Objectives: The tall cell variant of papillary thyroid carcinoma (TCV-PTC) is an aggressive variant of PTC requiring accurate cytopathologic diagnosis for early aggressive management. Study Design: Twenty-five cases of TCV-PTC in which the tall cells comprised at least 30% of surgically resected tumor were included in the study. The direct smears from a preoperative fine needle aspiration (FNA) and available hematoxylin and eosin cell block sections were reviewed. Ten cases of TCV-PTC were randomly selected and blinded with an equal number of conventional PTC cases. Representative slides were independently reviewed by 7 cytologists. Results: In a majority of the cases, the FNA direct smears were hypercellular and displayed flat monolayer sheets of cells. Tall columnar cells with cytoplasmic tails were seen in 56% of cases. The presence of large polygonal follicular cells with abundant granular oncocytic cytoplasm and distinct cell borders was the most common feature seen in all cases. Seventeen (68%) cases displayed intranuclear pseudoinclusions in cells with abundant granular cytoplasm. A correct diagnosis of TCV-PTC was made in 30-40% of cases by 7 study participants. Conclusions: The correct recognition of TCV-PTC features in preoperative FNA is important for clinical management, and reporting these features in a cytopathology report is suggested.

1.
Hawk WA, Hazard JB: The many appearances of papillary carcinoma of the thyroid. Cleve Clin Q 1976;43:207-216.
2.
Ostrowski ML, Merino MJ: Tall cell variant of papillary thyroid carcinoma: a reassessment and immunohistochemical study with comparison to the usual type of papillary carcinoma of the thyroid. Am J Surg Pathol 1996;20:964-974.
3.
LiVolsi VA: Papillary carcinoma tall cell variant (TCV): a review. Endocr Pathol 2010;21:12-15.
4.
Morris LG, Shaha AR, Tuttle RM, Sikora AG, Ganly I: Tall-cell variant of papillary thyroid carcinoma: a matched-pair analysis of survival. Thyroid 2010;20:153-158.
5.
Jalisi S, Ainsworth T, Lavalley M: Prognostic outcomes of tall cell variant papillary thyroid cancer: a meta-analysis. J Thyroid Res 2010;2010:325602.
6.
Filie AC, Chiesa A, Bryant BR, Merino MJ, Sobel ME, Abati A: The tall cell variant of papillary carcinoma of the thyroid: cytologic features and loss of heterozygosity of metastatic and/or recurrent neoplasms and primary neoplasms. Cancer 1999;87:238-242.
7.
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al: Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214.
8.
Clark DP, Faquin WC: Thyroid Cytopathology. New York, Springer, 2005.
9.
Harach HR, Zusman SB: Cytopathology of the tall cell variant of thyroid papillary carcinoma. Acta Cytol 1992;36:895-899.
10.
Bocklage T, DiTomasso JP, Ramzy I, Ostrowski ML: Tall cell variant of papillary thyroid carcinoma: cytologic features and differential diagnostic considerations. Diagn Cytopathol 1997;17:25-29.
11.
Kaw YT: Fine needle aspiration cytology of the tall cell variant of papillary carcinoma of the thyroid. Acta Cytol 1994;38:282.
12.
Gamboa-Dominguez A, Candanedo-Gonzalez F, Uribe-Uribe NO, Angeles-Angeles A: Tall cell variant of papillary thyroid carcinoma. A cytohistologic correlation. Acta Cytol 1997;41:672-676.
13.
Ohori NP, Schoedel KE: Cytopathology of high-grade papillary thyroid carcinomas: tall-cell variant, diffuse sclerosing variant, and poorly differentiated papillary carcinoma. Diagn Cytopathol 1999;20:19-23.
14.
Dina R, Capitanio A, Damiani S: A morphometric analysis of cytological features of tall cell variant and classical papillary carcinoma of the thyroid. Cytopathology 2000;11:124-128.
15.
Solomon A, Gupta PK, LiVolsi VA, Baloch ZW: Distinguishing tall cell variant of papillary thyroid carcinoma from usual variant of papillary thyroid carcinoma in cytologic specimens. Diagn Cytopathol 2002;27:143-148.
16.
Urano M, Kiriyama Y, Takakuwa Y, Kuroda M: Tall cell variant of papillary thyroid carcinoma: its characteristic features demonstrated by fine-needle aspiration cytology and immunohistochemical study. Diagn Cytopathol 2009;37:732-737.
17.
Tranchida P, Bernacki E, Budev H, Giorgadze T: Preoperative cytologic diagnosis of papillary thyroid carcinoma with mixed columnar cell and tall cell features. Diagn Cytopathol 2012;40(suppl 1):E4-E7.
18.
Olson MT, Tatsas AD, Ali SZ: Cytotechnologist-attended on-site adequacy evaluation of thyroid fine-needle aspiration: comparison with cytopathologists and correlation with the final interpretation. Am J Clin Pathol 2012;138:90-95.
19.
Michels JJ, Jacques M, Henry-Amar M, Bardet S: Prevalence and prognostic significance of tall cell variant of papillary thyroid carcinoma. Hum Pathol 2007;38:212-219.
20.
Ruter A, Nishiyama R, Lennquist S: Tall-cell variant of papillary thyroid cancer: disregarded entity? World J Surg 1997;21:15-20, discussion 20-21.
21.
Machens A, Holzhausen HJ, Lautenschlager C, Dralle H: The tall-cell variant of papillary thyroid carcinoma: a multivariate analysis of clinical risk factors. Langenbecks Arch Surg 2004;389:278-282.
22.
Leung AK, Chow SM, Law SC: Clinical features and outcome of the tall cell variant of papillary thyroid carcinoma. Laryngoscope 2008;118:32-38.
23.
Ghossein R, Livolsi VA: Papillary thyroid carcinoma tall cell variant. Thyroid 2008;18:1179-1181.
24.
Johnson TL, Lloyd RV, Thompson NW, Beierwaltes WH, Sisson JC: Prognostic implications of the tall cell variant of papillary thyroid carcinoma. Am J Surg Pathol 1988;12:22-27.
25.
Akslen LA, LiVolsi VA: Prognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma. Cancer 2000;88:1902-1908.
26.
Ghossein RA, Leboeuf R, Patel KN, Rivera M, Katabi N, Carlson DL, et al: Tall cell variant of papillary thyroid carcinoma without extrathyroid extension: biologic behavior and clinical implications. Thyroid 2007;17:655-661.
27.
Rosai J: Thyroid gland; in Rosai J (ed): Ackerman's Surgical Pathology, ed 8. St Louis, Mosby, 1996, pp 493-567.
28.
Regalbuto C, Malandrino P, Frasca F, Pellegriti G, Le Moli R, Vigneri R, et al: The tall cell variant of papillary thyroid carcinoma: clinical and pathological features and outcomes. J Endocrinol Invest 2013;36:249-254.
29.
Cameselle-Teijeiro J, Febles-Perez C, Cameselle-Teijeiro JF, Alfonsin-Barreiro N, Moldes-Boullosa J, Barreiro F: Cytologic clues for distinguishing the tall cell variant of thyroid papillary carcinoma. A case report. Acta Cytol 1997;41:1310-1316.
30.
De Rizzolo EB, Prytyka A, Leale MJ: Thyroid gland: tall cell variant of papillary carcinoma and papillary oncocytic carcinoma. Acta Cytol 1995;39:280.
31.
Nair M, Kapila K, Karak AK, Verma K: Papillary carcinoma of the thyroid and its variants: a cytohistological correlation. Diagn Cytopathol 2001;24:167-173.
32.
Das DK, Mallik MK, Sharma P, Sheikh ZA, Mathew PA, Sheikh M, et al: Papillary thyroid carcinoma and its variants in fine needle aspiration smears. A cytomorphologic study with special reference to tall cell variant. Acta Cytol 2004;48:325-336.
33.
Damiani S, Dina R, Eusebi V: Cytologic grading of aggressive and nonaggressive variants of papillary thyroid carcinoma. Am J Clin Pathol 1994;101:651-655.
34.
VA L: Papillary lesions of the thyroid; in Bennington JL (ed): Surgical Pathology of the Thyroid Major Problems in Pathology. Philadelphia, Saunders, 1990, vol 22, pp 136-172.
35.
Kini SR, Miller JM, Hamburger JI, Smith MJ: Cytopathology of papillary carcinoma of the thyroid by fine needle aspiration. Acta Cytol 1980;24:511-521.
36.
Jalisi S, Ainsworth T, Lavalley M: Prognostic outcomes of tall cell variant papillary thyroid cancer: a meta-analysis. J Thyroid Res 2010;2010:325602.
37.
Nechifor-Boila A, Decaussin-Petrucci M, Gazzo S, Pascanu I, Borda A: Detection of BRAF V600E mutation in thyroid fine-needle aspiration specimens by High Resolution Melting (HRM) analysis. Rom J Morphol Embryol 2012;53:263-267.
38.
Ohori NP, Singhal R, Nikiforova MN, Yip L, Schoedel KE, Coyne C, et al: BRAF mutation detection in indeterminate thyroid cytology specimens: underlying cytologic, molecular, and pathologic characteristics of papillary thyroid carcinoma. Cancer Cytopathol 2013;121:197-205.
39.
Virk RK, Van Dyke AL, Finkelstein A, Prasad A, Gibson J, Hui P, et al: BRAF V600E mutation in papillary thyroid microcarcinoma: a genotype-phenotype correlation. Mod Pathol 2013;26:62-70.
40.
Li C, Lee KC, Schneider EB, Zeiger MA: BRAF V600E mutation and its association with clinicopathological features of papillary thyroid cancer: a meta-analysis. J Clin Endocrinol Metab 2012;97:4559-4570.
41.
Rossi ED, Martini M, Capodimonti S, Lombardi CP, Pontecorvi A, Vellone VG, et al: BRAF (V600E) mutation analysis on liquid-based cytology-processed aspiration biopsies predicts bilaterality and lymph node involvement in papillary thyroid microcarcinoma. Cancer Cytopathol 2013;121:291-297.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.