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Aggressive follicular cell derived thyroid carcinoma: what do you need from the pathologist
1Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA. ths9004@med.cornell.edu.
Summary
Identifying aggressive differentiated thyroid carcinomas (DTC) is crucial. Pathologic and molecular features, including high-grade morphology and TERT promoter mutations, help predict poor outcomes and guide management.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Differentiated thyroid carcinomas (DTC) are common thyroid cancers with generally good prognoses.
- A subset of DTC exhibit aggressive behavior, including distant metastasis (DM), radioactive iodine (RAI) resistance, and reduced survival.
- Accurate identification of aggressive DTC is vital for risk stratification and patient management.
Purpose of the Study:
- To review key pathologic and molecular features associated with aggressive behavior in DTC.
- To highlight diagnostic criteria, prognostic significance, and clinical management implications of these features.
- To emphasize the importance of integrating morphologic and molecular findings for comprehensive risk stratification.
Main Methods:
- Review of existing literature on pathologic and molecular markers in DTC.
- Analysis of diagnostic criteria for high-grade differentiated thyroid carcinoma (HGDTC) and specific histologic subtypes.
- Evaluation of the prognostic significance of mutations such as BRAFV600E and TERT promoter mutations.
Main Results:
- Pathologic features like vascular invasion (VI), capsular invasion (CI), and extrathyroidal extension (ETE) predict aggressive behavior.
- High-grade features, as defined by the 2022 WHO Classification, and certain PTC subtypes (tall cell, hobnail, columnar cell) are associated with poorer outcomes.
- TERT promoter mutations, especially with BRAFV600E co-occurrence, are linked to aggressive tumor biology, DM, RAI resistance, and decreased survival.
Conclusions:
- Comprehensive pathologic evaluation, integrating both morphologic and molecular data, is essential for accurate risk stratification of DTC.
- Understanding these aggressive features aids in tailoring treatment strategies and improving patient outcomes.
- The classification of HGDTC acknowledges the prognostic significance of high-grade features, aligning its prognosis with poorly differentiated thyroid carcinoma (PDTC).
