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Anaplastic Carcinoma of the Thyroid Arising More Often from Follicular Carcinoma than Papillary Carcinoma

¹ Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 160, Sec. 3, Chungkang Road, Taichung, Taiwan
² Department of Medical Research, Mackay Memorial Hospital, No. 45, Minsheng Road, Tamshui, Taipei, Taiwan
³ Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 222, Maijin Road, Keelung, Taiwan
⁴ Division of Medical Oncology, Kuang Tien General Hospital, No. 117, Shatian Road, Shalu, Taichung, Taiwan
⁵ Department of General Surgery, E-da Hospital, No. 1, Yida Road, Yanchau, Kaoshiung, Taiwan
⁶ Department of Surgery, Ten-Chan Hospital, No. 155, Yanping Road, Chungli, Taoyuan, Taiwan
⁷ Department of Pathology, Mackay Memorial Hospital, No. 45, Minsheng Road, Tamshui, Taipei, Taiwan
⁸ Mackay Medicine, Nursing and Management College, No. 92, Shengjing Road, Beitou, Taipei, Taiwan
⁹ National Taipei College of Nursing, No. 365, Minte Road, Beitou, Taipei, Taiwan

Correspondence: Address correspondence and reprint requests to: Chin-Yuan Tzen, MD, PhD; E-mail: jeffrey{at}ms2.mmh.org.tw

Background: Anaplastic thyroid carcinoma (ATC), a rare and highly malignant tumor, has long been thought to arise from well-differentiated carcinoma (WDC) such as follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC). The purpose of this study was to test this notion by examining whether and, if so, how often ATC harbors the oncogenes that are commonly associated with WDC, such as RAS in FTC and BRAF in PTC.

Methods: We analyzed the mutation hotspots of BRAF (codon 600) and N-, K-, and H-RAS (codons 12, 13, and 61) in 16 ATCs. We also examined two genes, PIK3CA (exons 9 and 20) and TP53 (exons 5–9), both of which have been reported in ATCs.

Results: The results showed that approximately 31% (5 of 16) of ATCs harbored N-RAS mutation, 6% (1 of 16) had mutated BRAF, and approximately 56% (9 of 16) had mutated TP53. As to the three ATCs that had coexisted PTCs, mutated BRAF was detected in all PTC components but only in one ATC, while mutated PIK3CA was found in only one PTC component but not in the ATC.

Conclusion: A number of ATCs arise from WDCs, more often from RAS-mutant tumors than from BRAF-mutant tumors, implying that particular attention should be paid to the WDC harboring RAS mutation.

Key Words: Anaplastic thyroid carcinoma • Follicular thyroid carcinoma • Papillary thyroid carcinoma • BRAF mutation • N-RAS mutation • TP53 mutation