Clinically Relevant Prognostic Parameters in Differentiated Thyroid Carcinoma
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Clinically Relevant Prognostic Parameters in Differentiated Thyroid Carcinoma Tyler Janovitz 1 & Justine A. Barletta 1
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Although differentiated thyroid carcinomas typically pursue an indolent clinical course, it is important to identify the subset of tumors that are most likely to behave aggressively so that patients with these tumors are counseled and treated appropriately. Extent of disease is fundamental to the prognostication for differentiated thyroid carcinoma; however, there are additional histologic features of the tumor separate from extent of disease that have been shown to affect clinical course. This review will start with a discussion of aggressive variants of papillary thyroid carcinoma, move to the prognostic significance of vascular invasion in follicular thyroid carcinoma, and finish with a discussion of Hürthle cell carcinoma, with an emphasis on why it is not considered a subtype of follicular thyroid carcinoma in the 2017 WHO Classification of Tumors of Endocrine Organs. Keywords Thyroid carcinoma . Risk stratification . Tall cell variant . Hobnail variant . Hürthle cell carcinoma
Introduction Follicular cell-derived differentiated thyroid carcinomas include papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and Hürthle cell carcinoma (HCC). PTC accounts for approximately 85% of thyroid carcinomas [1]. Most PTC follow an indolent clinical course with diseasespecific survival rates of 98 and 93% at 5 and 10 years, respectively; however, with long-term follow-up, as many as 28% of PTC recur [2]. Clinical and pathologic variables to risk stratify differentiated thyroid carcinomas are outlined by the American Thyroid Association (ATA) [3]. Based on these variables, tumors can be categorized as having a low, intermediate, or high risk of structural disease recurrence. There is a range for recurrence risk for each risk category depending on the features present. The upper risk of recurrence is approximately 5, 30, and 55% for the low, intermediate, and high-risk categories, respectively. This review will start with a discussion of aggressive histologic variants of PTC which, in the absence of high-risk features, results in the characterization * Justine A. Barletta [email protected]; [email protected] Tyler Janovitz [email protected] 1
Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
of a tumor as intermediate risk. Per ATA guidelines, intermediate-risk tumors should undergo total thyroidectomy and radioactive iodine should be considered [3]. Next, the prognostic significance of vascular invasion in FTC will be reviewed. Extent of vascular invasion is another important parameter in risk stratification of differentiated thyroid carcinomas. FTC with extensive vascular invasion is categorized as high risk with a 30–55% risk of structural disease recurrence [3]. Finally, this review will conclude with a discussion
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