Differentiated carcinoma of the thyroid with extrathyroidal extension

Andersen, Peter E.; Kinsella, John; Loree, Thom R.; Shaha, Ashok R.; Shah, Jatin P.

doi:10.1016/s0002-9610(99)80331-6

Cited by 233 publications

(147 citation statements)

References 8 publications

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“…In the majority of cases, well-differentiated carcinomas respond well to RAI, and overall younger patients have better long-term outcomes compared with older patients when matched for tumor size. 14 Unfortunately, there appears to be no way to predict the behavior in these rare, well-differentiated RAIR tumors by morphology because extrathyroidal extension is not considered to be predictive of a poor response to RAI in young people. In such cases, the tumors may have an inability to concentrate iodine or may have a genetic profile that is similar to PDTC without demonstrating the classic phenotype (ie, they belie their true nature and appear well-differentiated, yet having a genetic profile akin to PDTC).…”

Section: Discussionmentioning

confidence: 99%

Histopathologic characterization of radioactive iodine‐refractory fluorodeoxyglucose‐positron emission tomography‐positive thyroid carcinoma

Rivera

Ghossein

Schöder

et al. 2008

Cancer

196

130

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BACKGROUND.Radioactive iodine‐refractory (RAIR) 18F‐fluorodeoxyglucose (FDG)‐positron emission tomography (PET) positive thyroid carcinomas represent the major cause of deaths from thyroid carcinomas (TC) and are therefore the main focus of novel target therapies. However, to the authors' knowledge, the histology of FDG‐PET‐positive RAIR metastatic thyroid carcinoma has not been described to date.METHODS.Metastatic tissue from RAIR PET‐positive patients identified between 1996 and 2003 at the study institution were selected for histologic examination. The biopsied metastatic site corresponded to a FDG‐PET positive lesion sampled within 2 years (87% of which were sampled within 1 year) of the PET scan. Detailed microscopic examination was performed on the metastatic deposit and the available primary tumors. Poorly differentiated thyroid carcinomas (PDTC) were defined on the basis of high mitotic activity (≥5 mitoses/10 high‐power fields) and/or tumor necrosis. Other types of carcinomas were defined by conventional criteria. The histology of the metastases and primary were analyzed, with disease‐specific survival (DSS) as the endpoint.RESULTS.A total of 70 patients satisfied the selection criteria, 43 of whom had primary tumors available for review. Histologic characterization of the metastasis/recurrence in 70 patients revealed that 47.1% (n = 33 patients) had PDTC, 20% (n = 14 patients) had the tall cell variant (TCV) of papillary thyroid carcinoma, 22.9% (n = 16 patients) had well‐differentiated papillary thyroid carcinoma (WDPTC), 8.6% (n = 6 patients) had Hurthle cell carcinoma (HCC), and 1.4% (n = 1 patient) had anaplastic carcinomas. The histopathologic distribution of the tumor in the primaries was: PDTC, 51%; TCV, 19%; WDPTC, 23%; and widely invasive HCC, 7%. A differing histology between the primary tumor and metastasis was observed in 37% of cases (n = 16 patients). In the majority of instances (63%; 10 of 16 patients) this was noted as transformation to a higher grade. Of the primary tumors classified as PTC, 70% progressed to more aggressive histotypes in the metastasis. Tumor necrosis and extensive extrathyroid extension in the primary tumor were found to be independent predictors of poorer DSS in this group of patients (P = .015). Approximately 68% of the PDTC primary tumors were initially classified by the primary pathologist as better‐differentiated tumors on the basis of the presence of papillary and/or follicular architecture or the presence of typical PTC nuclear features.CONCLUSIONS.Several observations can be made based on the results of the current study. The majority of metastases in patients with RAIR PET‐positive metastases are of a histologically aggressive subtype. However, well‒differentiated RAIR metastatic disease is observable. Poorly differentiated disease is underrecognized in many cases if defined by architectural and nuclear features alone. The presence of tumor necrosis was found to be a strong predictor of aggressive behavior, even within this group of clinically aggressive tumors. Finally, there is a significant amount of histologic plasticity between primary tumors and metastases that may reflect the genetic instability of these tumors. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Histopathologic characterization of radioactive iodine‐refractory fluorodeoxyglucose‐positron emission tomography‐positive thyroid carcinoma

Rivera

Ghossein

Schöder

et al. 2008

Cancer

196

130

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“…13 However, there are also factors associated with a less favorable outcome including age (445 years), large tumor size (45 cm), histology (tall cell variant histology), extrathyroidal extension, distant metastases, lymph nodal metastases, and positive family history. [14][15][16][17] Another important component of the body's immune defense arsenal that has been identified in papillary thyroid cancer tissues is the complement system. The complement system is composed of several serum proteins that assist in the elimination of invading pathogens and modified self-cells.…”

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confidence: 99%

Immunoglobulin G expression and its colocalization with complement proteins in papillary thyroid cancer

et al. 2012

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Except for the well-known immunoglobulin G (IgG) producing cell types, ie, mature B lymphocytes and plasma cells, various non-lymphoid cell types, including human cancer cells, neurons, and some specified epithelial cells, have been found to express IgG. In this study, we detected the expression of the heavy chain of IgG (IgGc) and kappa light chain (Igj) in papillary thyroid cancer cells. Using in situ hybridization, we detected the constant region of human IgG1 (IGHG1) in papillary thyroid cancer cells. With laser capture microdissection followed by RT-PCR, mRNA transcripts of IGHG1, Igj, recombination activating gene 1 (RAG1), RAG2, and activation-induced cytidine deaminase genes were successfully amplified from isolated papillary thyroid cancer cells. We further confirmed IgG protein expression with immunohistochemistry and found that none of the IgG receptors was expressed in papillary thyroid cancer. Differences in the level of IgGc expression between tumor size, between papillary thyroid cancer and normal thyroid tissue, as well as between papillary thyroid cancer with and without lymph node metastasis were significant. Taken together, these results indicate that IgG is produced by papillary thyroid cancer cells and that it might be positively related to the growth and metastasis of papillary thyroid cancer cells. Furthermore, it was demonstrated that IgGc colocalized with complement proteins in the same cancer cells, which could indicate that immune complexes were formed. Such immune complexes might consist of IgG synthesized by the host against tumor surface antigens and locally produced anti-idiotypic IgG with specificity for the variable region of these 'primary' antibodies. The cancer cells might thus escape the host tumor-antigen-specific immune responses, hence promoting tumor progression.

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“…These are well-known prognostic factors in thyroid cancer, and their presence correlates well with disease-specific mortality. 6,7,16,17 The inclusion of these factors in our multivariable models strengthens our ability to make valid comparisons between surgery types. In addition, our analysis represents a more recent cohort from the NCDB (1998-2006 vs.1985-1998); completeness of data collection by participating registries and accuracy of administrative databases are expected to improve over time.…”

Section: Discussionmentioning

confidence: 92%

Extent of Surgery for Papillary Thyroid Cancer Is Not Associated with Survival: An Analysis of 61,775 Patients

Ann

2014

VideoEndocrinology

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Objective-To examine the association between extent of surgery and overall survival (OS) in a large contemporary cohort of patients with papillary thyroid cancer (PTC).Background-Guidelines recommend total thyroidectomy for PTC tumors >1 cm based on older data demonstrating an OS advantage for total thyroidectomy over lobectomy.Methods-Adult patients with PTC tumors 1.0-4.0 cm undergoing thyroidectomy in the National Cancer Database, 1998-2006, were included. Cox proportional hazards models were applied to measure the association between extent of surgery and OS while adjusting for patient demographic and clinical factors, including comorbidities, extrathyroidal extension, multifocality, nodal and distant metastases, and radioiodine treatment. Conclusions-Current guidelines suggest total thyroidectomy for PTC tumors >1 cm. However, we did not observe a survival advantage associated with total thyroidectomy compared to lobectomy. These findings call into question whether tumor size should be an absolute indication for total thyroidectomy. Results-Among

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Differentiated carcinoma of the thyroid with extrathyroidal extension

Cited by 233 publications

References 8 publications

Histopathologic characterization of radioactive iodine‐refractory fluorodeoxyglucose‐positron emission tomography‐positive thyroid carcinoma

Histopathologic characterization of radioactive iodine‐refractory fluorodeoxyglucose‐positron emission tomography‐positive thyroid carcinoma

Immunoglobulin G expression and its colocalization with complement proteins in papillary thyroid cancer

Extent of Surgery for Papillary Thyroid Cancer Is Not Associated with Survival: An Analysis of 61,775 Patients

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