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Abstract：
Papillary thyroid carcinoma (PTC) with hobnail areas above 30% is classified as hobnail variant (HVPTC). Although it is widely accepted that HVPTC has a worse outcome than classical PTC, it is unclear whether PTC with hobnail features below 30% is as aggressive as HVPTC. We gathered the largest mono-institutional series of PTC with hobnail areas and HVPTC to evaluate differences in terms of pathological features of aggressiveness, molecular profile, and treatment outcome. A total of 99 PTC with hobnail features above 5% were retrospectively selected; 34 of them met the criteria for HVPTC (0.4% of all PTC diagnosed at our institution). All tumors showed high rates of extra-thyroidal extension (40.4%), lymph node metastasis (68.1% of patients with lymphadenectomy), and vascular emboli (49.5%), with no differences according to the 30% cutoff. On the other hand, distant metastases were present in HVPTC only (9.4%). Also, advanced age, advanced disease stage, and TERT promoter mutation were associated with HVPTC. More than half of the patients with follow-up had structural or biochemical persistence after 1 year from surgery. Structural persistence was significantly more common in patients with HVPTC (37.5% vs. 8.7%), while no differences were observed considering structural and biochemical persistence together. The presence of hobnail features identifies locally aggressive tumors, and, consequently, it should be always acknowledged in the pathological report. However, tumors with more than 30% hobnail areas frequently present TERT promoter mutations, advanced disease stage, and structural persistence after radioiodine ablation.
摘要：
hobnail区域超过30％的乳头状甲状腺癌（PTC）被归类为hobnail变体（HVPTC）。尽管人们普遍认为HVPTC的结果比经典的PTC差，目前尚不清楚hobnail特征低于30％的PTC是否与HVPTC一样具有侵略性。我们收集了最大的单机构系列PTC与hobnail区域和HVPTC，以评估侵袭性病理特征方面的差异，分子分布,和治疗结果。回顾性选择了99个具有5％以上的指甲特征的PTC；其中34个符合HVPTC的标准（占我们机构诊断的所有PTC的0.4％）。所有肿瘤均表现出高甲状腺外延伸率（40.4%），淋巴结转移（68.1％的患者进行淋巴结清扫），血管栓塞（49.5%），根据30%的截止值没有差异。另一方面,仅在HVPTC中存在远处转移(9.4%).此外，高龄,晚期疾病阶段，TERT启动子突变与HVPTC相关。超过一半的随访患者在手术1年后具有结构或生化持久性。结构持久性在HVPTC患者中更为常见（37.5％vs.8.7%），而考虑到结构和生化持久性，没有观察到差异。hobnail特征的存在可以识别出局部侵袭性肿瘤，and,因此,它应该总是在病理报告中承认。然而,hobnail区域超过30％的肿瘤经常存在TERT启动子突变，晚期疾病阶段，放射性碘消融后的结构持久性。
