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Loss of cellular polarity/cohesiveness in the invasive front of papillary thyroid carcinoma, a novel predictor for lymph node metastasis; possible morphological indicator of epithelial mesenchymal transition
  1. Zhiyan Liu1,2,
  2. Kennichi Kakudo1,
  3. Yanhua Bai1,
  4. Yaqiong Li1,
  5. Takashi Ozaki1,
  6. Akira Miyauchi3,
  7. Emiko Taniguchi1,
  8. Ichiro Mori1
  1. 1Department of Human Pathology, Wakayama Medical University, Kimiidera, Wakayama Japan
  2. 2Department of Pathology and Pathophysiology, Shandong University School of Medicine, Jinan, Shandong, P.R. China
  3. 3Department of Surgery, Kuma Hospital, Chuo-ku, Kobe, Japan
  1. Correspondence to Kennichi Kakudo, Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan; kakudo-k{at}


Background Loss of cellular polarity/cohesiveness (LOP/C) in the invasive front of papillary thyroid carcinoma (PTC) results in a high recurrence risk of PTC.

Aims To investigate the immunohistochemical features of LOP/C in PTC and to show that this feature is linked to a high association of lymph node metastasis (LNM) at surgery and tumour recurrence.

Methods The degree of LOP/C of the PTCs was evaluated histologically using a cut-off value of 20% and the immunohistochemical features of LOP/C were analysed using immunohistochemical staining for E-cadherin, β-catenin and vimentin. The relationship between the LOP/C and the other clinicopathological parameters was analysed.

Results 43 cases of PTC with LOP/C (≥20%) were selected and 27 cases with LOP/C (<20%) were included as control tumours. 11/44 cases (25%) were observed to develop recurrence, LNM or distant metastasis at an average follow-up of 31 months. Less expression of E-cadherin and aberrant localisation of β-catenin and vimentin were observed in PTC tumour cells with LOP/C. LOP/C (≥20%) was significantly correlated with extrathyroid invasion (r=0.336, p=0.003), advanced tumour stage (r=0.275, p=0.017), LNM (r=0.389, p<0.001) and recurrence after surgery (r=0.302, p=0.036). Both extrathyroid invasion and LOP/C were independent significant predictors of LNM.

Conclusions LOP/C may be a useful morphological feature of epithelial mesenchymal transition under H&E observation, and it is an important indicator of lymph node metastasis and aggressive clinical behaviour of PTC.

  • Papillary carcinoma
  • thyroid
  • epithelial mesenchymal transition
  • lymph node metastasis
  • differentiation
  • carcinoma
  • differentiation
  • morphology
  • thyroid

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  • Funding ZL is an exchange PhD student in Wakayama Medical University from Shandong University. She is supported by scholarships from both China Scholarship Council 2007102087 and Wakayama Medical University.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of both Kuma Hospital and Wakayama Medical University ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.