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

  • Raouef Ahmed Bichoo
  • Anjali MishraEmail author
  • Niraj Kumari
  • Narendra Krishnani
  • Gyan Chand
  • Gaurav Agarwal
  • Amit Agarwal
  • Saroj Kanta Mishra
Original Article



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.


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).


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.


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.


Differentiated thyroid carcinoma Poorly differentiated area Aggressive thyroid carcinoma 


Authors’ 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.

Funding information

No funding was received from any source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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).

Supplementary material

423_2019_1753_MOESM1_ESM.docx (183 kb)
ESM 1 (DOCX 183 kb)


  1. 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, LyonGoogle Scholar
  2. 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 52:1849–1855CrossRefGoogle Scholar
  3. 3.
    Carcangiu ML, Zampi G, Rosai J (1984) Poorly differentiated (“insular”) thyroid carcinoma. Am J Surg Pathol 8:655–668CrossRefGoogle Scholar
  4. 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 31:1256–1264CrossRefGoogle Scholar
  5. 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 59:35–367CrossRefGoogle Scholar
  6. 6.
    Sanders EM Jr, LiVolsi VA, Brierley J et al (2007) An evidence-based review of poorly differentiated thyroid cancer. World J Surg 31:934–945CrossRefGoogle Scholar
  7. 7.
    Tallini G (2011) Poorly differentiated thyroid carcinoma, are we there yet? Endocr Pathol 22:190–194CrossRefGoogle Scholar
  8. 8.
    DettmerM SA, Steinert H et al (2011) Poorly differentiated thyroid carcinomas: how much poorly differentiated is needed? Am J Surg Pathol 35:1866–1872CrossRefGoogle Scholar
  9. 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 23:196–201CrossRefGoogle Scholar
  10. 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 200913:424Google Scholar
  11. 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 34:40–47CrossRefGoogle Scholar
  12. 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, DCGoogle Scholar
  13. 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 873Google Scholar
  14. 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 23:1269–1278CrossRefGoogle Scholar
  15. 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 99:1245–1252CrossRefGoogle Scholar
  16. 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 64:263–273CrossRefGoogle Scholar
  17. 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 100:950–957CrossRefGoogle Scholar
  18. 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 117:185–194Google Scholar
  19. 19.
    Yu MG, Rivera J, Jimeno C (2017) Poorly differentiated thyroid carcinoma: 10-year experience in a southeast Asian population. Endocrinol Metab (Seoul) 32:288–295CrossRefGoogle Scholar
  20. 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 92:40–47CrossRefGoogle Scholar
  21. 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.
  22. 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 106:1286–1295CrossRefGoogle Scholar
  23. 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 8:11212–11217Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Endocrine SurgerySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of PathologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

Personalised recommendations