Scientific Paper
Tall cell papillary thyroid cancer: Incidence and prognosis*

https://doi.org/10.1016/S0002-9610(05)80099-6Get rights and content

Background:

The tall cell variant (TCV) of papillary thyroid cancer is reported to have a poor prognosis. This study examines the incidence and end result of surgical treatment of TCV.

Methods:

In this study, 240 thyroid cancers treated over a 23-year period at two hospital centers are reviewed. A total of 153 patients with papillary cancer were available for follow-up. All microscopic slides were re-examined.

Results:

Of the total 183 papillary cancers, 19 (10.4%) were TCV. The remainder were usual papillary or other papillary cancer variants. Patient age, tumor size, lymph node and soft-tissue involvement, recurrence, and death rates were evaluated. Multivariate statistical analysis disclosed that TCV histology, as well as age and tumor size, were significant predictors of recurrence.

conclusion:

Despite a high rate of recurrence in TCV cases over age 50 (6/9), there were no recurrent TCVs in cases under age 50 (0/8). Pathologists and surgeons must develop an increased awareness of this entity and implications for more radical treatment in the older age group.

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    Consequently, it is evident that a patient's PTC may or may not be diagnosed as TCV depending on the aforementioned factors. Despite all these conundrums, many studies with various designs and statistical analyses, including meta-analyses and large cancer registry studies, have reinforced the apparent more aggressive clinical behavior for TCV, when compared to classic PTC.18–22,25–28,32–34 Conclusions derived from these studies have reported that TCV is associated with older age at diagnosis, higher rate of gross extrathyroidal extension, increased lymph node and distant metastasis, and reduced disease-specific survival.18–22,25–28,32–34

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    The vast majority of patients (98%) in our series presented with papillary carcinoma, and in later years, tall cell variant of papillary carcinoma was noted in up to 38% of cases. This is a far greater rate than the reported general incidence of tall cell carcinoma within standard groups of DTC patients27 and is congruent with its recognized association with ETE and increasing age.28 In terms of factors prognostic of oncologic outcome in this group of patients, Rosa Pelizzo et al18 found that older age, more extensive disease, less than total thyroidectomy, and no neck dissection were all independently predictive of poor outcome.

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*

Presented at the joint meeting of the Society of Head and Neck Surgeons and the European Organization for Research and Treatment of Cancer (EORTC), Paris, France, May 25–28, 1994.

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