Saglietti C, Onenerk A M, Faquin W C, Sykiotis G P, Ziadi S, Bongiovanni M
Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cytopathology. 2017 Dec;28(6):467-474. doi: 10.1111/cyt.12497. Epub 2017 Nov 2.
Poorly differentiated thyroid carcinoma (PDTC) is a follicular cell-derived tumour that was recognised as a distinct entity by the World Health Organisation in 2004. The natural history and pathological features of PDTC are reported to be intermediate between those of well-differentiated and undifferentiated (anaplastic) thyroid carcinomas. Preoperative identification of PDTC could facilitate better initial patient management in many cases, namely more extensive surgery, without any delay. However, according to some experts, a diagnosis of PDTC can only be rendered on histologic specimens based on criteria recommended in the Turin proposal. Although high-grade features (namely necrosis and mitoses) can be recognised in FNA material, other cytomorphological features have limited value for the preoperative diagnosis of PDTC and specific features for a definitive diagnosis of PDTC have not yet been clearly defined. Here, we review the current status and future prospects for cytological recognition of PDTC; we emphasise the features that should raise suspicion of this rare condition in FNA cytology and provide an update on molecular features and management of PDTC. Despite proposed histological criteria for the diagnosis of PDTC, its recognition on routine thyroid cytology presents a notable challenge. Current and future advances in molecular testing could contribute to the cytological diagnosis of PDTC.
低分化甲状腺癌（PDTC）是一种滤泡细胞来源的肿瘤，2004年被世界卫生组织确认为一种独立的实体。据报道，PDTC的自然病史和病理特征介于高分化和未分化（间变性）甲状腺癌之间。在许多情况下，术前识别PDTC有助于更好地进行初始患者管理，即进行更广泛的手术，且不延误。然而，一些专家认为，只有根据都灵提议中推荐的标准，在组织学标本上才能做出PDTC的诊断。虽然在细针穿刺抽吸（FNA）材料中可以识别出高级别特征（即坏死和有丝分裂），但其他细胞形态学特征对PDTC的术前诊断价值有限，且尚未明确确定PDTC确诊的特异性特征。在此，我们回顾了PDTC细胞学识别的现状和未来前景；我们强调了在FNA细胞学中应引起对这种罕见疾病怀疑的特征，并提供了PDTC分子特征和管理的最新情况。尽管提出了PDTC诊断的组织学标准，但其在常规甲状腺细胞学上的识别仍面临显著挑战。分子检测的当前和未来进展可能有助于PDTC的细胞学诊断。
