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Endocrine Pathology
Published in: Endocrine Pathology 4/2018

01-12-2018

Clinically Relevant Prognostic Parameters in Differentiated Thyroid Carcinoma

Authors: Tyler Janovitz, Justine A. Barletta

Published in: Endocrine Pathology | Issue 4/2018

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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.
Literature
1.
Fagin JA, Wells SA Biologic and clinical perspectives on thyroid cancer. The New England journal of medicine 375: 1054–1067, 2016.CrossRef
2.
Grogan RH, Kaplan SP, Cao H et al. A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up. Surgery 154: 1436–1446 discussion 1446–1437, 2013.CrossRef
3.
Haugen BR, Alexander EK, Bible KC et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA, 2016; 1–133.
4.
Hawk WA, Hazard JB The many appearances of papillary carcinoma of the thyroid. Cleveland Clinic quarterly 43: 207–215, 1976.CrossRef
5.
Wang X, Cheng W, Liu C, Li J Tall cell variant of papillary thyroid carcinoma: current evidence on clinicopathologic features and molecular biology. Oncotarget 7: 40792–40799, 2016.PubMedPubMedCentral
6.
Ghossein RA, Leboeuf R, Patel KN et al. Tall cell variant of papillary thyroid carcinoma without extrathyroid extension: biologic behavior and clinical implications. Thyroid : official journal of the American Thyroid Association 17: 655–661, 2007.CrossRef
7.
Morris LGT, Shaha AR, Tuttle RM, Sikora AG, Ganly I Tall-cell variant of papillary thyroid carcinoma: a matched-pair analysis of survival. Thyroid : official journal of the American Thyroid Association 20: 153–158, 2010.CrossRef
8.
Kazaure HS, Roman SA, Sosa JA Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients. Annals of Surgical Oncology 19: 1874–1880, 2012.CrossRef
9.
Ito Y, Hirokawa M, Fukushima M et al. Prevalence and prognostic significance of poor differentiation and tall cell variant in papillary carcinoma in Japan. World Journal Of Surgery 32: 1535–1543 discussion 1544–1535, 2008.CrossRef
10.
Network CGAR Integrated genomic characterization of papillary thyroid carcinoma. Cell 159: 676–690, 2014.CrossRef
11.
Adeniran AJ, Zhu Z, Gandhi M et al. Correlation between genetic alterations and microscopic features, clinical manifestations, and prognostic characteristics of thyroid papillary carcinomas. The American journal of surgical pathology 30: 216–222, 2006.CrossRef
12.
Liu X, Bishop J, Shan Y et al. Highly prevalent TERT promoter mutations in aggressive thyroid cancers. Endocrine-related cancer 20: 603–610, 2013.CrossRef
13.
Liu R, Bishop J, Zhu G, Zhang T, Ladenson PW, Xing M Mortality risk stratification by combining BRAF V600E and TERT promoter mutations in papillary thyroid cancer: genetic duet of BRAF and TERT promoter mutations in thyroid cancer mortality. JAMA oncology 3: 202–208, 2016.CrossRef
14.
van den Brekel MW, Hekkenberg RJ, Asa SL, Tomlinson G, Rosen IB, Freeman JL Prognostic features in tall cell papillary carcinoma and insular thyroid carcinoma. The Laryngoscope 107: 254–259, 1997.CrossRef
15.
Ganly I, Ibrahimpasic T, Rivera M et al. Prognostic implications of papillary thyroid carcinoma with tall-cell features. Thyroid : official journal of the American Thyroid Association 24: 662–670, 2014.CrossRef
16.
Gopal PP, Montone KT, Baloch Z, Tuluc M, LiVolsi V The variable presentations of anaplastic spindle cell squamous carcinoma associated with tall cell variant of papillary thyroid carcinoma. Thyroid : official journal of the American Thyroid Association 21: 493–499, 2011.CrossRef
17.
Bishop JA, Sharma R, Westra WH PAX8 immunostaining of anaplastic thyroid carcinoma: a reliable means of discerning thyroid origin for undifferentiated tumors of the head and neck. Human pathology 42: 1873–1877, 2011.CrossRef
18.
Rivera M, Ghossein RA, Schoder H, Gomez D, Larson SM, Tuttle RM Histopathologic characterization of radioactive iodine-refractory fluorodeoxyglucose-positron emission tomography-positive thyroid carcinoma. Cancer 113: 48–56, 2008.CrossRef
19.
Ghossein R, Livolsi VA Papillary thyroid carcinoma tall cell variant. Thyroid : official journal of the American Thyroid Association 18: 1179–1181, 2008.CrossRef
20.
DeLellis RA, Lloyd R, Heitz PU, Eng C World Health Organization Classification of Tumours: Pathology and Genetics Tumours of Endocrine Organs, 2004.
21.
Lloyd RV, Osamura R, Kloppel G, Rosai J WHO Classification of Tumours of Endocrine Organs, 2017.
22.
Beninato T, Scognamiglio T, Kleiman DA et al. Ten percent tall cells confer the aggressive features of the tall cell variant of papillary thyroid carcinoma. Surgery 154: 1331–1336 discussion 1336, 2013.CrossRef
23.
Dettmer MS, Schmitt A, Steinert H et al. Tall cell papillary thyroid carcinoma: new diagnostic criteria and mutations in BRAF and TERT. Endocrine-related cancer 22: 419–429, 2015.CrossRef
24.
Oh WJ, Lee YS, Cho U et al. Classic papillary thyroid carcinoma with tall cell features and tall cell variant have similar clinicopathologic features. Korean journal of pathology 48: 201–208, 2014.CrossRef
25.
Hernandez-Prera JC, Machado RA, Asa SL et al. Pathologic reporting of tall-cell variant of papillary thyroid cancer: have we reached a consensus? Thyroid : official journal of the American Thyroid Association 27: 1498–1504, 2017.CrossRef
26.
Asioli S, Erickson LA, Righi A, Lloyd RV Papillary thyroid carcinoma with hobnail features: histopathologic criteria to predict aggressive behavior. Human pathology 44: 320–328, 2013.CrossRef
27.
Asioli S, Erickson LA, Sebo TJ et al. Papillary thyroid carcinoma with prominent hobnail features: a new aggressive variant of moderately differentiated papillary carcinoma. A clinicopathologic, immunohistochemical, and molecular study of eight cases. The American journal of surgical pathology 34: 44–52, 2010.CrossRef
28.
Ambrosi F, Righi A, Ricci C, Erickson LA, Lloyd RV, Asioli S Hobnail variant of papillary thyroid carcinoma: a literature review. Endocrine Pathology 28: 293–301, 2017.CrossRef
29.
Saltman B, Singh B, Hedvat CV, Wreesmann VB, Ghossein R Patterns of expression of cell cycle/apoptosis genes along the spectrum of thyroid carcinoma progression. Surgery 140: 899–905 discussion 905–896, 2006.CrossRef
30.
Amacher AM, Goyal B, Lewis JS, El-Mofty SK, Chernock RD Prevalence of a hobnail pattern in papillary, poorly differentiated, and anaplastic thyroid carcinoma: a possible manifestation of high-grade transformation. The American journal of surgical pathology 39: 260–265, 2015.CrossRef
31.
Cameselle-Teijeiro JM, Rodríguez-Pérez I, Celestino R et al. Hobnail variant of papillary thyroid carcinoma: clinicopathologic and molecular evidence of progression to undifferentiated carcinoma in 2 cases. The American journal of surgical pathology 41: 854–860, 2017.CrossRef
32.
Lubitz CC, Economopoulos KP, Pawlak AC et al. Hobnail variant of papillary thyroid carcinoma: an institutional case series and molecular profile. Thyroid : official journal of the American Thyroid Association 24: 958–965, 2014.CrossRef
33.
Morandi L, Righi A, Maletta F et al. Somatic mutation profiling of hobnail variant of papillary thyroid carcinoma. Endocrine-related cancer 24: 107–117, 2017.CrossRef
34.
Teng L, Deng W, Lu J et al. Hobnail variant of papillary thyroid carcinoma: molecular profiling and comparison to classical papillary thyroid carcinoma, poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma. Oncotarget 8: 22023–22033, 2017.PubMedPubMedCentral
35.
Watutantrige-Fernando S, Vianello F, Barollo S et al. The hobnail variant of papillary thyroid carcinoma: clinical/molecular characteristics of a large monocentric series and comparison with conventional histotypes. Thyroid: official journal of the American Thyroid Association 28: 96–103, 2018.CrossRef
36.
Evans HL Columnar-cell carcinoma of the thyroid. A report of two cases of an aggressive variant of thyroid carcinoma. American journal of clinical pathology 85: 77–80, 1986.CrossRef
37.
Ferreiro JA, Hay ID, Lloyd RV Columnar cell carcinoma of the thyroid: report of three additional cases. Human pathology 27: 1156–1160, 1996.CrossRef
38.
Evans HL Encapsulated columnar-cell neoplasms of the thyroid. A report of four cases suggesting a favorable prognosis. The American journal of surgical pathology 20: 1205–1211, 1996.CrossRef
39.
Wenig BM, Thompson LD, Adair CF, Shmookler B, Heffess CS Thyroid papillary carcinoma of columnar cell type: a clinicopathologic study of 16 cases. Cancer 82: 740–753, 1998.CrossRef
40.
Bongiovanni M, Mermod M, Canberk S et al. Columnar cell variant of papillary thyroid carcinoma: Cytomorphological characteristics of 11 cases with histological correlation and literature review. Cancer cytopathology 125: 389–397, 2017.CrossRef
41.
Sujoy V, Pinto A, Nosé V Columnar cell variant of papillary thyroid carcinoma: a study of 10 cases with emphasis on CDX2 expression. Thyroid : official journal of the American Thyroid Association 23: 714–719, 2013.CrossRef
42.
Enriquez ML, Baloch ZW, Montone KT, Zhang PJ, Livolsi VA CDX2 expression in columnar cell variant of papillary thyroid carcinoma. American journal of clinical pathology 137: 722–726, 2012.CrossRef
43.
Chen J-H, Faquin WC, Lloyd RV, Nosé V Clinicopathological and molecular characterization of nine cases of columnar cell variant of papillary thyroid carcinoma. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 24: 739–749, 2011.CrossRef
44.
Rosai J, DeLellis RA, Carcangiu ML, Frable WJ, Tallini G AFIP Atlas of Tumor Pathology: Tumors of the Thyroid and Parathyroid Glands, 2016.
45.
Mete O, Asa SL Pathological definition and clinical significance of vascular invasion in thyroid carcinomas of follicular epithelial derivation. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 24: 1545–1552, 2011.CrossRef
46.
D’Avanzo A, Treseler P, Ituarte PHG et al. Follicular thyroid carcinoma: histology and prognosis. Cancer 100: 1123–1129, 2004.CrossRef
47.
O’Neill CJ, Vaughan L, Learoyd DL, Sidhu SB, Delbridge LW, Sywak MS Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 37: 181–185, 2011.CrossRef
48.
Xu B, Wang L, Tuttle RM, Ganly I, Ghossein R Prognostic impact of extent of vascular invasion in low-grade encapsulated follicular cell-derived thyroid carcinomas: a clinicopathologic study of 276 cases. Human pathology 46: 1789–1798, 2015.CrossRef
49.
Lang W, Choritz H, Hundeshagen H Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings. The American journal of surgical pathology 10: 246–255, 1986.CrossRef
50.
Ito Y, Hirokawa M, Masuoka H et al. Prognostic factors of minimally invasive follicular thyroid carcinoma: extensive vascular invasion significantly affects patient prognosis. Endocrine journal 60: 637–642, 2013.CrossRef
51.
Kiernan CM, Solórzano CC Bethesda Category III, IV, and V thyroid nodules: can nodule size help predict malignancy? Journal of the American College of Surgeons 225: 77–82, 2017.CrossRef
52.
Haigh PI, Urbach DR The treatment and prognosis of Hürthle cell follicular thyroid carcinoma compared with its non-Hürthle cell counterpart. Surgery 138: 1152–1157 discussion 1157–1158, 2005.CrossRef
53.
Hundahl SA, Fleming ID, Fremgen AM, Menck HR A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer 83: 2638–2648, 1998.CrossRef
54.
Samaan NA, Maheshwari YK, Nader S et al. Impact of therapy for differentiated carcinoma of the thyroid: an analysis of 706 cases. The Journal of clinical endocrinology and metabolism 56: 1131–1138, 1983.CrossRef
55.
Sugino K, Kameyama K, Ito K et al. Does Hürthle cell carcinoma of the thyroid have a poorer prognosis than ordinary follicular thyroid carcinoma? Annals of surgical oncology 20: 2944–2950, 2013.CrossRef
56.
Goffredo P, Roman SA, Sosa JA Hurthle cell carcinoma: a population-level analysis of 3311 patients. Cancer 119: 504–511, 2013.CrossRef
57.
Petric R, Gazic B, Besic N Prognostic factors for disease-specific survival in 108 patients with Hürthle cell thyroid carcinoma: a single-institution experience. BMC cancer 14: 777, 2014.CrossRef
58.
Ghossein RA, Hiltzik DH, Carlson DL et al. Prognostic factors of recurrence in encapsulated Hurthle cell carcinoma of the thyroid gland: a clinicopathologic study of 50 cases. Cancer 106: 1669–1676, 2006.CrossRef
59.
Bishop JA, Wu G, Tufano RP, Westra WH Histological patterns of locoregional recurrence in Hürthle cell carcinoma of the thyroid gland. Thyroid : official journal of the American Thyroid Association 22: 690–694, 2012.CrossRef
60.
Lopez-Penabad L, Chiu AC, Hoff AO et al. Prognostic factors in patients with Hürthle cell neoplasms of the thyroid. Cancer 97: 1186–1194, 2003.CrossRef
61.
Chindris A-M, Casler JD, Bernet VJ et al. Clinical and molecular features of Hürthle cell carcinoma of the thyroid. The Journal of clinical endocrinology and metabolism 100: 55–62, 2015.CrossRef
62.
Ganly I, Ricarte Filho J, Eng S et al. Genomic dissection of Hurthle cell carcinoma reveals a unique class of thyroid malignancy. The Journal of clinical endocrinology and metabolism 98: E962–E972, 2013.CrossRef
63.
Evangelisti C, de Biase D, Kurelac I et al. A mutation screening of oncogenes, tumor suppressor gene TP53 and nuclear encoded mitochondrial complex I genes in oncocytic thyroid tumors. BMC cancer 15: 157, 2015.CrossRef
64.
Wei S, Livolsi VA, Montone KT, Morrissette JJD, Baloch ZW PTEN and TP53 mutations in oncocytic follicular carcinoma. Endocrine pathology 26: 365–369, 2015.CrossRef
65.
Landa I, Ganly I, Chan TA et al. Frequent somatic TERT promoter mutations in thyroid cancer: higher prevalence in advanced forms of the disease. The Journal of clinical endocrinology and metabolism 98: E1562–E1566, 2013.CrossRef
66.
Kasaian K, Chindris A-M, Wiseman SM et al. MEN1 mutations in Hürthle cell (oncocytic) thyroid carcinoma. The Journal of clinical endocrinology and metabolism 100: E611–E615, 2015.CrossRef
67.
Máximo V, Botelho T, Capela J et al. Somatic and germline mutation in GRIM-19, a dual function gene involved in mitochondrial metabolism and cell death, is linked to mitochondrion-rich (Hurthle cell) tumours of the thyroid. British journal of cancer 92: 1892–1898, 2005.CrossRef
68.
Máximo V, Soares P, Lima J, Cameselle-Teijeiro J, Sobrinho-Simões M Mitochondrial DNA somatic mutations (point mutations and large deletions) and mitochondrial DNA variants in human thyroid pathology: a study with emphasis on Hürthle cell tumors. The American journal of pathology 160: 1857–1865, 2002.CrossRef
Metadata
Title
Clinically Relevant Prognostic Parameters in Differentiated Thyroid Carcinoma
Authors
Tyler Janovitz
Justine A. Barletta
Publication date
01-12-2018
Publisher
Springer US
Published in
Endocrine Pathology / Issue 4/2018
Print ISSN: 1046-3976
Electronic ISSN: 1559-0097
DOI
https://doi.org/10.1007/s12022-018-9548-1

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