Clinicopathologic features and outcomes in patients with diffuse sclerosing variant of papillary thyroid carcinoma.
BACKGROUND
Diffuse sclerosing variant (DSV) of papillary thyroid carcinoma (PTC) is a rare variant more common among younger patients.


METHODS
Excluding patients with microcarcinoma, 5848 patients with PTC underwent initial surgery between 1995 and 2011. Twenty-two patients (0.4 %) were histologically diagnosed with DSV, of whom 20 (91 %) were <45 years old. We compared clinicopathologic characteristics and outcomes between patients with DSV and those with classical PTC <45 years old. Univariate analysis by the Kaplan-Meier method in relation to cause-specific survival (CSS) and disease-free survival (DFS) rates was performed with regard to the following variables: sex; anti-thyroglobulin antibody (TgAb) positivity; presence of distant metastasis; pathological lymph node metastasis; extra-thyroidal invasion; and pathological variant (classical vs. DSV).


RESULTS
The 20 patients with DSV <45 years old comprised 18 females and 2 males. Frequencies of TgAb, pN1b, and local recurrence were higher in the DSV group than in the classical PTC group. Ten-year CSS and DFS rates for PTC patients <45 years old were 99.7 and 88.6 % in the classical PTC group and 100 and 60.5 % in the DSV group. CSS rate did not differ between groups, but DFS rate was significantly lower in the DSV group than in the classical PTC group (p < 0.0001, log-rank test). Multivariate analysis identified DSV group and pN1b as prognostic factors for recurrence in young PTC patients.


CONCLUSIONS
Most DSV patients were young and had a background of chronic thyroiditis. Outcomes for DSV were very good, but recurrence was more common than in classical PTC.
Department of Surgery, Ito Hospital, 4-3-6, Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan, j-akaishi@ito-hospital.jp.
Junko
J
Akaishi
Kiminori
K
Sugino
Kaori
K
Kameyama
Chie
C
Masaki
Kenichi
K
Matsuzu
Akifumi
A
Suzuki
Takashi
T
Uruno
Keiko
K
Ohkuwa
Hiroshi
H
Shibuya
Wataru
W
Kitagawa
Mitsuji
M
Nagahama
Kazuo
K
Shimizu
Koichi
K
Ito
D000293:Adolescent; D000328:Adult; D002277:Carcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D050031:Hashimoto Disease / Q000150:complications; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D013954:Thyroglobulin / Q000032:analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
D013954:Thyroglobulin