Pathologic diagnosis of papillary thyroid carcinoma: today and tomorrow

Papillary thyroid carcinoma is the most common malignancy of the thyroid. It is a well-differentiated tumor and the majority behaves in an indolent fashion. The pathologic diagnosis of papillary carcinoma in both cytology and histologic specimens is based upon demonstration of typical nuclear morphology. Using these morphologic criteria, most papillary cancers can be diagnosed with ease, except cases in which there is a paucity of diagnostic nuclear features. Despite advances in the treatment of thyroid cancer, disease recurrences and metastasis can be observed in 20% of cases. Recently, many advances have been made in the pathogenesis of papillary thyroid carcinoma. The notable genetic events include Ret/PTC rearrangements, Ras and BRAF gene mutations. The identification of these has also led to their use in diagnosis and predicting prognosis of papillary thyroid carcinoma. In addition, these involved genes may also serve as targets for cancer chemotherapy in patients where standard thyroid cancer treatment is not effective.