Papillary Carcinoma Tall Cell Variant (TCV): A Review
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Papillary Carcinoma Tall Cell Variant (TCV): A Review Virginia A. LiVolsi
Published online: 20 February 2010 # Springer Science+Business Media, LLC 2010
Abstract Tall cell variant of papillary thyroid carcinoma is an aggressive form of thyroid cancer with a significant mortality. This review describes the pathology of this variant, compares it to its pathologic mimics and discusses its clinical pathologic features. The literature on this tumor is reviewed. A brief discussion of molecular pathologic correlates is included. Keywords Thyroid cancer . Tall cell variant . Clinical pathologic correlations Thyroid papillary carcinoma, the most common endocrine malignancy, is a tumor of such indolent biological and clinical behavior that the survival rate for patients with this tumor is equal or almost equal to that of individuals who never had cancer. Only a small percentage of patients with papillary carcinoma of the thyroid are affected by a tumor of considerable clinical aggressiveness. I often refer to this as “real carcinoma” of the thyroid. The most common of these subtypes is the tall cell variant of papillary carcinoma. Tall cell variant was initially defined as an aggressive lesion by Hawk and Hazard in 1976 [1]. The definition they proposed and accepted widely by pathologists to this day includes the presence of a papillary tumor whose cells are at least twice as long (tall) as they are wide [1–3]. The tumors tend to be extremely papillary and the papillae are elongated. The papillae may coalesce and the low power appearance may simulate a trabecular pattern in parts of the tumor. The cells are large and often eosinophilic without V. A. LiVolsi (*) Department of Pathology and Laboratory Medicine, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA e-mail: [email protected]
cytoplasmic granularity so they are not true Hürthle cells. The nuclei are elongate and sometimes conform to the elongated cell in which they are contained, have prominent grooves, clearing and intranuclear inclusions (Fig. 1). Multiple inclusions may be seen and especially in fine needle aspiration preparations, these can be helpful in suggesting the tumor is a tall cell papillary carcinoma. These multiple inclusions have been likened to “soap bubbles” within the nucleus [4]. Several aspects of tall cell variant (TCV) will be discussed in this review. First the definition of TCV: how much of a tumor needs to show the features of TCV to be diagnosed as such? Secondly, what is not TCV? Thirdly, what are the consequences of a diagnosis of TCV? Finally, what are the molecular features of this group of tumors and how can this assist us in understanding the pathogenesis and behavior of this subtype of papillary carcinoma of the thyroid. Many clinicians feel that there are significant consequences to the diagnosis of TCV. On the other hand, there appears to be confusion on the part of pathologists in recognizing this tumor or alternatively in overdiagnosing TCV. Indeed, in one study performed in a large
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