Abstract
There is controversy in the literature regarding a distinct subset of thyroid carcinoma whose histologically classification falls between well-differentiated and anaplastic carcinomas, previously identified as ‘poorly differentiated thyroid carcinoma’ (PDTC), or ‘insular carcinoma’, in view of the peculiar morphological characteristics of the cell groupings. The correct diagnosis and treatment of this entity have important prognostic and therapeutic significance. In this review, we describe the epidemiology, diagnosis, and management of PDTC and report our single centre experience to add to the limited evidence existing in the literature.
Highlights
There is controversy in the literature regarding a distinct subset of thyroid carcinoma whose histologically classification falls between well-differentiated and anaplastic carcinomas, previously identified as ‘poorly differentiated thyroid carcinoma’ (PDTC), or ‘insular carcinoma’, in view of the peculiar morphological characteristics of the cell groupings
We describe the epidemiology, diagnosis, and management of PDTC and report our single centre experience to add to the limited evidence existing in the literature
PDTC-reported incidence varies according to the geographic area considered: less than 1% of the whole thyroid cancers diagnosed in Japan [3], 2–3% in North American [4], and 15% of those diagnosed in northern Italy [5]
Summary
Ultrasound (US) scan of the neck is an essential imaging technique for the evaluation of thyroid disease [8], and it is used to guide fine-needle aspiration cytologic (FNAC) and coreneedle biopsy procedures [9]. The so-called ‘sword sign’ is of particular importance, and it is observed only in poorly or undifferentiated thyroid carcinomas, with Colour Doppler US [13,14]. The reason for these appearances is supposed to be in relation to the abnormal circumscribed proliferation driven by genetic mutations and following atypical hyperplasia of thyroid follicular epithelial cells. This is commonly observed in immune diseases, as for example, in Hashimoto thyroiditis [15], and other goitre diseases where the abnormal lymphocytes stimulation might occur with higher frequency. Microcalcifications presence could be considered as a sign of malignancy in suspicious nodules, as they mostly represent psammoma bodies and might raise awareness of an occult ipsilateral or contralateral disease [17]
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