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Citation
Tags
HERO ID
9911834
Reference Type
Journal Article
Title
Poorly differentiated thyroid carcinomas: how much poorly differentiated is needed?
Author(s)
Dettmer, M; Schmitt, A; Steinert, H; Haldemann, A; Meili, A; Moch, H; Komminoth, P; Perren, A
Year
2011
Is Peer Reviewed?
Yes
Journal
American Journal of Surgical Pathology
ISSN:
0147-5185
EISSN:
1532-0979
Volume
35
Issue
12
Page Numbers
1866-1872
Language
English
PMID
21989341
DOI
10.1097/PAS.0b013e31822cf962
Abstract
BACKGROUND:
Poorly differentiated (PD) carcinomas of the thyroid are conceptually situated between well-differentiated (papillary or follicular) carcinomas and anaplastic thyroid carcinomas. Although the morphologic criteria for PD tumors are well defined, it is not clear how much of a PD area besides a well-differentiated component in a given tumor is required to allow such a diagnosis.
METHODS:
We identified 42 patients suffering from thyroid carcinoma with an adverse clinical outcome. Fifty patients with follicular carcinoma were added as controls. We analyzed poorly differentiated areas by applying the Turin criteria of PD carcinomas. These criteria consisted of the presence of a solid/trabecular/insular growth pattern, lack of nuclear features of papillary carcinoma, and presence of 1 of the following features: (1) convoluted nuclei, (2) tumor necrosis, (3) 3 or more mitoses per 10 high-power fields.
RESULTS:
Using a cutoff value of 10% of PD areas per examined tumor surface, we identified a total of 35 PD carcinomas. Despite using a threshold of 10% of the tumor area as poorly differentiated, the survival data in a Kaplan-Meier analysis were significantly worse than those in the control group (P<0.001) and did not differ from tumors with a PD area >50%. In a multivariate analysis that included age, sex, tumor stage, and PD area >10% against survival data, the only consistent significant factor was PD differentiation (P<0.001).
CONCLUSIONS:
As even slight amounts of PD areas (≥ 10%) in a thyroid carcinoma affect the prognosis significantly, the presence of such areas may be worth reporting in thyroid carcinomas.
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