Molecular Classification and Histopathological Correlates in Follicular Cell-Derived Thyroid Neoplasms

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Thyroid neoplasms are classified as two or three molecular groups based on the mutational and gene expression profiles:
    • Two molecular groups:
      • BRAF V600E-like
      • RAS-like
    • Three molecular groups:
      • BRAF V600E-like
      • RAS-like
      • Non-BRAF V600E / non-RAS-like
  • The BRAF V600E group:
    • Is most commonly represented by:
      • Papillary thyroid carcinoma (PTC)
  • The BRAF V600E-like molecular profile includes:
    • The BRAF V600E mutation
    • Gene fusions involving:
      • BRAF, RET, and neurotrophic receptor tyrosine kinase 1/3 (NTRK1/3)
  • RAS-like molecular profiles include:
    • NRAS, HRAS, KRAS, EIF1AX, enhancer of zeste 1 polycomb repressive complex 2 subunit (EZH1), Dicer 1, ribonuclease III (DICER1), phosphatase and tensin homolog (PTEN) mutations, BRAF K601E, and gene fusions involving peroxisome proliferator-activated receptor gamma (PPARG) and THADA
  • When the three-group molecular classification is applied:
    • PAX8::PPARG gene fusion and mutations of EIF1AX, EZH1, IDH1, SOS1, SPOP, DICER1, and PTEN genes are classified as a non-BRAFV600E-/non-RAS-like group
  • Encapsulated / circumscribed thyroid tumors with a predominant follicular growth pattern:
    • Generally have a RAS-like molecular profile
  • High grade is histologically defined:
    • As the presence of ≥ 5 mitoses per 2 mm2 and / or tumor necrosis.
  • Y, yes; N, no; Q, questionable; PDTC, poorly differentiated thyroid carcinoma; ATC, anaplastic thyroid carcinoma; DHGTC, dif- ferentiated high-grade thyroid carcinoma; IEFVPTC, invasive encapsulated follicular variant of papillary thyroid carcinoma; WDT-UMP, well-differentiated tumor of uncertain malignant potential; NIFTP, non-invasive follicular thyroid neoplasm with papillary-like nuclear fea- tures; FT-UMP, follicular tumor of uncertain malignant potential; FTC, follicular thyroid carcinoma; OCA, oncocytic carcinoma of the thy- roid; TERT, telomerase reverse transcriptase; TP53, tumor protein p53; PAX8, paired box 8
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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