Original contributionPrevalence and prognostic significance of tall cell variant of papillary thyroid carcinoma
Introduction
Papillary carcinoma is the most frequent differentiated thyroid carcinoma, representing 60% to 80% of all malignant thyroid tumors. Papillary thyroid carcinomas (PTC) are characterized by an excellent overall prognosis with long-term survival close, in some series, to that of a normal population of similar age [1], with a 5% incidence of tumor deaths [1] and a survival rate of more than 98% for young patients [2].
Within papillary carcinomas, numerous variants have been described in the last decades: follicular [3]; macrofollicular [4], [5], with lymphocytic stroma reaction [6]; pseudo-Warthin [7], [8], [9]; and clear cell [10], [11], which are considered to have the same good prognosis as the classic PTC. The prognosis of the oncocytic [12], [13] and solid or trabecular variants [11] is still subject to controversy. The diffuse sclerosing [14], diffuse follicular [15], [16], tall cell (TCV), and columnar cell variants are associated with a less favorable outcome.
Although TCV was first described in 1976 by Hawk and Hazard [17]; it is still an underrecognized entity [18].The same applies for the seldom-occurring and recently described columnar cell carcinoma [19], which is sometimes difficult to differentiate from tall cell carcinoma with some mixed tall/columnar cell carcinomas [20], [21]. There is a consensus in the literature that TCV and columnar cell carcinoma, in particular, the columnar cell variant, are clinically more aggressive. This poor prognosis has initially been ascribed to the histologic subtype, and hence, some authors emphasized the urgent need to properly diagnose these rarely occurring tumors to provide the most appropriate therapy [18].
The largest study published to date [22], challenged this prevailing opinion concerning the columnar cell variant, showing that the prognosis was related not to the histologic subtype but to the stage. Concerning the TCV, the literature is rather poor and confusing because some authors did not consider the stage, which is a prominent prognostic factor. Nonetheless, a recent study comparing different subtypes of PTC [23] concluded that not histologic subtype per se but histologic grade along with mitotic activity are the significant factors explaining the different prognosis.
The purpose of this retrospective study was to compare the clinicopathologic data, prevalence, and long-term outcome of patients with tall cell or columnar cell carcinomas with those of patients with conventional forms (CFs) of papillary carcinomas. Another aim was to consider the grade as described by Akslen [23] and the “Metasasis, Age, Completeness, Invasion, Size” (MACIS) classification, which is a prognostic scoring system coined at the Mayo Clinic [24].
Section snippets
Materials and methods
In 1996, both a prospective and retrospective study of all thyroid cancers originating from follicular cells was launched in the région de Basse Normandie, thanks to a computerized search of the files of the cancer registry and of the files of the pathology departments of the 2 hospitals involved in this study (University Hospital and the François Baclesse Comprehensive Cancer Center in Caen, Calvados, France), which allowed us to identify all patients with a diagnosis of thyroid carcinoma from
Results
Overall, the database included 945 patients; the slides of 778 (82.3%) were reviewed; 674 (85%) had papillary carcinoma, with 503 of the CFs and 171 of the other variants—tall or columnar cells (56 cases), oncocytic (24 cases), pseudo-Warthin (16 cases), solid (67 cases), diffuse sclerosing (5 cases), and 2 cases of macrofollicular and 1 of clear cell variant. The TCV included 3 columnar cell carcinomas (Fig. 4) and 1 which was a mixed tumor with a major component of tall cells and a minor
Discussion
Overall, PTC has an excellent prognosis. Poor prognostic factors include age (>50 years), male sex, increased tumor size, lack of encapsulation, extrathyroidal extension, multicentricity, and distant metastases at presentation [1], [11], [23], [36], [37]. For some authors, a lymphocytic stroma reaction is associated with an improved prognosis [6], [32].
Some histologic patterns of papillary carcinoma have been linked to an aggressive behavior: TCV [11], [27], [35] (in patients older than 50
Acknowledgments
The authors thank following physicians who participated in this study: from the Centre Hospitalier Universitaire of Caen—E Babin, Valdazo (Department of Head and Neck Surgery), J Mahoudeau (Endocrinology Department), G Samama (Thoracic Surgery), F Galateau-Salle (Pathology Department); from the Centre François Baclesse of Caen—JP Rame, D De Raucourt (Head and Neck Surgery); and pathologists J Jehan, B Gallet, F Petit, D Panthou, E Anger, MC Besnard-Bernadac, P Raffy, B Léguéné, H Elie, Y
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