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In Situ Evidence of Neoplastic Cell Phagocytosis by Macrophages in Papillary Thyroid Cancer¹

Servizio di Anatomia ed Istologia Patologica, Presidio Ospedaliero Vittorio Emanuele II; and Istituto di Medicina Interna e di Malattie Endocrine e Metaboliche, Cattedra di Endocrinologia (A.B., G.M.S., R.V.), and Cattedra di Chirurgia (O.I., R.V.), University of Catania, Catania, Italy 95123

Address all correspondence and requests for reprints to: Antonino Belfiore, M.D., Istituto di Medicina Interna e di Malattie Endocrine e del Metabolismo, Cattedra di Endocrinologia, P.zza S. Maria di Gesù 1, 95123 Catania, Italy. E-mail: endo.uni.ct{at}mail.tau.it

We evaluated the occurrence, tissue distribution, and prognostic value of tumor-associated macrophages in 121 papillary thyroid carcinomas using immunohistochemical staining with anti-CD68 antibody in archival paraffin-embedded sections. Lymphocytic infiltration and dendritic cell presence were also evaluated. Three groups were identified according to the presence and characteristics of macrophages: 1) tumors without evidence of infiltrating macrophages: (n = 35); 2) tumors with infiltrating macrophages but no evidence of neoplastic cells phagocytosis (n = 68); and 3) tumors with infiltrating macrophages and in situ evidence of active neoplastic cell phagocytosis (n = 18).

Neoplastic cell phagocytosis by macrophages was positively correlated with both lymphocytic infiltration and dendritic cells (P = 0.0000), whereas it was negatively correlated with vascular invasion (P = 0.0032). Distant metastases developed in none of the 18 tumors with neoplastic cell phagocytosis, but occurred in 15 of 103 of the remaining tumors (P = 0.0647) and were significantly and negatively associated with lymphocytic infiltration or dendritic cells.

The present study indicates, therefore, that immune reaction, involving neoplastic cell phagocytosis by macrophages and lymphocytic infiltration, plays a role in the development of distant metastases in patients with papillary thyroid cancer.

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