tall cell variant of papilary thyroid cancer

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The Clinical Features Of The Tall Cell Variant Of Papillary Thyroid Carcinoma : 

The Clinical Features Of The Tall Cell Variant Of Papillary Thyroid Carcinoma E. Alagoz, N. Arslan, S. Ilgan, A.Ö. Karaçalıoğlu, Ö. Emer, A. Ayan, B. Günalp, K.Okuyucu, M. Tuncel, and M.A. Özgüven GATA Medical Faculty, Department of Nuclear Medicine Ankara / TURKEY

Tall Cell Variant of Papillary Thyroid CA : 

Tall Cell Variant of Papillary Thyroid CA Hawk & Hazard, 1976 composed of cells twice as tall as they are wide basally oriented nuclei 5-10% of PTC average age: 57 yrs larger size (> 6cm) 22% mortality in 2 yrs

Tall Cell Variant of Papillary Thyroid CA : 

presented with more extrathyroidal disease cervical nodes 75% vs. 42% soft tissue 42% vs. 5% recurrent disease 59% vs. 9% metastases 17% vs. 1% (lung/bone/breast) Tall Cell Variant of Papillary Thyroid CA

Aim : 

Aim To study the clinical features of the tall cell variant (TCV) of papillary thyroid carcinoma (PTC) and compare the results with classic papillary thyroid cancer

Materials and Methods : 

Materials and Methods A single-institution retrospective analysis was performed on 1093 patients with well differentiated thyroid cancer diagnosed from 1993 to 2006 The data then further analyzed and compared with the classic type

Results - I : 

Results - I Mean age 58 -yr-old (range; 23 - 85) of TCV pts of TCV pts 28 of 951 pts (3% of PTC) diagnosed with TCV

Results – II (I-131 Treatments) : 

Results – II (I-131 Treatments) The clinical follow up was available in 14/28 (50%) of patients with TCV Median follow-up was 4 yr Mean I-131 dose : 259 mCi 131-I Dose range: 75 to 1300* mCi 57 yrs-old male, inital Tg: 1500 ng/mL, lymph node +bone + nodular lung mets, survived 5 yrs

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58 yrs 47 yrs p value: 0.015 Results – III (Age)

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Results – IV (Mean Tm Size) 25 mm 18 mm p value: 0.06

Results - V : 

Results - V 11% 27% 3% <1% P= 0.02 P= 0.05

Results - VI : 

Results - VI p:0.522 p:0.793 p:0.449 p:0.274 p:0.317 No statistically significant differences between TCV and classic type of PTC

Results - VII : 

Results - VII TCV presented as higher stage (p: 0,0001) Total remission rate was found to be lower in patients TCV when compared to the classic type (57% vs 84% p:0,03)

37-yr-old female with TCV,High Tg after Ablation Therapy : 

37-yr-old female with TCV,High Tg after Ablation Therapy Bilateral total thyroidectomy Post therapy [200 mCi (5550 MBq)] WB I-131 scan showed normal biodistrubition On follow-up >> Tg : <0.2 ng/mL Anti Tg-Ab: 1300 IU/mL A

FDG PET vs. I-131 : 

FDG PET vs. I-131 Focal increased FDG uptake in paratraceal area consistent with local recurrrence which was confirmed pathologically

Conclusion : 

Conclusion TCV of PTC presents at a higher stage with more advanced local disease It has a higher risk of locoregional relapse and a lower remission rate More aggressive treatment and close follow up with US (and whenever its needed with FDG PET) is mandatory