Endocrine Pathology

, Volume 16, Issue 4, pp 323–330 | Cite as

Papillary carcinoma of thyroid: A 30-yr clinicopathological review of the histological variants

Clinical Research

Abstract

Many histological variants of PTC have been described and some are known to have prognostic significance. However, their relative frequencies and associated clinicopathological features in a large cohort of patients with PTC treated at a single institution have seldom been documented. We reclassified 1035 malignant thyroid tumors treated in a 30-yr study period, into variants of PTC according to current histological criteria and analyzed their features. Six hundred and fifty two patients (153 men; 499 women) with PTC were identified. PTC accounted for 72.8% of primary thyroid cancers. Conventional papillary carcinoma (n=300) accounted for 46% of PTC and papillary microcarcinoma 27.8% (n=181). The frequencies of the common histological variants were follicular (17.6%, n=115), tall cell (4%, n=26), and diffuse sclerosing (1.8%, n=12). Uncommon histological variants including solid (n=5), diffuse follicular (n=5), papillary carcinoma with focal insular component (n=3), columnar cell (n=2), papillary carcinoma with fasciitis-like stroma (n=2), and oncocytic (n=1) were also noted. Histological variants of PTC had different age presentation, tumor size, frequencies of lymph node metastases, calcification, metaplastic bone, and psammoma bodies, when compared with conventional PTC. We conclude that a high prevalence of different variants of PTC with distinct clinico-pathological features can be documented. Recognition of these histological variants may be important for better management of patients with PTC.

Key Words

Thyroid papillary carcinoma histological variants 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lorentz TG, Lau PW, Lo CY, Law WL, Wan KY, Lauder IJ. Multivariate analysis of risk factors influencing survival in 110 ethnic Chinese with papillary thyroid cancer. World J Surg 18:547–550, 1994.PubMedCrossRefGoogle Scholar
  2. 2.
    Chan JK. Papillary carcinoma of thyroid: classical and variants. Histol Histopathol 5:241–257, 1990.PubMedGoogle Scholar
  3. 3.
    Khan AR, Abu-Eshy SA. Variants of papillary carcinoma of the thyroid: experience at Asir Central Hospital. J R Coll Surg Edinb 43:20–25, 1998.PubMedGoogle Scholar
  4. 4.
    DeLellis RA, Lloyd RV, Heitz PU, Eng C. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Endocrine Organs. Lyon: IARC (International Agency for Research on Cancer) Press, 2004.Google Scholar
  5. 5.
    Sobin LH, Wittekind CH, eds. International Union Against Cancer (UICC) TNM Classification of Malignant Tumours, 6th ed. Berlin: Springer Press, 2002.Google Scholar
  6. 6.
    Piersanti M, Ezzat S, Asa SL. Controversies in papillary microcarcinoma of the thyroid. Endocr Pathol 14:183–191, 2003.PubMedCrossRefGoogle Scholar
  7. 7.
    Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer 98:31–40, 2003.PubMedCrossRefGoogle Scholar
  8. 8.
    Lam KY, Lo CY. Papillary carcinoma with subacute thyroiditis. Endocr Pathol 13:263–265, 2002.PubMedCrossRefGoogle Scholar
  9. 9.
    Appetecchia M, Scarcello G, Pucci E, Procaccini A. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res 21:159–164, 2002.PubMedGoogle Scholar
  10. 10.
    Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13:381–387, 2003.PubMedCrossRefGoogle Scholar
  11. 11.
    Lindsay S. Carcinoma of the thyroid gland. A clinical and pathologic study of 293 patients at the University of California Hospital. Springfield, IL: Charles C. Thomas, 1960.Google Scholar
  12. 12.
    Lloyd RV, Erickson LA, Casey MB, et al. Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma. Am J Surg Pathol 28:1336–1340, 2004.PubMedCrossRefGoogle Scholar
  13. 13.
    Passler C, Prager G, Scheuba C, et al. Follicular variant of papillary thyroid carcinoma: a long-term follow-up. Arch Surg 138:1362–1366, 2003.PubMedCrossRefGoogle Scholar
  14. 14.
    Ruter A, Nishiyama R, Lennquist S. Tall-cell variant of papillary thyroid cancer: disregarded entity? World J Surg 21:15–20, 1997.PubMedCrossRefGoogle Scholar
  15. 15.
    Prendiville S, Burman KD, Ringel MD, et al. Tall cell variant: an aggressive form of papillary thyroid carcinoma. Otolaryngol Head Neck Surg 122:352–357, 2000.PubMedCrossRefGoogle Scholar
  16. 16.
    Carcangiu ML, Bianchi S. Diffuse sclerosing variant of papillary thyroid carcinoma: clini-copathological study of 15 cases. Am J Surg Pathol 13:1041–1049, 1989.PubMedCrossRefGoogle Scholar
  17. 17.
    Chow SM, Chan JK, Law SC, et al. Diffuse sclerosing variant of papillary thyroid carcinoma: clinical features and outcome. Eur J Surg Oncol 29:446–449, 2003.PubMedCrossRefGoogle Scholar
  18. 18.
    Vickery AL, Carcangiu ML, Johannessen JV, Sobrinho-Simoes M. Papillary carcinoma: session I of thyroid rumour pathology. Semin Diagn Pathol 2:90–100, 1985.PubMedGoogle Scholar
  19. 19.
    Ivanova R, Soares P, Castro P, Sobrinho-Simoes M. Diffuse (or multinodular) follicular variant of papillary thyroid carcinoma: a clinicopathological and immunohistochemical analysis of ten cases of an aggressive form of differentiated thyroid carcinoma. Virchows Arch 440:418–424, 2002.PubMedCrossRefGoogle Scholar
  20. 20.
    Gamboa-Dominguez A, Vieitez-Martinez I, Barredo-Prieto BA, et al. Macrofollicular variant of papillary thyroid carcinoma: a case and control analysis. Endocr Pathol 7:303–308, 1996.PubMedGoogle Scholar
  21. 21.
    Ashfaq R, Vuitch F, Delgado R, Albores-Saavedra J. Papillary and follicular thyroid carcinomas with an insular component. Cancer 73:416–423, 1994.PubMedCrossRefGoogle Scholar
  22. 22.
    Ferreiro JA, Hay ID, Lloyd RV. Columnar cell carcinoma of the thyroid: report of three additional cases. Hum Pathol 27:1156–1160, 1996.PubMedCrossRefGoogle Scholar
  23. 23.
    Gaertner EM, Davidson M, Wenig BM. The columnar cell variant of thyroid papillary carcinoma: case report and discussion of an unusually aggressive thyroid papillary carcinoma. Am J Surg Pathol 19:940–947, 1995.PubMedCrossRefGoogle Scholar
  24. 24.
    Nikiforov YE, Erickson LA, Nikiforova MN, Caudill CM, Lloyd RV. Solid variant of papillary thyroid carcinoma: incidence, clinical-pathologic characteristics, molecular analysis, and biologic behavior. Am J Surg Pathol 25:1478–1484, 2001.PubMedCrossRefGoogle Scholar
  25. 25.
    Acosta J, Rodriguez JM, Sola J, et al. Nodular fasciitis-type papillary thyroid carcinoma: presentation of a new case. Eur J Surg Oncol 24:80–81, 1998.PubMedCrossRefGoogle Scholar
  26. 26.
    Chan JK, Carcangiu ML, Rosai J. Papillary carcinoma of thyroid with exuberant nodular fasciitis-like stroma: report of three cases. Am J Clin Pathol 95:309–314, 1991.PubMedGoogle Scholar
  27. 27.
    Michal M, Chlumska A, Fakan F. Papillary carcinoma of thyroid with exuberant nodular fasciitis-like stroma. Histopathology 21:577–579, 1992.PubMedCrossRefGoogle Scholar
  28. 28.
    Naganuma H, Iwama N, Nakamura Y, et al. Papillary carcinoma of the thyroid gland forming a myofibroblastic nodular tumour: report of two cases and review of the literature. Pathol Int 52:54–58, 2002.PubMedCrossRefGoogle Scholar
  29. 29.
    Nair M, Kapila K, Karak AK, Verma K. Papillary carcinoma of the thyroid and its variants: a cytohistological correlation. Diagn Cytopathol 24:167–173, 2001.PubMedCrossRefGoogle Scholar
  30. 30.
    Terayama K, Toda S, Yonemitsu N, Koike N, Sugihara H. Papillary carcinoma of the thyroid with exuberant nodular fasciitis-like stroma. Virchows Arch 431:291–295, 1997.PubMedCrossRefGoogle Scholar
  31. 31.
    Toti P, Tanganelli P, Schurfeld K, et al. Scarring in papillary carcinoma of the thyroid: report of two new cases with exuberant nodular fasciitis-like stroma. Histopathology 35:418–422, 1999.PubMedCrossRefGoogle Scholar
  32. 32.
    Us-Krasovec M, Golouh R. Papillary thyroid carcinoma with exuberant nodular fasciitis-like stroma in a fine needle aspirate: a case report. Acta Cytol 43:1101–1104, 1999.PubMedGoogle Scholar
  33. 33.
    Yang YJ, LiVolsi VA, Khurana KK. Papillary thyroid carcinoma with nodular fasciitis-like stroma. Pitfalls in fine-needle aspiration cytology. Arch Pathol Lab Med 123:838–841, 1999.PubMedGoogle Scholar
  34. 34.
    Inaba M, Umemura S, Satoh H, et al. Papillary thyroid carcinoma with fibromatosis-like stroma: a report of two cases. Endocr Pathol 13:263–265, 2002.CrossRefGoogle Scholar
  35. 35.
    Baloch ZW, LiVolsi VA. Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med 124:1192–1195, 2000.PubMedGoogle Scholar
  36. 36.
    Urano M, Abe M, Kuroda M, et al. Warthin-like tumour variant of papillary thyroid carcinoma: case report and literature review. Pathol Int 51:707–712, 2001.PubMedCrossRefGoogle Scholar
  37. 37.
    Apel RL, Asa SL, LiVolsi VA. Papillary Hurthle cell carcinoma with lymphocytic stroma. “Warthin-like tumour” of the thyroid. Am J Surg Pathol 19:810–814, 1995.PubMedCrossRefGoogle Scholar
  38. 38.
    Ludvikova M, Ryska A, Korabecna M, Rydlova M, Michal M. Oncocytic papillary carcinoma with lymphoid stroma (Warthin-like tumour) of the thyroid: a distinct entity with favourable prognosis. Histopathology 39:17–24, 2001.PubMedCrossRefGoogle Scholar
  39. 39.
    Lam KY, Lo CY, Wei WI. Warthin tumor-like variant of papillary thyroid carcinoma: a case with dedifferentiation (anaplastic changes) and aggressive biological behaviour. Endo Pathol 16:83–89, 2005.CrossRefGoogle Scholar
  40. 40.
    Johannessen JV, Sobrinho-Simoes M. The origin and significance of thyroid psammoma bodies. Lab Invest 43:287–296, 1980.PubMedGoogle Scholar
  41. 41.
    Carcangiu ML, Zampi G, Rosai J. Papillary thyroid carcinoma: a study of its many morphologic expressions and clinical correlates. Pathol Ann 20:1–44, 1985.Google Scholar
  42. 42.
    Khoo ML, Asa SL, Witterick IJ, Freeman JL. Thyroid calcification and its association with thyroid carcinoma. Head Neck 24:651–655, 2002.PubMedCrossRefGoogle Scholar
  43. 43.
    Alonso N, Lucas A, Salinas I, Castella E, Sanmarti A. Frozen section in a cytological diagnosis of thyroid follicular neoplasm. Laryngoscope 113:563–566, 2003.PubMedCrossRefGoogle Scholar
  44. 44.
    Duek SD, Goldenberg D, Linn S, Krausz MM, Hershko DD. The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules. Surg Today 32:857–861, 2002.PubMedCrossRefGoogle Scholar
  45. 45.
    Mandell DL, Genden EM, Mechanick JI, Bergman DA, Biller HF, Urken ML. Diagnostic accuracy of fine-needle aspiration and frozen section in nodular thyroid disease. Otolaryngol Head Neck Surg 124:531–536, 2001.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc 2005

Authors and Affiliations

  1. 1.Discipline of Pathology, School of MedicineGriffith UniversityGold CoastAustralia
  2. 2.Department of Surgery, Faculty of MedicineUniversity of Hong KongHong Kong
  3. 3.Department of Medicine, Faculty of MedicineUniversity of Hong KongHong Kong

Personalised recommendations