Squamous cell carcinoma of the thyroid (SCT) is an unusual neoplasm thought to arise as a primary tumor or as a component of an undifferentiated carcinoma. The role of p53 and Ki-67 as prognostic indicators in this type of tumor is not known. We studied eight cases of primary SCT. Three cases were analyzed for Ki-67 by immunohistochemistry and for p53 by immunohistochemistry and loss of heterozygosity. Seven patients were women, and one was a man (age range, 31 to 90 years). SCT were firm, were tan with areas of necrosis, and ranged in size from 2 to 8 cm. Histologically, they had islands of squamous cells with spindle cell areas (two of eight). In four of eight cases, SCT was associated with the tall cell variant of papillary carcinoma (TCV). Positive staining for p53 was seen in two of three cases, and in one of three the TCV was also positive for p53. Mean MIB1 labeling index was 30% and 17% in SCT and TCV, respectively. At the time of presentation, six of eight patients had cervical lymph node metastases. In one case, the primary tumor had SCT and TCV; however, only the SCT component metastasized. After mean follow-up of 48 months, one patient had died of disease, five were alive with recurrent or metastatic tumor, and two were lost to follow-up. Primary SCT is an aggressive neoplasm that may be found in association with TCV. p53 expression and high MIB1 labeling index occur in these tumors and may be useful prognosticators.KEY WORDS: Squamous cell carcinoma, Tall cell variant, Thyroid neoplasms.Mod Pathol 2000;13(7):742-746Squamous cell carcinoma of the thyroid gland (SCT) is an unusual tumor with only a few reported cases. According to classic literature, it is thought to arise in two settings: as a primary tumor or as a component of an anaplastic or undifferentiated thyroid carcinoma, often mixed with heterologous elements and usually associated with areas of welldifferentiated papillary or follicular carcinoma. The tall cell variant of papillary carcinoma (TCV), first described by Hawk and Hazard (1), is defined by the presence of neoplastic cells having a height that is at least twice the width in an otherwise typical papillary carcinoma. Several investigators found the TCV to have a more aggressive behavior than ordinary well-differentiated papillary carcinoma (2, 3).We and others (4) have noticed that most cases of SCT are associated with TCV. However, it is not known whether the presence of an SCT component connotes a worse prognosis. In addition, the role of p53 and Ki-67 expression in these tumors is not known.In the present study, we reviewed the histologic features of our cases of SCT and investigated whether detection of p53 tumor suppressor gene and Ki-67 antigen by immunohistochemistry and loss of heterozygosity (LOH) analysis are helpful prognosticators.
MATERIALS AND METHODSEight cases of primary SCT were studied. Five of the cases were obtained by reviewing the surgical pathology material of more than 200 cases of thyroid carcinomas at the Laboratory of Pathology, National Institutes of Hea...