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

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 to those of conventional papillary thyroid carcinoma (PTC).

METHODS: From 2010 to 2016, 25 cases of HPTC, characterized clinically and molecularly (BRAF, RAS, TERT promoter, and TP53 mutations), were compared to 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 mutation, 12% had a mutation in the TERT promoter, 17% had a TP53 mutation, and not had a RAS mutation. 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). Compared to the PTC control group, the HPTC patients had larger tumors (30 mm vs. 16 mm; p < 0.001), more frequent lymph node involvement (68% vs. 38%; p = 0.01), and remote disease (16% vs. 3%; p < 0.0001), a similar prevalence of the BRAFV600E mutation (58% vs. 59%), a higher prevalence of TP53 mutations (17% vs. 1%; p < 0.05), and a worse outcome (structural/biochemical disease: 32% vs. 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
Number of pages8
JournalThyroid
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 2018

Keywords

  • Adult
  • Aged
  • Biomarkers, Tumor/genetics
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mutation
  • Promoter Regions, Genetic
  • Prospective Studies
  • Proto-Oncogene Proteins B-raf/genetics
  • Telomerase/genetics
  • Thyroid Cancer, Papillary/genetics
  • Thyroid Neoplasms/genetics
  • Thyroidectomy
  • Tumor Suppressor Protein p53/genetics
  • Young Adult
  • ras Proteins/genetics

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    Watutantrige-Fernando, S., Vianello, F., Barollo, S., Bertazza, L., Galuppini, F., Cavedon, E., Censi, S., Benna, C., Ide, E. C., 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, 28(1), 96-103. https://doi.org/10.1089/thy.2017.0248