This review in question-and-answer form covers the aggressive end of follicular cell-derived thyroid cancer. High-grade non-anaplastic carcinoma is now split into poorly differentiated thyroid carcinoma and the more recently defined high-grade differentiated thyroid carcinoma, of which high-grade papillary carcinoma is the commonest. These sit between well-differentiated carcinoma and anaplastic carcinoma in both molecular profile and behaviour.
For anaplastic carcinoma, the authors stress the breadth of the differential, which must be worked through before the diagnosis is made, and the frequent problem of small biopsies. They also emphasise that biomarker testing has become central because targeted and checkpoint inhibitor treatments are now available.
The practical point is that the high-grade categories change management and prognosis, so they have to be recognised in the report rather than buried under the parent subtype. Small biopsies in a rapidly growing neck mass should be handled with biomarker testing in mind from the outset.
- Recognise and name high-grade differentiated and poorly differentiated thyroid carcinoma in the report.
- Work through the full differential before diagnosing anaplastic carcinoma, especially on small samples.
- Preserve tissue from small neck-mass biopsies for biomarker testing.
- Discuss suspected anaplastic carcinoma with the treating team quickly, given the pace of the disease.
Why it matters
The high-grade categories now change treatment, so missing them in a report has consequences.
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