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Some authors suggest that certain variants of WDTC may be independent high-risk factors for poor prognosis.15 We estimated that even in the classical type of WDTC, very aggressive forms might be observed. In our study, we observed a higher incidence of extrathyroidal invasion, adjacent organ and tissue infiltration, distant metastases, and recurrence. Our study provided important evidence that even in such a homogenous group as the classical type of WDTC, some very aggressive entities might occur. Finally, we undertook these analyses because of the results of some other studies such as that of Kuo et al. These authors compared the classical type of PTC with the tall cell variant and did not find significant differences in overall and disease-specific survival.31
On the basis of our observations, we believe that even in the classical type of WDTC characterized by an excellent prognosis, very aggressive entities might be observed. In such cases, even after very extensive surgical procedures with lymph node dissection performed for small intrathyroidal tumors, early distant metastases and local recurrence might appear. On the other hand, we want to emphasize that very aggressive entities of the classical type of WDTC are rare findings. They are associated with aggressive histopathologic features and poor long term outcomes. Surgery is the treatment of choice for all WDTCs, even those with very aggressive behavior. Thus, patients with the aggressive classical type of WDTC should have close, life-long surveillance and ought to be treated according to evidence-based guidelines for high risk TC. All of these characteristics make this type of cancer unpredictable.
Ethical approval and informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. The study protocol was approved by the Bioethics Committee of Wroclaw Medical University (signature number: KB-296/2015). Written consent was obtained from all of the participants included in this study.
Acknowledgments
The author is grateful to all the staff at the study center who contributed to this study. This work did not receive any specific funding. Disclosure The author declares that he has no conflicts of interest in this work.
Krzysztof Kaliszewski
First Department and Clinic of General, Gastroenterological, and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
References
1. Manzella L, Stella S, Pennisi MS, et al. New insights in thyroid cancer and p53 family proteins. Int J Mol Sci. 2017;18:E1325. doi:10.3390/ijms18061325
2. Pani F, Macerola E, Basolo F, Boi F, Scartozzi M, Mariotti S. Aggressive differentiated thyroid cancer with multiple metastases and NRAS and TERT promoter mutations: a case report. Oncol Lett. 2017;14:2186–2190. doi:10.3892/ol.2017.6395
3. Sobin LH. Histological typing of thyroid tumours. Histopathology. 1990;16:513. doi:10.1111/j.1365-2559.1990.tb01559.x
4. Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid. 2013;23:885–891. doi:10.1089/thy.2013.0045
5. Kaliszewski K, Strutyńska-Karpińska M, Zubkiewicz-Kucharska A, et al. Should the prevalence of incidental thyroid cancer determine the extent of surgery in multinodular goiter? PLoS One. 2016;11: e0168654. doi:10.1371/journal.pone.0168654
6. Kaliszewski K, Diakowska D, Wojtczak B, et al. Fine-needle aspiration biopsy as a preoperative procedure in patients with malignancy in solitary and multiple thyroid nodules. PLoS One. 2016;11: e0146883. doi:10.1371/journal.pone.0146883
7. Tuttle RM, Ball DW, Byrd D, et al. National comprehensive cancer network. J Natl Compr Canc Netw. 2010;8:1228–1274.
8. Stratmann M, Sekulla C, Dralle H, Brauckhoff M. Current TNM system of the UICC/AJCC: the prognostic significance for differentiated thyroid carcinoma. Chirurg. 2012;83:646–651. doi:10.1007/s00104-011-2216-3
9. Gimm O, Dralle H. Differentiated thyroid carcinoma. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence- Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6979/
10. Agate L, Lorusso L, Elisei R. New and old knowledge on differentiated thyroid cancer epidemiology and risk factors. J Endocrinol Invest. 2012;35:3–9.
11. Edge SE, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A III, eds. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010.
12. Paschke R, Lincke T, Müller SP, Kreissl MC, Dralle H, Fassnacht M. The treatment of well-differentiated thyroid carcinoma. Dtsch Arztebl Int. 2015;112:452–458. doi:10.3238/arztebl.2015.0452
13. Erler P, Keutgen XM, Crowley MJ, et al. Dicer expression and microRNA dysregulation associate with aggressive features in thyroid cancer. Surgery. 2014;156:1342–1350. doi:10.1016/j.surg.2014.08.007
14. Michels JJ, Jacques M, Henry-Amar M, Bardet S. Prevalence and prognostic significance of tall cell variant of papillary thyroid carcinoma. Hum Pathol. 2007;38:212–219. doi:10.1016/j.humpath.2006.08.001
15. Gunalp B, Okuyucu K, Ince S, Ayan A, Alagoz E. Impact of tall cell variant histology on predicting relapse and changing the management of papillary thyroid carcinoma patients. Hell J Nucl Med. 2017;20:122–127. doi:10.1967/s002449910552
16. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JWA, Wiersinga W. European thyroid cancer T: European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787–803. doi:10.1530/eje.1.02158
17. 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. Thyroid. 2016;26:1–133. doi:10.1089/thy.2015.0020
18. Palme CE, Waseem Z, Raza SN, Eski S, Walfish P, Freeman JL. Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004;130:819–824. doi:10.1001/archotol.130.7.819
19. Clark OH. Thyroid cancer and lymph node metastases. J Surg Oncol. 2011;1003:615–618. doi:10.1002/jso.21804
20. Mazzaferri E, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–428.
21. Tubiana M, Schlumberger M, Rougier P, et al. Long term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer. 1985;55:794–804.
22. Miftari R, Topciu V, Nura A, Haxhibeqiri V. Management of the patient with aggressive and resistant papillary thyroid carcinoma. Med Arch. 2016;70:314–317. doi:10.5455/medarh.2016.70.314- 317
23. Pillai S, Gopalan V, Smith RA, Lam AKY. Diffuse sclerosing variant of papillary thyroid carcinoma – an update of its clinic pathological features and molecular biology. Crit Rev Oncol Hematol. 2015;94:64–73. doi:10.1016/j.critrevonc.2014.12.001
24. Dralle H, Musholt TJ, Schabram J, et al. German association of endocrine surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg. 2013;398:347–375.
25. Nath MC, Erickson LA. Aggressive variants of papillary thyroid carcinoma: hobnail, tall cell, columnar, and solid. Adv Anat Pathol. 2018;25:172–179. doi:10.1097/PAP.0000000000000184
26. Kaliszewski K, Diakowska D, Strutyńska-Karpińska M, et al. Diagnostics of thyroid malignancy and indications for surgery in the elderly and younger counterparts: comparison of 3,749 patients. Biomed Res Int. 2017;2017:1012451. doi:10.1155/2017/ 1012451
27. Yunta PJ, Ponce JL, Prieto M, Merino F, Sancho-Fornos S. The importance of a tumor capsule in columnar cell thyroid carcinoma: a report of two cases and review of the literature. Thyroid. 1999;9:815–819. doi:10.1089/thy.1999.9.815
28. Sacks W. Management of aggressive metastatic papillary thyroid cancer involves multiple treatment methods. Clin Thyroidology. 2013;25:20–23.
29. Volante M, Collini P, Nikiforov Y, et al. Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol. 2007;31:1256–1264. doi:10.1097/PAS.0b013e31 80309e6a
30. Marti JL, Clark VE, Harper H, et al. Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases. Thyroid. 2012;22:400–406. doi:10.1089/thy.2011.0162
31. Kuo EJ, Goffredo P, Sosa JA, Roman SA. Aggressive variants of papillary thyroid microcarcinoma are associated with extrathyroidal spread and lymph-node metastases: a population-level analysis. Thyroid. 2013;23:1305–1311. doi:10.1089/thy.2012.0563.
Source: Cancer Management and Research.
Originally published April 1, 2019.
