Ganly Ian, Wang Laura, Tuttle R Michael, Katabi Nora, Ceballos Gustavo A, Harach H Ruben, Ghossein Ronald
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065.
Department of Medicine, Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065.
Hum Pathol. 2015 May;46(5):657-64. doi: 10.1016/j.humpath.2015.01.010. Epub 2015 Feb 4.
The prognosis of the encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) and its relationship to encapsulated follicular carcinoma (EFC) and follicular adenoma (FA) is subject to controversy. All EFVPTCs, EFCs, and FAs identified at a single institution between 1981 and 2003 were analyzed microscopically. A cohort of FAs from a different hospital was also examined. EFVPTCs were subdivided into noninvasive EFVPTC (NIEFVPTC) and invasive EFVPTC (IEFVPTC) displaying capsular/vascular invasion. There were 83 EFVPTCs (57 noninvasive, 26 invasive), 14 EFCs, and 52 FAs. Similar to FA, over a median follow-up of 9.5 years, none of the NIEFVPTCs manifested lymph node metastasis (LNM) or recurred. Furthermore, with a median follow-up of 10.5 years, none of 39 NIEFVPTCs without radioactive iodine therapy recurred. Four (15%) of 26 IEFVPTCs and none of 14 EFCs harbored distant metastasis (P = .29). There was no difference in LNM rate and degree of vascular or capsular invasion between IEFVPTC and EFC (P > .1). All 4 IEFVPTCs with adverse behavior presented with distant metastasis and no LNM. Sixteen percent of IEFVPTCs had poor outcome, whereas there was none in the NIEFVPTCs (P = .007). In conclusion, NIEFVPTC seems to behave similarly to FA, whereas IEFVPTC can metastasize and spread like EFC. Thus, invasion rather than nuclear features drives outcome in encapsulated follicular tumors. Non-IEFVPTC could be treated in a conservative manner sparing patients unnecessary total thyroidectomy and radioactive iodine therapy. The position of the EFVPTC in the classification of thyroid neoplasia should be reconsidered.
甲状腺乳头状癌包膜型滤泡变体（EFVPTC）的预后及其与包膜型滤泡癌（EFC）和滤泡性腺瘤（FA）的关系存在争议。对1981年至2003年间在同一机构发现的所有EFVPTC、EFC和FA进行了显微镜分析。还检查了来自另一家医院的一组FA。EFVPTC分为无侵袭性EFVPTC（NIEFVPTC）和表现出包膜/血管侵袭的侵袭性EFVPTC（IEFVPTC）。共有83例EFVPTC（57例无侵袭性，26例侵袭性）、14例EFC和52例FA。与FA相似，在中位随访9.5年期间，NIEFVPTC均未出现淋巴结转移（LNM）或复发。此外，在中位随访10.5年时，39例未接受放射性碘治疗的NIEFVPTC均未复发。26例IEFVPTC中有4例（15%）发生远处转移，14例EFC均未发生远处转移（P = 0.29）。IEFVPTC和EFC之间的LNM率以及血管或包膜侵袭程度没有差异（P > 0.1）。所有4例具有不良行为的IEFVPTC均出现远处转移且无LNM。16%的IEFVPTC预后不良，而NIEFVPTC中无一例预后不良（P = 0.007）。总之，NIEFVPTC的行为似乎与FA相似，而IEFVPTC可像EFC一样发生转移和扩散。因此，在包膜型滤泡性肿瘤中，侵袭而非核特征决定预后。非IEFVPTC可采用保守治疗，避免患者接受不必要的全甲状腺切除术和放射性碘治疗。应重新考虑EFVPTC在甲状腺肿瘤分类中的位置。
