Cervical lymphoma

We have a pap smear of 58 year-old, female patient. The smear reveals multifocal high N/C ratio cells like HSIL. We did immunohistochemical stains CK for epithelial marker and LCA (CD 45) for lymphoid differentiation. Defend on the cytological findings, patient's history and immunohistochemical stains, it is diagnosed lymphoma.

Figure 1. Pap stain x 1000

Figure 2. Pap stain x 1000

Figure 3. Pap stain x 1000

Figure 4 . Immunohistochemical stain Cytokeratin (CK)

Figure 5 . Immunohistochemical stain LCA (CD-45)

Pathology of prostate gland adenocarcinoma and its histologic variants

Prostate cancer is now the sixth most common cancer in the world, and third in importance in men. The incidence and mortality have increased in the last several decades, due in part to the introduction of newer diagnostic tests, such as PSA screening. The incidence varies greatly with geographic location, ethnic background, and age. The highest incidence is seen in the United States, Australia, and Scandinavian countries, whereas prostate carcinoma is relatively uncommon in countries of the Far East. In the United States, blacks have a much higher incidence and mortality than whites. The incidence rises dramatically with age. The clinical disease is uncommon before the age of 50 years. The 2004 World Health Organization (WHO) classification of neoplasms of the prostate is given in Table 1.

Prostate adenocarcinoma, an invasive carcinoma with prostatic secretory cell differentiation is the most common form of prostatic cancer.

Macroscopy

Gross diagnosis of prostatic carcinoma is possible in radical prostatectomy tissues but not in needle biopsy or TURP chip tissues. On section, grossly evident cancers are firm, solid, and range in color from white-gray to yellow-orange; the tumors contrast with the adjacent benign parenchyma, which is typically tan and spongy. (Fig 1.)

Figure 1. A, B Section of prostate showing peripheral zone adenocarcinoma. C Section of prostate showing transition zone adenocarcinoma, difficult to distinguish from nodules of BPH.

Microscopy

Adenocarcinomas of the prostate range from well-differentiated gland forming cancers, where it is often difficult to distinguish them from benign prostatic glands, to poorly differentiated tumors, difficult to identify as being of prostatic origin. Prostate carcinoma has a constellation of architectural, cytoplasmic, nuclear, and intraluminal features. They can be divided into major and minor diagnostic criteria. (Table.2)

Major criteria

1. Architectural features. Benign glands tend to grow either as circumscribed nodules within benign prostatic hyperplasia, radiate in columns out from the urethra in a linear fashion, or are evenly dispersed in the peripheral zone. In contrast, gland-forming prostate cancers typically contain glands that are more crowded than in benign prostatic tissue, although there is overlap with certain benign mimickers of prostate cancer. Glands of adenocarcinoma of the prostate typically grow in a haphazard fashion. Glands oriented perpendicular to each other and glands irregularly separated by bundles of smooth muscle are indicative of an infiltrative process. Another pattern characteristic of an infiltrative process is the presence of small atypical glands situated in between larger benign glands. (Fig.2) With the loss of glandular differentiation and the formation of cribriform structures, fused glands, and poorly formed glands, the distinction between benign glands based on the architectural pattern becomes more apparent. Tumors composed of solid sheets, cords of cells, or isolated individual cells characterize undifferentiated prostate cancer.

2. Basal cell absence, can sometimes be difficult to evaluate in H&E-stained sections, so in difficult cases and for small foci of adenocarcinoma, immunohistochemical staining for basal cells using antibodies against high-molecular-weight cytokeratins and p63 may be performed. (Fig.2) While a positive basal cell immunostain effectively rules out invasive adenocarcinoma, benign glands can focally lack a basal cell layer, so basal cell ummunostains should be interpreted in the context of the H&E histological findings.

3. Nuclear atypia. Typically, prostate carcinoma displays nuclear characteristics distinct from surrounding benign glands, including enlarged nuclei and prominent nucleoli. (Fig.2) Some prostate carcinomas lack prominent nucleoli yet have enlarged and hyperchromatic nuclei. Mitoses and apoptotic bodies are more common in prostate carcinoma, although they are rarely found in benign glands and still not frequently seen in malignant glands. Cancer nuclei, even in poorly differentiated ones, show little variation in size and shape.

Figure 2. A Haphazard distribution of small acini indicative of infiltrative growth. B Fused acinar adenocarcinoma. C Nuclear atypia in adenocarcinoma: appearance of nuclei D p63 immunohistochemical stain highlights the invasion of the malignant glands, which lack basal cells (brown signal).

Minor criteria tend to be found more often in adenocarcinoma, but are not specific for adenocarcinoma.

1. Intraluminal blue mucin. Acidic sulfated and non-sulfated mucin is often seen in the acini of adenocarcinoma, appearing in routine sections as amorphous or delicate thread-like basophilic secretions. (Fig.3) This mucin stains with Alcian blue and is best demonstrated at pH 2.5, whereas normal prostatic epithelium contains periodic acid-Schiff-reactive neutral mucin. Acidic mucin is not specific for carcinoma, and maybe found in PIN and rarely in BPH.

2. Pink amorphous secretions. Ill-formed secretions are more often found in the lumen of suspicious and cancerous acini than in benign acini, and vary from lightly pink and scant to brightly eosinophilic and extensive. (Fig.3) In contrast, corpora amylacea, which consists of well-circumscribed round to oval structures with concentric lamellar rings, are common in benign glands and only rarely seen in prostate cancer.

3. Mitotic figures may be relatively common in high-grade cancer, yet are infrequent in lower grade tumors.

4. Crystalloids are sharp rhomboid or needle-like eosinophilic structures that are often present in the lumen of well- and moderately differentiated carcinoma. (Fig.3) They are can be found in other conditions such as atypical adenomatous hyperplasia. The presence of crystalloids in metastatic adenocarcinoma of unknown site of origin is strong presumptive evidence of prostatic origin, although it is an uncommon finding.

5. Amphophilic cytoplasm. Glands of adenocarcinoma of the prostate tend to have a discrete crisp, sharp luminal border without undulations or ruffling of the cytoplasm. In contrast, equivalently sized benign glands have an irregular luminal surface with small papillary infoldings and a convoluted appearance. The finding of apical snouts is not helpful in distinguishing benign versus malignant glands as they can be seen both. Cytoplasmic features of low grade prostate cancer are also often not very distinctive, since they are often pale-clear, similar to benign glands. Neoplastic glands may have amphophilic cytoplasm. Prostate cancer cytoplasm of all grades typically lacks lipofuscin, in contrast to its presence in some benign prostatic glands.

Figure 3 Blue-tinged mucin is found in the cancer glandular lumina (A), as are intraluminal pink, acellular, dense secretions (B) and crystalloids (C).

Cancer specific features: There are three histologic features, which are diagnostic of prostate carcinoma, called cancer-specific features. (Fig.4)

1. Collagenous micronodules are a specific but infrequent and incidental finding in prostatic adenocarcinoma, consisting of loose fibrous tissue with an ingrowth of fibroblasts, sometimes reflecting organization of intraluminal mucin. Collagenous micronodules are formed by subepithelial accumulations of fragmented collagen fibers, possibly related to the digestion by collagenase produced by prostatic adenocarcinoma cells.

2. Glomeruloid formation is created by intraluminal cribriform proliferation of malignant cells and is often surrounded by a crescensic space, resembling a renal glomerulus.

3. Perineural invasion with cancer glands completely or near-completely encircling the nerve is pathognomic of prostate carcinoma. Benign glands can occasionally be found to abut a nerve; however, circumferential extension of benign glands entirely around a nerve has not been described.

Figure 4. A Collagenous micronodules. B Glomeruloid formations. C Perineural invasion.

Histologic variants of prostate carcinoma

Histologic variants of prostate carcinoma account for 5% to 10% of all the carcinomas in the prostate and are typically seen in association with ordinary acinar prostate carcinoma. These variants often differ from the latter in clinical, immunophenotypic, ultrastructural, and genetic features. Many also differ in prognosis and may prompt a different therapeutic approach.

Atrophic carcinoma. The cancer glands have scant cytoplasm and may be confused with benign atrophy (Fig.5). The diagnosis is based on several features. First, atrophic prostate carcinoma displays an infiltrative growth pattern, with atrophic cancer glands intermingling with larger benign glands. In contrast, benign atrophy usually has a lobulated configuration. Atrophic prostate carcinoma has significant cytologic atypia, namely, nuclear enlargement and prominent nuclei. Finally, atrophic prostate carcinoma is often intermixed with nonatrophic ordinary prostate carcinoma. Whereas some forms of atrophy, are associated with fibrosis, atrophic prostate cancer lack such a desmoplastic stromal response.

Figure 5. A Cancer acini with round dilated and distorted lumina.

Figure 5. B Higher magnification shows acini lined by flattened cells with scant cytoplasm and enlarged nuclei with prominent nucleoli.

Pseudohyperplastic carcinoma resembles benign prostate glands in that the neoplastic glands are large with branching and papillary infolding. The recognition of cancer with this pattern is based on the architectural pattern of numerous closely packed glands as well as nuclear features more typical of carcinoma. One pattern of pseudohyperplastic adenocarcinoma consists of numerous large glands that are almost back-to-back with straight even luminal borders, and abundant cytoplasm. Comparably sized benign glands either have papillary infoldings or are atrophic. The presence of cytologic atypia in some of these glands further distinguishes them from benign glands. It is almost always helpful to verify pseudohyperplastic cancer with the use of immunohistochemistry to verify the absence of basal cells. Pseudohyperplastic cancer, despite its benign appearance, may be associated with typical intermediate grade cancer and can exhibit aggressive behavior.

Figure 6. A Pseudohyperplastic adenocarcinoma. Branching and papillary type of growth is typical. B. Perineural invasion. C Higher magnification, showing prominent nucleoli.

Foamy gland carcinoma. Cancer cells have abundant foamy or “xanthoma’-like cytoplasm with a very low nuclear/cytoplasmic ratio (Fig.7). Although the cytoplasm is xanthomatous in appearance, it contains empty vacuoles rather than lipid. The nuclei of foamy gland prostate carcinoma cells are typically small and hyperchromatic and lack the cytologic features of ordinary prostate carcinoma. The diagnosis of foamy gland prostate carcinoma is based on its architectural pattern of crowded and/or infiltrative glands, abundant foamy cytoplasm, and frequent intraluminal, dense, pink, acellular secretions. Basal cells are absent by immunohistochemistry. Despite its bland cytology, most of the cases that include an associated nonfoamy cancer are Gleason score 6 or greater. Foamy gland prostate carcinoma, therefore, appears best classified as an intermediate-grade carcinoma.

Mucinous (Colloid) carcinoma is defined as a cancer in which 25% or more of the tumor consists of lakes of extracellular mucin. Prostate carcinoma with less than 25% mucinous component should be classified as having mucinous features, whereas prostate carcinoma with intraluminal mucin without lakes of extracellular mucin is not considered as mucinous prostate carcinoma. Clinically, the average age for mucinous prostate carcinoma is often advanced, with locally advanced or metastatic disease. Microscopically, tumor cells float in lakes of extracellular mucin that are sharply demarcated from the stroma. Tumor cells are arranged in cribriform configurations, cords, strands, acini, or tubules. Cytologically, they appear bland with occasional prominent nucleoli. (Fig.7)

Figure 7 A Foamy gland carcinoma. Note pale eosinophilic with finely vacuolated cytoplasm, distinct cell membranes, basal nuclei, and small punctuate nucleoli. B Another case with clear finely vacuolated cytoplasm and hyperchromatic nuclei with indistinct nucleoli. C, D Mucinous (colloid carcinoma). Abundant luminal mucin expands the malignant acinar lumina.

Signet-ring-like carcinoma. Defined as 25% or more of tumor mass consisting of signet-ring-appearing cells, this histologic variant is a rare entity with an aggressive clinical course. Microscopically, the signet-ring-like tumor cells display nuclear displacement and indentation by clear cytoplasmic vacuoles (Fig.8). In the majority of cases, these vacuoles contain lipid rather than mucin, as with true signet cells. The cancer cells grow in sheets, in small clusters, and as single cells. They are invariably mixed with ordinary acinar prostate carcinoma components. Before establishing a diagnosis of prostatic signet-ring carcinoma, a metastasis from other anatomic sites, including stomach, lung, colon, and pancreaticobiliary system, must be excluded. On the other hand, a prostatic signet-ring carcinoma should be considered when one encounters a signet-ring-cell carcinoma of unknown primary, especially if mucin stains are negative.

Sarcomatoid carcinoma (Carcinosarcoma). Sarcomatoid prostate carcinoma is composed of both malignant epithelial and spindle cell elements (Fig.8). It may be a de novo diagnosis, or patients may have a previous history of prostate carcinoma treated with radiation or hormonal ablation therapy or both. Serum PSA is within normal limits in most cases, despite the frequent presence of nodal and distant metastasis. The 5-year survival rate is less than 40%. Microscopically, sarcomatoid prostate carcinoma is biphasic, with a glandular component showing variable Gleason patterns and a sarcomatoid component often exhibiting nondescript malignant spindle cell proliferation. Specific mesenchymal differentiation can also be present, including osteosarcoma, chondrosarcoma, and rhabdomyosarcoma. Immunohistochemically, the epithelial elements are positive for PSA and/or pancytokeratins, whereas sarcomatoid elements react with markers of corresponding mesenchymal differentiation and variably express cytokeratins.

Figure 8. A Signet-ring-like cancer cells display nuclear displacement and indentation by clear cytoplasmic vacuoles.

Figure 8. B This sarcomatoid prostate carcinoma is biphasic, with a glandular component and a sarcomatoid component

exhibiting malignant spindle cell proliferation

Bibliography

David G. Bostwick, Liang Cheng (2008). Urologic surgical pathology

Eble J.N, Sauter G., Epstein J.I, Sesterhenn I.A (Eds.) (2004). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs.

Ming Zhou, Cristina Magi-Galluzzi. (2006). Genitourinary Pathology.

Robert O.P, Isabella A.S, Charles J.D. (2008). Urologic Pathology.

Multiple squamous cell carcinomas in head and neck and esophagus.

Бүгдэнд нь энэ өдрийн мэнд!

Саяхан бидэнд улаан хоолой, төвөнхийн давхар анхдагч (double primary) хавтгай хучуур эдийн хавдрын сонирхолтой тохиолдол ирснийг та бүхэнтэй хуваалцахыг хүслээ.

Өвчтөн 50 настай, эрэгтэй. Дурангийн биопси болон дүрс оношлогооны шинжилгээгээр улаан хоолой, төвөнхийн хавдартай болох нь оношлогдсон. Төвөнх, улаан хоолой тайрах, хүзүүний тунгалгийн булчирхай түүх хагалгаанууд хийгдсэн.

Gross findings of the esophagus.

The specimen consists of a segment of esophagus and short segment of stomach. The specimen measures 8.5 cm in length of esophagus and 3.5 cm in the longest length of stomach . The external surface is slightly irregular in the mid part. On opening, the esophageal mucosa reveals a well-defined ulceroinfiltrative lesion, measuring 3.5 x 3.5 cm. It is located at 3.5 cm and 3.5 cm apart from the proximal and distal resection margins, respectively.
After applying Lugol solution, it reveals an ill-defined geographic unstained mucosa around mass. There is another unstained mucosal leison, 2 cm apart from the mass, measuring 2.2 x 1 cm, abutting the proximal margin.
On section, the cut surface of main mass shows a white-gray infiltrative tumor, which seems to be extending to the muscle layer.
Microscopic feature of the main mass.
Microscopic feature of the main mass.
Microscopic feature of separate Lugol solution unstained area abutting the proximal margin.

Gross finding of the larynx.
The mucosal surface of the epiglottis area shows a gray white granular ulcerative lesion in the left side, measuring 2.5 x 2.5 x 1.7 cm. The mucosal resection margin of tongue base is grossly free from the tumor. On multiple cut sections, the tumor is gray white infiltrative tumor, which seems to be confined to the epiglottis.
Cut surface and microscopic finding of main glottic tumor.

Gross and microscopic finding of mucosal irregularity in right subglottic area.

Pulmonary aspergilloma

48 year-old male patient is admitted in a hospital, due to cough & chest pain.
Bronchial washing cytology: There are numerous acute inflammatory cells (abscess) and a few acute angle branching fungal hypae are seen. Diagnosis of cytology: 1. Negative for malignancy. 2. Aspergilloma.

Gross findings: Pleural surface is irregular and slightly thickened. On CT guided sections, there are a dilated bronchi which filled with green muddy materials. The remaning parenchyma shows multiple curd-like caseous necrosis of variable sizes.

Microscopic findings: The dilated bronchi contains acute angle branching fungal material. The histochemical stain for fungi (GMS) shows definite acute angle branching and hypae, so consistent with aspergillus spp. The last photo shows chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. The result of TB-PCR is positive for AFB.

Final pathological diagnosis:

1. Bronchiectasis

2. Aspergilloma

3. Chronic granulamatous inflammation, consistent with tuberculosis.

Tuberculous lymphadenitis

46 year-old female patient is admitted in a hospital due to cervical node enlargement. The following slides are come from FNA cytology of cervical nodes. The cytological findings show multiple granulomas composed of epitheloid cells, lymphocytes and macrophages, but giant cells aren't identified. The Ziehl-Neelsen stain for AFB is negative, but TB-PCR shows positive result. The cytological diagnosis of this specimen was tuberculous lymphadenitis.

Parathyroid carcinoma

28 настай эмэгтэй palpable neck mass гэсэн зовиуртайгаар эмнэлэгт хандсан бөгөөд лабораторийн шинжилгээгээр PTH- 1476 pg/mL (15-65 pg/mL), ALP-1072U/L (<85 U/L), Ca-11.1 mg/dL (8.6-10.0 mg/mL), P-2.1 (2.7-4.5 mg/mL) тус тус ихэссэн байв. Бусад лабораторийн үзүүлэлтүүд болон бамбайн дааврууд хэвийн хэмжээнд байсан.

Pre-op ultrasonography: Well-defined hypoechoic mass

CT findings:
FNA cytology: The immunohistochemical stain (IHC) for parathyroid hormone (PTH) is positive. The possibility of parathyroid neoplasm is suggested.

Gross findings:
Microscopic findings: There are capsular invasion and vascular invasion. IHC stain for vascular invasion (CD34) is positive.

Final pathological diagnosis:
Parathyroid gland, right, parathyroidectomy : Parathyroid carcinoma.

Эмч та

Эмч та
Эмч та энэрэнгүй ёсны илч
Эмч та эрүүл энхийн манаач
Эмч та эх үрсийг жаргаагч
Эмч та эмгэг өвчнийг намнагч
Эмч та өтөлснийг залуужуулагч
Эмч та өвдсөнийг эдгэрүүлэгч
Эмч та эмнэлгийн армийн цэрэг
Эмч та энэ ертөнцийн ачтан

Та бүхэнд амралтын өдрийн мэнд хүргэе. Өчигдөр IF зураг авч байгаад энэ дүрсийг бидний оршин буй эх дэлхий ба түүний дагуул болох сар хоёртой зүйрлэж болох юм шиг санагдаад ...

Undifferentiated (Anaplastic) Thyroid Carcinoma (3)

Undifferentiated (anaplastic) thyroid carcinoma is the most aggressive and lethal form of thyroid cancer. Fortunately, it accounts for only 1% to 2% of all thyroid malignancy. If we review the term of undifferentiated (anaplastic) carcinoma, it is very interesting history. It is used to have several kind of diagnostic term. According to the time interval it is named as a sarcoma of thyroid in 1930, spindle and giant cell metaplasia in 1950, and spindle and giant cell carcinoma in 1960. Then it is renamed as anaplastic carcinoma in 1970. In this time, the immunohistochemistry was beginning to introduce, the small cell type of anaplastic carcinoma is termed as lymphoma, medullary type is termed as medullary carcinoma through the immunohistochemistry. Lastly, it is renamed undifferentiated carcinoma by WHO international classification in 2000.

Definition
Undifferentiated thyroid carcinomas (UTC) are highly malignant tumors that histologically appear wholly or partially composed of undifferentiated cells that exhibits immunohistochemical or ultrastructral features indicative of epithelial differentiation.

Etiology
Most cases of UTC show evidence of a pre-existing differentiated or poorly differentiated thyroid carcinoma.

Clinical features
Almost all patients with UTC present with rapidly expanding neck mass (Figure 1). The most frequent and important sign and symptoms are hoarseness (80%), followed by dysphagia (60%), vocal cord paralysis (50%), cervical pain (30%) and dyspenia (20%). The tumor maybe fixed or hard (75%), and may present as a single (60%) or multiple nodule (40%) with bilateral involvement in 25% of cases. Surrounding structures are frequently invaded: muscle (65%), trachea (50%), esophagus (45%), laryngeal nerve (30%) and larynx (15%). Cervical adenopathy is present in more than 40% of patients. At least 40% of patients have distant metastases at the time of diagnosis, 50% involving the lungs, 15 % the bones and 10% the brain. Cardiac metastases have also been described.

Figure 1. Undifferentiated (anaplastic) thyroid carcinoma, showing the rapidly enlarging, fixed mass. Tumor fungation is seen at the tracheostomy site.

Macroscopy
The tumors are large, fleshy, and white-tan in color, often exhibiting areas of necrosis and hemorrhage. They are typically infiltrative and in most instances replace most of the gland parenchyma with invasion into the surrounding soft tissue and adjacent structures including lymph nodes, larynx, pharynx, trachea, and esophagus.

Tumor spread and staging
Undifferentiated carcinomas typically spread beyond the thyroid by direct local extension. Metastases to regional nodes are also common but their presence is often overshadowed by the presence of extensive soft tissue. Distant metastases may be present in any sites. All undifferentiated carcinomas are considered to be T4 tumors.

Histopathology
Histologically, the majority of UTCs are widely invasive tumors composed of an admixture of spindle cells, pleomorphic giant cells and epithelioid cells. There is considerable variation in both the percentage and distribution of these cellular elements from case to case. The spindle cells can be slender pr plump, and the giant cells may contain single or multiple, bizarre nuclei. These patterns are descriptively designated squamoid, spindle cell, giant cell, paucicellular and lymphoepithelioma like (Figure 2).
The squamoid pattern is so named because of its morphologic similarity to nonkeratinizing squamous cell carcinoma of other organs, such as lung or cervix. The appearance in these areas is unmistakably epithelial because of the formation of distinct tumor nests of irregular configuration. Pleomorphism is moderate, giant cells are generally absent. The cytoplasm is abundant and acidophilic. In rare instances, squamous pearls are seen in the center of islands. In these cases, the appearance is epidermoid rather than merely squamoid. Small foci of mucin accumulation can sometimes be demonstrated in these areas by the use Mayer mucicarmine or other mucin stains.
The spindle cell pattern is best described as sarcoma-like, in the sense that, on purely morphologic grounds, it is indistinguishable from a true sarcoma. In most instances, however, the marked degree of nuclear pleomorphism scattered giant tumor cells, storiform pattern of growth, and inflammatory infiltrate give the tumor an appearance similar to that exhibited by the usual form of malignant-fibrous histiocytoma. These cellular areas alternate with extensive areas of necrosis and sclerohyaline deposition.
The giant cell pattern is characterized by a degree of pleomorphism that is substantially higher than that seen in association with the other patterns. The tumor giant cells maybe the only elements present, but more often they are seen interspersed with smaller mononuclear tumor cells that have otherwise similar morphologic features. The pattern of growth in these area is usually solid, but on occasion an artifactual separation of the cells leads to be formation of alveolar (pseudoglandular) or pseudovascular structures.
The paucicellular variant is characterized by a hypocellular proliferation of mildly atypical spindle tumor cells embedded in a dense fibrous stroma that resemble Riedel’s thyroiditis. The lymphoepithelioma-like variant histologically resembles nasopharyngeal lymphoepithelioma but is not been found to be associated with EBV infection.

Molecular genetics alteration
Multiple molecular genetic and expression studies have been performed in UTC, many involving small sample sizes. The increased replicative potential is reflected by alterations in components involved in cell cycle control such as over-expression of cyclin D1, decreased expression of p27, and inactivation of PTEN and p16. The most consistent finding is the strong association of UTC with TP53 mutations.

Figure 2. Undifferentiated (anaplastic) carcinoma. The tumor has a squamoid (A), giant cell (B) and paucicellular (C) growth patterns. D. The wall of vessel is invaded by undifferentiated carcinoma, but the lumen is still patent.

Prognosis and predictive factors
Undifferentiated thyroid carcinoma is a highly aggressive malignant neoplasm typified by rapidly progressive local disease. The overall five-year survival ranges from 0-14 % and the median survival is 2.5-6 months. Prognostic factors are related primarily to the extent of disease at presentation. Rare cases exhibiting a better prognosis usually include localized tumors less than 5 cm, particularly small foci that are only identified microscopically. Undifferentiated thyroid cancers may be associated with adjacent well-differentiated thyroid cancer, but the prognosis depends on the size of undifferentiated component and the efficacy of eradicative surgery. Those patients with tumors that are amenable to complete surgical resection combined with preoperative or postoperative adjuvant doxorubicin-based chemotherapy and irradiation may have prolonged survival. Predictor factors are associated with histomorphologic and genetic features of the tumor have not been identified.