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Incidence and Clinicopathological Features of Differentiated High-Grade Thyroid Carcinomas: An Institutional Experience

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Abstract

Differentiated high-grade thyroid carcinoma (DHGTC) is a new entity in the 2022 WHO classification. We aimed to investigate the incidence and clinicopathological features of differentiated HG thyroid carcinoma (DHGTC) and compare the clinicopathological parameters of DHGTC, DTC without HG features, and poorly differentiated thyroid carcinoma (PDTC). A total of 1069 DTCs including papillary thyroid carcinomas (PTCs) and follicular thyroid carcinomas (FTCs) were included in this study. Consecutive 22 PDTCs were also included for comparative purposes. There were a total of 14 (1.3%) cases of DHGTCs, with 13 HGPTCs (1.2% of PTCs) and one HGFTC (6.7% of FTCs). Compared to DTCs without HG features, DHGTCs were associated with larger tumor size, presence of blood vessel invasion, gross extrathyroidal extension, distant metastasis at the time of diagnosis, higher American Joint Committee on Cancer stage, high American Thyroid Association risk, and TERT promoter mutations. DHGTC and PDTC showed a significantly shorter recurrence-free survival (RFS) than DTC without HG features. Multivariate Cox regression analysis revealed that blood vessel invasion, lateral node metastasis, TERT promoter mutations, and HG features were independent prognostic factors (all p < 0.05). When tumor necrosis and increased mitotic count were evaluated separately, tumor necrosis, but not increased mitotic counts, was found to be an independent prognostic factor (p = 0.006). This study confirmed that DHGTC is significantly associated with aggressive clinicopathological features and poor clinical outcomes, similar to PDTC. Although the incidence is low, careful microscopic examination of HG features in DTC is required.

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Authors and Affiliations

  1. Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea

    Se In Jeong, So Yeon Park & Hee Young Na

  2. Department of Pathology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea

    Se In Jeong, So Yeon Park & Hee Young Na

  3. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, Republic of Korea

    Woochul Kim, Hyeong Won Yu & June Young Choi

  4. Department of Surgery, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea

    Hyeong Won Yu & June Young Choi

  5. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea

    Chang Ho Ahn & Jae Hoon Moon

  6. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea

    Sang Il Choi

  7. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea

    Wonjae Cha & Woo-Jin Jeong

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Contributions

S.J. contributed to data curation, formal analysis and writing-original draft. W.K., H.Y., and J.C. contributed to investigation, resources, methodology and writing-review and editing. C.A., J.M., S.C., W.C. and W.J. contributed to methodology, validation, resources, and writing-review and editing. S.P. contributed to conceptualization, data curation, writing-review and editing and supervision. H.N. contributed to conceptualization, data curation, formal analysis, writing-original draft, writing-review and editing and supervision.

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Correspondence to So Yeon Park or Hee Young Na.

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This study was approved by the Institutional Review Board of the Seoul National University Bundang Hospital (IRB No. B-2303-815-303). The requirement for informed consent was waived.

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Jeong, S.I., Kim, W., Yu, H.W. et al. Incidence and Clinicopathological Features of Differentiated High-Grade Thyroid Carcinomas: An Institutional Experience. Endocr Pathol 34, 287–297 (2023). https://doi.org/10.1007/s12022-023-09778-w

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