ArticleThe American journal of surgical pathology2026
Columnar Cell Subtype of Papillary Thyroid Carcinoma Is Characterized By A High Frequency of High-Grade Tumors That Exhibit Aggressive Clinicopathologic Features and Poor Outcomes: A Multicenter Study of 71 Cases.
Article in The American journal of surgical pathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Papillary thyroid carcinoma, columnar cell subtype (PTC-CC) is a PTC characterized by nuclear pseudostratification and elongation. High-grade differentiated thyroid carcinoma is a novel classification of the WHO classification, defined by mitotic count ≥5/2 mm 2 and/or tumor necrosis, which may exhibit CC morphology and can be termed as high-grade PTC-CC (HGPTC-CC). In this multicenter retrospective study, we conducted a detailed clinicopathologic review in a retrospective cohort of 71 PTC-CC and HGPTC-CC. HGPTC-CC was common among tumors showing columnar cell morphology, accounting for 46% (33/71) of the entire cohort. Compared with PTC-CC, HGPTC-CC was significantly associated with male sex, infiltrative tumors, angioinvasion, microscopic extrathyroidal extension (ETE), positive resection margin, and advanced pT stage. Furthermore, HGPTC-CC had significantly shortened disease-specific survival (DSS), distant metastasis-free survival (DMFS), and regional recurrence-free survival (RRFS). The 10-year DSS was 95% and 57%, the 10-year DMFS was 87% and 26%, and the 10-year RRFS was 85% and 55% for PTC-CC and HGPTC-CC, respectively. Among tumors with known BRAFV600E and RASQ61R status, BRAFV600E mutation was detected in 40% (19/47), whereas RASQ61R was identified in 15% (6/39). HGPTC-CC was associated with a significantly higher percentage of RASQ61R (PTC-CC 4%, HGPTC-CC 36%). In conclusion, a significant percentage (46%) of PTC-CCs are high-grade. HGPTC-CC is associated with adverse clinicopathologic features and poor outcomes. The impression of PTC-CC as an aggressive PTC subtype may be attributed to the high prevalence of high-grade histology in these tumors. Careful examination for mitoses and necrosis is required for accurate diagnosis and prognostication in PTC-CC.
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