Az Diferansiye Tiroid Karsinomlarının Turin ve “Memorial Sloan Kettering Kanser Merkezi” Kriterlerine Göre Retrospektif Değerlendirilmesi

Amaç: Az diferansiye tiroid karsinomları (ADTK), biyolojik davranışlarına göre, iyi diferansiye tiroid karsinomlarla anaplastik karsinomlar arasında yeralır. ADTK tanısını koymak için, Turin tanı kriterleri 2017 Dünya Sağlık Örgütü (DSÖ) sınıflamasında kabul edilmiştir. Bu çalışmada, son 15 yıllık arşivimizdeki ADTK tanılı olgularımızın bu kriterlere göre yeniden değerlendirmesi amaçlandı. Yöntem: Kurumumuzda 2006-2020 yılları arasında tanı konulan tüm primer tiroid karsinomu olguları tarandı. ADTK tanısı almış olan olgular çalışma grubuna alındı ve bu olgular, klinikopatolojik bulguları ile mikroskopik olarak Turin ve “Memorial Sloan Kettering kanser merkezi” (MSKCC) kriterlerine göre yeniden değerlendirildi. Bulgular: Arşivimizde primer tiroid karsinomu tanısı almış toplam 2138 olgu vardı. Bunların 16’sı (%0,75) ADTK tanısı almıştı. Olguların 11’i kadın, 5’i erkek ve ortalama yaş 53,5 (yaş aralığı: 13-68 yıl); ortalama tümör çapı 50 mm idi (32-75 mm). Turin kriterlerine göre yeniden değerlendirilen olguların 11’i bu kriterleri tümüyle sağlarken (%68,7), 2’si (%12,5) ADTKnun tüm özelliklerini içermemekteydi. Geriye kalan 3 (%18,7) konsültasyon olgusu hakkında elimizde yeterli veri bulunmamaktaydı. Olguların hepsi total tiroidektomili olup, 2’sinde bölgesel lenf nodu metastazı ve 3’ünde de uzak organ metastazı geliştiği saptandı. Bunlar içerisindeki bir olguda, hem bölgesel lenf nodu hem de uzak organ metastazı birlikteydi. Turin kriterlerini tümüyle sağlamayan 2 olguda ise bölgesel ya da uzak metastaz saptanmadı. Sonuç: Görülme sıklığı az olmakla birlikte, ADTKlar, birçok tümör ile ayrırıcı tanı yapmanın önemli olduğu agresif tümörlerdir. ADTK, solid / trabeküler /insüler gelişim paterni gösteren tiroid yerleşimli tümörlerde ayırıcı tanıya alınmalı ve Turin ve MSKCC kriterleri sorgulanmalıdır.

Anahtar Kelimeler:

Az diferansiye tiroid karsinomu, ADTK, insuler karsinom, Turin kriterleri, MSKCC kriterleri.

Retrospective Evaluation of Poorly Differentiated Thyroid Carcinomas According to Turin and Memorial Sloan Kettering Cancer Center Criteria

Objective: Poorly differentiated thyroid carcinomas (PDTC) are among well-differentiated and anaplastic carcinomas, according to their biological behavior. For diagnosis of PDTC, Turin criteria were accepted in the 2017 World Health Organization (WHO) classification. In this study, we aim to re-evaluate our PDTC patients for last 15 years according to these criteria. Methods: All primary thyroid carcinoma cases were screened in our department between 2006-2020. The cases diagnosed with PDTC were included in the study group and re-evaluated microscopically according to the Turin and Memorial Sloan Kettering cancer center (MSKCC) criteria with their clinicopathological findings. Results: In our archive, there were 2138 cases diagnosed with primary thyroid carcinoma. 16 of them (0.75%) had been diagnosed with PDTC. 11 cases were female, 5 were male. The mean age was 53.5 (13-68 years); mean diameter was 50 mm (32-75 mm). 11 cases were re-evaluated by Turin criteria and they were fully included (68.7%). Of the cases, 2 (12.5%) were not included all the features of PDTC. We did not have sufficient data on the remaining 3 (18.7%) due to consultation cases. All the cases had total thyroidectomy, 2 of them had regional lymph node and 3 had distant organ metastasis. In one of these cases, both regional lymph node and distant organ metastases were present. Regional or distant metastasis wasn’t detected in 2 cases who did not fully meet the Turin criteria. Conclusion: Although low incidence, PDTCs are aggressive tumors, and it is important to make differential diagnosis with tumors. PDTC should distinguish from tumors located in thyroid and show solid/trabecular/insular growth pattern. Turin and MSKCC criteria should be questioned.

Keywords:

poorly differentiated thyroid carcinoma PDTC, insular carcinoma, Turin proposal, Turin criteria, MSKCC criteria.,

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