Clinicopathological significance of poorly differentiated thyroid carcinoma.

The clinicopathological importance of a heterogeneous group of poorly differentiated thyroid carcinomas is not fully understood. Using data obtained from 303 surgically treated patients with differentiated thyroid carcinomas, the correlations between the aggressive histologic features and the clinicopathological findings, postoperative recurrences, and prognosis were retrospectively examined. In 201 cases, the carcinomas were well differentiated. The remaining 102 cases of poorly differentiated carcinomas were divided into two groups: focal-poorly differentiated (<10%) and diffuse-poorly differentiated (> or = 10%) carcinomas according to the extent of the poorly differentiated component. These poorly differentiated carcinomas were associated with high age (focal-poorly differentiated and diffuse-poorly differentiated versus well differentiated: 55 years and 59 versus 49; p < 0.0001), frequent presence of lymph node metastases (70% and 66% versus 48%; p = 0.0099) and distant metastases at diagnosis (11% and 11% versus 2%; p = 0.0098), and extrathyroidal invasion (53% and 53% versus 21%; p < 0.0001). There was independent correlation with age and the presence of extrathyroidal invasion. Cases of diffuse-poorly differentiated carcinomas showed frequent relapse (diffuse-poorly differentiated versus focal-poorly differentiated and well differentiated: 45% versus 30% and 24%; p = 0.0062) and poor prognoses (mean survival period = 9.15 versus 19.03 and 20.87 years; p < 0.0001) compared with the well and focal-poorly differentiated carcinomas. These data suggest that diffuse-poorly differentiated carcinoma is an important clinicopathological entity.