One hundred twenty-one cases of anaplastic carcinoma of the thyroid treated at M. D. Anderson Cancer Center, Houston, were reviewed. Anaplastic carcinoma is a rapidly growing neoplasm with a dismal prognosis. The mean survival of our patients was 7.2 areas of well-differentiated thyroid carcinoma elsewhere, supporting the hypothesis that anaplastic thyroid carcinoma arises from preexisting well-differentiated thyroid carcinoma. Twenty-four of 30 tumors analyzed (84%) stained for keratin, 28 (93.3%) stained for vimentin, and ten (33%) stained for epithelial membrane antigen. Younger patients lived longer than older patients, and patients whose disease was earlier-stage at presentation responded better than patients with metastases at presentation. Radical surgery alone did not significantly increase survival duration over less radical surgery. The role of multimodality therapy needs further evaluation. Cancer 66:321-330,1990. 10 months. A significant percentage of our patients (35%) had NAPLASTIC THYROID CARCINOMA accounts for A 5% to 14% of primary malignant thyroid neoplasm^.'-^ In contrast to papillary and follicular thyroid carcinoma, anaplastic carcinoma is one of the most aggressive neoplasms affecting humans. This is exemplified by a 5-year survival rate of 7.1% and a mean survival period of 6.2 months seen in a previous review from The
Eighty-four cases of spindle and giant cell carcinoma of the thyroid were reviewed. This is a swiftly growing, and rapidly fatal neoplasm that generally develops in the elderly. Treatment of this disease was generally unsuccessful with a 7.1% five-year survival rate and a mean survival period of 6.2 months from the time of tissue diagnosis. In the majority of cases, areas of well-differentiated thyroid carcinoma could be identified, supporting the concept that spindle and giant cell carcinoma results from the transformation of preexisting well-differentiated thyroid carcinoma. Because of the aggressive biologic activity of this neoplasm, we treat all cases as disseminated disease at the time of presentation. Our best therapeutic results have been obtained with a combination of surgery, irradiation, and chemotherapy; however, these results still leave much to be desired. Patients with only small foci of spindle and giant cell carcinoma, at the time of diagnosis, may have a better chance of prolonged survival.
A retrospective analysis of clinical and pathological data was conducted on 706 patients (514 females and 192 males) treated for differentiated thyroid carcinoma at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1951 to 1975 and followed to 1981. The histological diagnoses were mixed papillary/follicular carcinoma (66.7%), papillary carcinoma (14.6%), follicular carcinoma (15.3%), or Hurthle cell carcinoma (3.4%). Patients diagnosed before the age of 40 yr lived significantly longer than those diagnosed over the age of 40 yr, and females lived longer than males. According to survival analyses and disease-free intervals, the order of increasing aggressiveness of the tumors was papillary, mixed, follicular, and Hurthle cell. Total thyroidectomy was associated with longer disease-free intervals and fewer recurrences. The 136 patients who received ablative 131I after surgery had fewer recurrences than a matched group who did not, but the disease-free interval and survival rate showed no significant difference. Further classification showed that patients with follicular and mixed tumors, and those who underwent total thyroidectomy benefited from 131I. There were 78 deaths attributed to thyroid cancer in the whole group. Approximately two thirds occurred in the first 10 yr after diagnosis. In conclusion, total thyroidectomy is recommended, when feasible, for differentiated thyroid cancer, followed by ablative 131I therapy, at least for follicular and mixed varieties.
To determine the diagnostic pitfalls of thyroid fine-needle aspiration (FNA), we reviewed 394 thyroid aspirates obtained between January 1986 and December 1990. Surgical follow-up was available for 150 aspirations. The cytologic diagnoses were categorized into four groups: benign, 57; indeterminate, 51; malignant, 33; and nondiagnostic specimen, nine. There were three false negative diagnoses (3%), which upon review were judged to be inadequate specimens. Three false positive diagnoses (7%) were identified: in the first two cases, follicular adenomas were mistaken for papillary carcinoma; in the third case, atypical Hürthle cells were mistaken for a Hürthle cell carcinoma. Our results showed a sensitivity of 93% and a specificity of 91% for the detection of malignancy. If indeterminate cases were considered positive, the specificity decreased to 50%, while the sensitivity increased to 97%. We conclude that: 1) certain follicular adenomas may display cytologic features mimicking papillary carcinoma; 2) as in follicular neoplasms, aspirates of Hürthle cell adenomas cannot be differentiated from Hürthle cell carcinomas; 3) with adequate sampling, false negative results can be markedly reduced.
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