Ghossein Ronald A, Leboeuf Rebecca, Patel Kepal N, Rivera Michael, Katabi Nora, Carlson Diane L, Tallini Giovanni, Shaha Ashok, Singh Buvanesh, Tuttle R Michael
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Thyroid. 2007 Jul;17(7):655-61. doi: 10.1089/thy.2007.0061.
The tall cell variant (TCV) is a histologic subtype of papillary thyroid carcinoma (PTC) that is more aggressive than "classical" PTC. Most authors believe that TCV's worse prognosis is related to older age at presentation, larger tumor size, and high frequency of extrathyroid tumor extension (ETE). To assess the biologic and clinical behavior of TCV without ETE, we performed a detailed comparative clinicopathologic analysis of classical PTC and TCV without ETE.
TCV was defined as a PTC harboring >50% tall cells, while classical PTC was restricted to those tumors containing >1% papillae and <30% tall cells. Microscopic analysis and chart review identified 62 cases of TCV and 83 classical PTC without ETE. These patients were analyzed for various pathologic, imaging, and clinical parameters including outcome.
There was no statistical difference between TCV and classical PTC in relation to age, gender, tumor size, risk stratification, type of therapy, and length of follow-up. TCV displayed more invasion of the tumor capsule and more often infiltrated into the thyroid capsule (p = 0.047 and 0.0004, respectively). Among patients with microscopically assessable regional lymph node (LN), 33 of 49 (67.3%) patients with TCV had LN metastasis at presentation, while only 24 of 60 (40%) classical PTC had positive nodes (p = 0.004). In multivariate analysis, histologic subtype (TCV vs. classical PTC) was the only independent factor associated with LN metastases (p = 0.007). In patients with adequate follow-up, 4 of 62 (6.5%) classical PTC and 7 of the 47 (14.9%) TCV had thyroid cancer recurrence (p = 0.202). TCV recurred at a distant site (3 of 47, 6.4%) while none of the 62 classical PTC developed distant metastases (p = 0.077).
TCV without ETE is biologically a more aggressive tumor than classical PTC without ETE independent of age, gender, and tumor size.
高细胞变体（TCV）是甲状腺乳头状癌（PTC）的一种组织学亚型，其侵袭性高于“经典”PTC。大多数作者认为，TCV较差的预后与就诊时年龄较大、肿瘤体积较大以及甲状腺外肿瘤侵犯（ETE）的高频率有关。为了评估无ETE的TCV的生物学和临床行为，我们对经典PTC和无ETE的TCV进行了详细的比较临床病理分析。
TCV被定义为高细胞含量>50%的PTC，而经典PTC仅限于乳头含量>1%且高细胞含量<30%的肿瘤。通过显微镜分析和病历审查，确定了62例TCV和83例无ETE的经典PTC。对这些患者的各种病理、影像学和临床参数（包括预后）进行了分析。
TCV与经典PTC在年龄、性别、肿瘤大小、风险分层、治疗类型和随访时间方面无统计学差异。TCV表现出更多的肿瘤包膜侵犯，并且更常浸润到甲状腺包膜中（分别为p = 0.047和0.0004）。在显微镜下可评估区域淋巴结（LN）的患者中，49例TCV患者中有33例（67.3%）在就诊时有LN转移，而60例经典PTC患者中只有24例（40%）有阳性淋巴结（p = 0.004）。在多变量分析中，组织学亚型（TCV与经典PTC）是与LN转移相关的唯一独立因素（p = 0.007）。在随访充分的患者中，62例经典PTC中有4例（6.5%）和47例TCV中有7例（14.9%）出现甲状腺癌复发（p = 0.202）。TCV在远处复发（47例中有3例，6.4%），而62例经典PTC中无一例发生远处转移（p = 0.077）。
无ETE的TCV在生物学上是一种比无ETE的经典PTC更具侵袭性的肿瘤，与年龄、性别和肿瘤大小无关。
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