TY - JOUR
T1 - The Hobnail Variant of Papillary Thyroid Carcinoma
T2 - Clinical/Molecular Characteristics of a Large Monocentric Series and Comparison with Conventional Histotypes
AU - Watutantrige-Fernando, Sara
AU - Vianello, Federica
AU - Barollo, Susi
AU - Bertazza, Loris
AU - Galuppini, Francesca
AU - Cavedon, Elisabetta
AU - Censi, Simona
AU - Benna, Clara
AU - Ide, Eric Casal
AU - Parisi, Alessandro
AU - Nacamulli, Davide
AU - Iacobone, Maurizio
AU - Pennelli, Gianmaria
AU - Mian, Caterina
PY - 2018/1
Y1 - 2018/1
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 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.
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 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.
KW - Adult
KW - Aged
KW - Biomarkers, Tumor/genetics
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Mutation
KW - Promoter Regions, Genetic
KW - Prospective Studies
KW - Proto-Oncogene Proteins B-raf/genetics
KW - Telomerase/genetics
KW - Thyroid Cancer, Papillary/genetics
KW - Thyroid Neoplasms/genetics
KW - Thyroidectomy
KW - Tumor Suppressor Protein p53/genetics
KW - Young Adult
KW - ras Proteins/genetics
U2 - 10.1089/thy.2017.0248
DO - 10.1089/thy.2017.0248
M3 - Article
C2 - 29179638
VL - 28
SP - 96
EP - 103
JO - Thyroid
JF - Thyroid
SN - 1050-7256
IS - 1
ER -