Comparison Of The Clinicopathological Features And Oncologic Outcomes Of The Classic Papillary Thyroid Carcinoma With Tall Cell Features And Tall Cell Variant
Kwangsoon Kim1^, Chan Kwon Jung2^, Dong-Jun Lim3^, Ja Seong Bae1^, Jeong Soo Kim1^
1 Department of Surgery, College of Medicine , The Catholic University of Korea , Department of Hospital Pathology, College of Medicine , The Catholic University of Korea , Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine , The Catholic University of Korea , , Korea
Contributions: Conception and design: JS Bae Administrative support: CK Jung, DJ Lim, JS Kim Provision of study materials or patients: K Kim, JS Bae, JS Kim Collection and assembly of data: K Kim, CK Jung, JS Bae Data analysis and interpretation: K Kim, JS Bae Manuscript writing: All authors Final approval of manuscript: All authors.
^ORCID: Kwangsoon Kim, 0000-0001-6403-6035 Chan Kwon Jung, 0000-0001-6843-3708 Dong-Jun Lim, 0000-0003-0995-6482 Ja Seong Bae, 0000-0002-6271-2105 Jeong Soo Kim, 0000-0002-9982-7838.
Background: The tall cell variant of papillary thyroid carcinoma is the most common aggressive variant of PTC. Classic PTC with tall cell features is defined as PTC with noticeable tall cells but the percentage of these cells is lower than that required for the diagnosis of TCVPTC. We aimed to investigate the potential differences between TCVPTC and classic PTC with TCF with respect to clinicopathological characteristics and oncologic outcomes.
Keywords: Tall cell features tall cell variant papillary thyroid carcinoma disease-free survival
How Is Thyroid Cancer Staged
Staging for thyroid cancer is based on:
- The size of your tumor seen on imaging tests and what is found after surgery.
- Surgery to test if your lymph nodes have cancer cells.
- Any evidence of spread to other organs .
- Your age is also considered in staging.
The staging system is very complex. Below is a summary of the staging. Talk to your provider about the stage of your cancer.
Differentiated thyroid cancer
People who are younger than 55 years old and do not have distant spread are always considered Stage I. All patients who are younger than 55 years old and have distant spread of the cancer are considered Stage II. Staging for people of all ages is listed below:
- Younger than 55: . The cancer is any size and might or might not have spread to nearby lymph nodes . It has not spread to distant sites .
- : The cancer is no larger than 2cm wide and is confined to the thyroid OR
- : The cancer is larger than 2cm wide but no larger than 4cm and is confined to the thyroid . It has not spread to nearby lymph nodes or to distant sites .
- Older than 55: : The cancer is any size and has grown beyond the thyroid gland into nearby tissues of the neck, like the larynx , trachea , esophagus , or the nerve to the larynx .
- Older than 55: : The cancer is any size and has grown beyond the thyroid gland back toward the spine or into nearby large blood vessels . It may or may not have spread to nearby lymph nodes . It has not spread to distant sites .
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for thyroid cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign the cancer has spread outside of the thyroid.
- Regional: The cancer has spread outside of the thyroid to nearby structures.
- Distant: The cancer has spread to distant parts of the body, such as the bones.
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Prognostic Outcomes Of Tall Cell Variant Papillary Thyroid Cancer: A Meta
Objective. To evaluate the prognosis of tall cell variant compared to usual variant papillary thyroid cancer by comparing disease-related mortality and recurrence data from published studies. Methods. Ovid MEDLINE keyword search using tall cell variant papillary thyroid cancer was used to identify studies published in English that calculated disease-related mortality and recurrence rates for both TCV and UV. Results. A total of 131 cases of tall cell variant papillary thyroid cancer were reviewed. The combined odds ratio of recurrence for TCV compared to UV is 4.50 with a 95% confidence interval from 2.90 to 6.99. For disease-related mortality, the combined odds ratio for TCV was compared to UV of 14.28 with a 95% confidence interval from 8.01 to 25.46. . Currently published data suggests that TCV is a negative prognostic indicator in papillary thyroid cancer and requires aggressive therapy. This meta-analysis provides the largest prognostic data series on TCV in the literature and clearly identifies the need for accurate pathological identification of TCV and its further study as an independent prognostic factor.
W. A. Hawk and J. B. Hazard, The many appearances of papillary carcinoma of the thyroid, Cleveland Clinic Quarterly, vol. 43, no. 4, pp. 207216, 1976.
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Papillary Thyroid Cancer: Who Gets It
Papillary thyroid cancer can occur in people of all ages from early childhood to advanced ages although it is most common in people between age 30 and 50. Papillary thyroid cancer affects women more commonly than men, and it is most common in young women. Thyroid cancer is now the fifth most common malignancy among women in the United States. Since it can occur at any age, everybody should be aware of any changes in their thyroid gland and make sure their doctor feels the thyroid gland when getting a routine check-up. For more details on who gets papillary thyroid cancer, the increasing incidence, and ages of patients affected, go to our page on the Incidence of Papillary Thyroid Cancer.
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Case Report: A Papillary Thyroid Microcarcinoma Patient With Skip Lymph Node Metastasis And Multiple Distant Metastasis
- 1Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- 2Xiangya Nursing School, Central South University, Changsha, China
- 3Department of General Surgery, Huaihua Second Peoples Hospital, Huaihua, China
Papillary thyroid carcinoma is the most common type of thyroid cancer. Papillary thyroid microcarcinoma is defined as PTC with a diameter less than 1 centimeter. Most lymph nodes of PTC patients have metastasized to the central neck, and a few lymph nodes have metastasized to the lateral neck. Skip lymph node metastasis, that is, lateral cervical lymph node metastasis without central lymph node metastasis, is even less common. Additionally, distant metastasis of PTMC is also rare, mainly occurring in the lung and bone. Here, we reported a case of PTMC patient with skip lymph node metastasis and multiple distant metastasis. The patient presented with a huge shoulder mass and the primary tumor was found to originate from the thyroid. However, the patient only suffered with PTMC via postoperative pathological results, and interestingly, the patient only had skip lymph node metastasis. Thus, we should focus on PTMC patients with lateral cervical lymph nodes metastasis, especially those with skip metastasis. In addition, this case provides a new perspective for us to understand of skip lymph metastasis and distant metastasis of PTMC.
Stage Information For Papillary And Follicular Thyroid Cancer
|T = primary tumor N = regional lymph node M = distant metastasis.|
|aReprinted with permission from AJCC: Thyroid–Differentiated and Anaplastic Carcinoma. In: Amin, MB, Edge Sb, Greene FL et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 87390.|
|bAll categories may be subdivided: solitary tumor and multifocal tumor .|
|Age at diagnosis is 55 years:|
|III||T4a, Any N, M0||T4a = Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve from a tumor of any size.|
|Any N = See descriptions in Table 2.|
|M0 = No distant metastasis.|
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Papillary Thyroid Cancer Quick Facts:
- Peak onset ages 30 through 50
- Females more common than males by 3 to 1 ratio
- Prognosis directly related to tumor size
- Accounts for 85% of thyroid cancers
- Can be caused by radiation or x-ray exposure
- Spread to lymph nodes of the neck present in up to 50% of cases
- Distant spread is very rare
- Overall cure rate very high
Papillary Thyroid Cancer Overview
Papillary thyroid cancer is the most common of all thyroid cancers . It can also be called papillary thyroid carcinoma since carcinoma implies a certain type of cancer. Since thyroid cancer is relatively common, and papillary thyroid cancer is the most common form of thyroid cancer, it is very likely that you will know somebody that had or has this form of cancer. Papillary thyroid cancer typically starts within the thyroid as growth, or bump on the thyroid that grows out of the otherwise normal thyroid tissue. Papillary thyroid cancer is clearly increasing in its incidence both in the United States and globally–it is one of the few cancers that are becoming more common, but we don’t know why this is happening. Our Introduction to Thyroid Cancer page has a great general overview of all types of thyroid cancer–read it if you haven’t already!
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General Information About Thyroid Cancer
In This Section
Thyroid cancer includes the following four main types:
For clinical management ofthe patient, thyroid cancer is generally divided into the following two categories:
Well-differentiated tumors are highly treatable and usually curable. Poorly differentiated and undifferentiated thyroid tumors are less common, aggressive, metastasize early, and have a poorer prognosis. Medullary thyroid cancer is a neuroendocrine cancer that has an intermediate prognosis.
Thethyroid gland may occasionally be the site of other primary tumors, includingsarcomas, lymphomas, epidermoid carcinomas, and teratomas. The thyroid may also be the siteof metastasis from other cancers, particularly of the lung, breast, and kidney.
Spectrum Of Risk Exists For Papillary Thyroid Carcinoma
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Aggressive papillary thyroid carcinoma variants appeared associated with a wide range of survival outcomes, suggesting greater emphasis should be placed on tailored treatment approaches for patients with histologically and prognostically distinct subtypes, according to study results published in JAMA Oncology.
We have empirically noted an increase in incidence of more exotic papillary thyroid carcinoma subtypes over time however, the literature on these rare variants is not as robust as we would like,Allen S. Ho, MD, director of the head and neck cancer program at Cedars-Sinai Medical Center, told Healio. For instance, some papers find diffuse sclerosing variant to be aggressive, others find it to be indolent. We furthermore saw that modern guidelines consolidate all papillary thyroid carcinoma subtypes as intermediate risk, when we were clearly seeing that they have different phenotypes. A spectrum of risk exists for thyroid cancers.
Investigators examined incidence, clinicopathologic characteristics and outcomes of 5,447 aggressive variants of papillary thyroid carcinoma identified from hospital-based and population-based U.S. cancer registries. These included 415 diffuse sclerosing variant, 3,339 tall cell variant, 362 insular variant and 1,331 poorly differentiated thyroid carcinoma cases.
Median follow-up was 51.2 months .
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Guidelines Still Recommend Total Thyroidectomy With Subsequent Rai
While lower-intensity treatment options, with a lower risk of complications, have gained favor in the treatment of low-risk papillary thyroid cancer, guidelines still recommend the consideration of total thyroidectomy and subsequent radioactive iodine ablation for intermediate-risk cancers due to the higher chance of recurrence, particularly among those with clinically positive nodes.
However, data on the superiority of a total thyroidectomy, with or without RAI, versus lobectomy is inconsistent, prompting first author Siyuan Xu, MD, of the Department of Head and Neck Surgical Oncology, National Cancer Center, Beijing, China, and colleagues to compare the risk of recurrence with the two approaches.
For the study, patients with intermediate-risk papillary thyroid cancer treated at the Chinese Academy of Medical Sciences Cancer Hospital in Beijing between January 2000 and December 2017, who had a lobectomy or total thyroidectomy, were paired 1:1 in a propensity score matching analysis.
Other than treatment type, the 265 pairs of patients were matched based on all other potential prognostic factors, including age, sex, primary tumor size, minor extrathyroidal extension, multifocality, number of lymph node metastases, and lymph node ratio.
Participants were a mean age of 37 years and 66% were female.
The primary endpoint, 5-year rate of recurrence-free survival, was also not significantly different between the lobectomy and total thyroidectomy groups .
Types Of Thyroid Cancer
There are 5 main types of thyroid cancer:
In addition, other types of cancer may start in or around the thyroid gland. For lymphoma in the thyroid, read Cancer.Nets Guide to Non-Hodgkin Lymphoma. For more information on sarcoma in the thyroid, read the Cancer.Net Guide to Sarcoma. For information on a tumor in the nearby parathyroid gland, read Cancer.Nets Guide to Parathyroid Cancer.
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Patient And Tumor Characteristics
The SEER database contained 23,189 adult patients treated with total thyroidectomy for PTC between 1988 and 2007. Of these, 10,955 cases contained data on lymph nodes and the patient and tumor features of this subset are listed in Table 1. The average age was 48.8 ± 3.6 years old, and 75.0% of patients were female as expected . Over 86% of the patients were Caucasian .
What Are The Symptoms Of Papillary Thyroid Cancer
The main sign of papillary thyroid cancer is a painless lump or nodule on your thyroid gland. PTC usually doesnt cause any other symptoms.
In rare cases, you may experience pain in your neck, jaw or ear from PTC. If the nodule is large enough to compress your windpipe or esophagus, it may cause difficulty with breathing or swallowing.
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New Uchicago Medicine Research Sheds Light On Outcomes As Cases Increase Dramatically
Thyroid cancer survivors report poor quality of life after diagnosis and treatment compared with other patients who are diagnosed with more lethal cancers, according to new research from the University of Chicago Medicine.
The findings, published Dec. 11 in the journal Thyroid, shed light on a rarely studied outcome for a growing group of patients who are expected to soon account for 10 percent of all of American cancer survivors.
Thyroid cancer patients have a nearly 98 percent five-year survival rate, according to the National Cancer Institute. More than 95 percent survive a decade, leading some to call it a good cancer. But those successful outcomes mean few thyroid cancer survivorship studies have been conducted.
UChicago Medicine researchers Briseis Aschebrook-Kilfoy, PhD, assistant research professor in epidemiology, and Raymon Grogan, MD, assistant professor of surgery, are trying to address that data gap. Together, they lead the North American Thyroid Cancer Survivorship Study .
For their most recent research, Aschebrook-Kilfoy and Grogan recruited 1,174 thyroid cancer survivors 89.9 percent female with an average age of 48 from across the U.S. and Canada. Participants were recruited through the thyroid cancer clinics at UChicago Chicago Medicine, the clinics of six other universities, as well as through thyroid cancer survivor support groups and social media.
The researchers will continue to track participants to further understand this data.
With Total Thyroidectomy Rai Can Be Given
An important argument in favor of total thyroidectomy is that with the complete resection of thyroid tissue RAI ablation can then be used for postoperative detection of residual or metastatic disease, as well as for treatment, the authors note.
Indeed, a study using the Surveillance, Epidemiology, and End Results database showed RAI ablation is associated with a 29% reduction in the risk of death in patients with intermediate-risk papillary thyroid cancer, with a hazard risk of 0.71.
However, conflicting data from Memorial Sloan-Kettering Cancer Center suggests no significant benefit with total thyroidectomy and RAI ablation.
The current study’s analysis of patients treated with RAI, though limited in size, supports the latter study’s findings, the authors note.
“When we performed further stratified analyses in patients treated with total thyroidectomy plus RAI ablation and their counterparts, no significant difference was found, which conformed with result from the whole cohort.”
“Certainly, the stratified comparison did not have enough power to examine the effect of RAI ablation on tumor recurrence subject to the limitation of sample size and case selection further study is needed on this topic,” they write.
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How Is Papillary Thyroid Cancer Diagnosed
Papillary thyroid cancer usually presents as a lump or nodule on your thyroid gland. You may notice it, or your healthcare provider may discover it during a routine neck examination. Sometimes, the nodule is discovered incidentally by imaging tests you get for other medical reasons.
Your healthcare provider will likely order the following tests to help diagnose PTC:
- Imaging tests: Your provider may order imaging tests to identify the nodule on your thyroid. These tests might include thyroid ultrasound, CT scan and/or magnetic resonance imaging .
- Fine needle aspiration : Your provider will likely want to take a small tissue sample, called a biopsy, from the nodule on your thyroid using a very thin needle. A pathologist will look at the tissue under a microscope to see if there are cancer cells and, if so, what type of thyroid cancer it is.
Your healthcare provider may also recommend genetic counseling to see if you have a genetic condition that may have caused PTC and may cause other types of tumors.