Papillary thyroid carcinoma with prominent hobnail features: a new aggressive variant of moderately differentiated papillary carcinoma. A clinicopathologic, immunohistochemical, and molecular study of eight cases.

Papillary thyroid carcinomas (PTC) are the most common thyroid tumors that usually have a good prognosis. Recurrence, metastases, and cancer death may occur in a few patients and are more commonly associated with more aggressive tumors, Such as tall cell, columnar cell, or diffuse sclerosing variants of the PTC. We present the clinicopathologic, immunohistochemical, and molecular features of a rare aggressive variant of the PTC showing prominent hobnail features. The patients included 6 females and 2 males. Ages ranged from 28 to 78 years (mean 57.6). Patients presented with a neck mass and cervical lymphadenopathy. Tumor size ranged from 1.0cm to 4.0cm (mean 2.5cm). The tumors were usually multifocal with variably sized complex papillary structures lined by cells with increased nuclear/cytoplasmatic ratios and apically placed nuclei that produced a surface bulge (hobnail appearance). Thyroglobulin, TTF-1, HBME-1. and p53 were positive in all cases, and there was membrane staining for B-catenin and E-cadherin. The proliferative index with Ki67 ranged from 2% to 20% with a mean of 10%. BRAF mutation was present in 4/7 (57.1%) cases. Distant metastases to liver, lung, bone, brain, muscle, and pancreas developed in 5 patients. The average follow-Lip time was 77.2 months. Four patients died of disease after a mean of 42.8 months. Two patients are alive with disease after 4 and 87 months, respectively. Two patients are alive without disease after 120 and 236 months. PTC with a prominent hobnail pattern is a moderately differentiated PTC variant with aggressive clinical behavior and significant mortality

Papillary Thyroid Carcinoma with Prominent Hobnail Features: A New Aggressive Variant of Moderately Differentiated Papillary Carcinoma \u2013 A Clinicopathological, Immunohistochemical and Molecular Study of 8 Cases

Background: Papillary thyroid carcinomas (PTC) are the most common thyroid tumors and usually have a good prognosis. Recurrence, metastases and cancer death may occur in a few patients and are usually associated with more aggressive variants of PTC and with the presence of BRAF mutation. We present the clinicopathological, immunohistochemical and molecular features of a novel rare aggressive variant of PTC showing prominent hobnail features. Design: We reviewed 2,534 primary PTC from patients who underwent primary surgical treatment between 1955-2004, at one institution in the USA. Six cases were identified according to following criteria: 1) non-solid type of PTC; 2) 64 10% of the tumor showed tall/columnar or diffuse sclerosing features; 3) loss of polarity/cohesiveness with hobnail features in 65 30% of the tumor cells; 4) available clinical data and followup. Two additional cases were included from the consultation files of the authors. We assessed epithelial membrane antigen, TTF1, thyroglobulin, HBME1, E-cadherin, \u3b2-catenin, cytokeratin 7, cytokeratin 19, p53, Ki67/MIB1 expression in all 8 cases by immunohistochemistry. Tumor samples were also analyzed for BRAF mutation using PCR amplification and DNA sequencing. Results: The patients included 6 women and 2 men with a mean age of 57.6 years. Patients presented with a neck mass and cervical lymphadenopathy. Tumor size ranged from 1.0 to 4.0 cm. The tumors were usually multifocal with variably-sized complex papillary structures lined by cells with increased nuclear cytoplasmatic ratios and apically placed nuclei that produced a surface bulge leading to hobnail appearance. Thyroglobulin, TTF1, HBME1 and p53 were diffusely positive in all cases, and there was membrane staining for \u3b2-catenin and E-cadherin. The proliferative index with Ki67/MIB1 showed a mean of 10%. BRAF mutation was found in 4/7 (57.1%) cases. The average follow-up time was 77 months. Four patients died of disease after a mean of 42 months. Two patients are alive with disease after 4 and 87 months, respectively. Two patients are alive without disease after 120 and 236 months. Conclusions: PTC with a prominent hobnail pattern is a moderately differentiated PTC variant with aggressive clinical behavior and significant mortality

Papillary Thyroid Carcinoma with Prominent Hobnail Features: A New Aggressive Variant of Moderately Differentiated Papillary Carcinoma \u2013 A Clinicopathological, Immunohistochemical and Molecular Study of 8 Cases

Background: Papillary thyroid carcinomas (PTC) are the most common thyroid tumors and usually have a good prognosis. Recurrence, metastases and cancer death may occur in a few patients and are usually associated with more aggressive variants of PTC and with the presence of BRAF mutation. We present the clinicopathological, immunohistochemical and molecular features of a novel rare aggressive variant of PTC showing prominent hobnail features. Design: We reviewed 2,534 primary PTC from patients who underwent primary surgical treatment between 1955-2004, at one institution in the USA. Six cases were identified according to following criteria: 1) non-solid type of PTC; 2) 64 10% of the tumor showed tall/columnar or diffuse sclerosing features; 3) loss of polarity/cohesiveness with hobnail features in 65 30% of the tumor cells; 4) available clinical data and followup. Two additional cases were included from the consultation files of the authors. We assessed epithelial membrane antigen, TTF1, thyroglobulin, HBME1, E-cadherin, \u3b2-catenin, cytokeratin 7, cytokeratin 19, p53, Ki67/MIB1 expression in all 8 cases by immunohistochemistry. Tumor samples were also analyzed for BRAF mutation using PCR amplification and DNA sequencing. Results: The patients included 6 women and 2 men with a mean age of 57.6 years. Patients presented with a neck mass and cervical lymphadenopathy. Tumor size ranged from 1.0 to 4.0 cm. The tumors were usually multifocal with variably-sized complex papillary structures lined by cells with increased nuclear cytoplasmatic ratios and apically placed nuclei that produced a surface bulge leading to hobnail appearance. Thyroglobulin, TTF1, HBME1 and p53 were diffusely positive in all cases, and there was membrane staining for \u3b2-catenin and E-cadherin. The proliferative index with Ki67/MIB1 showed a mean of 10%. BRAF mutation was found in 4/7 (57.1%) cases. The average follow-up time was 77 months. Four patients died of disease after a mean of 42 months. Two patients are alive with disease after 4 and 87 months, respectively. Two patients are alive without disease after 120 and 236 months. Conclusions: PTC with a prominent hobnail pattern is a moderately differentiated PTC variant with aggressive clinical behavior and significant mortality

Prediction of pathological stage in prostate cancer through the percentage of involved fragments upon biopsy

INTRODUCTION: The need for defining the extension of disease in patients undergoing radical prostatectomy due to prostate adenocarcinoma is a relevant factor cure in such individuals. In order to identify a new independent preoperative factor for predicting the extension of prostate cancer, we assessed the role of the percentage of positive fragments upon biopsy. MATERIALS AND METHODS: A retrospective study compared the percentage of positive fragments on biopsy with the extension of disease as defined by the pathological examination of the surgical specimen from 898 patients undergoing radical prostatectomy due to clinically localized prostate cancer. RESULTS: On the univariate analysis, the percentage of positive fragments on biopsy showed a statistical significance for predicting confined disease (p < 0.001), which was found in 66.7% of the cases under study. Additionally, we observed that the total number of removed fragments exerts no influence on the extension of the disease (p = 0.567). CONCLUSION: the percentage of positive fragments is an independent factor for predicting the pathological stage of prostate adenocarcinoma, and the number of removed fragments is not related to the extension of the disease