Follicular variant of papillary thyroid cancer - Encapsulated, nonencapsulated, and diffuse

Distinct biologic and clinical entities

Sachin Gupta, Oluyomi Ajise, Linda Dultz, Beverly Wang, Daisuke Nonaka, Jennifer Ogilvie, Keith S. Heller, Kepal N. Patel

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Objective: To examine genotypic and clinical differences between encapsulated, nonencapsulated, and diffuse follicular variant of papillary thyroid carcinoma (EFVPTC, NFVPTC, and diffuse FVPTC, respectively), to characterize the entities and identify predictors of their behavior. Design: Retrospective medical chart review and molecular analysis. Setting: Referral center of a university hospital. Patients: The pathologic characteristics of 484 consecutive patients with differentiated thyroid cancer who underwent surgery by the 3 members of the New York University Endocrine Surgery Associates from January 1, 2007, to August 1, 2010, were reviewed. Forty-five patients with FVPTC and in whom at least 1 central compartment lymph node was removed were included. Main Outcome Measures: Patients with FVPTC were compared in terms of age, sex, tumor size, encapsulation, extrathyroid extension, vascular invasion, central nodal metastases, and the presence or absence of mutations in BRAF, H-RAS 12/13, K-RAS 12/13, N-RAS 12/13, H-RAS 61, K-RAS 61, N-RAS 61, and RET/PTC1. Results: Nopatient with EFVPTC had central lymph node metastasis, and in this group, 1 patient (4.5%) had a BRAF V600E mutation and 2 patients (9%) had RAS mutations. Of the patients with NFVPTC, none had central lymph node metastasis (P>.99) and 2 (11%) had a BRAF V600E mutation (P=.59). Of the patients with diffuse FVPTC, all had central lymph node metastasis (P<.001), and 2 (50%) had a BRAF V600E mutation (P=.06). Conclusions: FVPTC consists of several distinct subtypes. Diffuse FVPTC seems to present and behave in a more aggressive fashion. It has a higher rate of central nodal metastasis and BRAF V600E mutation in comparison with EFVPTC and NFVPTC. Both EFVPTC and NFVPTC behave in a similar fashion. The diffuse infiltrative pattern and not just presence or absence of encapsulation seems to determine the tumor phenotype. Understanding the different subtypes of FVPTC will help guide appropriate treatment strategies.

Original languageEnglish (US)
Pages (from-to)227-233
Number of pages7
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume138
Issue number3
DOIs
StatePublished - Mar 1 2012

Fingerprint

Mutation
Neoplasm Metastasis
Lymph Nodes
Papillary Thyroid cancer
Thyroid Neoplasms
Blood Vessels
Neoplasms
Referral and Consultation
Outcome Assessment (Health Care)
Phenotype
Therapeutics

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

Follicular variant of papillary thyroid cancer - Encapsulated, nonencapsulated, and diffuse : Distinct biologic and clinical entities. / Gupta, Sachin; Ajise, Oluyomi; Dultz, Linda; Wang, Beverly; Nonaka, Daisuke; Ogilvie, Jennifer; Heller, Keith S.; Patel, Kepal N.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 138, No. 3, 01.03.2012, p. 227-233.

Research output: Contribution to journalArticle

Gupta, Sachin ; Ajise, Oluyomi ; Dultz, Linda ; Wang, Beverly ; Nonaka, Daisuke ; Ogilvie, Jennifer ; Heller, Keith S. ; Patel, Kepal N. / Follicular variant of papillary thyroid cancer - Encapsulated, nonencapsulated, and diffuse : Distinct biologic and clinical entities. In: Archives of Otolaryngology - Head and Neck Surgery. 2012 ; Vol. 138, No. 3. pp. 227-233.
@article{db97ca9f2c0e4ee9b1a215a3afeb4586,
title = "Follicular variant of papillary thyroid cancer - Encapsulated, nonencapsulated, and diffuse: Distinct biologic and clinical entities",
abstract = "Objective: To examine genotypic and clinical differences between encapsulated, nonencapsulated, and diffuse follicular variant of papillary thyroid carcinoma (EFVPTC, NFVPTC, and diffuse FVPTC, respectively), to characterize the entities and identify predictors of their behavior. Design: Retrospective medical chart review and molecular analysis. Setting: Referral center of a university hospital. Patients: The pathologic characteristics of 484 consecutive patients with differentiated thyroid cancer who underwent surgery by the 3 members of the New York University Endocrine Surgery Associates from January 1, 2007, to August 1, 2010, were reviewed. Forty-five patients with FVPTC and in whom at least 1 central compartment lymph node was removed were included. Main Outcome Measures: Patients with FVPTC were compared in terms of age, sex, tumor size, encapsulation, extrathyroid extension, vascular invasion, central nodal metastases, and the presence or absence of mutations in BRAF, H-RAS 12/13, K-RAS 12/13, N-RAS 12/13, H-RAS 61, K-RAS 61, N-RAS 61, and RET/PTC1. Results: Nopatient with EFVPTC had central lymph node metastasis, and in this group, 1 patient (4.5{\%}) had a BRAF V600E mutation and 2 patients (9{\%}) had RAS mutations. Of the patients with NFVPTC, none had central lymph node metastasis (P>.99) and 2 (11{\%}) had a BRAF V600E mutation (P=.59). Of the patients with diffuse FVPTC, all had central lymph node metastasis (P<.001), and 2 (50{\%}) had a BRAF V600E mutation (P=.06). Conclusions: FVPTC consists of several distinct subtypes. Diffuse FVPTC seems to present and behave in a more aggressive fashion. It has a higher rate of central nodal metastasis and BRAF V600E mutation in comparison with EFVPTC and NFVPTC. Both EFVPTC and NFVPTC behave in a similar fashion. The diffuse infiltrative pattern and not just presence or absence of encapsulation seems to determine the tumor phenotype. Understanding the different subtypes of FVPTC will help guide appropriate treatment strategies.",
author = "Sachin Gupta and Oluyomi Ajise and Linda Dultz and Beverly Wang and Daisuke Nonaka and Jennifer Ogilvie and Heller, {Keith S.} and Patel, {Kepal N.}",
year = "2012",
month = "3",
day = "1",
doi = "10.1001/archoto.2011.1466",
language = "English (US)",
volume = "138",
pages = "227--233",
journal = "JAMA Otolaryngology - Head and Neck Surgery",
issn = "2168-6181",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Follicular variant of papillary thyroid cancer - Encapsulated, nonencapsulated, and diffuse

T2 - Distinct biologic and clinical entities

AU - Gupta, Sachin

AU - Ajise, Oluyomi

AU - Dultz, Linda

AU - Wang, Beverly

AU - Nonaka, Daisuke

AU - Ogilvie, Jennifer

AU - Heller, Keith S.

AU - Patel, Kepal N.

PY - 2012/3/1

Y1 - 2012/3/1

N2 - Objective: To examine genotypic and clinical differences between encapsulated, nonencapsulated, and diffuse follicular variant of papillary thyroid carcinoma (EFVPTC, NFVPTC, and diffuse FVPTC, respectively), to characterize the entities and identify predictors of their behavior. Design: Retrospective medical chart review and molecular analysis. Setting: Referral center of a university hospital. Patients: The pathologic characteristics of 484 consecutive patients with differentiated thyroid cancer who underwent surgery by the 3 members of the New York University Endocrine Surgery Associates from January 1, 2007, to August 1, 2010, were reviewed. Forty-five patients with FVPTC and in whom at least 1 central compartment lymph node was removed were included. Main Outcome Measures: Patients with FVPTC were compared in terms of age, sex, tumor size, encapsulation, extrathyroid extension, vascular invasion, central nodal metastases, and the presence or absence of mutations in BRAF, H-RAS 12/13, K-RAS 12/13, N-RAS 12/13, H-RAS 61, K-RAS 61, N-RAS 61, and RET/PTC1. Results: Nopatient with EFVPTC had central lymph node metastasis, and in this group, 1 patient (4.5%) had a BRAF V600E mutation and 2 patients (9%) had RAS mutations. Of the patients with NFVPTC, none had central lymph node metastasis (P>.99) and 2 (11%) had a BRAF V600E mutation (P=.59). Of the patients with diffuse FVPTC, all had central lymph node metastasis (P<.001), and 2 (50%) had a BRAF V600E mutation (P=.06). Conclusions: FVPTC consists of several distinct subtypes. Diffuse FVPTC seems to present and behave in a more aggressive fashion. It has a higher rate of central nodal metastasis and BRAF V600E mutation in comparison with EFVPTC and NFVPTC. Both EFVPTC and NFVPTC behave in a similar fashion. The diffuse infiltrative pattern and not just presence or absence of encapsulation seems to determine the tumor phenotype. Understanding the different subtypes of FVPTC will help guide appropriate treatment strategies.

AB - Objective: To examine genotypic and clinical differences between encapsulated, nonencapsulated, and diffuse follicular variant of papillary thyroid carcinoma (EFVPTC, NFVPTC, and diffuse FVPTC, respectively), to characterize the entities and identify predictors of their behavior. Design: Retrospective medical chart review and molecular analysis. Setting: Referral center of a university hospital. Patients: The pathologic characteristics of 484 consecutive patients with differentiated thyroid cancer who underwent surgery by the 3 members of the New York University Endocrine Surgery Associates from January 1, 2007, to August 1, 2010, were reviewed. Forty-five patients with FVPTC and in whom at least 1 central compartment lymph node was removed were included. Main Outcome Measures: Patients with FVPTC were compared in terms of age, sex, tumor size, encapsulation, extrathyroid extension, vascular invasion, central nodal metastases, and the presence or absence of mutations in BRAF, H-RAS 12/13, K-RAS 12/13, N-RAS 12/13, H-RAS 61, K-RAS 61, N-RAS 61, and RET/PTC1. Results: Nopatient with EFVPTC had central lymph node metastasis, and in this group, 1 patient (4.5%) had a BRAF V600E mutation and 2 patients (9%) had RAS mutations. Of the patients with NFVPTC, none had central lymph node metastasis (P>.99) and 2 (11%) had a BRAF V600E mutation (P=.59). Of the patients with diffuse FVPTC, all had central lymph node metastasis (P<.001), and 2 (50%) had a BRAF V600E mutation (P=.06). Conclusions: FVPTC consists of several distinct subtypes. Diffuse FVPTC seems to present and behave in a more aggressive fashion. It has a higher rate of central nodal metastasis and BRAF V600E mutation in comparison with EFVPTC and NFVPTC. Both EFVPTC and NFVPTC behave in a similar fashion. The diffuse infiltrative pattern and not just presence or absence of encapsulation seems to determine the tumor phenotype. Understanding the different subtypes of FVPTC will help guide appropriate treatment strategies.

UR - http://www.scopus.com/inward/record.url?scp=84863370412&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863370412&partnerID=8YFLogxK

U2 - 10.1001/archoto.2011.1466

DO - 10.1001/archoto.2011.1466

M3 - Article

VL - 138

SP - 227

EP - 233

JO - JAMA Otolaryngology - Head and Neck Surgery

JF - JAMA Otolaryngology - Head and Neck Surgery

SN - 2168-6181

IS - 3

ER -