Advertisement

Endocrine Pathology

, Volume 28, Issue 2, pp 177–185 | Cite as

Metastatic Follicular Thyroid Carcinoma and the Primary Thyroid Gross Examination: Institutional Review of Cases from 1990 to 2015

  • Krzysztof Glomski
  • Vania Nosé
  • William C. Faquin
  • Peter M. Sadow
Article

Abstract

The diagnosis of follicular-patterned carcinomas, including follicular thyroid carcinoma, oncocytic (Hürthle cell) carcinoma, and the encapsulated follicular variant of papillary thyroid carcinoma, requires evidence of capsular and/or vascular invasion. With minimally invasive carcinomas classified often within less than a millimeter of tissue segregating them from adenomas and non-invasive follicular thyroid neoplasms with papillary-like nuclear features, opinions vary internationally over how much of the capsule to submit in order to deem it well enough represented, considering that even if grossly entirely submitted in microcassettes, without leveling through each tissue block, the capsule is truly never entirely examined microscopically. Here, we retrospectively examine submission practices and outcomes at a single, high-volume institution over a 25-year period. Our results indicate that the vast majority of lesions with poor outcomes are those with wide invasion, and tumors lacking gross evidence of capsular perturbation rarely lead to recurrence or metastasis, an unsurprising result that should prompt re-evaluation of our grossing methods and approach to follicular-patterned tumors in a time of cost restraint, molecular diagnostics, and low biological potential of encapsulated, circumscribed neoplasia of the thyroid.

Keywords

Follicular thyroid carcinoma Capsule Capsular invasion 

References

  1. 1.
    Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140(4):317–322.CrossRefPubMedGoogle Scholar
  2. 2.
    De Crea C, Raffaelli M, Sessa L, et al. Actual incidence and clinical behaviour of follicular thyroid carcinoma: an institutional experience. ScientificWorldJournal 2014;2014:952095.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Seethala RR, Asa SL, Carty SE, et al. College of American Pathologists (CAP) protocol for examination of specimens from patients with carcinomas of the thyroid gland. Jan;2016 http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-thyroid-16protocol-3200.pdf
  4. 4.
    Baloch ZW, LiVolsi VA. Our approach to follicular-patterned lesions of the thyroid. J Clin Pathol 2007;60(3):244–250.CrossRefPubMedGoogle Scholar
  5. 5.
    DeLellis RA, Lloyd RV, Heitz PU and Eng C., eds. In: World Health Organization Classification of Tumours: Pathology & Genetics Tumours of Endocrine Organs. Third Edition. IARC Press: Lyon, 2004.Google Scholar
  6. 6.
    Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology II. Acta Cytol 2016;60(5):397–398.CrossRefPubMedGoogle Scholar
  7. 7.
    O’Neill CJ, Vaughan L, Learoyd DL, et al. Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion. Eur J Surg Oncol 2011;37(2):181–185.CrossRefPubMedGoogle Scholar
  8. 8.
    Sugino K, Kameyama K, Ito K, et al. Outcomes and prognostic factors of 251 patients with minimally invasive follicular thyroid carcinoma. Thyroid 2012;22(8):798–804.CrossRefPubMedGoogle Scholar
  9. 9.
    Podda M, Saba A, Porru F, et al. Follicular thyroid carcinoma: differences in clinical relevance between minimally invasive and widely invasive tumors. World J Surg Oncol 2015;13:193.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Faquin WC. The thyroid gland: recurring problems in histologic and cytologic evaluation. Arch Pathol Lab Med 2008;132(4):622–632.PubMedGoogle Scholar
  11. 11.
    Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol 2016;2(8):1023–1029.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Franc B, de la Salmonière P, Lange F, et al. Interobserver and intraobserver reproducibility in the histopathology of follicular thyroid carcinoma. Hum Pathol 2003;34(11):1092–1100.CrossRefPubMedGoogle Scholar
  13. 13.
    Nikiforov, YE. Molecular diagnostics of thyroid tumors. Arch Pathol Lab Med 2011;135(5):569–577.PubMedGoogle Scholar
  14. 14.
    Xing M. Molecular pathogenesis and mechanisms of thyroid cancer. Nat Rev Cancer 2013;13(3):184–199.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Agrawal N, Akbani R, Aksoy BA, for the Cancer Genome Atlas Research Network.et al. Integrated genomic characterization of papillary thyroid carcinoma. Cell 2014;159(3):676–690.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Lang W, Georgii A, Stauch G, Kienzle E. The differentiation of atypical adenomas and encapsulated follicular carcinomas in the thyroid gland. Virchows Arch A Pathol Anat Histol 1980;385(2):125–141.CrossRefPubMedGoogle Scholar
  17. 17.
    Schmid KW, Tötsch M, Ofner D, et al. Minimally invasive follicular thyroid carcinoma: a clinico-pathological study. Curr Top Pathol 1997;91:37–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Thompson LD, Wieneke JA, Paal E, et al. A clinicopathologic study of minimally invasive follicular carcinoma of the thyroid gland with a review of the English literature. Cancer 2001;91(3):505–524.CrossRefPubMedGoogle Scholar
  19. 19.
    LiVolsi VA Follicular lesions of the thyroid. In: Surgical Pathology of the Thyroid. Major Problems in Pathology, Vol 22. 1990. Saunders, Philadelphia, pp 173–212.Google Scholar
  20. 20.
    Nosé V, Asa SL, Erickson L, et al. Diagnostic Pathology: Endocrine. Salt Lake City, Utah: Amirsys, 2012.Google Scholar
  21. 21.
    Yamashina M. Follicular neoplasms of the thyroid. Total circumferential evaluation of the fibrous capsule. Am J Surg Pathol 1992;16(4):392–400.CrossRefPubMedGoogle Scholar
  22. 22.
    Howitt BE, Jia Y, Sholl LM, Barletta JA. Molecular alterations in partially-encapsulated or well-circumscribed follicular variant of papillary thyroid carcinoma. Thyroid 2013;23(10):1256–1262.CrossRefPubMedGoogle Scholar
  23. 23.
    Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98(2):564–570.CrossRefPubMedGoogle Scholar
  24. 24.
    Xu B, Wang L, Tuttle RM, et al. Prognostic impact of extent of vascular invasion in low-grade encapsulated follicular cell-derived thyroid carcinomas: a clinicopathologic study of 276 cases. Hum Pathol 2015;46(12):1789–1798.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ganly I, Wang L, Tuttle RM, Katabi N, et al. Invasion rather than nuclear features correlates with outcome in encapsulated follicular tumors: further evidence for the reclassification of the encapsulated papillary thyroid carcinoma follicular variant. Hum Pathol 2015;46(5):657–664.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Xu B, Ghossein R. Encapsulated thyroid carcinoma of follicular cell origin. Endocr Pathol 2015;26(3):191–199.CrossRefPubMedGoogle Scholar
  27. 27.
    Mete O, Asa SL. Pathological definition and clinical significance of vascular invasion in thyroid carcinomas of follicular epithelial derivation. Mod Pathol 2011;24(12):1545–1552.CrossRefPubMedGoogle Scholar
  28. 28.
    Alexander EK, Kennedy GC, Baloch ZW, et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med 2012;367(8):705–715.CrossRefPubMedGoogle Scholar
  29. 29.
    Faquin WC. Can a gene-expression classifier with high negative predictive value solve the indeterminate thyroid fine-needle aspiration dilemma? CancerCytopathol 2013;121(3):116–119.Google Scholar
  30. 30.
    Alexander EK, Schorr M, Klopper J, et al. Multicenter clinical experience with the Afirma gene expression classifier. J Clin Endocrinol Metab 2014;99(1):119–125.CrossRefPubMedGoogle Scholar
  31. 31.
    Parangi S, Suh H. The role of genetic markers in the evaluation and management of thyroid nodules. Surg Clin North Am 2014;94(3):515–528.CrossRefPubMedGoogle Scholar
  32. 32.
    Krane JF. Lessons from early clinical experience with the Afirma gene expression classifier. Cancer Cytopathol 2014;122(10):715–719.CrossRefPubMedGoogle Scholar
  33. 33.
    Xing M, Haugen BR, Schlumberger M. Progress in molecular-based management of differentiated thyroid cancer. Lancet 2013;381(9871):1058–1069.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Valderrabano P, Zota VE, McIver B, et al. Molecular assays in cytopathology for thyroid cancer. Cancer Control 2015;22(2):152–157.CrossRefPubMedGoogle Scholar
  35. 35.
    Beaudenon-Huibregtse S, Alexander EK, Guttler RB, et al. Centralized molecular testing for oncogenic gene mutations complements the local cytopathologic diagnosis of thyroid nodules. Thyroid 2014;24(10):1479–1487.CrossRefPubMedGoogle Scholar
  36. 36.
    Nikiforov YE, Carty SE, Chiosea SI, et al. Impact of the multi-gene ThyroSeq next-generation sequencing assay on cancer diagnosis in thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance cytology. Thyroid 2015;25(11):1217–1223.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Krane JF, Alexander EK, Cibas ES, Barletta JA. Coming to terms with NIFTP: a provisional approach for cytologists. Cancer. 2016:124(11):767–772Google Scholar
  38. 38.
    Strickland KC, Vivero M, Jo VY, et al. Preoperative cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a prospective analysis. Thyroid 2016;26(10):1466–1471.CrossRefPubMedGoogle Scholar
  39. 39.
    Asa SL, Giordano TJ, LiVolsi VA. Implications of the TCGA genomic characterization of papillary thyroid carcinoma for thyroid pathology: does follicular variant papillary thyroid carcinoma exist? Thyroid 2015;25(1):1–2.CrossRefPubMedGoogle Scholar
  40. 40.
    Zhao L, Dias-Santagata D, Sadow PM, Faquin WC. Cytological, molecular and clinical features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features versus invasive forms of follicular variant of papillary thyroid carcinoma. Cancer Cytopathol. 2017 In Press.Google Scholar
  41. 41.
    Thompson LD. Thyroid gland follicular carcinoma. Ear Nose Throat J 2015;94(3):100–102.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Krzysztof Glomski
    • 1
    • 2
  • Vania Nosé
    • 1
    • 2
  • William C. Faquin
    • 1
    • 2
    • 3
  • Peter M. Sadow
    • 1
    • 2
    • 3
  1. 1.Pathology Service, WRN219Massachusetts General HospitalBostonUSA
  2. 2.Department of PathologyHarvard Medical SchoolBostonUSA
  3. 3.Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonUSA

Personalised recommendations