背景:分化型高级别甲状腺癌(DHGTC)是最新在2022年世界卫生组织(WHO)内分泌和神经内分泌肿瘤分类中定义的一种新的诊断实体。这个新实体在文献中得到了最低限度的描述,和其他分类为此类的案件失踪。
方法:确定了2012年至2022年在我们机构诊断的DHGTC病例,并回顾了以下内容:细胞学和组织学诊断,辅助测试,免疫组织化学染色,治疗,和患者结果。对缺乏这种免疫染色的选定病例进行Ki67的免疫组织化学染色。使用PubMed和Embase对2013年至2023年DHGTC的英文文献进行了系统的文献综述。
结果:病例队列包括32例DHGTC,平均年龄为52.6岁(17-84岁),男女比例为1.3:1。所有病例均接受细针穿刺(FNA),并通过Bethesda甲状腺细胞病理学报告系统(TBSRTC)分类如下:14例恶性(43.8%),10为滤泡性肿瘤(31.3%),5为不确定显著性的非典型性(15.6%),2为可疑恶性肿瘤(6.2%),1为非诊断性(3.1%)。肿瘤平均大小5.15cm,以甲状腺乳头状癌居多(28,87.5%),经典亚型是最常见的。21例显示肿瘤坏死,无坏死病变的有丝分裂活动平均为每2mm25.5个有丝分裂(范围0-7)。平均Ki67增殖指数为5.6%。甲状腺外延伸17例,血管侵犯21例,淋巴侵犯7例,神经周侵犯1例。在5例中确定了固体或小梁生长的病灶。在诊断时发现淋巴结转移10例,其中7例表现为远处转移或局部复发。迄今为止,25个病人还活着,其中一人死于疾病。
结论:我们的机构经验表明,DHGTC是一种罕见的,但侵袭性甲状腺肿瘤亚型,需要在高分化甲状腺肿瘤的背景下考虑,以适当评估可能的疾病复发和确定患者预后。
BACKGROUND: Differentiated high-grade thyroid carcinomas (DHGTCs) are a new diagnostic entity most recently defined in the 2022 World Health Organization\'s (WHO) Classification of Endocrine and Neuroendocrine Tumors. This new entity has been minimally described in the literature, and additional cases classified as such are missing.
METHODS: Cases of DHGTCs diagnosed at our institution from 2012 to 2022 were identified, and the following were reviewed: cytologic and histologic diagnoses, ancillary testing, immunohistochemical staining, treatments, and patient outcomes. Immunohistochemical staining for Ki67 was performed on selected cases lacking this immunostain. A systematic literature review of the English literature on DHGTCs from 2013 to 2023 was performed using PubMed and Embase.
RESULTS: Case cohort included 32 cases of DHGTCs, with an average age of 52.6 years (range 17-84 years) and a male:female ratio of 1.3:1. All cases underwent fine needle aspiration (FNA) and were categorized by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) as follows: 14 cases as malignant (43.8 %), 10 as follicular neoplasm (31.3 %), 5 as atypia of undetermined significance (15.6 %), 2 as suspicious for malignancy (6.2 %), and 1 as non-diagnostic (3.1 %). The average tumor size was 5.15 cm, and most were papillary thyroid carcinoma (28, 87.5 %), with classic subtype being the most common. Twenty-one cases revealed tumor necrosis and the mitotic activity in lesions without necrosis averaged to 5.5 mitoses per 2 mm2 (range 0-7). The average Ki67 proliferative index was 5.6 %. Extrathyroidal extension was seen in 17, angioinvasion in 21, lymphatic invasion in 7, and perineural invasion in 1 case. Foci of solid or trabecular growth were identified in five cases. Lymph node metastases at the time of diagnosis were noted in 10 cases and 7 demonstrated distant metastases or locoregional recurrence. To date, 25 patients are alive, and one has died from disease.
CONCLUSIONS: Our institutional experience demonstrates that DHGTC is a rare, but aggressive thyroid tumor subtype that requires consideration in the setting of a well-differentiated thyroid neoplasm to appropriately assess for possible disease recurrence and determination of patient prognosis.