Poorly differentiated thyroid carcinoma and poorly differentiated area in differentiated thyroid carcinoma: is there any difference?

Bichoo, Raouef Ahmed; Mishra, Anjali; Kumari, Niraj; Krishnani, Narendra; Chand, Gyan; Agarwal, Gaurav; Agarwal, Amit; Mishra, Saroj Kanta

doi:10.1007/s00423-019-01753-6

Cited by 21 publications

(16 citation statements)

References 21 publications

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“…In this large retrospective study, which is the largest published on the subject, we further confirm that the HGTC MSKCC criteria identify a group of thyroid carcinomas with a prognosis intermediate between those of well‐differentiated carcinoma and anaplastic carcinoma, characterised by poor long‐term survival and a high propensity for distant metastasis. The disease‐specific mortality rate at 20 years is 65%, which is similar to the 57%–86% mortality rate reported for HGTC‐PDTC diagnosed according to the Turin consensus 2,20 . Additionally, we show that HGTC has a high propensity for distant metastasis (including late metastasis): the rates of distant spread are 47% at 3 years and 78% at 20 years, highlighting the need for long‐term follow‐up for the identification of distant metastases in these patients.…”

Section: Discussionsupporting

confidence: 80%

“…The diseasespecific mortality rate at 20 years is 65%, which is similar to the 57%-86% mortality rate reported for HGTC-PDTC diagnosed according to the Turin consensus. 2,20 Additionally, we show that HGTC has a high propensity for distant metastasis (including late metastasis): the rates of distant spread are 47% at 3 years and 78% at 20 years, highlighting the need for long-term follow-up for the identification of distant metastases in these patients. Independent adverse prognostic clinicopathological factors identified include older age (for DSS, DMFS, and LRRFS), extensive tumour necrosis (for DSS and LRRFS), lack of encapsulation (for DSS), the presence of vascular invasion (for DMFS), positive margins (for LRRFS), and nodal metastasis (for LRRFS).…”

Section: Discussionmentioning

confidence: 79%

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Primary high‐grade non‐anaplastic thyroid carcinoma: a retrospective study of 364 cases

David

Doğan

et al. 2021

Histopathology

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Aims We aimed to study the clinicopathological and molecular features of high‐grade non‐anaplastic thyroid carcinomas (HGTCs), a carcinoma with a prognosis intermediate between those of well‐differentiated carcinoma and anaplastic carcinoma. Methods and results This study included 364 HGTC patients: 200 patients (54.9%) were diagnosed with poorly differentiated thyroid carcinoma (PDTC), based on the Turin consensus (HGTC‐PDTC), and 164 were diagnosed with high‐grade features that did not meet the Turin criteria (HGTC‐nonPDTC). HGTCs are aggressive: the 3‐year, 5‐year, 10‐year and 20‐year disease‐specific survival (DSS) rates were 89%, 76%, 60%, and 35%, respectively. Although DSS was similar between HGTC‐PDTC and HGTC‐nonPDTC patients, HGTC‐PDTC was associated with higher rate of radioactive iodine avidity, a higher frequency of RAS mutations, a lower frequency of BRAF V600E mutations and a higher propensity for distant metastasis (DM) than HGTC‐nonPDTC. Independent clinicopathological markers of worse outcome were: older age, male sex, extensive necrosis and lack of encapsulation for DSS; older age, male sex and vascular invasion for DM‐free survival; and older age, necrosis, positive margins and lymph node metastasis for locoregional recurrence‐free survival. The frequencies of BRAF, RAS, TERT, TP53 and PTEN alterations were 28%, 40%, 55%, 11%, and 10%, respectively. TP53, PTEN and TERT were independent molecular markers associated with an unfavourable outcome, independently of clinicopathological parameters. The coexistence of BRAF V600E and TERT promoter mutation increased the risk of DM. Conclusions The above data support the classification of HGTC as a single group with two distinct subtypes based on tumour differentiation: HGTC‐PDTC and HGTC‐nonPDTC.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 79%

Primary high‐grade non‐anaplastic thyroid carcinoma: a retrospective study of 364 cases

David

Doğan

et al. 2021

Histopathology

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“…A recent study has demonstrated that PTC with high-grade features, which has a higher BRAF V600E mutation rate, a trend toward more gene fusions compared with those with PDTC, and more aggressive behavior, should be considered a distinct group from PDTC ( 27 ). Secondly, there has not been a threshold of the minimum proportion of poorly differentiated (PD) area in DTC tissue to diagnose PDTC since the survival data in patients with PD area >50% did not differ from those with PD area >10%, and no difference was found in the outcomes of PDTC and DTC with PD area ( 28 , 29 ), which makes us wonder the presence of any PD area should be enough to label a tumor as PDTC rather than the proportion. Finally, Hiltzik et al showed that growth patterns did not correlate with overall survival using multivariate analysis, suggesting that the growth pattern may not be representative of tumor aggressiveness ( 30 ).…”

Section: Diagnosismentioning

confidence: 99%

Poorly differentiated thyroid carcinoma: a clinician’s perspective

Tong

Ruan

Jin

et al. 2022

European Thyroid Journal

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Poorly differentiated thyroid carcinoma (PDTC) is a rare thyroid carcinoma originated from follicular epithelial cells. No explicit consensus can be achieved to date due to sparse clinical data, potentially compromising outcomes of patients. In this comprehensive review from a clinician’s perspective, the epidemiology and prognosis are described, diagnosis based on manifestations, pathology, and medical imaging are discussed, and both traditional and emerging therapeutics are addressed as well. Turin consensus remains the mainstay diagnostic criteria for PDTC, and individualized assessments are decisive for treatment option. The prognosis is optimal if complete resection is performed at early stage, but dismal in nearly half of patients with locally advanced and/or distant metastatic diseases, in which adjuvant therapies such as 131I therapy, external beam radiation therapy, and chemotherapy should be incorporated. Emerging therapeutics including molecular targeted therapy, differentiation therapy, and immunotherapy deserve further investigations to improve the prognosis of PDTC patients with advanced disease.

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“…6,10,[23][24][25][26] Pure PDTCs has similar outcome as tumors with both PDTC and well-differentiated thyroid carcinoma area. 26 It appears that it is the diagnosis of HGFCTC rather than the absolute amount of it that influences prognosis.…”

Section: Pathologic Prognostic Factors In Hgfctcmentioning

confidence: 99%

Advances in Thyroid Pathology: High Grade Follicular Cell-derived Thyroid Carcinoma and Anaplastic Thyroid Carcinoma

Ghossein

2022

Advances in Anatomic Pathology

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In the upcoming World Health Organization fifth edition classification of endocrine tumors, there were several major changes related to high grade follicular-derived thyroid carcinoma (HGFCTC) and anaplastic thyroid carcinoma (ATC) based on emerging evidence about the diagnostic criteria clinical behavior, prognostic factors, and molecular signatures of these tumors. In this review, we aim to summarize the major evolutions of HGFCTC and ATC. HGFCTC is a nonanaplastic carcinoma with high grade features (High mitotic count, tumor necrosis). It is subdivided into poorly differentiated thyroid carcinoma diagnosed using the Turin proposal and differentiated high grade thyroid carcinoma. The latter is defined by the presence of the cytoarchitectutal features of well-differentiated thyroid carcinoma (eg, papillae) but harbors elevated mitotic activity and/or tumor necrosis. Poorly differentiated thyroid carcinoma is predominantly RAS-driven and associated with RAI avidity and high propensity for distant metastasis, whereas differentiated high grade thyroid carcinoma is mostly BRAFV600E-driven. ATC may show a wide range of histologic features. Carcinoma of pure squamous phenotype is associated with a high frequency of BRAF V600E mutations and is now considered as a subtype of ATC. There is a stepwise molecular progression from well-differentiated carcinoma to HGFCTC to ATC manifested by 1) early and persistent driver alteration in the MAPK pathway, particularly BRAF V600E and RAS mutations, and 2) gain of secondary aggressive molecular signatures (such as TERT promoter and TP53 mutations) when tumors progress from well-differentiated to high grade to anaplastic carcinoma.

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Poorly differentiated thyroid carcinoma and poorly differentiated area in differentiated thyroid carcinoma: is there any difference?

Cited by 21 publications

References 21 publications

Primary high‐grade non‐anaplastic thyroid carcinoma: a retrospective study of 364 cases

Primary high‐grade non‐anaplastic thyroid carcinoma: a retrospective study of 364 cases

Poorly differentiated thyroid carcinoma: a clinician’s perspective

Advances in Thyroid Pathology: High Grade Follicular Cell-derived Thyroid Carcinoma and Anaplastic Thyroid Carcinoma

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