Variants of papillary carcinoma of the thyroid

Papillary carcinoma of the thyroid is now further subclassifiable into its different variants. We report incidence, clinical behaviour and outcome of rare variants of papillary thyroid cancers at Asir Central Hospital, Saudi Arabia. These variants differ from each other not only on a morphometric basis, but also in clinical behaviour. Accordingly, we report our experience of different variants in a series of 35 papillary carcinomas. These cases were received in the surgical pathology laboratory of Asir Central Hospital from January 1987 to December 1994. We have reviewed clinical charts, microscopic slides and pathological reports of these carcinomas. The following results have been obtained: 20 cases were classical (usual) papillary thyroid carcinomas; seven were follicular variants; three were tall cell columnar variants; two were oxyphilic variants; and one was a diffuse sclerosing variant. There were two de-differentiated papillary carcinomas (anaplastic carcinomas with foci of well-differentiated papillary carcinomas). These variants were also correlated with clinical parameters such as age, sex and nationality of the patients, aggressiveness of the tumours, types of surgery required, and follow-up when available.
Keywords: papillary carcinoma of thyroid, thyroid cancer.
Until recently, papillary carcinoma of the thyroid was regarded as a single group with indolent clinical course and excellent prognosis. This view is now changing. Recent reports¹ emphasize that papillary carcinoma should be further subclassified into its variants because of prognostic implications. These variants include follicular,² tall cell,³ columnar cell,⁴ diffuse sclerosing, oxyphilic (Hurthle cell), cribriform,⁵ trabecular,⁶ muco-epidermoid,⁷ papillary carcinoma with nodular fasciitis-like stroma,⁸ and de-differentiated papillary Accordingly, in this report, we have determined the incidence of different types of papillary thyroid neoplasms at Asir Central Hospital, and have correlated this with the clinical findings.
MATERIAL AND METHODS
We searched surgical pathology files that related to goitre specimens received in Asir Central Hospital during a period of 8 years from January 1987 to December 1994. We reviewed only those cases in which a diagnosis of papillary carcinoma was made. The microscopic slides were examined and papillary carcinomas were further subclassified into the following groups based on histological pattern: usual papillary carcinomas; follicular variants of papillary carcinomas; tall cell/columnar variants; diffuse sclerosing variants; oxyphilic variants; and de-differentiated papillary carcinomas. We also reviewed clinical charts to determine such parameters as age, sex and nationality of these patients, aggressiveness of the tumours, types of surgery required and follow-up when available.

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