J Korean Soc Endocrinol.  2006 Apr;21(2):132-141. 10.3803/jkes.2006.21.2.132.

Clinical Characteristics of Poorly Differentiated Carcinoma of the Thyroid and Comparison of Its Survival to the Tall Cell and Columnar Cell Variants of Papillary Carcinoma

• Jung TS
• Chung JH
• Oh YL
• Kim TY
• Shong YK
• Kim WB
• Kim KW
• Park YJ
• Cho BY

• KMID: 1511952
• DOI: http://doi.org/10.3803/jkes.2006.21.2.132

Abstract

BACKGROUND: Poorly differentiated carcinoma (PDC) of the thyroid includes tall and columnar cell variants (TCV) of the papillary carcinoma as well as the thyroid carcinoma with trabecular, insular and solid (TIS) growth patterns. There have been a few clinical studies on the PDC of the thyroid. We evaluated the clinical characteristics and the outcome of the PDC.
METHODS
We investigated the clinicopathologic features of the thyroid carcinoma with TIS growth patterns (n = 46) and TCV of the papillary carcinoma (n = 14). We investigated the clinical features of ten patients diagnosed as PDC of the thyroid who had been undergone thyroidectomy for well differentiated carcinoma previously and compared these outcome with those of patients primarily diagnosed as PDC of the thyroid (n = 60).
RESULTS
The clinical course of the thyroid carcinoma with TIS growth patterns was slightly more aggressive than that of TCV of the papillary carcinoma. However, disease-specific survivals of both cancers were not significantly different. Disease-specific survival was independently correlated with the presence of distant metastasis at diagnosis and high dose radioiodine therapy. The clinical features and outcome of the patients with PDC detected at recurred sites after operation for well-differentiated carcinoma were more aggressive than those diagnosed as PDC of the thyroid.
CONCLUSION
The prognosis of the thyroid carcinoma with TIS growth patterns and TCV of the papillary carcinoma were similar. The PDC which was detected after thyroidectomy for well-differentiated carcinoma had worse prognosis than primarily diagnosed as PDC of the thyroid.

MeSH Terms

Carcinoma, Papillary*
Diagnosis
Humans
Neoplasm Metastasis
Prognosis
Thyroid Gland*
Thyroid Neoplasms
Thyroidectomy

Figure

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  Fig. 1 A, Disease-specific survival distribution based on Kaplan-Meir product-limit estimate according to the presence of distant metastasis. There was good disease-specific survival in the patients with no metastasis of thyroid cancer (P < 0.001). B, Disease-specific survival distribution based on Kaplan-Meir product-limit estimate according to the radioactive iodine therapy There was good disease-specific survival in the patients with postoperative radioactive iodine therapy group (P = 0.047).

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  Fig. 2 A, Disease-specific survival distribution based on Kaplan-Meir product-limit estimate according to the patients with thyroid carcinoma with insular, trabecular and solid growth patterns and the patients with aggressive variants of papillary carcinoma, There were no statistical differences between insular, trabecular and solid types of the poorly differentiated carcinoma (n = 46) and tall cell and columnar cell variants of the papillary carcinoma (n = 14, P = 0.51). B, Disease-specific survival distribution based on Kaplan-Meir product-limit estimate according to the patients with diagnosed as poorly differentiated carcinoma (PDC) after thyroidectomy for well-differentiated carcinoma (WDC). There was significant difference between the patients with primarily diagnosed as PDC of the thyroid and the patients with diagnosed as PDC after thyroidectomy for WDC of the thyroid (n = 10, P = 0.0175).

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  Fig. 3 Disease-specific survival distribution based on Kaplan-Meir product-limit estimate according to pathologic-Tumor-Node-Metastasis (pTNM) stage. There were statistically significant difference in TNM stage I versus II (P = 0.0072) and TNM stage I versus IV (P = 0.0006). The significance levels were adjusted by using Bonferroni's correction to eliminate chance associations.

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