Departments of Pathology.
Department of Surgery, Nakhchivan Autonomous Republic Hospital, Nakhchivan, Nakhchivan Autonomous Republic, Azerbaijan.
Am J Surg Pathol. 2020 Sep;44(9):1161-1172. doi: 10.1097/PAS.0000000000001522.
Given the high incidence and excellent prognosis of many papillary thyroid microcarcinomas, the Porto proposal uses the designation papillary microtumor (PMT) for papillary microcarcinomas (PMCs) without risk factors to minimize overtreatment and patients' stress. To validate Porto proposal criteria, we examined a series of 190 PMC series, also studying sex hormone receptors and BRAF mutation. Our updated Porto proposal (uPp) reclassifies as PMT incidental PMCs found at thyroidectomy lacking the following criteria: (a) detected under the age of 19 years; (b) with multiple tumors measuring >1 cm adding up all diameters; and (c) with aggressive morphologic features (extrathyroidal extension, angioinvasion, tall, and/or hobnail cells). PMCs not fulfilling uPp criteria were considered "true" PMCs. A total of 102 PMCs were subclassified as PMT, 88 as PMC, with no age or sex differences between subgroups. Total thyroidectomy and iodine-131 therapy were significantly more common in PMC. After a median follow-up of 9.6 years, lymph node metastases, distant metastases, and mortality were only found in the PMC subgroup. No subgroup differences were found in calcifications or desmoplasia. Expression of estrogen receptor-α and estrogen receptor-β, progesterone receptor, and androgen receptor was higher in PMC than in nontumorous thyroid tissue. BRAF mutations were detected in 44.7% of PMC, with no differences between subgroups. In surgical specimens, the uPp is a safe pathology tool to identify those PMC with extremely low malignant potential. This terminology could reduce psychological stress associated with cancer diagnosis, avoid overtreatment, and be incorporated into daily pathologic practice.
鉴于许多甲状腺乳头状微小癌的高发病率和良好的预后，波多提议使用乳头状微肿瘤（PMT）来命名无危险因素的甲状腺乳头状微小癌（PMCs），以最大限度地减少过度治疗和患者的压力。为了验证波多提议的标准，我们检查了一系列 190 例 PMC 系列，还研究了性激素受体和 BRAF 突变。我们更新的波多提议（uPp）将在甲状腺切除术中发现的无以下标准的偶然 PMCs 重新分类为 PMT：（a）年龄在 19 岁以下；（b）多个肿瘤直径>1cm 相加；和（c）具有侵袭性形态特征（甲状腺外侵犯、血管侵犯、高柱状和/或鞋钉细胞）。不符合 uPp 标准的 PMCs 被认为是“真正的”PMCs。共有 102 例 PMCs 被分类为 PMT，88 例为 PMC，亚组之间在年龄或性别上没有差异。在 PMC 中，全甲状腺切除术和碘-131 治疗更为常见。中位随访 9.6 年后，仅在 PMC 亚组中发现淋巴结转移、远处转移和死亡。在钙化或纤维变性方面，没有发现亚组差异。与非肿瘤性甲状腺组织相比，雌激素受体-α和雌激素受体-β、孕激素受体和雄激素受体在 PMC 中的表达更高。在 44.7%的 PMC 中检测到 BRAF 突变，亚组之间没有差异。在手术标本中，uPp 是一种安全的病理工具，可以识别那些恶性潜能极低的 PMC。这种术语可以减轻与癌症诊断相关的心理压力，避免过度治疗，并纳入日常病理实践。
