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

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Abstract

Purpose

Poorly differentiated thyroid carcinoma (PDTC) patients have worse outcomes than patients with differentiated thyroid carcinoma (DTC), but the implication of poorly differentiated areas (PDAs) noted in DTC is not very well understood. The aim of the present study was to compare the clinicopathologic profiles and outcomes of PDTC and DTC with PDA.

Methods

A total of 142 patients, managed at out center between September 1989 and June 2016, were enrolled in this retrospective study. Histology was reviewed, and the patients were divided in the following three groups: poorly differentiated carcinoma [PDTC; group 1 (n = 27)]; papillary thyroid carcinoma with PDA [PTC with PDA; group 2 (n = 27)]; and follicular thyroid carcinoma with PDA [FTC with PDA; group 3 (n = 88)]. Clinico-pathologic profiles and outcomes were compared between the three groups. The Kaplan–Meier method was used for survival analysis. The log-rank test and Cox regression model were used to perform univariate and multivariate analyses of the factors affecting the overall survival (OS).

Results

The clinical profiles of the three groups were comparable except for significantly less incidence of lymph node involvement (p = 0.002) and extra-thyroidal invasion (p = 0.002) and higher incidence of distant metastases (p = 0.01) in group 3. Median follow-up period was 47.5 months, and 5- and 10-year OS were 57 and 14%, respectively. There was no difference between OS of PDTC and DTC (group 2 + 3), but group 3 patients had significantly better OS than group 2 patients. Univariate analysis revealed that tumor size (p = 0.04), extra-thyroidal invasion (p = 0.05), lateral compartment lymphadenopathy (p = 0.002), distant metastases (p = < 0.001), absence of encapsulation (p = 0.03), and > 75% PDA (p = 0.001) were associated with worse OS. Multivariate analysis revealed tumor size (p = 0.005), distant metastases (p = 0.012), lymphadenopathy (p = 0.017), TNM staging (p = < 0.001), and PDA > 75% (p = < 0.001) to be significantly associated with OS.

Conclusion

There is no difference in the outcomes of PDTC and DTC with PDA. However, PTC patients with PDA have worse outcomes than FTC patients with PDA. Irrespective of tumor type, the presence of more than 75% PDA in DTC is associated with adverse outcomes.

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References

  1. DeLellis RA, Lloyd RV, Heitz PU, Eng C (2004) World Health Organization classification of tumours: pathology and genetics of tumours of endocrine organs. IARC Press, Lyon

    Google Scholar 

  2. Sakamoto A, Kasai N, Sugano H (1983) Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a high-risk group of papillary and follicular carcinomas. Cancer 52:1849–1855

    Article  PubMed  CAS  Google Scholar 

  3. Carcangiu ML, Zampi G, Rosai J (1984) Poorly differentiated (“insular”) thyroid carcinoma. Am J Surg Pathol 8:655–668

    Article  PubMed  CAS  Google Scholar 

  4. Volante M, Collini P, Nikiforov YE, Sakamoto A, Kakudo K, Katoh R, Lloyd RV, LiVolsi VA, Papotti M, Sobrinho-Simoes M, Bussolati G, Rosai J (2007) Poorly differentiated thyroid carcinoma: the Turin proposal for the use of uniform diagnostic criteria and an algorithmic diagnostic approach. Am J Surg Pathol 31:1256–1264

    Article  PubMed  Google Scholar 

  5. Kakudo K, Bai Y, Katayama S et al (2009) Classification of follicular cell tumors of the thyroid gland: analysis involving Japanese patients from one institute. Pathol Int 59:35–367

    Article  Google Scholar 

  6. Sanders EM Jr, LiVolsi VA, Brierley J et al (2007) An evidence-based review of poorly differentiated thyroid cancer. World J Surg 31:934–945

    Article  PubMed  Google Scholar 

  7. Tallini G (2011) Poorly differentiated thyroid carcinoma, are we there yet? Endocr Pathol 22:190–194

    Article  PubMed  CAS  Google Scholar 

  8. DettmerM SA, Steinert H et al (2011) Poorly differentiated thyroid carcinomas: how much poorly differentiated is needed? Am J Surg Pathol 35:1866–1872

    Article  Google Scholar 

  9. Rossi ED, Martini M, Capodimonti S, Straccia P, Revelli L, Lombardi CP, Pontecorvi A, Santeusanio G, Larocca LM, Fadda G (2015) Well-differentiated thyroid cancer with a minor poorly differentiated component: clonal heterogeneity through the prognostic role of cxcr4 and Braf analysis. Appl Immunohistochem Mol Morphol 23:196–201

    Article  PubMed  CAS  Google Scholar 

  10. Yadav S, Gupta SK, Godbole MM et al (2009) Persistence of severe iodine-deficiency disorders despite universal salt iodization in an iodine-deficient area in northern India. Public Health Nutr 200913:424

    Google Scholar 

  11. Bhargav PR, Mishra A, Agarwal G et al (2010) Long-term outcome of differentiated thyroid carcinoma—experience in a developing country. World J Surg 34:40–47

    Article  PubMed  Google Scholar 

  12. Rosai J, Carcangiu ML, DeLellis RA (1992) Armed forces institute of pathology, atlas of tumor pathology: 3rd series. In: Tumors of the thyroid gland. Armed Forces Institute of Pathology, Washington, DC

    Google Scholar 

  13. Tuttle RM, Morris LF, Haugen BR et al (2017) Thyroid-differentiated and anaplastic carcinoma. In: Amin MB et al (eds) AJCC cancer staging manual, 8th edn. Springer International Publishing, New York City, p 873

    Google Scholar 

  14. Asioli S, Erickson LA, Righi A, Jin L, Volante M, Jenkins S, Papotti M, Bussolati G, Lloyd RV (2010) Poorly differentiated carcinoma of the thyroid: validation of the Turin proposal and analysis of IMP3 expression. Mod Pathol 23:1269–1278

    Article  PubMed  Google Scholar 

  15. Ibrahimpasic T, Ghossein R, Carlson DL, Nixon I, Palmer FL, Shaha AR, Patel SG, Tuttle RM, Shah JP, Ganly I (2014) Poorly differentiated; thyroid cancer; outcome; diagnosis; therapy. J Clin Endocrinol Metab 99:1245–1252

    Article  PubMed  CAS  Google Scholar 

  16. Gnemmi V, Renaud F, Do Cao C, Salleron J, Lion G, Wemeau JL, Copin MC, Carnaille B, Leteurtre E, Pattou F, Aubert S (2014) Poorly differentiated thyroid carcinomas: application of the Turin proposal provides prognostic results similar to those from the assessment of high-grade features. Histopathology 64:263–273

    Article  PubMed  Google Scholar 

  17. Volante M, Landolfi S, Chiusa L, Palestini N, Motta M, Codegone A, Torchio B, Papotti MG (2004) Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients. Cancer 100:950–957

    Article  PubMed  Google Scholar 

  18. Bongiovanni M, Bloom L, Krane JF et al (2009) Cytomorphologic features of poorly differentiated thyroid carcinoma. A multi-institutional analysis of 40 cases. Cancer 117:185–194

    PubMed  Google Scholar 

  19. Yu MG, Rivera J, Jimeno C (2017) Poorly differentiated thyroid carcinoma: 10-year experience in a southeast Asian population. Endocrinol Metab (Seoul) 32:288–295

    Article  Google Scholar 

  20. de la Fouchardiere C, Decaussin-Petrucci M, Berthiller J et al (2018) Preditive factors of outcome in poorly differentiated thyroid carcinomas. Eur J Cancer 92:40–47

    Article  PubMed  Google Scholar 

  21. Tanaka K, Sonoo H, Saito W et al (2011). Analysis of clinical outcome of patients with poorly differentiated thyroid carcinoma. ISRN Endocrinology ISRN Endocrinol. https://doi.org/10.5402/2011/30802

  22. Hiltzik D, Carlson DL, Tuttle RM, Chuai S, Ishill N, Shaha A, Shah JP, Singh B, Ghossein RA (2006) Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis: a clinicopathologic study of 58 patients. Cancer 106:1286–1295

    Article  PubMed  Google Scholar 

  23. Liu L, Li D, Wang D et al (2015) Multifocality predicts poor outcome of patients with insular thyroid cancer: a clinicopathological study. Int J Clin Exp Pathol 8:11212–11217

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Raouef Ahmed Bichoo, Anjali Mishra, Gyan Chand, Gaurav Agarwal, Amit Agarwal & Saroj Kanta Mishra

  2. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Niraj Kumari & Narendra Krishnani

Authors
  1. Raouef Ahmed Bichoo
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  2. Anjali Mishra
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  3. Niraj Kumari
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  4. Narendra Krishnani
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  5. Gyan Chand
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  6. Gaurav Agarwal
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  7. Amit Agarwal
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  8. Saroj Kanta Mishra
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Contributions

Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, and Narendra Krishnani participated in the study conception and design. Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, Narendra Krishnani, Gyan Chand, Gaurav Agarwal, Amit Agarwal, and Saroj Kanta Mishra participated in the acquisition of data. Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, Narendra Krishnani, Gyan Chand, Gaurav Agarwal, Amit Agarwal, and Saroj Kanta Mishra participated in the analysis and interpretation of data. Raouef Ahmed Bichoo participated in the drafting of the manuscript. Raouef Ahmed Bichoo, Anjali Mishra, Niraj Kumari, Narendra Krishnani, Gyan Chand, Gaurav Agarwal, Amit Agarwal, and Saroj Kanta Mishra participated in the critical revision of manuscript.

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Correspondence to Anjali Mishra.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the Institute Ethics Committee (2016-84-MCH-EXP).

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Bichoo, R.A., Mishra, A., Kumari, N. et al. Poorly differentiated thyroid carcinoma and poorly differentiated area in differentiated thyroid carcinoma: is there any difference?. Langenbecks Arch Surg 404, 45–53 (2019). https://doi.org/10.1007/s00423-019-01753-6

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  • DOI: https://doi.org/10.1007/s00423-019-01753-6

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