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Xu YM, Gong ZJ, Wu HJ. Papillary Thyroid Carcinoma Incidentally Found in Cervical Lymph Nodes During Neck Dissection for Patients With Tongue Squamous Cell Carcinoma: A 3-Case Report and Literature Review. J Oral Maxillofac Surg 2018; 76:2454.e1-2454.e6. [PMID: 30107162 DOI: 10.1016/j.joms.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023]
Abstract
The incidence of papillary thyroid carcinoma (PTC) found in the cervical lymph nodes during neck dissection for patients with tongue squamous cell carcinoma (SCC) is infrequent, with the coexistence of PTC and SCC in the same cervical lymph node being the rarest. Some of these patients present with primary lesions in the thyroid gland, whereas others have no obviously malignant thyroid lesion. The reasons behind this clinical phenomenon and the relationship between tongue SCC and PTC found in the cervical lymph nodes are unclear. Moreover, for surgeons, making the choice between thyroid surgery and follow-up is still a clinical dilemma. Of the 956 patients who underwent neck dissection owing to maxillofacial tumors from January 2011 through December 2017 at Second Xiangya Hospital of Central South University, 3 with tongue SCC presented with PTC in the cervical lymph nodes. Neither the preoperative physical examination nor ultrasonography after surgery showed substantial nodules in the thyroid glands of these patients, so none of them underwent thyroid surgery or chemoradiotherapy. At follow-up (1 to 6.5 years), we found no obviously malignant lesions in the patients' thyroid glands or related metastatic disease. Our study suggests that tongue SCC may not affect the occurrence and development of PTC in the cervical lymph nodes. For patients with tongue SCC presenting with PTC in the cervical lymph nodes, it is not necessary to carry out thyroid surgery immediately if ultrasonography shows no substantially malignant lesion in the thyroid gland. Nevertheless, conducting periodic follow-up is very important.
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Affiliation(s)
- Yu-Ming Xu
- Resident, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhao-Jian Gong
- Associate Professor, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Han-Jiang Wu
- Professor and Department Head, Department of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China.
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52
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Won JH, Lee JY, Hong HS, Jeong SH. Thyroid nodules and cancer in children and adolescents affected by Hashimoto's thyroiditis. Br J Radiol 2018; 91:20180014. [PMID: 29595320 PMCID: PMC6221765 DOI: 10.1259/bjr.20180014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/13/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the rates of thyroid nodules and cancer in pediatric cases of Hashimoto's thyroiditis (HT) in Korea. METHODS We retrospectively reviewed 89 pediatric and adolescent patients (age, 3-18.0 years) with HT who underwent thyroid ultrasonography (US) at our institution from February 2006 to July 2016. The diagnosis of HT was based on the presence of thyroid autoantibodies. The presence of any thyroid nodules with US and cytopathologic features was analyzed. The malignancy rate was also determined. RESULTS Thyroid nodules were in 20 of the 89 patients (22.4%). Eight of these 20 patients (40%) had colloid cysts, two (10%) had nodular hyperplasia, one (5%) had follicular adenoma, and two (10%) had lymphocytic thyroiditis. Seven of the 89 patients (7.9%) were confirmed to have a malignancy, all of which were papillary thyroid carcinoma (PTC); of those, five patients had diffuse sclerosing variant PTC, and two had conventional PTC on pathology. CONCLUSION The prevalence of thyroid nodules in children and adolescents with HT was 22.4%. The malignancy rate of children with HT was 7.9%. The malignancy rate among thyroid nodules was 35%, which is higher than the 26% rate generally reported for children with nodules. Therefore, using thyroid US to survey known or suspected thyroid nodules might be helpful in children and adolescents with HT and may provide further useful diagnostic information. Advances in knowledge: Thyroid US could help to assess HT patients who have known or suspected thyroid nodules.
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Affiliation(s)
- Ji Hye Won
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun Hye Jeong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Miftari R, Topçiu V, Nura A, Haxhibeqiri V. Management of the Patient with Aggressive and Resistant Papillary Thyroid Carcinoma. Med Arch 2018; 70:314-317. [PMID: 27703298 PMCID: PMC5034967 DOI: 10.5455/medarh.2016.70.314-317] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/19/2016] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Papillary carcinoma is the most frequent type of thyroid cancer and was considered the most benign of all thyroid carcinomas, with a low risk of distant metastases. However, there are some variants of papillary thyroid carcinoma that have affinity to spread in many organs, such as: lymph nodes, lungs and bones. AIM The aim of this study was presentation of a case with papillary carcinoma of the thyroid gland, very persistent and resistant in treatment with I 131. MATERIAL AND RESULTS A man 56 years old were diagnosed with papillary carcinoma of thyroid gland. He underwent a surgical removal of the tumor and right lobe of thyroid gland. With histopathology examination, were confirmed follicular variant of papillary carcinoma pT4. Two weeks later he underwent total thyroidectomy and was treated with 100 mCi of J 131. Six months later, the value of thyroglobulin was found elevated above upper measured limits (more than 500 ng/ml). Patient underwent surgical removal of 10 metastatic lymph nodes in the left side of the neck and has been treated with 145 mCi of radioiodine I 131. The examination after 5 months shows elevation of thyroglobulin, more than 20000 ng/ml and focally uptake of J 131 in the left lung. Patient was treated once again with 150 mCi radioiodine J 131. Whole body scintigraphy was registered focal uptake of radioiodine in the middle of the left collarbone. After a month, patient refers the enlargement of the lymph node in the right side of the neck. Currently patient is being treated with kinase inhibitor drug sorafenib and ibandronate. We have identified first positive response in treatment. Enlarged lymph node in the neck was reduced and the patient began feeling better. CONCLUSION This study suggests that some subtypes of papillary thyroid carcinoma appear to have more aggressive biological course. Subtypes of papillary thyroid carcinoma such as diffuse sclerosing carcinoma, tall cell or columnar cell and insular variants, appears to have more aggressive biological course and need early detection and other kind of treatment.
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Affiliation(s)
- Rame Miftari
- Department of Nuclear Medicine, University Clinical Center of Kosova, Pristine, Kosovo
| | - Valdete Topçiu
- Department of Biochemistry, University Clinical Center of Kosova, Pristine, Kosovo
| | - Adem Nura
- Department of Sports Medicine, University Clinical Center of Kosova, Pristine, Kosovo
| | - Valdete Haxhibeqiri
- Department of Biochemistry, University Clinical Center of Kosova, Pristine, Kosovo
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54
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Lam AKY, Fridman M. Characteristics of cribriform morular variant of papillary thyroid carcinoma in post-Chernobyl affected region. Hum Pathol 2018; 74:170-177. [PMID: 29320754 DOI: 10.1016/j.humpath.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 01/30/2023]
Abstract
The aim is to study the characteristics of cribriform morular variant of papillary thyroid carcinoma (CMV-PTC) in patients living in the radiation-affected area of Belarus. The clinical and pathological features of 35 patients with CMV-PTC from Belarus were studied and compared with those of conventional papillary thyroid carcinoma diagnosed in the same period. The patients with CMV-PTC were all females and were younger at presentation (mean age = 24) than those with conventional papillary thyroid carcinoma. Familial adenomatous polyposis (FAP) was identified in 20% of the patients with CMV-PTC. The majority of the CMV-PTCs (29/35; 83%) were staged as pT1 and were less advanced than conventional papillary thyroid carcinoma. There was no evidence of lymph node metastases or distant metastases. CMV-PTCs were positive for β-catenin, APC (adenomatous polyposis coli) and p53 proteins. No psammoma bodies were identified on microscopic examination. Over a median follow-up of 9 years, all the patients were alive, and there was no cancer recurrence or mortality related to the thyroid cancer. To conclude, CMV-PTC in patients in the radiation-affected region behaves in an indolent fashion. They had distinctive features that are different from patients with conventional papillary thyroid carcinoma living in the same region.
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Affiliation(s)
- Alfred King-Yin Lam
- Discipline of Pathology, School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia.
| | - Mikhail Fridman
- Republican Centre for Thyroid Tumors, Nezavisimosty Av., 64, 220013 Minsk, Belarus
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55
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Abstract
There has been a steady incorporation of powerful new molecular tools into the evaluation and management of thyroid nodules and thyroid cancer. With an increasing incidence of nodules and differentiated thyroid cancer (DTC) being diagnosed in children and adolescents, oncogene data are providing insight into the clinical differences between pediatric and adult patients with histologically similar DTC. However, additional investment and efforts are needed to define the genomic landscape for pediatric DTC with the goal of improving preoperative diagnostic accuracy as well as stratifying treatment in an effort to reduce complications of therapy.
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Affiliation(s)
- Andrew J Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, The Children's Hospital of Philadelphia, The Perelman School of Medicine, The University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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56
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Oishi N, Kondo T, Nakazawa T, Mochizuki K, Inoue T, Kasai K, Tahara I, Yabuta T, Hirokawa M, Miyauchi A, Katoh R. Frequent BRAF V600E and Absence of TERT Promoter Mutations Characterize Sporadic Pediatric Papillary Thyroid Carcinomas in Japan. Endocr Pathol 2017; 28:103-111. [PMID: 28176151 DOI: 10.1007/s12022-017-9470-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric papillary thyroid carcinoma (PTC) has unique features but requires further genetic investigation. Moreover, there has been increasing concern about the risk for pediatric PTC in Japan after the Fukushima accident. This study aims to evaluate the frequencies of BRAF and TERT promoter mutations and to examine their significance in non-radiation-associated pediatric PTCs in Japan. We enrolled 81 pediatric PTC patients aged ≤20 years. The control group included 91 adult PTCs from patients >20 years old. BRAF and TERT mutations were analyzed by allele-specific-PCR and/or Sanger sequencing. Compared with adult PTCs, pediatric PTCs exhibited larger tumor size, more frequent lymph node metastasis, and less classical histology. The prevalence of BRAF V600E in pediatric PTCs was 54% and significantly lower than that in adults of 85%. In the pediatric PTCs, BRAF V600E was positively associated with older age, classical histology, and the lymph node metastasis but independent from other clinicopathological factors. TERT mutations were identified in 13% of adults and in none of the pediatric PTCs. In conclusion, pediatric PTCs are characterized by more advanced clinicopathological features, lower BRAF V600E frequency, and absence of TERT mutation. The BRAF V600E frequency in this study is similar to the reported BRAF V600E frequency in the ultrasonographically screened pediatric PTCs in Fukushima.
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Affiliation(s)
- Naoki Oishi
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Tadao Nakazawa
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Tomohiro Inoue
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Kazunari Kasai
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Ippei Tahara
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan
| | - Tomonori Yabuta
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Ryohei Katoh
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, 409-3898, Japan.
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57
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Vuong HG, Kondo T, Pham TQ, Oishi N, Mochizuki K, Nakazawa T, Hassell L, Katoh R. Prognostic significance of diffuse sclerosing variant papillary thyroid carcinoma: a systematic review and meta-analysis. Eur J Endocrinol 2017; 176:433-441. [PMID: 28183787 DOI: 10.1530/eje-16-0863] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/29/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diffuse sclerosing variant papillary thyroid carcinoma (DSVPTC) is an uncommon variant of papillary thyroid carcinoma (PTC). The biological behaviors and prognostic outcomes of this variant, however, are still controversial. The aim of this systematic review and meta-analysis is to investigate the prognostic significance and outcomes of DSVPTCs in comparison with classical PTCs (cPTCs). METHODS An electronic search was performed in five libraries: PubMed, Scopus, ISI, World Health Organization Global Health Library (WHO GHL) and Virtual Health Library (VHL) in June 2016. Published data were extracted and were pooled into odds ratios (OR), mean differences and corresponding 95% confidence intervals (CI) using random-effect model. Publication bias was analyzed using Egger's regression test and funnel plot observation. RESULTS From 315 articles, we included 16 articles comprising 732 DSVPTCs for meta-analysis. Overall, DSVPTC manifested more aggressive clinicopathological behaviors than cPTC such as higher rate of vascular invasion (OR: 5.33; 95% CI: 3.08-9.23), extrathyroidal extension (OR: 2.96; 95% CI: 2.04-4.30), lymph node metastasis (OR: 5.40; 95% CI: 2.82-10.35), distant metastasis (OR: 3.61; 95% CI: 1.89-6.88) and were more likely to relapse (OR: 2.83; 95% CI: 1.59-5.05). DSVPTC patients were associated with a worsened overall survival (HR: 1.89; 95% CI: 1.36-2.62). CONCLUSION DSVPTCs should be considered high-risk PTCs because of high propensity for tumor invasion, metastasis, relapse and mortality. Aggressiveness of DSVPTCs might be related to a different molecular pathway than that in cPTCs.
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Affiliation(s)
- Huy Gia Vuong
- Department of PathologyUniversity of Yamanashi, Yamanashi, Japan
- Department of PathologyCho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tetsuo Kondo
- Department of PathologyUniversity of Yamanashi, Yamanashi, Japan
| | - Thong Quang Pham
- Department of PathologyCho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Naoki Oishi
- Department of PathologyUniversity of Yamanashi, Yamanashi, Japan
| | - Kunio Mochizuki
- Department of PathologyUniversity of Yamanashi, Yamanashi, Japan
| | - Tadao Nakazawa
- Department of PathologyUniversity of Yamanashi, Yamanashi, Japan
| | - Lewis Hassell
- Department of PathologyOklahoma University of Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ryohei Katoh
- Department of PathologyUniversity of Yamanashi, Yamanashi, Japan
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58
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Lam AKY, Saremi N. Cribriform-morular variant of papillary thyroid carcinoma: a distinctive type of thyroid cancer. Endocr Relat Cancer 2017; 24:R109-R121. [PMID: 28314770 DOI: 10.1530/erc-17-0014] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
The aim of this systematic review is to study the features of cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) by analysing the 129 documented cases in the English literature. The disease occurred almost exclusively in women. The median age of presentation for CMV-PTC was 24 years. Slightly over half of the patients with CMV-PTC had familial adenomatous polyposis (FAP). CMV-PTC presented before the colonic manifestations in approximately half of the patients with FAP. Patients with FAP often have multifocal tumours in the thyroid. Microscopic examination of CMV-PTC revealed predominately cribriform and morular pattern of cancer cells with characteristic nuclear features of papillary thyroid carcinoma. Psammoma body is rare. On immunohistochemical studies, β-catenin is diffusely positive in CMV-PTC. The morular cells in CMV-PTC are strongly positive for CD10, bcl-2 and E-cadherin. Pre-operative diagnosis of CMV-PTC by fine-needle aspiration biopsy could be aided by cribriform architecture, epithelial morules and β-catenin immunostaining. Mutations of APC gene are found in the patients with CMV-PTC associated with FAP. In addition, mutations in CTNNB1, RET/PTC rearrangement and PI3K3CA mutations have been reported. BRAF mutation is negative in all CMV-PTC tested. Compared to conventional papillary thyroid carcinoma, CMV-PTC had a lower frequency of lymph node metastases at presentation (12%) and distant metastases (3%) as well as lower recurrence rates (8.5%) and patients' mortality rates (2%). To conclude, patients with CMV-PTC have distinctive clinical, pathological and molecular profiles when compared to conventional papillary thyroid carcinoma.
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Affiliation(s)
- Alfred King-Yin Lam
- Cancer Molecular PathologySchool of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Nassim Saremi
- Cancer Molecular PathologySchool of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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59
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Hu J, Li C, Liu C, Zhao S, Wang Y, Fu Z. Expressions of miRNAs in papillary thyroid carcinoma and their associations with the clinical characteristics of PTC. Cancer Biomark 2017; 18:87-94. [PMID: 28085013 DOI: 10.3233/cbm-161723] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The sensitivity and specificity of biomarkers which have been used in clinical practice for diagnosis of papillary thyroid carcinoma (PTC) are low, it is essential to develop novel diagnostic and prognostic biomarkers for PTC. OBJECTIVE To explore the expressions of miR-940, miR-15a, miR-16 and IL-23 in PTC tissues and plasma and their associations with the clinical characteristics of PTC. METHODS We investigated the expressions of miR-940, miR-15a, miR-16 and IL-23 in plasma and thyroid tissues of PTC, nodular goiter and healthy people with qRT-PCR, and further analyzed the associations between their levels and the clinical characteristics of PTC. RESULTS Level of IL-23 expression was higher while levels of miR-940, miR-15a and miR-16 expression in the PTC tissues were lower compared with the nodular goiter tissues and perineoplastic thyroid tissues. And the levels of miR-940, miR-15a, miR-16 and IL-23 expression in the PTC tissues were associated with some clinical characteristics of PTC, including bilateral tumor, multicentricity, extrallyroidal invasion, cervical lymph node metastasis, distant metastasis and clinical advanced stages (III/IV). CONCLUSIONS Expressions of miR-940, miR-15a, miR-16 and IL-23 in PTC tissues might be useful biomarkers and promising targets in the diagnosis of papillary thyroid carcinoma.
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Affiliation(s)
- Jianxia Hu
- The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengqian Li
- Endocrinology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chongkai Liu
- Department of Urology, The People's Hospital of Jimo, Qingdao, Shandong, China
| | - Shihua Zhao
- The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yangang Wang
- Endocrinology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhengju Fu
- Endocrinology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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60
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Ohashi R, Murase Y, Matsubara M, Watarai Y, Igarashi T, Sugitani I, Naito Z. Fine needle aspiration cytology of the papillary thyroid carcinoma with a solid component: A cytological and clinical correlation. Diagn Cytopathol 2017; 45:391-398. [PMID: 28224716 DOI: 10.1002/dc.23679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/02/2017] [Accepted: 01/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Solid variant of papillary thyroid carcinoma is a rare subtype of papillary thyroid carcinoma (PTC) containing a solid component (SC), and thus its cytological and clinicopathological features remain elusive. We examined fine needle aspiration (FNA) cytological features of PTC with variable degrees of SC (20-80% of the tumor)(PTCSC) in comparison to well-differentiated PTC (WPTC). METHODS Twenty-six cases of PTCSC were histologically stratified into major-SC (SC >50% of the tumor) and minor-SC (<49%) groups. Pre-operative FNA smears were compared between major-SC (n = 11) and minor-SC (n = 15) groups, and between PTCSC and WPTC (n = 39) groups. RESULTS In FNA smears of PTCSC, the presence of cohesive solid nests, trabecular patterns, overlapping, enlarged nuclei, pleomorphism, and distinct nucleolus, and the absence of colloid and psammoma bodies were noted more often than in WPTC, while classical cytological features of PTC, such as nuclear grooves and/or pseudo-nuclear inclusions, were preserved. There was no significant difference in FNA findings between the major-SC and minor-SC groups. The presence of either solid nests or trabecular patterns, and overlapping in FNA smears of PTCSC was associated with a higher recurrence rate of the tumor (P = 0.007 and P < 0.001, respectively). CONCLUSION PTCSC may pre-operatively be identified by detecting its characteristic cytological features in FNA smears, regardless of the proportion of SC within the tumor. Because clinical outcomes of PTCSC remain undetermined, it is imperative to postulate PTCSC as a differential diagnosis, even when classical nuclear features of PTC are present. Diagn. Cytopathol. 2017;45:391-398. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yukihiro Murase
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Miyuki Matsubara
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhiko Watarai
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Zenya Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
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61
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Ohashi R, Kawahara K, Namimatsu S, Igarashi T, Sakatani T, Sugitani I, Naito Z. Clinicopathological significance of a solid component in papillary thyroid carcinoma. Histopathology 2017; 70:775-781. [DOI: 10.1111/his.13132] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Ryuji Ohashi
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
| | - Kiyoko Kawahara
- Department of Integrated Diagnostic Pathology; Nippon Medical School; Tokyo Japan
| | - Shigeki Namimatsu
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery; Nippon Medical School Hospital; Tokyo Japan
| | - Takashi Sakatani
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
- Department of Integrated Diagnostic Pathology; Nippon Medical School; Tokyo Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery; Nippon Medical School Hospital; Tokyo Japan
| | - Zenya Naito
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
- Department of Integrated Diagnostic Pathology; Nippon Medical School; Tokyo Japan
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62
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Fridman M, Lam AKY, Krasko O. Characteristics of young adults of Belarus with post-Chernobyl papillary thyroid carcinoma: a long-term follow-up of patients with early exposure to radiation at the 30th anniversary of the accident. Clin Endocrinol (Oxf) 2016; 85:971-978. [PMID: 27314225 DOI: 10.1111/cen.13137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Studies of thyroid cancer related to the Chernobyl accident have focused on children as they are the most vulnerable group with the highest risk of developing radiation-associated cancer. In contrast, our research aimed to look at the clinical and pathological features of patients with post-Chernobyl papillary thyroid carcinoma that were 2 years old or less at the time of the Chernobyl accident. DESIGN The study subjects were patients (n = 359) aged 0 to 2 at the time of the Chernobyl accident and aged ≥19 years at presentation/surgery who were treated in Belarus for papillary thyroid carcinoma during the period 2003-2013. RESULTS In conventional or oncocytic variant of papillary thyroid carcinoma, the prevalence of extra-thyroidal extension, nodal disease, infiltrative growth or lymphatic vessel invasion was above 50%. These features were less pronounced when compared to tall cell or diffuse sclerosing variants of papillary thyroid carcinoma. The highest frequency of central lymph node metastases was found in patients aged 1-2 years at exposure (P = 0·004). Subjects exposed in utero were characterized by absent/insignificant lymphocytic infiltration around the carcinoma (P = 0·025), predominance of conventional papillary architecture and an association with lymphocytic thyroiditis. CONCLUSIONS A number of features were associated with this group of patients that were very young at the time of radiation exposure. In addition, the incidence and basic characteristics of adult papillary thyroid carcinoma varied depending on the types of exposure conditions.
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Affiliation(s)
| | - Alfred King-Yin Lam
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Olga Krasko
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Minsk, Belarus
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63
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Malandrino P, Russo M, Regalbuto C, Pellegriti G, Moleti M, Caff A, Squatrito S, Vigneri R. Outcome of the Diffuse Sclerosing Variant of Papillary Thyroid Cancer: A Meta-Analysis. Thyroid 2016; 26:1285-92. [PMID: 27349273 DOI: 10.1089/thy.2016.0168] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The diffuse sclerosing variant (DSV) of papillary thyroid cancer (PTC) is considered an aggressive histotype associated with poor prognosis. However, the available data for both the outcome and best management of this disease are inconsistent. METHODS This study reviewed the current literature by searching PubMed up to November 30, 2015, using the search terms "diffuse sclerosing variant" and "papillary thyroid cancer (or carcinoma)" and selecting only studies evaluating recurrent/persistent disease and cancer-related mortality in both DSV and classic PTC (cPTC). The association with some features of aggressiveness at diagnosis, the risk of recurrence or persistence, and the risk of cancer-related death were reported as odds ratio (OR) with confidence intervals (CI). Meta-regression analysis was used to assess the effect of covariates across the studies. RESULTS Ten studies met the eligibility criteria and contributed 585 DSV and 64,611 cPTC patients. Relative to patients with cPTC, patients with DSV exhibited a higher risk of extrathyroidal extension and lymph node and distant metastases. The risk of persistent/recurrent disease was three times higher in patients with DSV than it was in cPTC patients (OR = 3.19 [CI 1.86-5.49]). This risk was not different when only studies where post-surgical (131)I was routinely administered were considered (OR = 2.07 [CI 0.88-4.90]). The risk of cancer-related mortality was not different between DSV and cPTC (OR = 1.34 [CI 0.76-2.38]). CONCLUSIONS This meta-analysis confirms the aggressive biological behavior of DSV thyroid cancer. When preoperatively suspected, total thyroidectomy with lymph node excision followed by radioiodine therapy should be the correct management for DSV.
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Affiliation(s)
- Pasqualino Malandrino
- 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Russo
- 2 Endocrinology, Department of Clinical and Experimental Medicine, University of Messina , Policlinico "G. Martino," Messina, Italy
| | - Concetto Regalbuto
- 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy
| | - Gabriella Pellegriti
- 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy
| | - Mariacarla Moleti
- 2 Endocrinology, Department of Clinical and Experimental Medicine, University of Messina , Policlinico "G. Martino," Messina, Italy
| | - Andrea Caff
- 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy
| | - Sebastiano Squatrito
- 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy
| | - Riccardo Vigneri
- 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy
- 3 Humanitas, Catania Oncology Center , Catania, Italy
- 4 Institute of Biostructures and Bioimaging , CNR (National Research Council), Catania, Italy
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Kim SK, Park I, Woo JW, Lee JH, Choe JH, Kim JH, Kim JS. Follicular and Diffuse Sclerosing Variant Papillary Thyroid Carcinomas as Independent Predictive Factors of Loco-Regional Recurrence: A Comparison Study Using Propensity Score Matching. Thyroid 2016; 26:1077-84. [PMID: 27324748 DOI: 10.1089/thy.2016.0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Only about half of papillary thyroid carcinoma (PTC) cases are classified as conventional PTC (CV-PTC), whereas various histologic variants constitute the remaining cases. Since controversies about the clinical behavior and outcomes of PTC variants continue, the purpose of this study was to compare the outcomes of patients with PTC variants who were treated at a large tertiary referral center in Korea. METHODS The medical records for 15,598 CV-PTCs, 435 follicular variants of PTC (FV-PTCs), and 66 diffuse sclerosing variants of PTC (DSV-PTCs) were retrospectively reviewed. Loco-regional recurrences (LRR) among PTC variants were compared using propensity score matching. RESULTS Analysis I compared CV-PTC with FV-PTC. After rigorous matching, 367 pairs were established. Recurrence-free survival (RFS) rates in CV-PTC were 96.1% at 5 years, 92.2% at 10 years, and 92.2% at 15 years, while those for FV-PTC were 98.8% at 5 years, 98.8% at 10 years, and 98.8% at 15 years (p = 0.026). Analysis II compared CV-PTC with DSV-PTC. Rigorous matching yielded 56 pairs. RFS rates for CV-PTC were 87.4% at 5 years, 87.4% at 10 years, and 87.4% at 15 years, while those for DSV-PTC were 68.9% at 5 years, 57.5% at 10 years, and were not available at 15 years (p = 0.013). CONCLUSIONS Compared with CV-PTC, FV-PTC showed less aggressive behaviors and more favorable outcomes. However, DSV-PTC showed more aggressive behaviors and a less favorable outcome than CV-PTC did. Therefore, the management strategy and follow-up plan for PTC should be differentiated according to the histologic variant.
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Affiliation(s)
- Seo Ki Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Inhye Park
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Woo Woo
- 2 Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Changwon, South Korea
| | - Jun Ho Lee
- 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon, South Korea
| | - Jun-Ho Choe
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Han Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jee Soo Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
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Ho WLC, Zacharin MR. Thyroid carcinoma in children, adolescents and adults, both spontaneous and after childhood radiation exposure. Eur J Pediatr 2016; 175:677-83. [PMID: 26805408 DOI: 10.1007/s00431-016-2692-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Thyroid carcinoma is the most common second malignancy for childhood cancer survivors. Radiation exposure is linked to risk. Thyroid nodules in children have a high risk for malignancy, whether spontaneous or after radiation. Due to the extremely limited available paediatric data, we sought to review a series of patients with thyroid carcinoma, seen over 25 years. Forty-six patients were identified. Thirty-nine (84.8 %) had papillary thyroid carcinoma, five (10.9 %) follicular carcinoma and 2 (4.3 %) medullary thyroid carcinoma (MEN2B). Thirty-three (71.7 %) had childhood radiation exposure (17 females) with thyroid malignancy occurring 6-37 years later. The smallest nodule size found on surveillance to have thyroid malignancy was 4 mm. Thyroid cancer in patients 16 years and under was seen in 22 patients (47.8 %). All had total thyroidectomy, with initial central node clearance from 2005. Diagnostic rTSH stimulated I(123) scan was followed by ablative I(131) if any uptake was seen. Sixteen (32.6 %) had metastases. Twenty-four (52.2 %) had I(131), four requiring multiple courses. Forty-two remain alive and well. CONCLUSION Ultrasound screening is required for early diagnosis as small nodule size is not predictive of benign histology or absence of metastases. Central node clearance provides better outcome. Despite metastatic disease at presentation for some, prognosis is favourable. WHAT IS KNOWN • Incidence of thyroid cancer has been increasing and radiation exposure in childhood cancer survivors is clearly linked to risk. • Published guidelines in many places can only provide very low level evidence due to extremely limited available paediatric data. What is New: • Paper provides good evidence to confirm existing views with the largest cohort of thyroid cancer reported to date in the paediatric age group in Australia, and the largest cohort in Australia where there have been specific high risks of radiation exposure. The only other reported larger studies have come from the Children's Oncology Group and Childhood Cancer Survivor Study [24]. • Using diagnostic rTSH stimulated I(123) scan 6 weeks after surgery helps to determine if radioactive iodine ablation is necessary and limits unnecessary bone marrow exposure for young patients in whom future leukaemia is of greater concern.
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Affiliation(s)
- Wei Li Cindy Ho
- Department of Endocrinology and Diabetes, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, 3052, Victoria, Australia. .,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, 119074, Singapore. .,Department of Endocrinology, Royal Children's Hospital, Flemington Rd, Parkville, Victoria, 3052, Australia.
| | - Margaret R Zacharin
- Department of Endocrinology and Diabetes, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, 3052, Victoria, Australia
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Bae JS, Kim Y, Jeon S, Kim SH, Kim TJ, Lee S, Kim MH, Lim DJ, Lee YS, Jung CK. Clinical utility of TERT promoter mutations and ALK rearrangement in thyroid cancer patients with a high prevalence of the BRAF V600E mutation. Diagn Pathol 2016; 11:21. [PMID: 26857243 PMCID: PMC4746931 DOI: 10.1186/s13000-016-0458-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/14/2016] [Indexed: 12/14/2022] Open
Abstract
Background Mutations in the TERT promoter, ALK rearrangement, and the BRAF V600E mutation are associated with aggressive clinicopathologic features in thyroid cancers. However, little is known about the impact of TERT promoter mutations and ALK rearrangement in thyroid cancer patients with a high prevalence of BRAF mutations. Methods We performed Sanger sequencing to detect BRAF V600E and TERT promoter mutations and both immunohistochemistry and fluorescence in situ hybridization to identify ALK rearrangement on 243 thyroid cancers. Results TERT promoter mutations were not present in 192 well-differentiated thyroid carcinomas (WDTC) without distant metastasis or in 9 medullary carcinomas. However, the mutations did occur in 40 % (12/30) of WDTC with distant metastasis, 29 % (2/7) of poorly differentiated carcinomas and 60 % (3/5) of anaplastic carcinomas. ALK rearrangement was not present in all thyroid cancers. The BRAF V600E mutation was more frequently found in WDTC without distant metastasis than in WDTC with distant metastasis (p = 0.007). In the cohort of WDTC with distant metastasis, patients with wild-type BRAF and TERT promoter had a significantly higher response rate after radioiodine therapy (p = 0.024), whereas the BRAF V600E mutation was significantly correlated with progressive disease (p = 0.025). Conclusions The TERT promoter mutation is an independent predictor for distant metastasis of WDTC, but ALK testing is not useful for clinical decision-making in Korean patients with a high prevalence of the BRAF V600E mutation. Radioiodine therapy for distant metastasis of WDTC is most effective in patients without BRAF V600E and TERT promoter mutations.
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Affiliation(s)
- Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Yourha Kim
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea. .,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Sora Jeon
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea. .,Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Se Hee Kim
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Tae Jung Kim
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Sohee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Min-Hee Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Dong Jun Lim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Youn Soo Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Chan Kwon Jung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Salajegheh A, Vosgha H, Md Rahman A, Amin M, Smith RA, Lam AKY. Modulatory role of miR-205 in angiogenesis and progression of thyroid cancer. J Mol Endocrinol 2015; 55:183-96. [PMID: 26342107 DOI: 10.1530/jme-15-0182] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 01/05/2023]
Abstract
miR-205 plays a crucial role in angiogenesis and has been found in association with several types of cancers. The aims of this study were to investigate the clinical and functional roles of miR-205 on as the major initiator and modulator of angiogenesis in thyroid cancer. 101 thyroid carcinomas, including 51 conventional and 37 follicular variants of papillary thyroid carcinomas, and 13 undifferentiated thyroid carcinomas in addition to 13 lymph nodes with metastatic thyroid carcinoma were recruited to be compared with 14 nodular goitre and seven normal thyroid tissues. Five thyroid carcinoma cell lines, of papillary and undifferentiated origin with and without history of metastasis, were also used. Expression of vascular endothelial growth factor A (VEGFA) and miR-205 were measured and exogenous miR-205 were transfected to observe the changes of VEGFA (by immunofluorescence and western blot techniques). Proliferation assay, cell cycle analysis and apoptosis assays were also used to evaluate the role of miR-205 in these events. Significant under-expression of miR-205 and over-expression of VEGFA mRNA and protein were noticed in thyroid cancer tissues and cell lines compared to normal thyroid control. Transfection of miR-205 into the cancer cell lines caused significant reduction of VEGFA protein and significant inhibition in cell proliferation, arrest in G0-G1 of the cell cycle and promotion of total apoptosis (P<0.05). The angiogenic and tumour-suppressive roles of miRNA-205 were demonstrated for the first time in thyroid cancer. The current experiments provided specific information on the functional consequences of VEGF manipulation via miRNA on cancer.
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Affiliation(s)
- Ali Salajegheh
- Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia
| | - Haleh Vosgha
- Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia
| | - Atiqur Md Rahman
- Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia
| | - Moein Amin
- Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia
| | - Robert Anthony Smith
- Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia
| | - Alfred King-Yin Lam
- Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia Cancer Molecular PathologySchool of Medicine, Griffith Medical School, Menzies Health Institute Queensland, Gold Coast Campus, Gold Coast, Queensland 4222, AustraliaFaculty of HealthInstitute of Health and Biomedical Innovation, Genomics Research Centre, Queensland University of Technology, Brisbane, Queensland, AustraliaPathology Queensland and Gold Coast University HospitalGold Coast, Queensland, Australia
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