用于分离恶性滤泡上皮细胞衍生的甲状腺肿瘤的标准重叠,这些肿瘤具有有丝分裂和肿瘤坏死的高级特征,但缺乏间变性组织学。增长模式,核特征,肿瘤坏死,并建议各种有丝分裂指数截止,但尚未建立可重复的基于Ki-67的标记指数.回顾性分析41例诊断为低分化甲状腺癌(PDTC)或高级别分化滤泡细胞源性甲状腺癌(HGDFCDTC)的病例。具有组织学特征,有丝分裂图计数,和Ki-67标签指数审查了2010年至2021年南加州永久医疗集团内的病例,以确定任何潜在的结果差异。有17个HGDFCDTC(9个甲状腺乳头状癌;8个嗜酸细胞滤泡性甲状腺癌),中位年龄64岁,影响9名女性和8名男性。肿瘤很大(中位数,6.0cm),通常是单焦点(n=13),只有一个肿瘤缺乏侵袭。全部存在肿瘤坏死;有丝分裂计数中位数为5/2mm2(Ki-67标记指数中位数为8.3%)。三名患者在就诊时患有转移性疾病,4例患者有额外转移(41.2%发生转移);11例患者无疾病证据(中位数21.2个月);其余6例患者因转移性疾病存活(n=4)或死亡(n=2)(中位数25.8个月).与发展转移性疾病的风险增加相关的标准:广泛侵袭性肿瘤;年龄≥55岁;男性;晚期肿瘤大小和分期;甲状腺外扩展;但不增加有丝分裂率或更高的标记指数。有24个PDTC,中位年龄57.5岁,影响13名女性和11名男性。肿瘤很大(中位数,6.9cm),50%的多灶性疾病,三个肿瘤缺乏侵袭性。在所有肿瘤中均可见岛状/小梁/固体结构;23例出现肿瘤坏死;有丝分裂计数中位数为6/2mm2(Ki-67标记指数中位数为6.9%)。五名患者在就诊时患有转移性疾病,3例患者有额外转移(29.2%发生转移);16例无疾病证据(中位数,48.1个月);其余8例转移性疾病患者存活(n=3)或死亡(n=5)(中位数,22.4个月)。与发展转移性疾病的风险增加相关的标准:广泛侵袭性肿瘤;男性;晚期肿瘤大小和阶段;甲状腺外延伸;但不增加有丝分裂率或更高的标记指数。HGDFCDTC显示肿瘤坏死,Ki-67标记指数中位数为8.3%,高比例(41%)的患者发展为转移性疾病。侵入程度(非侵入性,微创,血管侵入性,广泛侵入性)与发展中的转移性疾病密切相关。PDTC的年龄稍小,患有大肿瘤,通常在多灶性肿瘤的背景下,几乎总是看到肿瘤坏死,Ki-67标记指数中位数为6.9%,29%的患者发展为转移性疾病。群体之间的分离是有意义的,因为早期转移性疾病相对常见,但有丝分裂计数/标记指数在各组之间没有差异,也不能对转移性疾病的发展进行潜在的分层风险.
Criteria overlap for separating between malignant follicular epithelial cell-derived thyroid gland neoplasms with high grade features of increased mitoses and tumor necrosis but lacking anaplastic histology. Patterns of growth, nuclear features, tumor necrosis, and various mitotic index cutoffs are suggested, but a reproducible Ki-67-based labeling index has not been established. Forty-one cases diagnosed as poorly differentiated thyroid carcinoma (PDTC) or high grade differentiated follicular cell-derived thyroid carcinoma (HGDFCDTC) were reviewed, with histologic features, mitotic figure counts, and Ki-67 labeling index reviewed on cases within Southern California Permanente Medical Group from 2010 to 2021 to establish any potential outcome differences. There were 17 HGDFCDTC (nine papillary thyroid carcinoma; eight oncocytic follicular thyroid carcinoma), median age 64 years, affecting nine females and eight males. Tumors were large (median, 6.0 cm), usually unifocal (n = 13), with only one tumor lacking invasion. Tumor necrosis was present in all; median mitotic count was 5/2 mm2 (median Ki-67 labeling index 8.3%). Three patients had metastatic disease at presentation, with additional metastases in four patients (41.2% developed metastases); 11 were without evidence of disease (median 21.2 months); with the remaining six patients alive (n = 4) or dead (n = 2) with metastatic disease (median 25.8 months). Criteria associated with an increased risk of developing metastatic disease: widely invasive tumors; age ≥ 55 years; male; advanced tumor size and stage; extrathyroidal extension; but not increased mitotic rate or higher labeling index. There were 24 PDTC, median age 57.5 years, affecting 13 females and 11 males. Tumors were large (median, 6.9 cm), with 50% part of multifocal disease, with three tumors lacking invasion. Insular/trabecular/solid architecture was seen in all tumors; tumor necrosis was present in 23; and median mitotic count was 6/2 mm2 (median Ki-67 labeling index 6.9%). Five patients had metastatic disease at presentation, with additional metastases in 3 patients (29.2% developed metastases); 16 were without evidence of disease (median, 48.1 months); with the remaining 8 patients alive (n = 3) or dead (n = 5) with metastatic disease (median, 22.4 months). Criteria associated with an increased risk of developing metastatic disease: widely invasive tumors; male; advanced tumor size and stage; extrathyroidal extension; but not increased mitotic rate or higher labeling index. HGDFCDTC shows tumor necrosis, a median Ki-67 labeling index of 8.3%, with a high percentage (41%) of patients developing metastatic disease. Extent of invasion (non-invasive, minimally invasive, angioinvasive, widely invasive) correlates strongly with developing metastatic disease. PDTC presents at a slightly younger age, with large tumors, often in a background of multifocal tumors, with tumor necrosis nearly always seen, a median Ki-67 labeling index of 6.9%, with 29% of patients developing metastatic disease. Separation between groups is meaningful as early metastatic disease is relatively common, but mitotic counts/labeling indices are not different between the groups nor able to potentially risk stratify development of metastatic disease.