A pathologic re-review of follicular thyroid neoplasms: The impact of changing the threshold for the diagnosis of the follicular variant of papillary thyroid carcinoma

Widder, Sandy; Guggisberg, Kelly; Khalil, Moosa; Pasieka, Janice L.

doi:10.1016/j.surg.2007.11.014

Cited by 71 publications

(48 citation statements)

References 22 publications

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“…A last point to refer that despite the 'old' idea that Hürthle cell FTCs tended to carry a guarded prognosis, there is consistent evidence showing that encapsulated, nonangioinvasive Hürthle cell FTC and Hürthle cell PTC carry, like their non-Hürthle cell counterparts, an excellent prognosis even after being treated conservatively (Widder et al 2008, Piana et al 2010, Woodford et al 2010.…”

Section: Hü Rthle Cell Tumorsmentioning

confidence: 99%

The biology and the genetics of Hürthle cell tumors of the thyroid

Máximo¹,

Lima²,

Prazeres³

et al. 2012

Endocrine-Related Cancer

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The biology and the genetics of Hü rthle cell tumors are reviewed starting from the characterization and differential diagnosis of the numerous benign and malignant, neoplastic and nonneoplastic lesions of the thyroid in which Hü rthle cell transformation is frequently observed. The clinicopathologic and molecular evidence obtained from the comparative study of the aforementioned conditions indicate that Hü rthle cell appearance represents a phenotype that is superimposed on the genotypic and conventional histopathologic features of the tumors. Hürthle cell tumors differ from their non-Hü rthle counterparts regarding the prevalence of large deletions of mitochondrial DNA (mtDNA), mutations of mtDNA genes coding for oxidative phosphorylation (OXPHOS) proteins (namely mutations of complex I subunit genes) and mutations of nuclear genes coding also for mitochondrial OXPHOS proteins. Such mitochondrial alterations lead to energy production defects in Hü rthle cell tumors; the increased proliferation of mitochondria may reflect a compensatory mechanism for such defects and is associated with the overexpression of factors involved in mitochondrial biogenesis. The mitochondrial abnormalities are also thought to play a major role in the predisposition for necrosis instead of apoptosis which seems to be blocked in most Hü rthle cell tumors. Finally, the results obtained in experimental models using cybrid cell lines and the data obtained from histopathologic and molecular studies of familial Hü rthle cell tumors are used, together with the aforementioned genetic and epigenetic alterations, to progress in the understanding of the mechanisms through which mitochondrial abnormalities may be involved in the different steps of thyroid carcinogenesis, from tumor initiation to metastization.

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Section: Hü Rthle Cell Tumorsmentioning

confidence: 99%

The biology and the genetics of Hürthle cell tumors of the thyroid

Máximo¹,

Lima²,

Prazeres³

et al. 2012

Endocrine-Related Cancer

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“…1,24,64 The term 'welldifferentiated tumor of uncertain malignant potential' should be used as rarely as possible and should never be considered as a substitute for adequate sampling of any follicular-patterned thyroid tumor. 1,65 In our experience, and in that of other groups, 19,20,62,63 these tumors are adequately treated with a conservative approach (lobectomy or lobectomy plus isthmectomy), but one still needs firmly established management protocols. Although we do not sympathize with the designation 'well-differentiated carcinoma, NOS,' we use it occasionally for two main reasons: some follicular-patterned carcinomas of the thyroid are difficult to characterize because they have intermediate nuclei or different types of nuclei, and the treatment is similar for 'conventional PTC,' 'angioinvasive FTC' and 'angioinvasive, well-differentiated carcinoma, NOS.…”

mentioning

confidence: 83%

“…The evidence on record suggests that for both situations, lobectomy or lobectomy plus isthmectomy will be enough. 18,20,62,63 Summing up, there are two separate problems in the diagnosis of encapsulated tumors with follicular architecture: to decide whether minor nuclear changes of the PTC type justify a diagnosis of FVPTC and to decide whether a minor degree of capsular penetration justifies a diagnosis of malignancy. 43 For the moment and although there is no additional evidence from the molecular pathology side, we agree with Williams and the Chernobyl Study Group 43 that it is more appropriate to recognize the difficulty in deciding whether the nuclei are typical than to arbitrarily place welldifferentiated encapsulated tumors with a follicular architecture, in which minor nuclear changes are the only indicator of a PTC, in a definite malignant or a definite benign category.…”

mentioning

confidence: 99%

Follicular thyroid carcinoma

et al. 2011

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Follicular thyroid carcinoma is being diagnosed less and less frequently despite the increasing incidence of well-differentiated thyroid carcinomas everywhere. This review will discuss the reasons underlying such an observation focusing on the evolution of the morphological and immunohistochemical diagnostic criteria of follicular thyroid tumors. It will address the differential diagnosis between follicular carcinoma and three tumor types-follicular adenoma, follicular variant of papillary carcinoma and poorly differentiated carcinoma-as well as the problems raised by the newly described categories of follicular tumors: follicular tumor of uncertain malignant potential, well-differentiated tumor of uncertain malignant potential and welldifferentiated carcinoma, not otherwise specified. Finally, the prognostic and therapeutic significance of some promising molecular biomarkers will be discussed within the frame of the aforementioned histopathological classification.

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“…The encapsulated follicular variant of papillary thyroid carcinoma, characterized by an encapsulated (sometimes partial) noninvasive tumor with a nearly exclusive follicular pattern, focal to diffuse distribution of characteristic nuclear features of papillary carcinoma, a low risk of lymph node metastases, very low recurrence risk, and a strong association with RAS mutations, 1,[4][5][6][7] has an excellent prognosis. 1,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Recently, reclassification of this tumor as a non-malignant neoplasm has been proposed by an international group of thyroid gland specialists, using the term Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP). 21 To date, there has not been a large, multi-institutional community practice evaluation of conservative management (surgery only without radioablative iodine or suppression therapy).…”

mentioning

confidence: 99%

Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma: A name change to Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features would help prevent overtreatment

2016

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Encapsulated follicular variant of papillary thyroid carcinoma is a common thyroid gland cancer, with a highly indolent behavior. Recently, reclassification as a non-malignant neoplasm has been proposed. There is no comprehensive, community hospital based longitudinal evaluation of encapsulated follicular variant of papillary thyroid carcinoma. Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma were identified in a review of all thyroid gland surgeries performed in 2002 within the Southern California Permanente Medical Group. All histology slides were reviewed and follow-up obtained. Seventy-five women and nineteen men, aged 20-80 years (mean 45.6 years), had a single (n = 61), multiple (same lobe; n = 20), or bilateral (n = 13) tumor(s), ranging in size from 0.7 to 9.5 cm in diameter (mean 3.3 cm). Histologically, all cases demonstrated a well-formed tumor capsule, with capsular and/or lymphovascular invasion in 17 and no invasion in 77 cases. Lymph node metastases were not identified. The tumors had a follicular architecture, without necrosis or 43 mitoses/10 high-power fields (HPFs). Classical papillary thyroid carcinoma nuclear features were seen in at least three HPFs per 3 mm of tumor diameter, including enlarged, elongated, crowded, and overlapping nuclei, irregular nuclear contours, nuclear grooves, and nuclear chromatin clearing. Lobectomy alone (n = 41), thyroidectomy alone (n = 34), or completion thyroidectomy (n = 19) was the initial treatment combined with post-op radioablative iodine in 25 patients. All patients were without evidence of disease after a median follow-up of 11.8 years. Encapsulated follicular variant of papillary thyroid carcinoma showed benign behavior, supporting conservative surgery alone and reclassification of these tumors to Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP).

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A pathologic re-review of follicular thyroid neoplasms: The impact of changing the threshold for the diagnosis of the follicular variant of papillary thyroid carcinoma

Cited by 71 publications

References 22 publications

The biology and the genetics of Hürthle cell tumors of the thyroid

The biology and the genetics of Hürthle cell tumors of the thyroid

Follicular thyroid carcinoma

Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma: A name change to Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features would help prevent overtreatment

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