en
Scientific article
English

Cytomorphologic features of poorly differentiated thyroid carcinoma: a multi-institutional analysis of 40 cases

Published inCancer, vol. 117, no. 3, p. 185-194
Publication date2009
Abstract

BACKGROUND: Poorly differentiated thyroid carcinoma (PDTC) is an uncommon and aggressive malignancy. Despite the significant clinical implications of a diagnosis of PDTC, its cytomorphologic features have not been well defined. Statistical analysis was applied to a series of 40 PDTCs to identify a specific set of cytomorphologic features that characterized these tumors on fine-needle aspiration biopsy (FNAB). METHODS: In total, 40 thyroid FNABs that were highly diagnosed histologically as PDTC (19 insular carcinomas and 21 noninsular carcinomas) comprised the study group. A control group of 40 well differentiated thyroid neoplasms were selected for comparison. All FNABs were reviewed and scored for a series of 32 cytomorphologic features. The results were evaluated using univariate and stepwise logistic regression (SLR) analyses. RESULTS: In univariate analysis, 17 cytomorphologic features were identified that characterized the 40 PDTCs: insular, solid, or trabecular cytoarchitecture (P < .001); high cellularity (P = .007); necrosis (P = .025) or background debris (P = .025); plasmacytoid appearance (P = .0007); single cells (P < .0001); high nuclear/cytoplasmic ratio (P < .0001); scant cytoplasm (P = .03); nuclear atypia (P < .0001), including nuclear pleomorphism (P = .0052) and anisokaryosis (P < .0001); granular/coarse chromatin (P = .026); naked nuclei (P = .01); mitotic activity (P = .0001) and apoptosis (P < .0001); endothelial wrapping (P = .0053); and severe crowding (P < .0001). In logistic regression analysis, severe crowding (P = .0008) and cytoarchitecture (P < .0001) were identified as the most significant cytomorphologic features of PDTCs, and the combination of cytoarchitecture, severe crowding, single cells, and high nuclear/cytoplasmic ratio was the most predictive of PDTC. CONCLUSIONS: PDTCs have characteristic cytomorphologic features. By using logistic regression analysis, the features that were identified as the most predictive of PDTC were severe crowding, insular/solid/trabecular morphology, single cells, and high nuclear/cytoplasmic ratio.

Keywords
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Biopsy, Fine-Needle/*methods
  • Female
  • Humans
  • Immunohistochemistry
  • Keratins/analysis
  • Logistic Models
  • Male
  • Middle Aged
  • Nuclear Proteins/analysis
  • Thyroglobulin/analysis
  • Thyroid Gland/chemistry/*pathology
  • Thyroid Neoplasms/metabolism/*pathology
  • Transcription Factors/analysis
Citation (ISO format)
BONGIOVANNI, Massimo et al. Cytomorphologic features of poorly differentiated thyroid carcinoma: a multi-institutional analysis of 40 cases. In: Cancer, 2009, vol. 117, n° 3, p. 185–194. doi: 10.1002/cncy.20023
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ISSN of the journal0008-543X
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