The Evaluation of Clinicopathologic Features of Differentiated Thyroid Cancers

Öz

Objectives: Papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) constitute most of the differentiated thyroid cancers (DTC). Frequency of follicular variant (FV)PTC, a variant of PTC, has been increasing in recent years. However, the data concerning clinicopathologic, radiologic, and cytologic features of this subtype are limited in the literature. The aim of this study was to compare the clinicopathologic features of patients who were diagnosed and followed-up as FTC and FV-PTC in our institution, and also to investigate if there are differences between two groups in the preoperative radiologic, cytologic characteristics, and histopathologic tumoral features.
Materials and Methods: Totally 177 (144 FV-PTC and 30 FTC) patients were included in this retrospective study. Preoperative thyroid function tests, thyroid antibodies, ultrasonographic and cytologic features of nodules, postoperative histopathologic features of both groups were compared.
Results: FV-PTC group had 23 (16%) male and 121 (84%) female patients, FTC group had 11 (36.70%) male and 19 (63.30%) female patients. FTC group had significantly higher male patients (p=0.009). When preoperative ultrasonographic features were compared, we found that longitudinal diameters and volume of nodules were significantly higher in the FTC group (respectively, p=0.007 and p=0.005). There were no significant differences according to other ultrasonographic features. In comparison to preoperative nodular cytological results according to the Bethesda classification, follicular neoplasia/suspicious for follicular neoplasia (FN/SFN) cytology was found higher in FTC group compared to FV-PTC (15.80% vs 5.30%, p=0.017). In the evaluation of histopathological tumoral features, tumor diameter was detected higher in the FTC group (median tumor diameter; 25 mm vs 14.5 mm, p <0.001). Capsular invasion and vascular invasion were significantly high in the FTC group (respectively, p<0.001 and p<0.001).

Conclusion: FV-PTC is a commonly seen subtype of the PTC. It has been reported that clinical feature of FV-PTC is between classical type PTC and FTC in the literature. Clinicopathologic behaviour of FV-PTC among the other differentiated thyroid cancers can be determined clearly with the further studies. 

Anahtar Kelimeler

• Follicular variant of papillary thyroid cancer,follicular thyroid cancer,ultrasound,cytology,tumoral features

Diferansiye Tiroid Kanserlerinin Klinikopatolojik Özelliklerinin Değerlendirilmesi

Öz

Amaç: Diferansiye tiroid kanserinin (DTK) büyük çoğunluğunu papiller tiroid Amaç: Diferansiye tiroid kanserinin (DTK) büyük çoğunluğunu papiller tiroid kanserleri (PTK) ve folliküler tiroid kanserleri (FTK) oluşturmaktadır. PTK varyantlarından olan folliküler varyant- PTK (FV-PTK) sıklığı son yıllarda artmaktadır. Ancak bu alt grup için klinikopatolojik, radyolojik ve sitolojik özelliklere ait literatür bilgisi kısıtlıdır. Bu çalışmada amaç, merkezimizde takip edilen FTK ve FV-PTK tanısı alan hastaların klinikopatolojik özelliklerin karşılaştırılması, preoperatif radyolojik ve sitolojik özellikler ile histopatolojik tümöral özellikler açısından bu iki grup arasında fark olup olmadığının araştırılmasıdır. 

Materyal ve Metot: Bu retrospektif çalışmaya toplam 177 (144 FV-PTK ve 30 FTK) hasta dahil edildi. Her iki hasta grubunun preoperatif tiroid fonksiyon testleri, tiroid antikorları, nodüllerinin ultrasonografik ve sitolojik özellikleri, operasyon sonrası histopatolojik özellikleri karşılaştırıldı.
Bulgular: FV-PTK grubunda 23 (%16) erkek hasta, 121 (%84) kadın hasta var iken, FTK grubunda 11 (%36,70) erkek 19 (%63,30) kadın hasta mevcut olup erkek hastaların sayısı FTK grubunda istatistiksel olarak anlamlı derece fazla idi (p=0,009). Preoperatif ultrasonografik özellikler karşılaştırıldığında FTK grubundaki nodüllerin longitudinal çapı ve volümü FV-PTK grubundan istatistiksel olarak anlamlı derecede daha büyüktü (sırası ile p=0,007 ve p=0,005). Ultrasonografik diğer özelliklerden açısından istatistiksel anlamlı farklılık izlenmedi. Her iki gruptaki nodüllerin preoperatif sitoloji sonuçları Bethesda sınıflamasına göre karşılaştırıldığında folliküler neoplazi/folliküler neoplazi şüphesi (FN/FNŞ) sitoloji sonucu FTK grubunda istatistiksel olarak anlamlı derece daha fazlaydı (%15,80’e karşılık %5,30, p=0,017). Histopatolojideki tümöral özellikle değerlendirildiğinde FTK grubunda tümör çapı, FV-PTK grubundan istatistiksel olarak anlamlı derece daha büyüktü (median tümör çapı 25 mm’e karşılık 14,5 mm, p <0,001). Kapsüler invazyon ve vasküler invazyon görülme oranı FTK grubunda istatistiksel anlamlı olarak daha fazlaydı (p<0,001).

Sonuç: FV-PTK, PTK’ının sık görülen bir alt grubudur. Literatür verilerine göre klinik özelliklerinin klasik tip PTK ile FTK arasında olduğu belirtilmektedir. Diğer DTK’lar içerisinde FV-PTK’nın klinikopatolojik davranışı ileri çalışmalarla daha net bir şekilde tanımlanabilir. 

Anahtar Kelimeler

• Folliküler varyant papiller tiroid kanseri,folliküler tiroid kanseri,ultrasonografi,sitoloji,tümör özellikleri

Kaynakça

1. 1. Russ G, Leboulleox S, Leenhardt L, Hegedus L. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and work up. Eur Thyroid J 2014;3:154-63.
2. 2. Hegedus L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764-71.
3. 3. Sherman SI. Thyroid carcinoma. Lancet 2003;361:501-11.
4. 4. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140:317-22.
5. 5. Gomez Segovia I, Gallowitsch HJ, Kresnik E, et al. Descriptive epidemiology of thyroid carcinoma in Carinthia, Austria: 1984-2001. Histopathologic features and tumor classification of 734 cases under elevated general iodination of table salt since 1990: population-based age-stratified analysis on thyroid carcinoma incidence. Thyroid 2004;14:277-86.
6. 6. Farahati J, Geling M, Mader U, et al. Changing trends of incidence and prognosis of thyroid carcinoma in lower Franconia, Germany, from 1981-1995. Thyroid 2004;14:141-7.
7. 7. Aschebrook-Kilfoy B, Grogan RH, Ward MH, Kaplan E, Devesa SS. Follicular thyroid cancer incidence patterns in the United States, 1980-2009. Thyroid 2013;23:1015-21.
8. 8. Tallini G, Tuttle RM, Ghossein RA. The history of the follicular variant of papillary thyroid carcinoma. J Clin Endocrinol Metab 2017;102:15-22.

9. 9. Chem KT,Rosai J. Follicular variant of thyroid papillary carcinoma: a clinicopathologic study of six cases. Am J Surg Pathol 1977;1:123-30.
10. 10. Verkooijen HM, Fioretta G, Pache JC, et al. Diagnostic changes as a reason fort he increase in papillary thyroid cancer incidence in Geneva, Switzerland. Cancer Causes Control 2003;14(1):13-7.
11. 11. Cipriani NA, Nagar S, Kaplan SP, et al. Follicular thyroid carcinoma: how have histologic diagnoses changed in the last half-century and what are the prognostic implications? Thyroid 2015;25:1209-16.
12. 12. Haugen BR, Alexander EK, Bible KC, et al. 2015 Americal Thyroid Association management guidelines for adult patients for thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133.
13. 13. Cibas ES, Ali SZ. The Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2009;19:1159-65.
14. 14. Jossart GH, Clark OH. Well-differentiated thyroid cancer. Curr Probl Surg 1994;31:933-1012.
15. 15. Lang BH, Lo CY, Chan WF, Lam AK, Wan KY. Classical and follicular variant of papillary thyroid carcinoma: a comparative study on clinicopathologic features and long-term outcome. World J Surg 2006;30:752-8.
16. 16. Lam AK, Lo CY, Lam KS. Papillary carcinoma of thyroid: a 30-yr clinicopathological review of the histological variants. Endocr Pathol 2005;16:323-30.
17. 17. Tielens ET, Sherman SI, Hruban RH, Ladenson PW. Follicular variant of papillary thyroid carcinoma. A clinicopathologic study. Cancer 1994;73:424-31.
18. 18. Zidan J, Karen D, Stein M, Rosenblatt E, Basher W, Kuten A. Pure versus follicular variant of papillary thyroid carcinoma: clinical features, prognostic factors, treatment, and survival. Cancer 2003;97:1181-5.
19. 19. Hughes NM, Nae A, Barry J, Fitzgerald B, Feeley L, Sheahan P. Sonographic differences between conventional and follicular variant papillary thyroid carcinoma. Eur Arch Otorhinolaryngol 2017;274:2907-13.
20. 20. Kim DS, Kim JH, Na DG, et al. Sonographic features of follicular variant papllary thyroid carcinomas in comparison with conventional papillary thyroid carcinomas. J Ultrasound Med 2009;28:1685-92.
21. 21. Merten MM, Castro MR, Zhang J, Durski J, Ryder M. Examining the role of preoperative positron emission tomography/computerized tomography in combination with ultrasonography in discriminating benign from malignant cytologically indeterminate thyroid nodules. Thyroid 2017;27:95-102.
22. 22. Kim ES, Nam-Goong IS, Gong G, Hong SJ, Kim WB, Shong YK. Postoperative findings and risk for malignancy in thyroid nodules with cytological diagnosis of the so-called ‘’follicular neoplasm’’. Korean J Intern Med 2003;18:94-7.
23. 23. Ganly I, Ricarte Filho J, Eng S, et al. Genomic dissection of Hurthle cell carcinoma reveals a unique class of thyroid malignancy. J Clin Endocrinol Metab 2013;98:962-72.
24. 24. Lee SH, Baek JS, Lee JY, et al. Predictive factors of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. Endocr Pathol 2013;24:177-83.
25. 25. Yu XM, Schneider DF, Leverson G, Chen H, Sippel RS. Follicular variant of papillary thyroid carcinoma is a unique clinical entity: A population-based study of 10.740 cases. Thyroid 2013;23(10):1263-8.
26. 26. Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2017; doi:10.1016/S2213-8587(17)30325-X.
27. 27. Goffredo P, Sosa JA, Roman SA. Differentiated thyroid cancer presenting with distant metastases: a population analysis over two deceades. World J Surg 2013;37:1599-605.