with the cytological features of such tumors including aggressive variants of papillary thyroid carcinoma, poorly differentiated thyroid carcinoma, and anaplastic thyroid carcinoma. These malignancies fall into 2 groups based on their cytomorphology: those that exhibit distinct microscopic features (eg, nuclear findings typical of classical papillary thyroid carcinoma or marked anaplasia) and those that present with more subtle cytologic features (eg, nuclear pseudostratification, "soap bubble" nuclei, supranuclear or subnuclear cytoplasmic vacuoles, rosette-like structures, hobnail cells). We review the literature regarding these aggressive thyroid cancers and highlight important phenotypic characteristics that can be useful for their diagnosis based on fine needle aspiration.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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20
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Abstract
Thyroid cancers of follicular cell derivation provide excellent phenotype-genotype correlations. Current morphologic classifications are complex and require simplification. Benign adenomas have follicular or papillary architecture and bland cytology. Well-differentiated thyroid carcinomas exhibit follicular architecture, expansile growth, and variable cytologic atypia and invasiveness; low-risk tumors have excellent prognosis after surgical resection whereas widely-invasive and angioinvasive tumors warrant total thyroidectomy and radioablation. Papillary carcinoma is less differentiated; indolent microcarcinomas can be managed by active surveillance, whereas clinical lesions with local or distant spread require therapy. Progression gives rise to poorly differentiated and anaplastic carcinomas that are less common but far more aggressive.
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Affiliation(s)
- Sylvia L Asa
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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21
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Kakudo K, Bychkov A, Bai Y, Li Y, Liu Z, Jung CK. The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives. Pathol Int 2018; 68:641-664. [PMID: 30537125 DOI: 10.1111/pin.12737] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kennichi Kakudo
- Faculty of Medicine, Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University, Ikoma-city, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kawagoe, Chiba, Japan.,Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yaqiong Li
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Zhiyan Liu
- Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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22
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Abstract
Although differentiated thyroid carcinomas typically pursue an indolent clinical course, it is important to identify the subset of tumors that are most likely to behave aggressively so that patients with these tumors are counseled and treated appropriately. Extent of disease is fundamental to the prognostication for differentiated thyroid carcinoma; however, there are additional histologic features of the tumor separate from extent of disease that have been shown to affect clinical course. This review will start with a discussion of aggressive variants of papillary thyroid carcinoma, move to the prognostic significance of vascular invasion in follicular thyroid carcinoma, and finish with a discussion of Hürthle cell carcinoma, with an emphasis on why it is not considered a subtype of follicular thyroid carcinoma in the 2017 WHO Classification of Tumors of Endocrine Organs.
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Affiliation(s)
- Tyler Janovitz
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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23
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Feng J, Shen F, Cai W, Gan X, Deng X, Xu B. Survival of aggressive variants of papillary thyroid carcinoma in patients under 55 years old: a SEER population-based retrospective analysis. Endocrine 2018; 61:499-505. [PMID: 29909599 DOI: 10.1007/s12020-018-1644-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients younger than 55 years of age with papillary thyroid carcinoma (PTC) have excellent survival. Diffuse sclerosing variant (DSV) and tall cell variant (TCV) of PTC are associated with aggressiveness; the survival of patients <55 years of age with these variants is still unclear. We aim to investigate the clinicopathological features and survival of these variants in the age group <55 years. METHODS All adult patients (<55 years old) with DSV, TCV and conventional PTC (CPTC) came from the Surveillance, Epidemiology, and End Results program (1988-2013). Kaplan-Meier method and log-rank test were used to analyze the survival. Prognostic factors associated with survival were analyzed by Cox multivariate regression. RESULTS There were 280 DSV, 615 TCV, and 56287 CPTC in the age group <55 years. DSV and TCV were associated with multifocality, extrathyroidal extension, lymph node and distant metastasis (all p < 0.05). The 10-year disease-specific survival (DSS) of TCV was worse than CPTC (96.3 vs. 99.4%, p < 0.01), but there was no significant difference between DSV and CPTC (99.5 vs. 99.4%, p > 0.05). Cox multivariate regression showed TCV was the independent predictor of DSS (HR: 5.39, p < 0.01). CONCLUSION In the age group <55 years, DSV and TCV are more likely to exhibit aggressive characteristics than CPTC. Patient <55 years of age with DSV have excellent survival likewise, while patients <55 years of age with TCV carry worse survival. Further investigation for the recurrence risk of patients <55 years with these variants would contribute to optimal clinical management making.
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Affiliation(s)
- Jianhua Feng
- Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China
| | - Fei Shen
- Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China
| | - Wensong Cai
- Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China
| | - Xiaoxiong Gan
- Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China
| | - Xingyan Deng
- Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China
| | - Bo Xu
- Department of Thyroid Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, 510180, Guangzhou, China.
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Song E, Jeon MJ, Oh HS, Han M, Lee YM, Kim TY, Chung KW, Kim WB, Shong YK, Song DE, Kim WG. Do aggressive variants of papillary thyroid carcinoma have worse clinical outcome than classic papillary thyroid carcinoma? Eur J Endocrinol 2018; 179:135-142. [PMID: 29875289 DOI: 10.1530/eje-17-0991] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/04/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evidence for unfavorable outcomes of each type of aggressive variant papillary thyroid carcinoma (AV-PTC) is not clear because most previous studies are focused on tall cell variant (TCV) and did not control for other major confounding factors contributing to clinical outcomes. DESIGN Retrospective cohort study. METHODS This study included 763 patients with classical PTC (cPTC) and 144 with AV-PTC, including TCV, columnar cell variant (CCV) and hobnail variants. Disease-free survival (DFS) and dynamic risk stratification (DRS) were compared after two-to-one propensity score matching by age, sex, tumor size, lymph node metastasis and extrathyroidal extension. RESULTS The AV-PTC group had significantly lower DFS rates than its matched cPTC group (HR = 2.16, 95% CI: 1.12-4.16, P = 0.018). When TCV and CCV were evaluated separately, there was no significant differences in DFS and DRS between patients with TCV (n = 121) and matched cPTC. However, CCV group (n = 18) had significantly poorer DFS than matched cPTC group (HR = 12.19, 95% CI: 2.11-70.33, P = 0.005). In DRS, there were significantly more patients with structural incomplete responses in CCV group compared by matched cPTC group (P = 0.047). CCV was an independent risk factor for structural persistent/recurrent disease in multivariate analysis (HR = 4.28; 95% CI: 1.66-11.00, P = 0.001). CONCLUSIONS When other clinicopathological factors were similar, patients with TCV did not exhibit unfavorable clinical outcome, whereas those with CCV had significantly poorer clinical outcome. Individualized therapeutic approach might be necessary for each type of AV-PTCs.
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Affiliation(s)
- Eyun Song
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Seon Oh
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minkyu Han
- Departments of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Wook Chung
- Departments of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
This article reviews the small percentage of thyroid tumours that are not classified as classic papillary thyroid carcinoma, follicular thyroid carcinoma, and medullary thyroid carcinoma. It includes subtypes of papillary thyroid carcinoma, including, tall-cell, hobnail/micropapillary, columnar cell, diffuse sclerosing and solid variants. Poorly differentiated carcinoma, high-grade carcinoma and anaplastic thyroid carcinoma are reviewed. Also discussed are entities that are unusual but need to be recognized as primary thyroid neoplasms, i.e. mucoepidermoid carcinoma, sclerosing mucoepidermoid carcinoma with eosinophilia, and mammary analogue secretory carcinoma/secretory carcinoma. The pathological features and prognostic factors are described; a brief review of molecular correlates of these neoplasms is included.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, PA, USA
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, PA, USA
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26
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Cho J, Shin JH, Hahn SY, Oh YL. Columnar Cell Variant of Papillary Thyroid Carcinoma: Ultrasonographic and Clinical Differentiation between the Indolent and Aggressive Types. Korean J Radiol 2018; 19:1000-1005. [PMID: 30174490 PMCID: PMC6082763 DOI: 10.3348/kjr.2018.19.5.1000] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/19/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the ultrasonography (US) features and clinical characteristics of columnar cell variant of papillary thyroid carcinoma (CCV-PTC) that can predict disease progression. Materials and Methods Six cases of CCV-PTC were identified via surgical pathology analysis at our institution from 1994 to 2016. The histological, architectural, and cytological features met the diagnostic criteria of CCV-PTC. We reviewed the US features and clinicopathological findings in the six cases. Results An indolent clinical course was observed in four young female patients aged 27–34 years (median: 32 years), while two older patients aged 55 years or 70 years had an aggressive clinical course. All patients underwent total thyroidectomy and radioiodine therapy. The indolent group included patients with T1 and nodal metastasis, where the disease was not observed during the follow-up period (range: 8–17 years). On the other hand, a larger tumor size (1.8 cm and 6.0 cm), gross extrathyroidal extension to the muscle and lymph node, and distant metastasis were observed in the aggressive group. In one male patient, recurrence occurred immediately after operation, and this patient died 4 years after the diagnosis of thyroid cancer. Based on US, the individuals from the indolent group had a smooth margin, except for one. Both cases in the aggressive group had a microlobulated margin. Conclusion Favorable prognosis in CCV-PTC is observed in young patients with T1 staging and demonstrates a smooth margin at US. These US findings might help exclude the same treatment as the aggressive type in the indolent type of CCV-PTC.
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Affiliation(s)
- Jooyeon Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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27
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Aggressive Variants of Papillary Thyroid Carcinoma: Hobnail, Tall Cell, Columnar, and Solid. Adv Anat Pathol 2018; 25:172-179. [PMID: 29351089 DOI: 10.1097/pap.0000000000000184] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Papillary thyroid carcinomas are the most common endocrine cancer and are usually associated with good survival. However, some variants of papillary thyroid carcinomas may behave more aggressively than classic papillary thyroid carcinomas. The tall cell variant of papillary thyroid carcinoma is the most common aggressive variant of papillary thyroid carcinoma. The aggressive behavior has been ascribed to the histologic subtype and/or to the clinicopathologic features, an issue that remains controversial. The columnar variant of papillary thyroid carcinoma can be aggressive, particularly in older patients, with larger tumors showing a diffusely infiltrative growth pattern and extrathyroidal extension. A papillary thyroid carcinoma is designated as solid/trabecular variant when all or nearly all of a tumor not belonging to any of the other variants has a solid, trabecular, or nested (insular) appearance. This tumor must be distinguished from poorly differentiated thyroid carcinoma which has the same growth pattern but lacks nuclear features of papillary thyroid carcinoma and may show tumor necrosis and high mitotic activity. New to the fourth edition of the WHO Classification of Tumours of Endocrine Organs, the hobnail variant of papillary thyroid carcinoma is a moderately differentiated papillary thyroid carcinoma variant with aggressive clinical behavior and significant mortality. All of these variants are histologically unique and important to recognize due to their aggressive behavior.
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28
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Gu H, Sui S, Cui X, Han B, Zhang C, Qi M, Li C, Liu Z. Thyroid carcinoma producing β-human chorionic gonadotropin shows different clinical behavior. Pathol Int 2018; 68:207-213. [PMID: 29446856 DOI: 10.1111/pin.12639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Haiyan Gu
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; The Affiliated Hospital of Qingdao University; 16#, Jiangsu Road Qingdao Shandong 266003 PR China
| | - Shaofeng Sui
- Institute of Occupational and Environmental Health; Shandong Center for Disease Control and Prevention; 16992#, Jingshi Road Jinan Shandong 250014 PR China
| | - Xiujie Cui
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of pathogeny biology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
| | - Bo Han
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; Shandong University Qilu Hospital; 107#, Wenhua Xi Road Jinan Shandong 250012 PR China
| | - Chunyan Zhang
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; The Affiliated Hospital of Jining Medical College; 89#, Guhuai Road Jining Shandong 272029 PR China
| | - Mei Qi
- Department of Pathology; Shandong University Qilu Hospital; 107#, Wenhua Xi Road Jinan Shandong 250012 PR China
| | - Congcong Li
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Obstetrics and Gynecology; Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200120 PR China
| | - Zhiyan Liu
- Department of Pathology; Shandong University School of Basic Medical Sciences; 44#, Wenhua Xi Road Jinan Shandong 250012 PR China
- Department of Pathology; Shandong University Qilu Hospital; 107#, Wenhua Xi Road Jinan Shandong 250012 PR China
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29
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O'Neill AH, Phung TB, Lai LT. Intramedullary spinal cord metastasis from thyroid carcinoma: Case report and a systematic pooled analysis of the literature. J Clin Neurosci 2017; 49:7-15. [PMID: 29248379 DOI: 10.1016/j.jocn.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022]
Abstract
Intramedullary spinal cord metastasis (ISCM) is rare and occurs most commonly in the setting of advanced malignancy. The optimal management pathways are not well defined and treatment outcomes from contemporary therapies remain variable. We report a case of a 49-year-old woman with known primary papillary thyroid carcinoma, who presented with rapidly progressive clinical features of Brown-Sequard syndrome. A detailed pooled analysis of the literature was conducted to characterise the clinical and demographic features, management options, and expected survival outcomes for cases of ISCM. We secondarily performed a subgroup analysis on the incidence, clinical and management characteristics of thyroid carcinoma ISCM.
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Affiliation(s)
- Anthea H O'Neill
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Teik Beng Phung
- Department of Anatomical Pathology, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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30
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Arnoux G, Pusztaszeri M. "Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features" With Focal Spindle Cell Metaplasia. Int J Surg Pathol 2017; 26:261-265. [PMID: 29212393 DOI: 10.1177/1066896917741548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
"Noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) is a recent reclassification of the encapsulated follicular variant of papillary thyroid carcinoma, which is supposed to reflect its indolent clinical behavior and to prevent overtreatment of patients with this neoplasm. The diagnosis of NIFTP can only be made histologically on the surgical specimen according to specific inclusion and exclusion criteria, which requires the examination of the whole nodule and its capsule. Spindle cell proliferations, especially of follicular cell origin, arising within thyroid follicular neoplasms are very rare and may cause diagnostic difficulties. Few reports described spindle cell proliferations arising in follicular thyroid adenoma and papillary thyroid carcinoma. To the best of our knowledge, only one case has been reported in NIFTP so far. In this article, we report a unique case of NIFTP associated with a spindle cell proliferation that was characterized immunohistochemically. Specific issues related to this case are discussed.
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Affiliation(s)
| | - Marc Pusztaszeri
- 1 Geneva University Hospital, Geneva, Switzerland.,Current affiliation: Department of Pathology, Jewish General Hospital and McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, Québec, Canada H3T 1E2
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31
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Konstantinidis A, Tracy E, Sosa JA, Roman SA. Risk prediction in children and adults less than 45 years old with papillary thyroid cancer. Expert Rev Endocrinol Metab 2017; 12:355-365. [PMID: 30058890 DOI: 10.1080/17446651.2017.1365597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The incidence of papillary thyroid cancer is increasing faster than any other cancer in young patients. The purpose of this review is to discuss the most recent determinants of risk of recurrence and compromised outcomes in this population. Areas covered: This review discusses the most updated data on patient age, including children and young adults, extent of disease and subsequent dynamic staging over time, molecular markers for disease aggressiveness, adequacy of surgical resection and surgeon volume, and novel therapies for advanced non-resectable disease as predictors of patient outcomes. Expert commentary: Young patients enjoy excellent outcomes, with long-term survivorship, but face higher risks of short-term complications and disease recurrence. Thoughtful evaluation of the extent of disease, tumor features associated with more aggressive behavior, the presence of locoregional or distant metastases, and an understanding of molecular changes in their tumors are important areas of consideration. High-volume surgeons should work collaboratively with endocrinologists, radiologists, and pathologists specializing in thyroid cancer to help patients achieve excellent outcomes. Emerging data challenging the status quo regarding the relative importance of patient age, tumor features, and dynamic risk-adjustment for overall prognosis of these patients will likely impact future care and staging systems.
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Affiliation(s)
| | - Elizabeth Tracy
- a Department of Surgery , Duke University Medical Center , Durham , NC , USA
| | - Julie Ann Sosa
- a Department of Surgery , Duke University Medical Center , Durham , NC , USA
| | - Sanziana A Roman
- a Department of Surgery , Duke University Medical Center , Durham , NC , USA
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32
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Abstract
OBJECTIVES To review how changes in the pathologic definitions for papillary tumors of the thyroid during recent decades have affected outcomes for patients with these tumors. METHODS Forty-nine previous reports or studies involving collectively 53,606 patients were reviewed, and new analyses were performed on the data to include analyses of agreement, incidence, survival, and diagnostic categories. RESULTS The past emphasis on cytologic features to define papillary tumors has not resulted in ideal pairwise agreement between pathologists and has produced incidence and survival data suggesting overdetection and overdiagnosis. Most recently, tissue patterns have been reemphasized. CONCLUSIONS With the recent reemphasis on diagnostic tissue patterns (over cytologic criteria), agreements between pathologists for the diagnosis of papillary tumors should improve, and the incidence of papillary carcinoma should decline. Nevertheless, updated survival analyses demonstrate excellent long-term survival for most of those diagnosed with papillary carcinomas.
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33
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Bongiovanni M, Mermod M, Canberk S, Saglietti C, Sykiotis GP, Pusztaszeri M, Ragazzi M, Mazzucchelli L, Giovanella L, Piana S. Columnar cell variant of papillary thyroid carcinoma: Cytomorphological characteristics of 11 cases with histological correlation and literature review. Cancer Cytopathol 2017; 125:389-397. [DOI: 10.1002/cncy.21860] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/16/2017] [Accepted: 03/07/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Massimo Bongiovanni
- Clinical Pathology Service, Institute of Pathology; Lausanne University Hospital; Lausanne Switzerland
| | - Maxime Mermod
- Department of Otolaryngology and Head and Neck Surgery; Lausanne University Hospital; Lausanne Switzerland
| | - Sule Canberk
- Division of Cytology, Department of Pathology; Acibadem University; Istanbul Turkey
| | - Chiara Saglietti
- Clinical Pathology Service, Institute of Pathology; Lausanne University Hospital; Lausanne Switzerland
| | - Gerasimos P. Sykiotis
- Endocrinology, Diabetology, and Metabolism Service; Lausanne University Hospital; Lausanne Switzerland
| | - Marc Pusztaszeri
- Department of Clinical Pathology; Geneva University Hospitals; Geneva Switzerland
| | - Moira Ragazzi
- Pathology Unit; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
| | | | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - Simonetta Piana
- Pathology Unit; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
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34
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Pusztaszeri M, Auger M. Update on the cytologic features of papillary thyroid carcinoma variants. Diagn Cytopathol 2017; 45:714-730. [PMID: 28262004 DOI: 10.1002/dc.23703] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/13/2022]
Abstract
Papillary thyroid cancer (PTC), which accounts for 85-90% of all thyroid cancers, is generally an indolent tumor with long term survival rates >95%. A reliable definitive diagnosis of PTC is usually straightforward in fine needle aspirates of conventional PTC whenever the characteristic papillary and/or flat honeycomb sheet-like architecture and the typical nuclear features of chromatin pallor, nuclear enlargement, crowding, grooves and pseudoinclusions are encountered. Conventional PTC, however, has diminished in relative frequency as compared to PTC variants, especially the noninvasive follicular variant of PTC, an indolent tumor which has recently been reclassified as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP). These PTC variants are characterized by various architecture, cell type and shape, and stromal features, some of which can be recognized cytologically. Awareness of the cytomorphological spectrum and of the characteristic cytological features of these PTC variants is important to avoid diagnostic pitfalls. In this article, we review the different variants of PTC, including their cytomorphologic features, differential diagnosis, and salient molecular features. Diagn. Cytopathol. 2017;45:714-730. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Marc Pusztaszeri
- Department of Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - Manon Auger
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
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35
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Abstract
Differentiated thyroid cancer (DTC) includes more than 90% of all thyroid carcinoma and its incidence is growing, mainly due to an increase in the incidence of papillary thyroid cancer (PTC) for the widespread use of neck ultrasonography. Areas covered: Several prognostic factors should be considered during the management of PTC in order to provide the most effective treatment. The most important prognostic factors in PTC include personal and pathological features such as patient's age, gender, hystotype, tumor size, extrathyroidal extension, lymph node involvement, presence of local or distant metastases and molecular analyses. We performed a search in the PubMed database for studies published in English since 1960 using the terms: 'thyroid cancer', 'prognostic factors', 'age', 'gender', 'hystotype', 'tumor size', 'extrathyroidal extension', 'lymph node', 'metastases' and 'molecular analyses'. Expert commentary: Prognostic factors can guide clinicians during the treatment and follow-up of DTC patients, but it is now evident that the risk of recurrence or death must be evaluated periodically, on the basis of individual risk, according to the response to initial therapy or the subsequent therapy required during follow-up.
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Affiliation(s)
- Fabio Maino
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Raffaella Forleo
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Furio Pacini
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
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36
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Yoo JY, Stang MT. Current Guidelines for Postoperative Treatment and Follow-Up of Well-Differentiated Thyroid Cancer. Surg Oncol Clin N Am 2016; 25:41-59. [PMID: 26610773 DOI: 10.1016/j.soc.2015.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Well-differentiated thyroid cancer is increasing in incidence but the disease-specific mortality remains very low. The only effective adjuvant treatment is radioactive iodine ablation. Guidelines regarding the use and dosage of radioactive iodine depend on pathologic features of the primary and metastatic tumor that define risk. Long-term treatment includes thyroid-stimulating hormone suppression and surveillance with serum thyroglobulin and radiologic assessment for nodal recurrence.
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Affiliation(s)
- Jenny Y Yoo
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 101, Pittsburgh, PA 15213, USA
| | - Michael T Stang
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 101, Pittsburgh, PA 15213, USA.
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37
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Clinicopathologic features and prognostic factors of tall cell variant of papillary thyroid carcinoma. Nucl Med Commun 2015. [DOI: 10.1097/mnm.0000000000000360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Bongiovanni M, Piana S, Crippa S, Ragazzi M, Giovanella L. Images in endocrine pathology: similar, but not the same! Endocr Pathol 2015; 26:187-9. [PMID: 24729036 DOI: 10.1007/s12022-014-9310-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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39
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Lee JH, Shin JH, Lee HW, Oh YL, Hahn SY, Ko EY. Sonographic and cytopathologic correlation of papillary thyroid carcinoma variants. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1-15. [PMID: 25542934 DOI: 10.7863/ultra.34.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Papillary thyroid carcinoma (PTC) is the most common thyroid cancer and constitutes more than 70% of thyroid malignancies. Although TNM staging is the most widely used parameter for determination of therapeutic plans, recent studies have suggested that different histopathologic variants of PTC can also have different clinical courses and patient prognoses. Sonographic criteria for PTC are well established and include a taller-than-wide shape, an irregular margin, microcalcifications, and marked hypoechogenicity. The role of sonography has expanded to enable the characterization of PTC variants based on their sonographic features. Tall cell and diffuse sclerosing variants appear to have more aggressive clinical courses with unfavorable prognoses, whereas the more recently described cribriform-morular and Warthin-like variants have relatively indolent clinical courses. The prognoses of patients with follicular, solid, columnar cell, and oncocytic variants are still controversial and may be similar to the prognosis of conventional PTC. Understanding the sonographic characteristics of PTC variants with clinicopathologic correlation may be helpful for suggesting an appropriate treatment plan.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology and Center for Imaging Science (J.J.L., J.H.S., S.Y.H., E.Y.K.) and Department of Pathology (H.-W.L., Y.L.O.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science (J.J.L., J.H.S., S.Y.H., E.Y.K.) and Department of Pathology (H.-W.L., Y.L.O.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Woo Lee
- Department of Radiology and Center for Imaging Science (J.J.L., J.H.S., S.Y.H., E.Y.K.) and Department of Pathology (H.-W.L., Y.L.O.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Radiology and Center for Imaging Science (J.J.L., J.H.S., S.Y.H., E.Y.K.) and Department of Pathology (H.-W.L., Y.L.O.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science (J.J.L., J.H.S., S.Y.H., E.Y.K.) and Department of Pathology (H.-W.L., Y.L.O.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science (J.J.L., J.H.S., S.Y.H., E.Y.K.) and Department of Pathology (H.-W.L., Y.L.O.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sen A, Nalwa A, Mathur SR, Jain D, Iyer VK. Cytomorphology of columnar cell variant of papillary carcinoma thyroid: A case report and review of the literature. Cytojournal 2014; 11:27. [PMID: 25379049 PMCID: PMC4220425 DOI: 10.4103/1742-6413.143303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 11/30/2022] Open
Abstract
A 58 years old lady reported with history of progressively increasing lump in the neck. Patient had earlier undergone sub-total thyroidectomy (details not available) in a private institute one year back. Fine needle aspiration cytology (FNAC) of the present lump revealed features of papillary carcinoma thyroid. Patient subsequently underwent total thyroidectomy along with excision of a tumor nodule in the larynx. Gross examination of the specimen revealed a tumor nodule in the right lobe of the thyroid. Microscopic examination of the tumor nodule in the thyroid and larynx revealed a columnar cell variant of papillary carcinoma thyroid. Very few reports describing the cytomorphologic features of this variant of papillary carcinoma are available in the published literature. These reports highlight the absence or paucity of nuclear grooves and intranuclear inclusions in this variant. We describe a case of columnar cell variant of papillary carcinoma where nuclear grooves were prominently seen. In addition, we report the occurrence of rosette-like structures which were brought out better on FNA smears. These rosette-like structures have not been emphasized earlier in the published literature. The cytomorphologic features of this rare variant are also reviewed in this report.
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Affiliation(s)
- Arijit Sen
- Address: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aasma Nalwa
- Address: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Address: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Address: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Address: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Lastra RR, LiVolsi VA, Baloch ZW. Aggressive variants of follicular cell-derived thyroid carcinomas: a cytopathologist's perspective. Cancer Cytopathol 2014; 122:484-503. [PMID: 24664970 DOI: 10.1002/cncy.21417] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 12/12/2022]
Abstract
Follicular cell-derived carcinomas of the thyroid gland comprise a heterogeneous group of malignant neoplasms of the thyroid gland with varied histologic appearance and molecular profiles. In most patients, these tumors represent relatively indolent neoplasms; however, certain subtypes/variants behave in an aggressive manner, and the recognition of this subset of tumors is essential because of their variable response to therapy and significant morbidity and mortality. Fine-needle aspiration is considered an essential tool for the diagnosis of suspicious thyroid nodules. In this review, the authors discuss the clinical, histologic, and molecular findings and the prognostic implications of aggressive thyroid neoplasms with emphasis on the characteristic cytomorphologic features on fine-needle aspiration smears.
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Affiliation(s)
- Ricardo R Lastra
- Division of Cytopathology and Cytometry, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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42
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Bongiovanni M, Piana S, Frattini M, Giovanella L, Spitale A, Ragazzi M, Ciarrocchi A. CDX2 expression in columnar variant of papillary thyroid carcinoma. Thyroid 2013; 23:1498-9. [PMID: 23734674 DOI: 10.1089/thy.2013.0146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Baloch Z, LiVolsi VA, Tondon R. Aggressive variants of follicular cell derived thyroid carcinoma; the so called 'real thyroid carcinomas'. J Clin Pathol 2013; 66:733-43. [PMID: 23626010 DOI: 10.1136/jclinpath-2013-201626] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pathological diagnoses and classification schemes for thyroid carcinoma have changed over the past 20 years and continue to do so. New entities have been described and molecular analyses have suggested better characterisation and grouping of certain tumours. Because some of the lesions have been named differently by different authors, clinicians and patients may be confused as to what a specific patient's lesion represents. In this review, we discuss the thyroid tumours of follicular origin which are clinically unusual but important to recognise as their behaviour may be aggressive, they may not respond to radioiodine treatment and they may cause significant mortality. This paper describes these important but rare lesions, their pathological features, important clinicopathological correlations, molecular correlates and prognostic implications.
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Affiliation(s)
- Zubair Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Kazaure HS, Roman SA, Sosa JA. Aggressive Variants of Papillary Thyroid Cancer: Incidence, Characteristics and Predictors of Survival among 43,738 Patients. Ann Surg Oncol 2011; 19:1874-80. [DOI: 10.1245/s10434-011-2129-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Indexed: 12/21/2022]
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Clinicopathological and molecular characterization of nine cases of columnar cell variant of papillary thyroid carcinoma. Mod Pathol 2011; 24:739-49. [PMID: 21358618 DOI: 10.1038/modpathol.2011.2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The majority of papillary thyroid carcinoma is indolent and associated with long-term survival. The columnar cell variant, however, is a rare subtype that is variable in biological behavior; some are clinically aggressive, whereas others are more clinically indolent. Tumor size, tumor circumscription, and encapsulation may influence the behavior of columnar cell carcinomas. Other variables including genetic changes and putative biomarkers associated with malignant growth have not been thoroughly examined in these neoplasms. In this study, nine cases of columnar cell variant of papillary thyroid carcinoma from three institutions were classified as clinically indolent or aggressive based on pathological features, clinical history, and outcome. Indolent tumors were typically small, circumscribed or encapsulated, and from younger female patients, whereas aggressive tumors were large, locally aggressive, associated with regional and distant metastasis, and from older male patients. The missense mutation, V600E in the BRAF oncogene (BRAF(V600E)), was detected in three of nine of cases, of which two were clinically aggressive. Immunohistochemical evaluation of neoplasia-associated markers showed increased nuclear cyclin D1 expression, elevated Ki-67 proliferation indices, and predominantly weak nuclear p53 staining in both indolent and aggressive tumors. Expression of β-catenin was largely restricted to a membranous pattern in both tumor types. Cytoplasmic expression of bcl-2 was overall mildly reduced in indolent neoplasms. Nuclear expression of estrogen and progesterone receptors was increased in both indolent and aggressive neoplasms, but was without sex- or age-related differences; however, whereas progesterone receptor expression was diffuse and strong in clinically indolent carcinomas, its expression was diminished in aggressive neoplasms. Recognition of the clinicopathological characteristics and the molecular and immunophenotypic features of the columnar cell variant of papillary thyroid carcinoma may aid in characterizing neoplasms that behave indolently or aggressively.
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Patterns of papillary thyroid carcinoma cells analyzed in fine-needle aspiration smears may reveal changes in tumor cell behavior. Diagn Cytopathol 2011; 40 Suppl 1:E55-61. [DOI: 10.1002/dc.21695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/16/2011] [Indexed: 12/19/2022]
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48
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Kim KJ, Hong SW, Lee YS, Kim BW, Lee SC, Chang HS, Park CS. Tumor margin histology predicts tumor aggressiveness in papillary thyroid carcinoma: a study of 514 consecutive patients. J Korean Med Sci 2011; 26:346-51. [PMID: 21394301 PMCID: PMC3051080 DOI: 10.3346/jkms.2011.26.3.346] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/13/2011] [Indexed: 11/20/2022] Open
Abstract
Histologic patterns at tumor margins may be related to prognosis in several malignancies. We investigated tumor aggressiveness with respect to tumor margin histology in patients with papillary thyroid carcinoma (PTC). Five hundred fourteen consecutive patients who underwent surgery for primary PTC between January and July 2009 were assigned to two groups, one with an infiltrative pattern (I-type, n = 347) at tumor margins and one with an expanding pattern (E-type, n = 167). Tumor aggressiveness was assessed by analyzing relationships between these patterns and known prognostic factors. The analysis showed that unfavorable prognostic factors such as tumor multiplicity (P = 0.002), extrathyroidal extension (P < 0.001), lateral neck lymph node metastasis (P < 0.001) and advanced TNM stage (P = 0.001) were significantly more prevalent in patients with I-type PTC than in those with the E-type. Central neck node metastases were more prevalent without statistical significance in the I-type patients (P = 0.376). Tumor margin histology was not related to gender or tumor size. These results suggest that histologic patterns at tumor margins predict aggressiveness in PTC.
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Affiliation(s)
- Kuk-Jin Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup-Woo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Chul Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.3342/kjorl-hns.2011.54.1.8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Silver CE, Owen RP, Rodrigo JP, Rinaldo A, Devaney KO, Ferlito A. Aggressive variants of papillary thyroid carcinoma. Head Neck 2010; 33:1052-9. [PMID: 20824810 DOI: 10.1002/hed.21494] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 04/06/2010] [Accepted: 04/21/2010] [Indexed: 11/07/2022] Open
Abstract
A number of histologic variants of well-differentiated papillary carcinoma have been found to be associated with more aggressive tumor behavior. Tall cell, columnar cell, diffuse sclerosing, solid/trabecular, and insular variants of well-differentiated papillary thyroid cancer are all potentially more aggressive than conventional papillary thyroid cancer. When subjected to multivariate analysis, however, evidence that the histologic subtype of tumor is an independent predictor of outcome is weak. Rather, the aggressive variants tend to present with features recognized by other staging systems as associated with a worse prognosis, including higher histologic grade, extracapsular spread, large tumor size, and the presence of distant metastases. Prognosis is directly related to the presence of these features. The state of our knowledge is limited by the relatively small number of cases that have been studied. The presence of an aggressive variant of papillary carcinoma should alert the surgeon that he is dealing with a potentially aggressive tumor. Clinical treatment decisions should be based on the stage of the disease, influenced by the knowledge that the aggressive variants tend to be associated with higher risk factors. The surgeon must be prepared to perform at the first, or second stage, a total thyroidectomy, central compartment neck dissection, additional lymphadenectomy, and/or resection of invaded surrounding structures, and search for distant metastasis. Postoperative radioactive iodine should generally be administered for these variants as they will generally be intermediate to advanced tumors. The tall cell variant is often refractory to such treatment but may be susceptible to treatment targeted against BRAF mutation. External beam irradiation may be used in cases of incomplete resection.
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Affiliation(s)
- Carl E Silver
- Departments of Surgery and Otolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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