Skip to main content
SpringerLink
Log in

Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid: A 35-Year Comparative Study at a Single Institution

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Diffuse sclerosing variant (DSV) is a rare variant of papillary thyroid carcinoma (PTC), and the features of this carcinoma have not been fully characterized. The aim of this study was to analyze the clinicopathologic features of a large cohort of patients with this disease.

Methods

We reclassified primary thyroid carcinomas treated in a 35-year study period and studied the clinicopathologic features and outcomes of DSV of PTC in comparison with classic PTC.

Results

Fifteen patients (2 men and 13 women) with DSV of PTC were identified who had surgical resection of the thyroid. Fine-needle aspiration biopsy diagnosed 83% (10 of 12) of the tumors. Compared with classic PTC, patients with DSV presented at a younger age (mean age, 29 vs. 46 years; P = .0001), had larger tumors (mean diameter, 3.6 vs. 2.2 cm; P = .002), and had a higher incidence of cervical nodal metastases (80% vs. 43%; P = .006). Ten patients had received postoperative iodine 131 ablation, and four had also received external-beam irradiation. Distant metastases were detected in two patients (one in lung and one in brain). One third (5 of 15) of the patients developed disease recurrence. Lymph node recurrence was detected in one patient 12 years after the initial operation. Over a median follow-up period of 10.7 years, one patient with an initial incomplete excision died of the carcinoma. The overall disease-specific survival rate was 93%.

Conclusions

DSV of PTC had distinctive clinicopathologic features and a high incidence of recurrence after operation but had a prognosis similar to that of classic PTC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vickery AL Jr, Carcangiu ML, Johannessen JV, Sobrinho-Simoes M. Papillary carcinoma. Semin Diagn Pathol 1985;2:90–100

    PubMed  Google Scholar 

  2. Matias-Guiu X, Esquius J. Aberrant expression of HLA-DR antigen in diffuse sclerosing variant of papillary carcinoma of thyroid. J Clin Pathol 1989;42:1309

    CAS  PubMed  Google Scholar 

  3. Carcangiu ML, Bianchi S. Diffuse sclerosing variant of papillary thyroid carcinoma. Clinicopathologic study of 15 cases. Am J Surg Pathol 1989;13:1041–9

    Article  CAS  PubMed  Google Scholar 

  4. Wu PS, Leslie PJ, McLaren KM, Toft AD. Diffuse sclerosing papillary carcinoma of thyroid: a wolf in sheep’s clothing. Clin Endocrinol 1989;31:535–40

    CAS  Google Scholar 

  5. Soares J, Limbert E, Sobrinho-Simoes M. Diffuse sclerosing variant of papillary thyroid carcinoma. A clinicopathologic study of 10 cases. Pathol Res Pract 1989;185:200–6

    CAS  PubMed  Google Scholar 

  6. Caruso G, Tabarri B, Lucchi I, Tison V. Fine needle aspiration cytology in a case of diffuse sclerosing carcinoma of the thyroid. Acta Cytol 1990;34:352–4

    CAS  PubMed  Google Scholar 

  7. Chan JK. Papillary carcinoma of thyroid: classical and variants. Histol Histopathol 1990;5:241–57

    CAS  PubMed  Google Scholar 

  8. Fujimoto Y, Obara T, Ito Y, Kodama T, Aiba M, Yamaguchi K. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Clinical importance, surgical treatment, and follow-up study. Cancer 1990;66:2306–12

    CAS  PubMed  Google Scholar 

  9. Mizukami Y, Nonomura A, Michigishi T, et al. Diffuse sclerosing variant of papillary carcinoma of the thyroid: report of three cases. Acta Pathol Jpn 1990;40:676–82

    CAS  PubMed  Google Scholar 

  10. Hayashi Y, Sasao T, Takeichi N, Kuma K, Katayama S. Diffuse sclerosing variant of papillary carcinoma of the thyroid: a histopathological study of four cases. Acta Pathol Jpn 1990;40:193–8

    CAS  PubMed  Google Scholar 

  11. Schroder S, Bay V, Dumke K, et al. Diffuse sclerosing variant of papillary thyroid carcinoma. S-100 protein immunocytochemistry and prognosis. Virchows Arch A Pathol Anat Histopathol 1990;416:367–71

    CAS  PubMed  Google Scholar 

  12. Gomez-Morales M, Alvaro T, Munoz M, et al. Diffuse sclerosing papillary carcinoma of the thyroid gland: immunohistochemical analysis of the local host immune response. Histopathology 1991;18:427–33

    CAS  PubMed  Google Scholar 

  13. Alejo M, Peiro G, Oliva E, Matias-Guiu X. Leu-M 1 immunoreactivity in papillary carcinomas of the thyroid gland; microcarcinoma, encapsulated, conventional and diffuse sclerosing subtypes. Virchows Arch A Pathol Anat Histopathol 1991;419:447–8

    Article  CAS  PubMed  Google Scholar 

  14. Macak J, Michal M. Diffuse sclerosing variant of papillary thyroid carcinoma. Cesk Patol 1993;29:6–8

    CAS  PubMed  Google Scholar 

  15. Moreno Egea A, Rodriguez Gonzalez JM, Sola Perez J, Soria T, Parrilla Paricio P. Clinicopathological study of the diffuse sclerosing variety of papillary cancer of the thyroid: presentation of 4 new cases and review of the literature. Eur J Surg Oncol 1994;20:7–11

    CAS  PubMed  Google Scholar 

  16. Nikiforov Y, Gnepp DR. Pediatric thyroid-cancer after the Chernobyl disaster. Pathomorphologic study of 84 cases (1991–1992) from the Republic of Belarus. Cancer 1994;74:748–66

    PubMed  Google Scholar 

  17. Damiani S, Dina R, Eusebi V. Cytologic grading of aggressive and nonaggressive variants of papillary thyroid carcinoma. Am J Clin Pathol 1994;101:651–5

    CAS  PubMed  Google Scholar 

  18. Scott GC, Meier DA, Dickinson CZ. Cervical lymph node metastasis of thyroid papillary carcinoma imaged with fluorine-18-FDG, technetium-99m-pertechnetate and iodine-131-sodium iodide. J Nucl Med 1995;36:1843–5

    CAS  PubMed  Google Scholar 

  19. Caplan RH, Wester S, Kisken AW. Diffuse sclerosing variant of papillary thyroid carcinoma: case report and review of the literature. Endocr Pract 1997;3:287–92

    CAS  PubMed  Google Scholar 

  20. Lloyd RV, Ferreiro JA, Jin L, Sebo TJ. TGFB, TGFB receptors, Ki-67, and p27(Kip)l expression in papillary thyroid carcinomas. Endocr Pathol 1997;8:293–300

    PubMed  Google Scholar 

  21. Martin-Perez E, Larranaga E, Serrano P. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Eur J Surg 1998;164:713–5

    CAS  PubMed  Google Scholar 

  22. Kumarasinghe MP. Cytomorphologic features of diffuse sclerosing variant of papillary carcinoma of the thyroid: a report of two cases in children. Acta Cytol 1998;42:983–6

    CAS  PubMed  Google Scholar 

  23. Albareda M, Puig-Domingo M, Wengrowicz S, et al. Clinical forms of presentation and evolution of diffuse sclerosing variant of papillary carcinoma and insular variant of follicular carcinoma of the thyroid. Thyroid 1998;8:385–91

    Article  CAS  PubMed  Google Scholar 

  24. Khan AR, Abu-Eshy SA. Variants of papillary carcinoma of the thyroid: experience at Asir Central Hospital. J R Coll Surg Edinb 1998;43:20–5

    CAS  PubMed  Google Scholar 

  25. Trovato M, Villari D, Bartolone L, et al. Expression of the hepatocyte growth factor and c-met in normal thyroid, non-neoplastic, and neoplastic nodules. Thyroid 1998;8:125–31

    Article  CAS  PubMed  Google Scholar 

  26. Muzaffar M, Nigar E, Mushtaq S, Mamoon N. The morphological variants of papillary carcinoma of the thyroid: a clinico-pathological study—AFIP experience. Armed Forces Institute of Pathology. J Pak Med Assoc 1998;48:133–7

    CAS  PubMed  Google Scholar 

  27. Ohori NP, Schoedel KE. Cytopathology of high-grade papillary thyroid carcinomas: tall-cell variant, diffuse sclerosing variant, and poorly differentiated papillary carcinoma. Diagn Cytopathol 1999;20:19–23

    Article  CAS  PubMed  Google Scholar 

  28. Imamura Y, Kasahara Y, Fukuda M. Multiple brain metastases from a diffuse sclerosing variant of papillary carcinoma of the thyroid. Endocr Pathol 2000;11:97–108

    Article  CAS  PubMed  Google Scholar 

  29. Santoro M, Thomas GA, Vecchio G, et al. Gene rearrangement and Chernobyl related thyroid cancers. Br J Cancer 2000;82:315–22

    CAS  PubMed  Google Scholar 

  30. Kebapci N, Efe B, Kabukcuoglu S, Akalin A, Kebapci M. Diffuse sclerosing variant of papillary thyroid carcinoma with primary squamous cell carcinoma. J Endocrinol Invest 2002;25:730–4

    CAS  PubMed  Google Scholar 

  31. Marchesi M, Biffoni M, Biancari F, Berni A, Campana FP. Predictors of outcome for patients with differentiated and aggressive thyroid carcinoma. Eur J Surg Suppl 2003;588:46–50

    PubMed  Google Scholar 

  32. Triggiani V, Ciampolillo A, Maiorano E. Papillary thyroid carcinoma, diffuse sclerosing variant, with abundant psammoma bodies. Acta Cytol 2003;47:1141–3

    PubMed  Google Scholar 

  33. Chow SM, Chan JK, Law SC, et al. Diffuse sclerosing variant of papillary thyroid carcinoma—clinical features and outcome. Eur J Surg Oncol 2003;29:446–9

    Article  PubMed  Google Scholar 

  34. Borson-Chazot F, Causeret S, Lifante JC, Augros M, Berger N, Peix JL. Predictive factors for recurrence from a series of 74 children and adolescents with differentiated thyroid cancer. World J Surg 2004;28:1088–92

    Article  PubMed  Google Scholar 

  35. Hirokawa M, Kuma S, Miyauchi A, et al. Morules in cribriform-morular variant of papillary thyroid carcinoma: immunohistochemical characteristics and distinction from squamous metaplasia. APMIS 2004;112:275–82

    Article  PubMed  Google Scholar 

  36. LiVolsi VA, Albores-Saavedra J, Asa SL, et al. Papillary carcinoma. In: DeLellis RA, Llyod RV, Heitz PU, Eng C, eds. World Health Organization Classification of Tumours: Pathology and Genetics—Tumours of Endocrine Organs. Lyon: International Agency for Research on Cancer, 2004:57–66

    Google Scholar 

  37. Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Endocr Pract 2004;10:234–41

    PubMed  Google Scholar 

  38. Furlan JC, Bedard YC, Rosen IB. Role of fine-needle aspiration biopsy and frozen section in the management of papillary thyroid carcinoma subtypes. World J Surg 2004;28:880–5

    Article  PubMed  Google Scholar 

  39. Gupta S, Sodhani P, Jain S, Kumar N. Morphologic spectrum of papillary carcinoma of the thyroid: role of cytology in identifying the variants. Acta Cytol 2004;48:795–800

    PubMed  Google Scholar 

  40. Lam KY, Lo CY, Chan KW, Wan KY. Insular and anaplastic carcinoma of the thyroid: a 45-year comparative study at a single institution and a review of the significance of p53 and p21. Ann Surg 2000;231:329–38

    Article  CAS  PubMed  Google Scholar 

  41. Hoie J, Stenwig AE, Kullmann G, Lindegaard M. Distant metastases in papillary thyroid cancer: a. review of 91 patients. Cancer 1988;61:1–6

    CAS  PubMed  Google Scholar 

  42. Carcangiu ML, Zampi G, Pupi A, Castagnoli A, Rosai J. Papillary carcinoma of the thyroid: a. clinicopathologic study of 241 cases treated at the University of Florence, Italy. Cancer 1985;55:805–28

    CAS  PubMed  Google Scholar 

  43. McConahey WM, Hay ID, Woolner LB, van Heerden JA, Taylor WF. Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy, and outcome. Mayo Clin Proc 1986;61:978–96

    CAS  PubMed  Google Scholar 

  44. Paker LN, Wu SY, Kim DD, Kollin J, Prasasvinichai S. Recurrence of papillary thyroid carcinoma presenting as a focal neurologic deficit. Arch Intern Med 1986;146:1985–7

    Google Scholar 

  45. Lorentz TG, Lau PW, Lo CY, Law WL, Wan KY, Lauder IJ. Multivariate analysis of risk factors influencing survival in 110 ethnic Chinese with papillary thyroid cancer. World J Surg 1994;18:547–50

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Discipline of Pathology, School of Medicine, Gold Coast Campus, Griffith University, PMB 50 Gold Coast Mail Centre, Queensland, 9726, Australia

    Alfred King Yin Lam MBBS, MD, FRCPA

  2. Department of Surgery, Faculty of Medicine, University of Hong Kong, Hong Kong

    Chung Yau Lo MBBS, MS, FRCS (Edin), FACS

Authors
  1. Alfred King Yin Lam MBBS, MD, FRCPA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chung Yau Lo MBBS, MS, FRCS (Edin), FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alfred King Yin Lam MBBS, MD, FRCPA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lam, A.K.Y., Lo, C.Y. Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid: A 35-Year Comparative Study at a Single Institution. Ann Surg Oncol 13, 176–181 (2006). https://doi.org/10.1245/ASO.2006.03.062

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.03.062

Keywords

Search

Navigation