The Hobnail variant of Papillary Thyroid Carcinoma

Clinical/molecular characteristics of a large monocentric series and comparison with conventional histotypes.

Sara Watutantrige-Fernando, Federica Vianello, Susi Barollo, Loris Bertazza, Francesca Galuppini, Elisabetta Cavedon, Simona Censi, Clara Benna, Eric Casal Ide, Alessandro Parisi, Davide Nacamulli, Maurizio Iacobone, Gianmaria Pennelli, Caterina Mian

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The hobnail variant of papillary thyroid carcinoma (HPTC) has an aggressive behavior. The aims of this prospective study were to define the clinical/molecular characteristics of HPTC, and to compare them with those of conventional papillary thyroid carcinoma (PTC). Methods: From 2010 to 2016, we treated 25 cases of HPTC, characterized clinically and molecularly (BRAF, RAS, TERT promoter and TP53), which were compared with a series of 165 consecutive cases of PTC. All patients underwent total thyroidectomy and received radioactive iodine treatment. Follow-up was available for 19 HPTC patients. Results: Among the HPTC patients, 64% had a hobnail component ≥30%, and 64% had multifocal disease. The mean tumor size was 30 mm; 96% of tumors were angio-invasive; 68% were N1, and 12% were M1; 58% harbored the BRAFV600E, 12% had a mutation on the TERT promoter, 17% had a TP53 mutation (no RAS mutations were found). At a mean follow-up of 39 months, 32% of patients had biochemical and/or structural disease. Tumor size was the only significant difference between patients with persistent disease and those with an excellent response (40 mm and 24 mm, respectively, p= 0.02). By comparison with the PTC control group, the HPTC patients had larger tumors (30 mm versus 16 mm, p<0.001), more frequent lymph node involvement (68% versus 38%, p=0.01), and remote disease (16% versus 3%, p<0.0001), a similar prevalence of the BRAFV600E mutations (58% versus 59%), a higher prevalence of TP53 mutations (17% versus 1%, p<0.05) and a worse outcome (structural/biochemical disease: 32% versus 9%, p<0.0001). Conclusions: HPTC is an aggressive variant, characterized by large tumor size, lymph node involvement, a tendency to metastasize, and a worse outcome.

Original languageEnglish
Pages (from-to)96-103
JournalThyroid
Early online dateNov 27 2017
DOIs
Publication statusPublished - Jan 1 2018

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Mutation
Neoplasms
Lymph Nodes
Papillary Thyroid cancer
Thyroidectomy
Iodine
Prospective Studies
Control Groups
Therapeutics

Keywords

  • aggressive behavior
  • Hobnail variant
  • molecular
  • papillary carcinoma
  • thyroid

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

The Hobnail variant of Papillary Thyroid Carcinoma : Clinical/molecular characteristics of a large monocentric series and comparison with conventional histotypes. / Watutantrige-Fernando, Sara; Vianello, Federica; Barollo, Susi; Bertazza, Loris; Galuppini, Francesca; Cavedon, Elisabetta; Censi, Simona; Benna, Clara; Casal Ide, Eric; Parisi, Alessandro; Nacamulli, Davide; Iacobone, Maurizio; Pennelli, Gianmaria; Mian, Caterina.

In: Thyroid, 01.01.2018, p. 96-103.

Research output: Contribution to journalArticle

Watutantrige-Fernando, S, Vianello, F, Barollo, S, Bertazza, L, Galuppini, F, Cavedon, E, Censi, S, Benna, C, Casal Ide, E, Parisi, A, Nacamulli, D, Iacobone, M, Pennelli, G & Mian, C 2018, 'The Hobnail variant of Papillary Thyroid Carcinoma: Clinical/molecular characteristics of a large monocentric series and comparison with conventional histotypes.', Thyroid, pp. 96-103. https://doi.org/10.1089/thy.2017.0248
Watutantrige-Fernando, Sara ; Vianello, Federica ; Barollo, Susi ; Bertazza, Loris ; Galuppini, Francesca ; Cavedon, Elisabetta ; Censi, Simona ; Benna, Clara ; Casal Ide, Eric ; Parisi, Alessandro ; Nacamulli, Davide ; Iacobone, Maurizio ; Pennelli, Gianmaria ; Mian, Caterina. / The Hobnail variant of Papillary Thyroid Carcinoma : Clinical/molecular characteristics of a large monocentric series and comparison with conventional histotypes. In: Thyroid. 2018 ; pp. 96-103.
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abstract = "Background: The hobnail variant of papillary thyroid carcinoma (HPTC) has an aggressive behavior. The aims of this prospective study were to define the clinical/molecular characteristics of HPTC, and to compare them with those of conventional papillary thyroid carcinoma (PTC). Methods: From 2010 to 2016, we treated 25 cases of HPTC, characterized clinically and molecularly (BRAF, RAS, TERT promoter and TP53), which were compared with a series of 165 consecutive cases of PTC. All patients underwent total thyroidectomy and received radioactive iodine treatment. Follow-up was available for 19 HPTC patients. Results: Among the HPTC patients, 64{\%} had a hobnail component ≥30{\%}, and 64{\%} had multifocal disease. The mean tumor size was 30 mm; 96{\%} of tumors were angio-invasive; 68{\%} were N1, and 12{\%} were M1; 58{\%} harbored the BRAFV600E, 12{\%} had a mutation on the TERT promoter, 17{\%} had a TP53 mutation (no RAS mutations were found). At a mean follow-up of 39 months, 32{\%} of patients had biochemical and/or structural disease. Tumor size was the only significant difference between patients with persistent disease and those with an excellent response (40 mm and 24 mm, respectively, p= 0.02). By comparison with the PTC control group, the HPTC patients had larger tumors (30 mm versus 16 mm, p<0.001), more frequent lymph node involvement (68{\%} versus 38{\%}, p=0.01), and remote disease (16{\%} versus 3{\%}, p<0.0001), a similar prevalence of the BRAFV600E mutations (58{\%} versus 59{\%}), a higher prevalence of TP53 mutations (17{\%} versus 1{\%}, p<0.05) and a worse outcome (structural/biochemical disease: 32{\%} versus 9{\%}, p<0.0001). Conclusions: HPTC is an aggressive variant, characterized by large tumor size, lymph node involvement, a tendency to metastasize, and a worse outcome.",
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AU - Barollo, Susi

AU - Bertazza, Loris

AU - Galuppini, Francesca

AU - Cavedon, Elisabetta

AU - Censi, Simona

AU - Benna, Clara

AU - Casal Ide, Eric

AU - Parisi, Alessandro

AU - Nacamulli, Davide

AU - Iacobone, Maurizio

AU - Pennelli, Gianmaria

AU - Mian, Caterina

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N2 - Background: The hobnail variant of papillary thyroid carcinoma (HPTC) has an aggressive behavior. The aims of this prospective study were to define the clinical/molecular characteristics of HPTC, and to compare them with those of conventional papillary thyroid carcinoma (PTC). Methods: From 2010 to 2016, we treated 25 cases of HPTC, characterized clinically and molecularly (BRAF, RAS, TERT promoter and TP53), which were compared with a series of 165 consecutive cases of PTC. All patients underwent total thyroidectomy and received radioactive iodine treatment. Follow-up was available for 19 HPTC patients. Results: Among the HPTC patients, 64% had a hobnail component ≥30%, and 64% had multifocal disease. The mean tumor size was 30 mm; 96% of tumors were angio-invasive; 68% were N1, and 12% were M1; 58% harbored the BRAFV600E, 12% had a mutation on the TERT promoter, 17% had a TP53 mutation (no RAS mutations were found). At a mean follow-up of 39 months, 32% of patients had biochemical and/or structural disease. Tumor size was the only significant difference between patients with persistent disease and those with an excellent response (40 mm and 24 mm, respectively, p= 0.02). By comparison with the PTC control group, the HPTC patients had larger tumors (30 mm versus 16 mm, p<0.001), more frequent lymph node involvement (68% versus 38%, p=0.01), and remote disease (16% versus 3%, p<0.0001), a similar prevalence of the BRAFV600E mutations (58% versus 59%), a higher prevalence of TP53 mutations (17% versus 1%, p<0.05) and a worse outcome (structural/biochemical disease: 32% versus 9%, p<0.0001). Conclusions: HPTC is an aggressive variant, characterized by large tumor size, lymph node involvement, a tendency to metastasize, and a worse outcome.

AB - Background: The hobnail variant of papillary thyroid carcinoma (HPTC) has an aggressive behavior. The aims of this prospective study were to define the clinical/molecular characteristics of HPTC, and to compare them with those of conventional papillary thyroid carcinoma (PTC). Methods: From 2010 to 2016, we treated 25 cases of HPTC, characterized clinically and molecularly (BRAF, RAS, TERT promoter and TP53), which were compared with a series of 165 consecutive cases of PTC. All patients underwent total thyroidectomy and received radioactive iodine treatment. Follow-up was available for 19 HPTC patients. Results: Among the HPTC patients, 64% had a hobnail component ≥30%, and 64% had multifocal disease. The mean tumor size was 30 mm; 96% of tumors were angio-invasive; 68% were N1, and 12% were M1; 58% harbored the BRAFV600E, 12% had a mutation on the TERT promoter, 17% had a TP53 mutation (no RAS mutations were found). At a mean follow-up of 39 months, 32% of patients had biochemical and/or structural disease. Tumor size was the only significant difference between patients with persistent disease and those with an excellent response (40 mm and 24 mm, respectively, p= 0.02). By comparison with the PTC control group, the HPTC patients had larger tumors (30 mm versus 16 mm, p<0.001), more frequent lymph node involvement (68% versus 38%, p=0.01), and remote disease (16% versus 3%, p<0.0001), a similar prevalence of the BRAFV600E mutations (58% versus 59%), a higher prevalence of TP53 mutations (17% versus 1%, p<0.05) and a worse outcome (structural/biochemical disease: 32% versus 9%, p<0.0001). Conclusions: HPTC is an aggressive variant, characterized by large tumor size, lymph node involvement, a tendency to metastasize, and a worse outcome.

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