Variants of papillary thyroid carcinoma: association with
               histopathological prognostic factors

Girardi, Fábio Muradás; Barra, Marinez Bizarro; Zettler, Cláudio Galleano

doi:10.5935/1808-8694.20130135

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Brazilian Journal of Otorhinolaryngology

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Original Articles • Braz J Otorhinolaryngol. 79 (6) • Nov-Dec 2013 • https://doi.org/10.5935/1808-8694.20130135 copy

Variants of papillary thyroid carcinoma: association with histopathological prognostic factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial.

OBJECTIVE:

To present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors.

METHOD:

Retrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years.

RESULTS:

We included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion.

CONCLUSION:

A small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases.

papillary carcinoma; prognosis; thyroid neoplasms

TU > 1 cm (N = 29)	Tumor variants	N
	Follicular	20
	Classic	16
	Solid	15
	Oncocytic	8
	Tall cells	3
	Columnar	2
	Clear Cells	1
	Diffuse sclerosing	1
TU ≤ 1 cm (N = 7)	Differentiation pattern
	Follicular	5
	Classic	4
	Oncocytic	3
	Solid	1

Case	Gender	Age	Variant or differentiation pattern	Hashimoto	Multifocality	Lymph vascular/ neural invasion	Largest nodule diameter	Gland capsular invasion	Extraglandular spill	T	N
1	F	34	Tall cells	A	A	A	2.6	P	A	T2	N0
2	F	53	Tall Cells + sclerosing (< 50%) + follicular (< 50%)	A	P	A	2	P	P	T3	N0
3	F	56	Tall Cells (< 50%) + follicular + oncocytic (< 50%)	P	P	A	2	A	A	T1	N0
4	F	68	Column	A	A	A	0.5	A	A	T1	N0
5	F	56	Column (< 50%) + solid (< 50%) + follicular	A	P	A	2.5	P	A	T2	N0
6	F	67	Column + solid (< 50%) + follicular (< 50%)	P	P	A	4	P	A	T2	N0
7	F	61	Sclerosing	A	A	A	7	P	A	T3	N0
8	F	35	Sclerosing	A	P	A	1.1	P	P	T3	N1b
9	F	25	Sclerosing	A	A	P	2.5	P	P	T3	N1b
10	F	39	Sclerosing	P	P	A	3	P	P	T3	N1b
11	F	68	Sclerosing	A	A	A	1	P	P	T3	N0
12	F	49	Solid	A	A	A	0.8	A	A	T1	N0
13	F	77	Solid	A	P	A	1.5	A	A	T1	N0
14	F	41	Solid	A	P	A	2	P	P	T3	N1a
15	F	60	Solid	A	A	A	5.5	A	A	T3	N0
16	M	64	Solid (< 50%) + Tall Cells (< 50%) - follicular	A	A	P	6.5	P	A	T3	N1b
17	M	69	Solid + clear cells (< 50%)	A	A	P	8	P	P	T3	N1b
18	F	63	Solid + classic (< 50%)	P	A	A	0.4	A	A	T1	N0
19	F	33	Solid (< 50%) + classic	A	A	A	5	P	P	T3	N0
20	M	72	Solid (< 50%) + classic	A	A	P	6.4	P	P	T3	N0
21	F	46	Solid + follicular (< 50%)	P	P	A	1.5	P	A	T1	N1a
22	F	43	Solid + follicular (< 50%)	A	A	A	3.8	A	A	T2	N0
23	M	29	Solid + follicular (< 50%)	A	A	A	3.6	P	A	T2	N0
24	F	23	Solid + follicular (< 50%)	A	A	P	4.5	P	P	T3	N0
25	F	51	Solid + follicular (< 50%) + classic (< 50%)	A	P	A	2	P	A	T1	N0
26	F	56	Solid (< 50%) + follicular + oncocytic (< 50%)	P	A	A	2.2	P	A	T2	N1a
27	F	58	Solid + follicular (< 50%) + oncocytic (< 50%)	A	P	A	1.8	P	P	T3	N0
28	F	38	Solid (< 50%) + oncocytic	A	A	A	1.2	P	P	T3	N0
29	F	13	Solid (< 50%) + oncocytic (< 50%) + classic	A	A	P	3.1	P	P	T3	N0

Variants or differentiation patterns	N (517)	% (100)
Classic variant	164	31.7
Follicular variant	83	16.0
Oncocytic variant	10	1.9
Diffuse sclerosing variant	4	0.7
Warthin-like variant	4	0.7
Solid variant	3	0.5
Tall Cells variant	1	0.1
Fasciite-like variant	1	0.1
Complex tumors	29	5.6
Microcarcinoma variant	218	42.1
Classic pattern	174	----
Follicular pattern	25	----
Oncocytic pattern	8	----
Solid pattern	1	----
Columnar pattern	1	----
Sclerosing diffuse pattern	1	----
Warthin-like pattern	1	----
Complex tumors	7	----

			Variant/differentiation pattern
	Classic		Follicular		Oncocytic		Total		p -value
	Mean (SD)		Mean (SD)		Mean (SD)		Mean (SD)
Age	46.6 (14.00)		47.75 (13.94)		50.81 (12.99)		47.04 (13.95)		0.3785
Tumor diameter (m ± SD)	1.39 (1.29)		2.27 (1.74)		1.88 (1.61)		1.63 (1.48)		----------
	Median (Min-Max)		Median (Min-Max)		Median (Min-Max)		Median (Min-Max)
Tumor diameter	1 (0.01-7.5)		1.6 (0.1-9)		1.3 (0.2-6)		1.2 (0.01-9)		0.0290
	N (329)	% (70.7)	N (118)	% (25.3)	N (18)	% (3.8)	N (465)	% (100)
Men/Women	56/273	17.0/82.9	24/94	20.3/79.6	4/14	22.2/77.7	84/381	18.0/81.9	0.6490
Associated Hashimoto's thyroiditis	44	13.3	22	18.6	3	16.6	69	14.8	0.3756
Lymph-vascular/neural invasion	18	5.4	11	9.3	0	0	29	6.2	0.1783
Multifocality	117	35.5	44	37.2	4	22.2	165	35.4	0.4603
Extraglandular spill	96	29.1	30	25.4	6	33.3	132	28.3	0.6610
Gland capsular invasion	177	53.7	60	50.8	8	44.4	245	52.6	0.6656
Positive neck LN	73	22.1	25	21.1	4	22.2	102	21.9	0.9744
LNs involved in the lateral compartment	28	8.5	7	5.9	0	0	35	7.5	0.3082
T Stage: 1-2	226	68.6	78	66.1	12	66.6	316	67.9	0.8684
T Stage: 3-4	103	31.3	40	33.8	6	33.3	149	32.0	0.8684

		Variant/differentiation pattern					p -value
	High malignancy potential		Low malignancy potential		Total
	Mean (SD)		Mean (SD)		Mean (SD)
Age	49.89 (16.50)		47.04 (13.96)		47.20 (14.11)		0.3685
Tumor diameter	3.03 (2.06)		1.64 (1.48)		1.72 (1.55)		----------
	Median (Min-Max)		Median (Min-Max)		Median (Min-Max)
Tumor diameter	2.5 (0.4-8)		1.2 (0.01-9)		1.2 (0.01-9)		0.0229
	N (29)	% (5.6)	N (482)	% (93.9)	N (511)	% (100)
Men/Women	4/25	13.7/86.2	88/394	18.2/81.7	92/419	18.0/81.9	0.7197
Associated Hashimoto's thyroiditis	4	12.9	69	14.3	73	14.2	0.8273
Lympho-vascular/neural invasion	6	20.6	30	6.2	36	7.0	0.0098
Multifocality	11	37.9	183	37.9	194	37.9	0.9969
Extraglandular spill	13	44.8	139	28.8	152	29.7	0.1052
Gland capsular invasion	22	75.8	257	53.3	279	54.5	0.0296
Positive neck LNs	8	27.5	107	22.1	115	22.5	0.6558
LNs involved in the lateral compartment	5	17.2	36	7.4	41	8.0	0.1261
T Stage: 1-2	13	44.8	325	67.4	338	66.1	0.0217
T Stage: 3-4	16	55.1	157	32.5	173	33.8	0.0217

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] Send correspondence to: Fábio Muradás Girardi. Avenida Independência. nº 354/901. Porto Alegre - RS. Brazil. CEP: 90035-070. Telefone: (51) 3214-8436. E-mail: fabiomgirardi@gmail.com