Papillary thyroid carcinoma tall cell variant.

Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Thyroid: official journal of the American Thyroid Association (Impact Factor: 2.6). 10/2008; 18(11):1179-81. DOI: 10.1089/thy.2008.0164
Source: PubMed

ABSTRACT BACKGROUND: The most common of the aggressive variant of papillary thyroid carcinoma (PTC) is the tall cell variant (TCV). Because there are serious prognostic and management implications to a diagnosis of TCV, we review the entity to inform clinicians about the many facets of TCV. SUMMARY: The TCV of PTC is characterized by cells having the nuclear features of PTC and whose height is at least twice or thrice their width. There is disagreement regarding the proportion of tall cells and the cell height required to diagnose TCV. In view of its blurred definition and rarity, studies have shown that TCV is still underdiagnosed. We propose that PTC be diagnosed as TCV if it is composed of > or =50% tall cells. The latter should have a height that is at least twice their width, an eosinophilic cytoplasm, and the nuclear features of PTC. Whatever its definition, there is a consensus that TCV has a higher recurrence and death rate than classical PTC. Most authorities believe that TCV's worse prognosis is related to its older age at presentation, larger tumor size, and high frequency of extrathyroid extension (ETE). However, in a recent article, TCV without ETE was shown to have a more aggressive behavior than classical PTC without ETE independent of age, gender, and tumor size. The aggressive behavior of TCV could be related to the high expression of Muc1 and matrix metalloproteinase and to the higher prevalence of B-RAF mutations when compared to classical PTC. The importance of TCV is accentuated by the fact that it is overrepresented in those fluorodeoxyglucose positron-emission tomogram (FDG-PET)-positive thyroid carcinomas that are refractory to radioactive iodine (RAI) therapy constituting 20% of these incurable tumors. Conclusion: TCV is a biologically and clinically aggressive form of PTC that is still underdiagnosed. TCV is overrepresented in patients with RAI refractory disease. It has a high prevalence of B-RAF mutations making the latter an attractive target in RAI refractory cases. Imaging modalities that can detect RAI refractory disease such as FDG-PET scanning are needed in many patients and a requirement in those with extensive ETE. More studies are needed to identify those TCV that become RAI refractory and develop effective target therapies against these incurable carcinomas.

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    ABSTRACT: Background: The tall cell variant of papillary thyroid cancer (TCV) is an aggressive variant of papillary thyroid cancer (PTC) that is believed to have worse outcomes than classical PTC. The objective of this study was to investigate the incidence, survival and disease recurrence of patients with TCV and compare them with other PTC in a whole population. Methods: Information on all thyroid carcinomas diagnosed in Iceland from 1990 to 2009 was obtained from the Icelandic Cancer Registry. PTC diagnosed post mortem was excluded. The date of diagnosis, sex and age at diagnosis was registered. All histopathology material was re-evaluated and papillary thyroid tumors classified as either TCV or other types of PTC. Tumors were classified as TCV if more than 50% of cells were tall (height > twice the width). TNM-stage was determined for all the cases. Endpoints were thyroid cancer specific death and thyroid cancer recurrence. Results: Out of 376 patients diagnosed with PTC in the study period, 49 (13%) were classified as TCV. Patients with TCV were older (66 years vs. 49 years, p<0.001), more often had pT4 tumors (71% vs. 15%, p<0.001), had higher rates of nodal metastasis (51% vs. 22%, p<0.001) and more often distant metastasis (14% vs. 2%, p<0.001). The age adjusted incidence of TCV for men was 0.5/100,000 (95% CI: 0.3-0.7) and for women 0.7/100,000 (95% CI: 0.4-1.0) between 1990-2009. The 5-year disease specific survival for TCV was 83% (95% CI 68-91) compared to 98% (95% CI: 96-99) for other PTC respectively (p<0.001). In multivariate analysis, TCV histology was an independent risk factor for recurrence (HR : 3.18, 95% CI 1.48-6.84) but not for disease specific survival (HR: 1.86, 95% CI 0.77-4.73). Conclusions: TCV comprises 13% of all diagnosed PTC in Iceland with an incidence of 0.5/100,000 for men and 0.7/100,000 for women. Patients diagnosed with TCV have worse 5-year disease specific survival than patients with other PTC. TCV histology is an independent risk factor for disease recurrence but not for disease specific survival.
    Thyroid: official journal of the American Thyroid Association 10/2014; DOI:10.1089/thy.2014.0075 · 2.60 Impact Factor
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    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. © 2015 by the American Institute of Ultrasound in Medicine.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 01/2015; 34(1):1-15. DOI:10.7863/ultra.34.1.1 · 1.53 Impact Factor
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    ABSTRACT: Thyroid carcinoma is the most common malignancy in endocrine organs and has varied prognosis from almost benign to lethal with less than six months' survival. It is important for pathologists to recognize the moderate-risk and high-risk thyroid carcinomas because under-or over-diagnosis of these carcinomas may create serious problems in the clinical management of patients. Patients with moderate-risk or high-risk thyroid carcinoma are candidates for more aggressive treatments, such as total thyroidectomy with neck dissection followed by radioactive iodine ablation, differing from lobectomy alone for patients with benign, borderline, or low-risk thyroid carcinoma at an early stage. This review explains diagnostic histopathologic features and prognostic implications of moderate-risk and high-risk thyroid carcinomas of follicular cell origin. The moderate-risk and high-risk thyroid carcinomas are not a single disease entity but a group of carcinomas that have an aggressive clinical course between well differentiated and undifferentiated carcinomas. They are aggressive variants of papillary thyroid carcinoma, angioinvasive follicular thyroid carcinoma and well differentiated thyroid carcinoma with distant metastasis in addition to poorly differentiated carcinoma and well differentiated thyroid carcinoma with minor anaplastic component.


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