title: The variable presentations of anaplastic spindle cell squamous carcinoma associated with tall cell variant of papillary thyroid carcinoma.
abstract: BACKGROUND
  In 1976, Hawk and Hazard described the tall cell variant (TCV) of papillary thyroid carcinoma (PTC). While the lesions they described had cytologic features of papillary carcinoma, they showed more aggressive behavior with a greater propensity for extrathyroid extension and lymphovascular invasion than classic PTC. In 1991, Bronner and LiVolsi described a series of patients with TCV that progressed to spindle cell squamous carcinoma (SCSC), a unique form of anaplastic thyroid carcinoma. This study describes the variable clinical and pathologic presentations in 31 patients with anaplastic SCSC arising in association with TCV.
  
  
  METHODS
  The surgical pathology archives as well as the personal consultation files of one of the authors (V.A.L.) were reviewed to retrieve cases of SCSC arising in association with TCV. The available clinical as well as pathologic information on all patients was reviewed.
  
  
  RESULTS
  A total of 31 patients with SCSC arising in association with TCV were retrieved from our files. The average age at primary presentation was 67 (range 32-92) with a female-to-male ratio of 2:1. Three clinical scenarios for SCSC associated with TCV were identified. These were type I, consisting of TCV with SCSC at the time of presentation (18 patients); type II, consisting of SCSC arising as a recurrence in patients with a known history of TCV (5 patients); and type III, consisting of SCSC presenting as a primary laryngeal squamous cell carcinoma in a patient with or without a known history of TCV (8 patients). The type III cases were of most concern since they often were confused with primary laryngeal squamous cell carcinoma and most often were diagnosed after laryngectomy.
  
  
  CONCLUSIONS
  SCSC of the thyroid is almost exclusively associated with TCV and can have variable clinical presentations. SCSC is most commonly seen associated with a primary diagnosis of TCV. SCSC may be seen, however, in patients with recurrent PTC and most importantly may present in a fashion similar to primary laryngeal SCSC. Therefore, caution should be exercised in evaluating laryngeal squamous lesions in patients with known history of TCV and without known risks factors for head and neck carcinogenesis.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. pallavi.gopal@uphs.upenn.edu
authors.forename: Pallavi P
authors.initials: PP
authors.lastname: Gopal
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Montone
authors.forename: Zubair
authors.initials: Z
authors.lastname: Baloch
authors.forename: Madalina
authors.initials: M
authors.lastname: Tuluc
authors.forename: Virginia
authors.initials: V
authors.lastname: LiVolsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D002291:Carcinoma, Papillary; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D065646:Thyroid Carcinoma, Anaplastic; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology