Encapsulated papillary thyroid carcinoma, follicular variant: A misnomer

Authors

  • Kennichi Kakudo,

    Corresponding author
    1. Department of Medical Technology, Faculty of Health Sciences, Kobe-Tokiwa University, Kobe
    2. Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
      Kennichi Kakudo, MD, PhD, Professor, Department of Medical Technology, Faculty of Health Sciences, Kobe-Tokiwa University, Ootani 2-6-2, Nagata-ku, Kobe 653-0838, Japan. Email: k-kakudo@kobe-tokiwa.ac.jp
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  • Yanhua Bai,

    1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing
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  • Zhiyan Liu,

    1. Department of Pathology and Pathophysiology, Shandong University School of Medicine, Jinan, China
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  • Takashi Ozaki

    1. Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
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Kennichi Kakudo, MD, PhD, Professor, Department of Medical Technology, Faculty of Health Sciences, Kobe-Tokiwa University, Ootani 2-6-2, Nagata-ku, Kobe 653-0838, Japan. Email: k-kakudo@kobe-tokiwa.ac.jp

Abstract

Papillary thyroid carcinoma (PTC) has long been diagnosed based on its unique nuclear features (PTC-N); however, significant observer discrepancies have been reported in the diagnosis of encapsulated follicular patterned lesions (EnFPLs), because the threshold of PTC-N is subjective. An equivocal PTC-N may often occur in non-invasive EnFPLs and benign/malignant disagreements often create serious problems for patients' treatment. This review collects recent publications focusing on the so-called encapsulated follicular variant of papillary thyroid carcinoma (EnFVPTC) and tries to emphasize problems in the histopathological diagnosis of this spectrum of tumors, which covers encapsulated common-type PTC (EncPTC), EnFVPTC, well-differentiated tumor of uncertain malignant potential (WDT-UMP), follicular adenoma (FA) with equivocal PTC-N and minimally invasive follicular carcinoma (mFTC). We propose that EnFVPTC and other EnFPLs with equivocal PTC-N should be classified into a unified category of borderline malignancy, such as well-differentiated tumor of uncertain behavior (WDT-UB), based on their homogeneous excellent outcome. It is suggested that the unified nomenclature of these lesions may be helpful to reduce significant observer disagreements in diagnosis, because complete agreement in the diagnosis of an EncPTC, EnFVPTC or FA by all pathologists may be not possible for this problematic group of tumors. In conclusion, a malignant diagnosis of EnFVPTC should not be used to cover this spectrum of tumors until uncertainty about the nature of this lesion is settled, whether it is benign, precancerous or malignant.

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