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Histopathology. 2019 Dec 07;:
Authors: Wong KS, Chen TY, Higgins SE, Howitt BE, Lorch JH, Alexander EK, Marqusee E, Cho NL, Nehs MA, Doherty GM, Barletta JA
Abstract
BACKGROUND: Hobnail variant of papillary thyroid carcinoma (PTC) is an aggressive PTC subtype characterized by a hobnail cytomorphology. However, some classic PTC have a "hobnail-like" cytomorphology associated with thick, hyalinized, variably edematous fibrovascular cores that appears to be a form of ischemic/degenerative atypia.
DESIGN: We studied 3 cohorts to compare the histopathologic characteristics and clinical outcome of "hobnail-like" classic PTC and true hobnail variant of PTC: Cohort 1 - PTC consecutively resected between 2016-2017 (to assess frequency of "hobnail-like" cytomorphology); Cohort 2 - 20 "hobnail-like" classic PTC resected between 2005 and 2007 (to assess clinical outcome); Cohort 3 - seven true hobnail variant of PTC.
RESULTS: A "hobnail-like" cytomorphology was identified in 16% of consecutively resected PTC. Compared with true hobnail variant, "hobnail-like" classic PTC occurred in younger patients (mean age 40 years versus 68 years, p<0.001), were smaller tumors (mean tumor size 2.1 cm versus 4.4 cm, p<0.001), had a lower rate of gross extrathyroidal extension (0% versus 71%, p<0.001), had a lower proliferative rate (>3 mitoses per 10 high power fields seen in 0% versus 71%, p<0.001; Ki67 index >5% in 0% versus 86%, p<0.001), a lower rate of secondary pathogenic mutations (for cases with molecular data, 0% versus 100%, p=0.0061), and improved survival (for cases with sufficient clinical outcome data, 10-year disease-free survival of 93% versus 0%, p=0.0016).
CONCLUSION: Classic PTC can show ischemic/degenerative atypia that mimics the hobnail cytomorphology of true hobnail variant; however, these tumors lack aggressive histopathologic features and pursue an indolent clinical course.
PMID: 31811787 [PubMed - as supplied by publisher]
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