Rüter A, Nishiyama R, Lennquist S
Department of Endocrinology and Metabolism (Surgery and Medicine), University Hospital, Linköping, S-581 85 Sweden.
World J Surg. 1997 Jan;21(1):15-20; discussion 20-1. doi: 10.1007/s002689900187.
The tall-cell variant of papillary thyroid carcinoma (TCV) has been described as an aggressive tumor with a significantly higher incidence of recurrence and mortality than other forms of papillary carcinoma. In some series it has accounted for up to 10%, whereas in other series it has not been reported at all, indicating that there are difficulties identifying it. In a series of 162 consecutively treated patients with papillary thyroid carcinoma treated by total thyroidectomy according to a highly standardized procedure, all specimens were specifically examined by an international group of pathologists to establish the occurrence of TCV. All patients with TCV were studied with regard to local aggressiveness, the presence of metastases, iodine uptake, DNA pattern, thyroglobulin production, treatment (surgical and adjuvant), and outcome (follow-up 3-17 years, median 10 years). At primary histopathologic evaluation by the local pathologist, three patients were recorded as having TCV. At special evaluation by the expert group, eight more cases were found, giving a total of 11 patients in this series (7%). Five of them had extracapsular growth, and four were multifocal. Three had metastases at the time of admission. Seven tumors were diploid, one tetraploid, and three aneuploid. Of the three patients with primary distant metastases two died (8 and 24 months after operation), and one is still alive after 10 years. Four other patients developed recurrences, one of whom died from cardiac failure, but the others have so far been treated successfully. Two of these recurrences had no radioiodine uptake, and one had no rise in thyroglobulin concentrations; the other two had rising values that correlated with recurrence. The other four patients are alive without recurrence. It was concluded that identification of the TCV requires examination by an experienced pathologist. Moreover, it may have a higher incidence than is generally recognized. No reliable criteria for prognostic classification were identified. The results suggest that early identification and active treatment can lead to an outcome more favorable than has previously been described.
甲状腺乳头状癌高细胞变体（TCV）被描述为一种侵袭性肿瘤，其复发率和死亡率明显高于其他形式的乳头状癌。在一些系列研究中，它占比高达10%，而在其他系列研究中则根本未被报道，这表明识别它存在困难。在一组按照高度标准化程序接受全甲状腺切除术治疗的162例连续的甲状腺乳头状癌患者中，所有标本均由一组国际病理学家进行专门检查，以确定TCV的发生率。对所有TCV患者进行了局部侵袭性、转移情况、碘摄取、DNA模式、甲状腺球蛋白产生、治疗（手术和辅助治疗）及预后（随访3 - 17年，中位时间10年）等方面的研究。在当地病理学家进行的初次组织病理学评估中，有3例患者被记录为患有TCV。在专家组的特殊评估中，又发现了8例，该系列中共有11例患者（7%）。其中5例有包膜外生长，4例为多灶性。3例在入院时已有转移。7个肿瘤为二倍体，1个为四倍体，3个为非整倍体。3例原发性远处转移患者中，2例死亡（术后8个月和24个月），1例在10年后仍然存活。另外4例患者出现复发，其中1例死于心力衰竭，但其他患者目前已成功接受治疗。这些复发患者中有2例无放射性碘摄取，1例甲状腺球蛋白浓度未升高；另外2例甲状腺球蛋白值升高且与复发相关。其他4例患者存活且无复发。得出的结论是，TCV的识别需要由经验丰富的病理学家进行检查。此外，其发生率可能比普遍认为的要高。未发现可靠的预后分类标准。结果表明，早期识别和积极治疗可带来比先前描述更有利的预后。
