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Suster D, Ronen N, Giorgadze T, Baisre-de Leon A, Montalvan I, Suster S. Oncocytic Follicular Cell-Derived Thyroid Tumors With Papillary Growth Pattern: A Clinicopathologic Study of 32 Cases. Arch Pathol Lab Med 2024; 148:997-1006. [PMID: 38100177 DOI: 10.5858/arpa.2023-0309-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 08/28/2024]
Abstract
CONTEXT.— Oncocytic thyroid tumors displaying a papillary growth pattern are rare and may cause diagnostic problems. OBJECTIVE.— To examine the clinicopathologic features of a series of 32 follicular cell-derived tumors composed of cells with oncocytic cytoplasm and displaying papillary architecture. DESIGN.— Thirty-two cases were collected and studied to assess clinicopathologic features, including immunohistochemical and molecular testing for BRAF V600E. RESULTS.— The patients were 26 women and 6 men, aged 17 to 77 years. The nodules ranged from 0.3 to 6.0 cm. Eighteen cases showed features of oncocytic hyperplastic nodules and were identified against a background of thyroid follicular nodular disease; 4 cases showed features of oncocytic follicular adenoma; and 10 cases corresponded to carcinomas with oncocytic and papillary features. Nuclear features of papillary thyroid carcinoma were absent or exceedingly rare. All cases were negative for HBME-1 and cytokeratin 19 (CK19) and wild type for BRAF V600E. Follow-up in 25 patients showed that all patients with hyperplastic nodules and oncocytic follicular adenomas were alive and well and free of disease from 7 to 20 years. One patient with oncocytic follicular carcinoma showed metastases and died of tumor at 16 months; 2 patients with carcinoma had metastases and recurrence at 6 and 7 years; and 5 patients with invasive tumors were free of disease from 5 to 10 years. CONCLUSIONS.— Oncocytic thyroid tumors with papillary features can span a spectrum from benign hyperplastic, to encapsulated neoplastic, to invasive malignant lesions. Owing to their papillary features, it is important not to confuse them for other types of thyroid tumors, such as oncocytic papillary thyroid carcinoma.
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Affiliation(s)
- David Suster
- From the Department of Pathology, Immunology & Laboratory Medicine, Rutgers University New Jersey Medical School, Newark (D. Suster, Baisre-de Leon, S. Suster)
| | - Natali Ronen
- the Department of Pathology, The Medical College of Wisconsin, Milwaukee (Ronen, Giorgadze, S. Suster)
| | - Tamara Giorgadze
- the Department of Pathology, The Medical College of Wisconsin, Milwaukee (Ronen, Giorgadze, S. Suster)
| | - Ada Baisre-de Leon
- From the Department of Pathology, Immunology & Laboratory Medicine, Rutgers University New Jersey Medical School, Newark (D. Suster, Baisre-de Leon, S. Suster)
| | - Ibsen Montalvan
- the Department of Pathology, University Hospital, Newark, New Jersey (Montalvan)
| | - Saul Suster
- the Department of Pathology, The Medical College of Wisconsin, Milwaukee (Ronen, Giorgadze, S. Suster)
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Zhang K, Wang X, Wei T, Li Z, Zhu J, Chen YW. Radioactive iodine therapy improves overall survival outcome in oncocytic carcinoma of the thyroid by reducing death risks from noncancer causes: A competing risk analysis of 4641 patients. Head Neck 2024. [PMID: 38572629 DOI: 10.1002/hed.27758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Oncocytic carcinoma of the thyroid (OCA) is an independent type of thyroid cancer. Radioactive iodine (RAI) therapy was frequently administered to OCA patients, but its contribution to improving survival is indefinite. METHODS 4641 OCA patients from 2000 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard regression and competing risk analysis were applied. RESULTS Tumor size, SEER stage, primary surgery, and neck dissection were prognostic factors for cancer-specific survival. The results of competing risk analysis demonstrated that age over 55 years dramatically increased non-OCA death risks. Treatments that improve non-OCA survival (including total thyroidectomy, RAI therapy, and systemic therapy) should be recommended in OCA patients older than 55 years of age. Neck lymphadenectomy should not be recommended for OCA, since the metastatic lymph node ratio was low (about 3%). CONCLUSIONS RAI therapy can improve survival in OCA by reducing noncancer death risks.
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Affiliation(s)
- Kun Zhang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinyi Wang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqiang Zhu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ya-Wen Chen
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cell, Developmental, and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Epithelial and Airway Biology and Regeneration, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Airway Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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3
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Kamalumpundi V, Meyers E, Torfah M, de Gusmão Correia ML. A patient with a rare co-occurrence of papillary and follicular thyroid carcinomas. Clin Case Rep 2024; 12:e8707. [PMID: 38585590 PMCID: PMC10996043 DOI: 10.1002/ccr3.8707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/09/2024] Open
Abstract
The occurrence of papillary and follicular thyroid carcinoma as a collision tumor is rare. We report on a case of a collision tumor consisting of papillary and follicular thyroid carcinoma treated successfully with surgery and radioiodine ablation.
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Affiliation(s)
| | - Erin Meyers
- Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Maisoon Torfah
- Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Marcelo Lima de Gusmão Correia
- Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
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Okuyucu K, Ince S, Cınar A, San H, Samsum M, Dizdar N, Alagoz E, Demirci I, Ozkara M, Gunalp B, Karaçalıoglu A. Comportamiento clínico de la variante oncocítica del cáncer papilar de tiroides: comparación de su evolución frente al cáncer papilar, variantes clásica y de células altas. Rev Esp Med Nucl Imagen Mol 2023. [DOI: 10.1016/j.remn.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Clinical behaviour of papillary thyroid cancer oncocytic variant: stage-matched comparison versus classical and tall cell variant papillary thyroid cancer. Rev Esp Med Nucl Imagen Mol 2023; 42:100-105. [PMID: 36155103 DOI: 10.1016/j.remnie.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Papillary thyroid cancer (PTC) has many variants and most of them are mild tumors. Oncocytic variant (OV) is a rare subtype of PTC. There are controversial results about its prognosis in the literature. We investigated its aggressivity and clinical course by comparing it with classical variant (CV) and tall cell variant (TV) of PTC over a stage-matched design. MATERIAL AND METHODS Pure 100 OV, 71TV and 1219 CV were included in this retrospective cohort study. OV was compared with CV and TV according to independent prognostic parameters. OV was also compared stage by stage with CV and TV for recurrence. RESULTS Mean age was 46,8 years and male/female ratio 25/75 for OV. The recurrence rates in our study were 16% in OV, 13,5% in CV and 56% in TV. There is a statistically significant difference according to recurrence between stage I and stage IV OV and CV (p=0.023, p=0.03, respectively). There is also a statistically significant difference between stage I and stage IV OV and TV according to recurrence (p=0.001, p=0.024, respectively). OV can be supposed to behave between CV and TV, but very closer to CV. CONCLUSIONS OV seems to be slightly more aggressive than CV. Despite an inadequate sample size for stage II and III, our findings imply an increased recurrence risk for OV than CV at the advanced stages (stage III and IV) and CV has an unfavorable prognosis than OV at early stages (stage I and II) according to stage-matched model.
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Lukovic J, Petrovic I, Liu Z, Armstrong SM, Brierley JD, Tsang R, Pasternak JD, Gomez-Hernandez K, Liu A, Asa SL, Mete O. Oncocytic Papillary Thyroid Carcinoma and Oncocytic Poorly Differentiated Thyroid Carcinoma: Clinical Features, Uptake, and Response to Radioactive Iodine Therapy, and Outcome. Front Endocrinol (Lausanne) 2021; 12:795184. [PMID: 34975765 PMCID: PMC8716491 DOI: 10.3389/fendo.2021.795184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The main objective of this study was to review the clinicopathologic characteristics and outcome of patients with oncocytic papillary thyroid carcinoma (PTC) and oncocytic poorly differentiated thyroid carcinoma (PDTC). The secondary objective was to evaluate the prevalence and outcomes of RAI use in this population. METHODS Patients with oncocytic PTC and PDTC who were treated at a quaternary cancer centre between 2002 and 2017 were retrospectively identified from an institutional database. All patients had an expert pathology review to ensure consistent reporting and definition. The cumulative incidence function was used to analyse locoregional failure (LRF) and distant metastasis (DM) rates. Univariable analysis (UVA) was used to assess clinical predictors of outcome. RESULTS In total, 263 patients were included (PTC [n=218], PDTC [n=45]) with a median follow up of 4.4 years (range: 0 = 26.7 years). Patients with oncocytic PTC had a 5/10-year incidence of LRF and DM, respectively, of 2.7%/5.6% and 3.4%/4.5%. On UVA, there was an increased risk of DM in PTC tumors with widely invasive growth (HR 17.1; p<0.001), extra-thyroidal extension (HR 24.95; p<0.001), angioinvasion (HR 32.58; p=0.002), focal dedifferentiation (HR 19.57, p<0.001), and focal hobnail cell change (HR 8.67, p=0.042). There was additionally an increased risk of DM seen in male PTC patients (HR 5.5, p=0.03).The use of RAI was more common in patients with larger tumors, angioinvasion, and widely invasive disease. RAI was also used in the management of DM and 43% of patients with oncocytic PTC had RAI-avid metastatic disease. Patients with oncocytic PDTC had a higher rate of 5/10-year incidence of LRF and DM (21.4%/45.4%; 11.4%/40.4%, respectively). Patients with extra-thyroidal extension had an increased risk of DM (HR 5.52, p=0.023) as did those with angioinvasion. Of the patients with oncocytic PDTC who received RAI for the treatment of DM, 40% had RAI-avid disease. CONCLUSION We present a large homogenous cohort of patients with oncocytic PTC and PDTC, with consistent pathologic reporting and definition. Patients with oncocytic PTC have excellent clinical outcomes and similar risk factors for recurrence as their non-oncocytic counterparts (angioinvasion, large tumor size, extra-thyroidal extension, and focal dedifferentiation). Compared with oncocytic PTCs, the adverse biology of oncocytic PDTCs is supported with increased frequency of DM and lower uptake of RAI.
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Affiliation(s)
- Jelena Lukovic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- *Correspondence: Jelena Lukovic, ; Ozgur Mete,
| | - Irina Petrovic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zijin Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Susan M. Armstrong
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - James D. Brierley
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Richard Tsang
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jesse D. Pasternak
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Karen Gomez-Hernandez
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sylvia L. Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Department of Pathology, Case Western Reserve University, Cleveland, OH, United States
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Pathology, University Health Network, Toronto, ON, Canada
- *Correspondence: Jelena Lukovic, ; Ozgur Mete,
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de Salins V, Loganadane G, Joly C, Abulizi M, Nourieh M, Boussion H, Belkacemi Y, Tournigand C, Kempf E. Complete response in anaplastic lymphoma kinase–rearranged oncocytic thyroid cancer: A case report and review of literature. World J Clin Oncol 2020; 11:495-503. [PMID: 32821654 PMCID: PMC7407927 DOI: 10.5306/wjco.v11.i7.495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Oncocytic carcinoma of the thyroid is a rare disease, characterized by a poor prognosis and low response rate to radioiodine therapy. Crizotinib is a specific anaplastic lymphoma kinase (ALK) inhibitor, which was initially developed in non-small cell lung cancer. Other solid tumors harboring a translocation in ALK have been described, such as renal carcinoma, thyroid, colorectal, ovarian cancers, and spitzoid melanoma. The research of ALK rearrangements in thyroid tumor is a promising therapeutic track, and treatments need to be explored.
CASE SUMMARY We report the case of a 76-year-old woman with a history of multinodular goiter, who was hospitalized for impairment of her general condition. She was diagnosed with metastatic oncocytic thyroid cancer. Synchrone metastases were found: Multiple mediastinal lymphadenopathies, lytic bone lesions and bilateral mammary lumps. Fluorescence in situ hybridization analysis revealed an ALK rearrangement in 61% of cells. No other mutation was found. A tumor board discussion based on molecular characteristics of the tumor suggested initiating a daily treatment by crizotinib, a specific ALK inhibitor. A positron emission tomography scan performed 4 mo after the initiation of crizotinib showed a complete metabolic response.
CONCLUSION This case highlights an unexpected efficacy of crizotinib in an ALK-rearranged thyroid tumor, and the need of further assessments.
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Affiliation(s)
- Victoire de Salins
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Gokoulakrichenane Loganadane
- Department of Radiation Oncology and Breast Center, Henri Mondor University Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil and IMRB-INSERM 955 Team 21, Creteil 94010, France
| | - Charlotte Joly
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Mukedaisi Abulizi
- Department of Nuclear Medicine, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Maya Nourieh
- Department of Pathology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Hélène Boussion
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Yazid Belkacemi
- Department of Radiation Oncology and Breast Center, Henri Mondor University Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil and IMRB-INSERM 955 Team 21, Creteil 94010, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
| | - Emmanuelle Kempf
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique – Hôpitaux de Paris, University of Paris-Est Creteil, Créteil 94010, France
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Clinical impact of follicular oncocytic (Hürthle cell) carcinoma in comparison with corresponding classical follicular thyroid carcinoma. Eur J Nucl Med Mol Imaging 2020; 48:449-460. [PMID: 32683470 PMCID: PMC7835150 DOI: 10.1007/s00259-020-04952-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/05/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE There are controversial debates if patients with Hürthle cell carcinoma, also known as oxyphilic or oncocytic cell follicular thyroid carcinoma, have a poorer outcome. In this study, we systematically evaluated the clinical outcome in a large patient cohort following thyroidectomy and initial I-131 radioactive iodine therapy (RIT). METHODS We retrospectively evaluated a total of 378 patients with diagnosed oncocytic follicular Hürthle cell carcinoma (OFTC) (N = 126) or with classical follicular thyroid carcinoma (FTC) (N = 252). Patients received thyroidectomy and complementary I-131 RIT. Clinical data regarding basic demographic characteristics, tumor grade, persistent disease and recurrence during follow-up, and disease-free, disease-specific, and overall survival were collected during follow-up of 6.9 years (interquartile range 3.7; 11.7 years). Univariate and multivariate analyses were used to identify factors associated with disease-related and overall survival. RESULTS Before and after matching for risk factors, recurrence was significantly more frequently diagnosed in OFTC patients during follow-up (17% vs. 8%; p value 0.037). Likewise, OFTC patients presented with a reduced mean disease-free survival of 17.9 years (95% CI 16.0-19.8) vs. 20.1 years (95% CI 19.0-21.1) in FTC patients (p value 0.027). Multivariate analysis revealed OFTC (HR 0.502; 95% CI 0.309-0.816) as the only independent prognostic factor for disease-free survival. Distant metastases of OFTC patients were significantly less iodine-avid (p value 0.014). Mean disease-specific and overall survival did not differ significantly (p value 0.671 and 0.687) during follow-up of median 6.9 years (3.7; 11.7 years). CONCLUSIONS Our study suggests that recurrence is more often seen in OFTC patients. OFTC patients have a poorer prognosis for disease-free survival. Thus, OFTC and FTC behave differently and should be categorized separately. However, patients suffering from OFTC present with the same overall and disease-specific survival at the end of follow-up indifferent to FTC patients after initial RIT.
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Torricelli F, Saxena A, Nuamah R, Neat M, Harling L, Ng W, Spicer J, Ciarrocchi A, Bille A. Genomic analysis in short- and long-term patients with malignant pleura mesothelioma treated with palliative chemotherapy. Eur J Cancer 2020; 132:104-111. [PMID: 32339978 DOI: 10.1016/j.ejca.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is an aggressive tumour with poor prognosis. The aim of this study was to identify genetic mutations associated with poor or extended survival in patients who received palliative chemotherapy. METHODS A total of 720 patients diagnosed with MPM between 2005 and 2015 were identified. Overall survival (OS) was longer than 30 months from diagnosis for 27 patients. Twelve of 27 (44%) of the pleural biopsies from long-term survivors were retrieved and matched with 12 biopsies from patients who survived less than 12 months; one biopsy was then excluded for poor DNA quality. RESULTS A total of 11 patients had a mean OS of 5.5 months, whereas 12 patients lived more than 30 months (mean OS: 55.8 ± 25). Mutational analysis identified 428 alterations; of which, 148, classified as somatic and functional, were considered further. Among these, 85% were missense variants, 8% were variants causing a stop gain and 6% were splice variants. Loss-of-function mutations in UQCRC1 were significantly associated with reduced survival in patients with MPM (p = 0.027), while a higher frequency of mutations in MXRA5 and RAPGEF6 was registered in long-term survivors. CONCLUSION This is the first study evaluating the relationship between the mutational profile and outcome in patients with MPM after palliative chemotherapy. UQCRC1 codes for cytochrome b-c1 complex subunit 1 which plays a fundamental role in normal mitochondrial functions and in cell metabolism. Recent studies described UQCRC1 deregulation in other cancers. Our results suggest a possible role for mitochondrial metabolism in the biology of mesothelioma.
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Affiliation(s)
- Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alka Saxena
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Rosamond Nuamah
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Michael Neat
- Cancer Genetics, Viapath, Guy's Hospital, London, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, UK
| | - Wen Ng
- Department of Pathology, Guy's Hospital, London, UK
| | - James Spicer
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Bille
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK; Department of Thoracic Surgery, Guy's Hospital, London, UK.
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10
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Long-term outcome of rare oncocytic papillary (Hürthle cell) thyroid carcinoma following (adjuvant) initial radioiodine therapy. Eur J Nucl Med Mol Imaging 2019; 46:2526-2535. [PMID: 31410542 DOI: 10.1007/s00259-019-04456-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/22/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Oncocytic (Hürthle cell) papillary thyroid carcinoma (OPTC) is a rare variant of the papillary thyroid carcinoma (PTC) which comprises approximately 1 to 11 % of PTC cases. Its clinical course and prognosis have not been comprehensively documented and the clinical outcome remains a controversial issue. Therefore, we investigated the long-term prognosis after thyroidectomy and (adjuvant) initial radioactive iodine therapy (RIT) of OPTC compared to PTC. METHODS A total of 563 patients (47 with OPTC and 516 with PTC) with a median follow-up of 9.9 (0.3; 23.5) years were studied. All patients underwent thyroidectomy followed by (adjuvant) initial RIT. Data on the patients' demographics, pathology, laboratory findings, imaging studies, treatment, and follow-up including recurrence, and disease-specific survival were collected. Cox's multivariate regression model was used to identify independent prognostic factors for survival. RESULTS OPTC patients were significantly older (55.2 ± 12.3 years) than PTC patients (50.3 ± 13.5) at the time of initial diagnosis (p value 0.016). Initial tumor size was larger in the OPTC group (2.8 ± 1.8 cm for OPTC patients, 1.5 ± 1.2 cm for PTC patients, p value < 0.001). Before matching, OPTC patients presented more often with evidence of disease at the last visit of follow-up (p value 0.046). However, this difference was not observed anymore after matching for risk factors (p value 0.637). Disease-specific survival did not differ significantly. Age (HR, 1.183; 95% CI, 1.097-1.276) was identified as an independent prognostic factor for disease-specific survival. OPTC patients predominantly showed a recurrence of distant metastasis within a shorter time despite being not statistically significant. CONCLUSION At initial diagnosis, OPTC shows significant differences in terms of age and initial tumor size compared to PTC. Patients suffering from OPTC present with the same clinical long-term outcome indifferent to PTC after (adjuvant) initial RIT after matching.
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11
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Censi S, Barollo S, Grespan E, Watutantrige-Fernando S, Manso J, Iacobone M, Casal Ide E, Galuppini F, Fassina A, Bertazza L, Vianello F, Pennelli G, Mian C. Prognostic significance of TERT promoter and BRAF mutations in TIR-4 and TIR-5 thyroid cytology. Eur J Endocrinol 2019; 181:1-11. [PMID: 31042674 DOI: 10.1530/eje-19-0073] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Follicular-derived thyroid cancers generally have a good prognosis, but in a minority of cases, they have an aggressive behavior and develop distant metastases, with an increase in the associated mortality. None of the prognostic markers currently available prior to surgery can identify such cases. METHODS TERT promoter and BRAF gene mutations were examined in a series of 436 consecutive TIR-4 and TIR-5 nodes referred for surgery. Follow-up (median: 59 months, range: 7-293 months) was available for 384/423 patients with malignant nodes. RESULTS TERT promoter and BRAF mutations were detected in 20/436 (4.6%) and 257/434 thyroid nodules (59.2%), respectively. At the end of the follow-up, 318/384 patients (82.8%) had an excellent outcome, 48/384 (12.5%) had indeterminate response or biochemical persistence, 18/384 (4.7%) had a structural persistence or died from thyroid cancer. TERT promoter mutations correlated with older age (P < 0.0001), larger tumor size (P = 0.0002), oxyntic and aggressive PTC variants (P = 0.01), higher tumor stages (P < 0.0001), distant metastases (<0.0001) and disease outcome (P < 0.0001). At multivariate analysis, TERT promoter mutation was not an independent predictor of disease outcome. TERT promoter mutation- (OR: 40.58; 95% CI: 3.06-539.04), and N1b lymph node metastases (OR: 40.16, 95% CI: 3.48-463.04) were independent predictors of distant metastases. BRAF mutation did not predict the outcome, and it correlated with a lower incidence of distant metastases (P = 0.0201). CONCLUSIONS TERT promoter mutation proved an independent predictor of distant metastases, giving clinicians the chance to identify many of the patients who warranted more aggressive initial treatment and closer follow-up.
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Affiliation(s)
- Simona Censi
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - Susi Barollo
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - Elisabetta Grespan
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | | | - Jacopo Manso
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - Maurizio Iacobone
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Endocrine Surgery Unit, University of Padua, Padua, Italy
| | - Eric Casal Ide
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), Endocrine Surgery Unit, University of Padua, Padua, Italy
| | - Francesca Galuppini
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, Pathology Unit, University of Padua, Padua, Italy
| | - Ambrogio Fassina
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, Pathology Unit, University of Padua, Padua, Italy
| | - Loris Bertazza
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
| | - Federica Vianello
- Department of Radiotherapy, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, Pathology Unit, University of Padua, Padua, Italy
| | - Caterina Mian
- Department of Medicine (DIMED), Endocrinology Unit, University of Padua, Padua, Italy
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12
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Kakudo K, Bychkov A, Bai Y, Li Y, Liu Z, Jung CK. The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives. Pathol Int 2018; 68:641-664. [PMID: 30537125 DOI: 10.1111/pin.12737] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kennichi Kakudo
- Faculty of Medicine, Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University, Ikoma-city, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kawagoe, Chiba, Japan.,Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yaqiong Li
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Zhiyan Liu
- Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Carr AA, Yen TWF, Ortiz DI, Hunt BC, Fareau G, Massey BL, Campbell BH, Doffek KL, Evans DB, Wang TS. Patients with Oncocytic Variant Papillary Thyroid Carcinoma Have a Similar Prognosis to Matched Classical Papillary Thyroid Carcinoma Controls. Thyroid 2018; 28:1462-1467. [PMID: 30215297 DOI: 10.1089/thy.2017.0603] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies have suggested that oncocytic variant papillary thyroid carcinoma (PTC) may be more aggressive, with higher rates of recurrent disease. The aim of this study was to evaluate characteristics and outcomes of patients with oncocytic variant PTC compared to classical PTC. METHODS Patients with oncocytic variant PTC were retrospectively identified from 519 patients who underwent thyroidectomy for PTC between January 2009 and August 2015. Data collected included patient demographics, laboratory and pathology findings, imaging studies, treatment, and follow-up. Patients were matched 1:1 by age, sex, and TNM stage with patients who underwent total thyroidectomy for classical PTC during the same time period. RESULTS The cohort included 21 patients, of whom 18 (86%) were female, with a median age of 53 years (range 23-68 years). All patients underwent total thyroidectomy, and 17 (81%) had a central compartment neck dissection (8 [38%] prophylactic). The median tumor size was 2.0 cm (range 0.9-6.5 cm), and four (19%) patients had extrathyroidal extension. There was no significant difference in histopathologic characteristics, including extrathyroidal extension and lymphovascular invasion, between the two groups except for an increased incidence of thyroiditis in oncocytic variant PTC (90.5% vs. 57%; p = 0.01). In oncocytic variant PTC patients who underwent central compartment neck dissection, malignant lymph nodes were found in 12 (57%) patients compared to 13 (62%) classical (p = 0.75). Lateral neck dissection was performed in 5 (24%) oncocytic variant and classical PTC patients, with metastatic lymphadenopathy found in four (a median of four malignant lymph nodes; range 1-6) and five (a median of 2.5 malignant lymph nodes; range 1-9), respectively. Radioactive iodine was administered to 18 (86%) oncocytic variant PTC and 18 (86%) classical PTC patients. At a median follow-up of 51 months (interquartile range 38-61), one oncocytic variant PTC patient had recurrent disease and underwent reoperation at 24 months. In classical PTC patients with a median follow-up time of 77 months (range 56-87 months), two (9.5%) patients had detectable thyroglobulin levels indicating early recurrence, but neither has undergone reoperation. CONCLUSIONS Oncocytic variant PTC was present in 5% of PTC patients. Most (95%) patients remain disease-free at four years, similar to classical PTC outcomes, suggesting that oncocytic variant may not represent a more aggressive variant.
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Affiliation(s)
- Azadeh A Carr
- 1 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Tina W F Yen
- 1 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | | | - Bryan C Hunt
- 3 Department of Pathology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Gilbert Fareau
- 4 Department of Endocrinology, and Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Becky L Massey
- 5 Department of Otolaryngology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Bruce H Campbell
- 5 Department of Otolaryngology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Kara L Doffek
- 1 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Douglas B Evans
- 1 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Tracy S Wang
- 1 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
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14
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Understanding Malignancies of the Thyroid Gland: Institutional Experience. Indian J Otolaryngol Head Neck Surg 2018; 70:482-489. [PMID: 30464902 DOI: 10.1007/s12070-018-1492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023] Open
Abstract
To study the epidemiological, pathological characters and determine survival in patients diagnosed of having thyroid gland malignancies. Retrospective chart review of patients having thyroid gland malignancies, which were managed by the two senior authors at our tertiary care institute from January 2000 to December 2006, were performed and evaluated in terms of various clinical, operative and histological parameters. Patients in which follow up of at least 10 years are available were included in the study. Survival was enquired telephonically in those patients who got cured and did not consent to come for follow up. Slides were reviewed. Statistical analysis was done using SPSS statistical software. Kaplan-Meier method was used for calculating survival. A total of 182 patients were included in the study. Papillary carcinoma was the commonest malignant lesion with a frequency of 87.91% followed by follicular carcinoma (7.69%), medullary carcinoma (3.29%) and anaplastic carcinoma (1.09%). Female predominance was seen (F:M-5.06:1). The 5 year and 10 year survival rates were 89% and 73% respectively. The most common postoperative squeal was transient hypocalcaemia, seen in (27/182) 15% patients which was followed by permanent hypocalcaemia 16/182 (8.79%), transient recurrent laryngeal nerve paresis 12/182 (6.59%) and permanent recurrent laryngeal nerve palsy 8/182 (4.39%). Thyroid malignancies affect all age groups and have good long term prognosis. Management yields promising results and hence early and adequate treatment is emphasized.
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15
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Abstract
Despite its structural simplicity the thyroid gland can give rise to a wide variety of tumor types. Although a substantial amount of work has been done in the past twenty-five years to redefine the clinic-pathological features of most types of thyroid tumors of follicular cell origin, some aspects of thyroid tumors composed of oncocytes, generally known as Hürthle cell tumors, are still matter of discussion. The major issues concern their very existence as a bona fide tumor type, the occurrence of benign and malignant forms and their relative frequency, the predictive value of morphologic parameters, the natural history of the malignant forms and the classification of Hürthle cell tumors with a papillary growth pattern. The definition of oncocytic cell, oncocytic neoplasm and oncocytic carcinoma as well as the pathologic characteristics and clinical behavior of neoplasms composed of oncocytes will be discussed.
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16
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Stanzel S, Gyürüs P, Kresnik E, Aigner R. A rare case of Marine-Lenhart syndrome with unilateral endocrine orbitopathy and Hürthle cell carcinoma. Nuklearmedizin 2017; 56:N28-N30. [PMID: 28488725 DOI: 10.3413/nukmed-0862-16-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022]
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17
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Kochummen E, Tong S, Umpaichitra V, Chin VL. A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent. Horm Res Paediatr 2017; 87:136-142. [PMID: 27467101 DOI: 10.1159/000448216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hürthle cell (HC) neoplasms are rare among pediatric thyroid cancers. HC adenomas (HCA) are typically benign and localized unilaterally without recurrence, and they are thus treated by hemithyroidectomy. HC carcinomas (HCC) can be bilateral and are more aggressive, necessitating total thyroidectomy. Diagnosis relies upon surgical histopathology demonstrating invasion for classification as HCC or lack of invasion in HCA, since fine needle aspiration fails to differentiate between the two. METHODS We report a case of a 14-year-old adolescent female with bilateral HCA. She had an initial left hemithyroidectomy for a large nodule measuring 2 × 1.5 × 1.2 cm3 in the left lobe, while smaller subcentimeter nodules remained under surveillance in the right. One year later, a nodule in the right lobe doubled in size, necessitating a right hemithyroidectomy which also revealed HCA. CONCLUSION To our knowledge, this is the first reported case of bilateral HCA in pediatrics. It highlights the importance of close surveillance of persistent small nodules, even in patients with previously documented benign lesions such as HCA, which are typically thought to be unilateral and localized. Both HCA and HCC remain unpredictable in behavior, and treatment of HCA should be individualized.
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Affiliation(s)
- Elna Kochummen
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, N.Y., USA
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18
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Abstract
A 70-year-old man with prostate cancer and increased prostate-specific antigen level of 55 ng/mL underwent staging F-fluorocholine PET/CT, which demonstrated the primary prostate tumor and a focal area corresponding to a 2-cm hypodense nodule in the left thyroid lobe. Fine-needle aspiration and subsequent total thyroidectomy with central lymph node dissection showed an oxyphilic papillary thyroid carcinoma and a medullary microcarcinoma. Oxyphilic tumors represent a significant proportion of the few case reports of incidental focal thyroid fluorocholine thyroid uptake.
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19
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Yoo JY, Stang MT. Current Guidelines for Postoperative Treatment and Follow-Up of Well-Differentiated Thyroid Cancer. Surg Oncol Clin N Am 2016; 25:41-59. [PMID: 26610773 DOI: 10.1016/j.soc.2015.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Well-differentiated thyroid cancer is increasing in incidence but the disease-specific mortality remains very low. The only effective adjuvant treatment is radioactive iodine ablation. Guidelines regarding the use and dosage of radioactive iodine depend on pathologic features of the primary and metastatic tumor that define risk. Long-term treatment includes thyroid-stimulating hormone suppression and surveillance with serum thyroglobulin and radiologic assessment for nodal recurrence.
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Affiliation(s)
- Jenny Y Yoo
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 101, Pittsburgh, PA 15213, USA
| | - Michael T Stang
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 101, Pittsburgh, PA 15213, USA.
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20
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Shawky M, Sakr M. Hurthle Cell Lesion: Controversies, Challenges, and Debates. Indian J Surg 2016; 78:41-8. [PMID: 27186039 PMCID: PMC4848220 DOI: 10.1007/s12262-015-1381-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/20/2015] [Indexed: 02/05/2023] Open
Abstract
Hurthle cell lesion is one of the most questionable clinico-pathological entities in most of its aspects. Literature has used the terms oncocytic, oxyphilic, Hurthle, and Ashkanazy interchangeably; what does each term denote? Who first described these cells? What is the cell of origin? How much Hurthle cells should be present to define the lesion as Hurthle cell one? Is it possible to differentiate hyperplastic from neoplastic and benign from malignant Hurthle cell lesion on a non-histopathologic ground? Does it belong to follicular or to papillary neoplasms or should it be classified separately? Can we anticipate its clinical behavior or predict its outcome? How can we manage? We will try to answer these questions in light of the ongoing relevant arguments with the aim of resolving some uncertainties and suggesting how to solve others.
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Affiliation(s)
- Michael Shawky
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Third Floor-Surgery Building, El Sultan Hussein St, Azarita, Alexandria, Egypt
| | - Mahmoud Sakr
- Department of Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Third Floor-Surgery Building, El Sultan Hussein St, Azarita, Alexandria, Egypt
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21
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Siddique I, Chengot P, Frewer J, Walker D. A rare case of gingival metastases from papillary thyroid carcinoma. Int J Surg Case Rep 2014; 7C:82-4. [PMID: 25594735 PMCID: PMC4336387 DOI: 10.1016/j.ijscr.2014.11.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 11/28/2014] [Indexed: 01/29/2023] Open
Abstract
The attached gingiva is a rare site for metastasis in the oral cavity. Metastasis to the oral cavity usually indicates disseminated malignant disease. Clinicians must be vigilant when presented with an oral soft tissue mass in patients with a known underlying malignancy. There should be a low threshold to biopsy gingival lesions in patients with a history of carcinoma. Early identification of distant metastases in the oral cavity is important in planning appropriate and timely palliative management.
Metastatic oral malignancy accounts for 1% of all oral cancers. Oral soft tissue involvement is rare and accounts for less than 0.1% of all oral tumours with the attached gingiva being the commonest site affected. We present the first reported case of a papillary thyroid carcinoma (PTC) with sarcomatoid transformation giving rise to gingival metastasis. A 71 year old man with a history of PTC presented with an asymptomatic gingival swelling adjacent to his lower right lateral incisor. Subsequent biopsy of the lesion confirmed PTC metastasis with aggressive sarcomatoid features. We present a clinical photograph of the gingival swelling and the pathology images demonstrating both the papillary and sarcomatoid features of the gingival biopsy. The prognosis of PTC is usually excellent but some histological variants of PTC behave more aggressively. The histology in our case demonstrated solid areas and sarcomatoid transformation and behaved far more aggressively than typical PTC. Sarcomatoid transformation in PTC has not been previously described and indicates a poor prognosis and the need for planning urgent palliation. These lesions can present a diagnostic challenge to both pathologists and clinicians in identifying the lesion as metastatic and locating the primary cancer. This case demonstrates the need for vigilance amongst health professionals when presented with an oral soft tissue mass in patients with a known primary malignancy. This may be the first evidence of disseminated disease and emphasises a low threshold to biopsy oral soft tissue lesions in patients with a history of malignant disease.
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Affiliation(s)
- Ibraz Siddique
- Department of Oral and Maxillofacial Surgery, Surgery, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Preetha Chengot
- St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
| | - John Frewer
- Pinderfields General Hospital, Aberford Road, Wakefield, WF1 4DG, UK.
| | - David Walker
- Pinderfields General Hospital, Aberford Road, Wakefield, WF1 4DG, UK.
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22
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 732] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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23
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Abstract
Papillary thyroid carcinomas are the most common thyroid cancers and constitute more than 70% of thyroid malignancies. The most common etiologic factor is radiation, but genetic susceptibility and other factors also contribute to the development of papillary thyroid carcinoma. The most common variants include conventional, follicular variant and tall cell variant. However, many other uncommon variants have been described including oncocytic, columnar cell, diffuse sclerosing and solid forms. Immunohistochemical staining with TTF-1 and thyroglobulin is very useful in confirming the diagnosis of papillary thyroid carcinoma especially in metastatic sites. Markers such as HBME-1 and CITED1 can assist in separating some difficult cases of follicular variants of papillary thyroid carcinomas from follicular adenomas. Molecular studies have shown that the BRAF V600E mutation is found mainly in papillary and anaplastic thyroid carcinomas. Other molecular markers such as HMGA2 and insulin-like growth factor II mRNA binding protein 3 have been used recently as molecular tests to separate papillary thyroid carcinoma and its variants from follicular adenomas and other benign thyroid nodules.
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MESH Headings
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma
- Carcinoma, Papillary
- Carcinoma, Papillary, Follicular/genetics
- Carcinoma, Papillary, Follicular/metabolism
- Carcinoma, Papillary, Follicular/pathology
- Humans
- Immunohistochemistry
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
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24
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Erickson LA, Lloyd RV. Well-Differentiated Papillary Thyroid Carcinoma. MOLECULAR PATHOLOGY LIBRARY 2010. [DOI: 10.1007/978-1-4419-1707-2_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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25
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Suliburk J, Delbridge L. Surgical management of well-differentiated thyroid cancer: state of the art. Surg Clin North Am 2009; 89:1171-91. [PMID: 19836491 DOI: 10.1016/j.suc.2009.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nonmedullary well-differentiated thyroid cancer (WDTC) comprises a group of tumors including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), with Hürthle cell carcinoma being a subtype of follicular carcinoma. This article reviews the epidemiology, pathogenesis, preoperative and diagnostic evaluation, imaging, and staging of WDTC. Different approaches to therapy and follow-up care are discussed. The prognosis for WDTC remains good and most patients can expect to be cured of their disease.
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Affiliation(s)
- James Suliburk
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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26
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Lee J, Hasteh F. Oncocytic variant of papillary thyroid carcinoma associated with Hashimoto's thyroiditis: a case report and review of the literature. Diagn Cytopathol 2009; 37:600-6. [PMID: 19526577 DOI: 10.1002/dc.21092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Identification of Hürthle cells on fine-needle aspiration (FNA) of the thyroid leads to a wide differential diagnosis including benignand malignant entities. We report the cytological and histological findings of a patient with an oncocytic variant of papillary thyroid carcinoma (PTC) with concurrent Hashimoto's thyroiditis. FNA revealed a lymphoplasmacytic infiltrate with Hürthle cells demonstrating abnormal chromatin patterns, nuclear enlargement, pleomorphism, intranuclear cytoplasmic invaginations, and foci of papillary aggregates. Because of the degree of nuclear atypia and suspicion for concurrent papillary thyroid carcinoma, a total thyroidectomy was performed revealing a papillary arrangement of Hürthle cells with classic PTC nuclear changes and associated Hashimoto's thyroiditis. This report discusses cytopathological features of a rare variant of PTC (oncocytic subtype) in the background of Hashimoto's thyroiditis. We also briefly discuss the differential diagnosis and diagnostic pitfalls of Hürthle cell lesions, with a review of the literature.
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Affiliation(s)
- John Lee
- Department of Pathology, University of California, San Diego, California 92103-8720, USA
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27
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Gross M, Eliashar R, Ben-Yaakov A, Weinberger JM, Maly B. Clinicopathologic Features and Outcome of the Oncocytic Variant of Papillary Thyroid Carcinoma. Ann Otol Rhinol Laryngol 2009; 118:374-81. [DOI: 10.1177/000348940911800510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The purpose of this study was to define the clinicopathologic features and outcome of the oncocytic variant of papillary thyroid carcinoma (OVPTC) with a review of the literature. Methods: Twenty-three patients with OVPTC over a 10-year period were studied. Demographic, clinical, and histopathologic features and outcome data were analyzed retrospectively. Results: Seventeen women and 6 men, ages ranging from 20 to 76 years (95% confidence interval, 43.0 to 54.48), were studied. Cervical lymph node involvement was found in 43.4% of the patients. Most of the recurrences were associated with thyroid masses greater than 2 cm in diameter. Evaluation of the overall survival data by the Kaplan-Meier method revealed that most recurrences took place earlier than 30 months, and the majority of patients (74%) were well, with no evidence of disease, up to 78 months after the last treatment. All of the OVPTC cases presented as nonencapsulated tumors, and 78.2% demonstrated extrathyroid stromal invasion. Conclusions: OVPTC is a unique variant of papillary thyroid carcinoma that has distinctive clinicopathologic features. Since OVPTC is often associated with local invasion and may involve cervical lymph nodes, it may require more extensive surgery than classic papillary thyroid carcinoma.
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28
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Mills S, Haq M, Smellie W, Harmer C. Hürthle cell carcinoma of the thyroid: Retrospective review of 62 patients treated at the Royal Marsden Hospital between 1946 and 2003. Eur J Surg Oncol 2009; 35:230-4. [DOI: 10.1016/j.ejso.2008.06.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 06/06/2008] [Accepted: 06/09/2008] [Indexed: 11/30/2022] Open
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29
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Induction of iodide uptake in transformed thyrocytes: a compound screening in cell lines. Eur J Nucl Med Mol Imaging 2008; 36:780-90. [DOI: 10.1007/s00259-008-1024-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
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30
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Fröhlich E, Fink I, Wahl R. Is transketolase like 1 a target for the treatment of differentiated thyroid carcinoma? A study on thyroid cancer cell lines. Invest New Drugs 2008; 27:297-303. [PMID: 18806930 DOI: 10.1007/s10637-008-9174-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 08/18/2008] [Indexed: 11/30/2022]
Abstract
Radioactive iodine-refractory [(18)F] fluorodeoxy-glucose-positron emission tomography-positive thyroid carcinomas represent especially aggressive tumors. Targeting glucose metabolism by the transketolase isoenzyme transketolase like 1 (TKTL-1) which is over-expressed in various neoplasms, may be effective. The correlation of TKTL-1 expression and the response to oxythiamine as the currently best-characterized inhibitor of transketolases was studied in differentiated thyroid cancer cell lines. We determined TKTL-1 expression, proliferation, glucose uptake and GLUT-1 expression in non-treated thyroid cells and recorded the effect of oxythiamine on iodide uptake and on thymidine uptake. TKTL 1 was highest expressed in cell lines derived from more invasive tumors but the expression level was not strongly correlated to proliferation rate, to GLUT-1 expression or to the response to oxythiamine. Oxythiamine showed only a weak effect in the TKTL-1 expressing cell lines. Over-expression of TKTL-1 is not an indicator for responsiveness to oxythiamine. More specific inhibitors should be tested.
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Affiliation(s)
- Eleonore Fröhlich
- Department of Endocrinology, Metabolism, Nephrology and Clinical Chemistry, Internal Medicine, University of Tuebingen, Tuebingen, Germany
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31
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Montone KT, Baloch ZW, LiVolsi VA. The Thyroid Hürthle (Oncocytic) Cell and Its Associated Pathologic Conditions: A Surgical Pathology and Cytopathology Review. Arch Pathol Lab Med 2008; 132:1241-50. [DOI: 10.5858/2008-132-1241-tthoca] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Hürthle cells are eosinophilic, follicular-derived cells that are associated with a variety of nonneoplastic and neoplastic thyroid lesions. The differential diagnosis of Hürthle cell lesions is quite broad.
Objective.—To review the pathologic conditions associated with Hürthle cells in the thyroid and to discuss pathology of thyroid lesions associated with oncocytic cytology.
Data Sources.—A variety of thyroid nonneoplastic (autoimmune thyroiditis, multinodular goiter) and neoplastic conditions (Hürthle cell adenoma, Hürthle cell carcinoma) are associated with Hürthle cell cytology. In addition, there are several thyroid neoplasms that should be considered when one observes a Hürthle cell neoplasm in the thyroid (oncocytic variant of medullary carcinoma, several variants of papillary thyroid carcinoma).
Conclusions.—Oncocytic cytology is seen in a variety of thyroid conditions that are associated with a broad differential diagnosis and care must be used for accurate diagnosis. Newer molecular-based techniques may be useful for further classification of thyroid neoplasms with oncocytic pathology.
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Affiliation(s)
- Kathleen T. Montone
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Zubair W. Baloch
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Virginia A. LiVolsi
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
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32
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Affiliation(s)
| | - David M. Brams
- From Endocrine Surgery, Lahey Clinic, Burlington, Massachusetts
| | - John P. Wei
- From Endocrine Surgery, Lahey Clinic, Burlington, Massachusetts
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Kushchayeva Y, Duh QY, Kebebew E, D’Avanzo A, Clark OH. Comparison of clinical characteristics at diagnosis and during follow-up in 118 patients with Hurthle cell or follicular thyroid cancer. Am J Surg 2008; 195:457-62. [DOI: 10.1016/j.amjsurg.2007.06.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 06/05/2007] [Accepted: 06/05/2007] [Indexed: 11/27/2022]
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Ahmed M, Yousef HB, Greer W, Faraz H, Al Sobhi S, Al Zahrani A, Raef H, Al Ghamdi A, Al Kadhi Y, Al Dayel F. HURTHLE CELL NEOPLASM OF THE THYROID GLAND. ANZ J Surg 2008; 78:139-43. [DOI: 10.1111/j.1445-2197.2007.04389.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
While most thyroid cancers are slow-growing and have an excellent prognosis after appropriate treatment, a subset of thyroid cancers behave aggressively, and approximately 1500 individuals in the US will die of the disease in the year 2007. Advanced thyroid malignancies can cause distressing and life-threatening symptoms by local invasion in the neck, growth of distant metastases in the lung, bone, and other organs, and tumor production of bioactive substances in the case of medullary thyroid cancer. This article will review palliative modalities, including surgery, radioactive iodine, external beam radiation, and chemotherapy, as well as novel targeted therapies, for the treatment of patients with advanced thyroid malignancies.
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Affiliation(s)
- David Yü Greenblatt
- Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
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36
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Monchik JM, DeLellis RA. Re-operative neck surgery for well-differentiated thyroid cancer of follicular origin. J Surg Oncol 2006; 94:714-8. [PMID: 17131395 DOI: 10.1002/jso.20693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This review focuses on the pathologic criteria for completion thyroidectomy in well differentiated thyroid cancer as well the diagnosis and treatment of recurrent disease. The roles of ultrasound in the diagnosis of a cervical recurrence, its value in determining the extent of lymph node dissection in the lateral compartment, and the importance of intra-operative ultrasound in re-operative thyroid surgery are discussed.
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Affiliation(s)
- Jack M Monchik
- Division of Endocrine Surgery, Rhode Island Hospital and Brown Medical School, Providence, Rhode Island, USA.
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Isildak M, Aksoy DY, Terzi A, Tezel GG, Bayraktar M. A thyroidectomy case with a surprising pathologic result: three different birds in one nest. Am J Med Sci 2006; 331:97-9. [PMID: 16479184 DOI: 10.1097/00000441-200602000-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neoplasms of the thyroid include types that range from indolent, localized papillary carcinomas to lethal anaplastic disease. Hurthle cell neoplasm is a histopathologic subtype that signals poor prognosis. Herein, we present the case of a 72-year-old female patient with multinodular goiter who, although fine needle aspiration biopsy revealed a benign result, underwent thyroid surgery because of the diameter of the largest nodule. Histopathologically, the neoplasm was diagnosed as papillary thyroid microcarcinoma on one lobe and Hurthle cell neoplasm on the other, whereas the remainder of the thyroid showed a typical pattern of colloidal goiter, all of which are not commonly encountered in one patient. Although multinodular goiter is usually acknowledged as a sign of a benign process, its risk of malignancy is no less than that of a solitary thyroid nodule. The age of the patient, the duration of the disease, or the number of the nodules should not mislead the physician, nor affect the therapeutic approach.
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Affiliation(s)
- Mehlika Isildak
- Department of Internal Medicine, Section of Endocrinology and Metabolism, HaceHepe University, Ankara, Turkey
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38
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Kim HH, Myssiorek D, Heller KS, Zahurullah F, Bhuiya T. Warthin-like Tumor of the Thyroid Gland: An Uncommon Variant of Papillary Thyroid Cancer. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Several variants of papillary thyroid cancer have been described, including, most recently, Warthin-like tumor of the thyroid gland. To bring attention to this uncommon variant, we review previous reports on this entity and we add 5 new cases to the literature. We retrospectively reviewed the records of all patients who had undergone thyroidectomy at our institution during a 7-year period. Among these cases, we identified 5 patients who had had a Warthin-like tumor of the thyroid. From their charts, we compiled data on age, sex, lymphadenopathy, distant spread, and treatment. Pathologic specimens were reviewed for tumor size, capsular invasion, and vascular invasion. All 5 patients were women (mean age: 51.6 yr). Tumor size ranged from 0.9 to 2.0 cm. Multifocality was seen in 1 of the 5 patients; this patient was also the only one who experienced capsular and vascular invasion. No patient had lymph node spread or distant metastasis. Because the follow-up period among these patients was still short, we were unable to analyze long-term survival data.
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Affiliation(s)
- Harold H. Kim
- Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, N.Y
| | - David Myssiorek
- Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, N.Y
| | - Keith S. Heller
- Department of Surgery, Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, N.Y
| | - Fazlur Zahurullah
- Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, N.Y
| | - Tawfiqul Bhuiya
- Department of Pathology, Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, N.Y
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Besic N, Hocevar M, Zgajnar J, Petric R, Pilko G. Aggressiveness of therapy and prognosis of patients with Hürthle cell papillary thyroid carcinoma. Thyroid 2006; 16:67-72. [PMID: 16487016 DOI: 10.1089/thy.2006.16.67] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hürthle cell papillary thyroid carcinoma (HCPTC) has been studied separately from other types of thyroid carcinoma in relatively few studies. The aim of our study was to determine the factors associated with the survival of patients with HCPTC in Slovenia, an iodine-deficient region. A total of 1552 patients with thyroid carcinoma were seen at our institute during the period of 1976-2003; of them, 42 patients (33 females, 9 males; age 10-85 years, median 56.5 years) had histopathologically verified HCPTC. The data on the patients' gender, age, disease history, extent of disease, morphologic characteristics, therapy, locoregional control, disease-free interval, and survival were collected. The statistical correlation between possible prognostic factors and the disease-free interval and survival was analyzed by chi2 test and log rank analysis. The tumor diameter ranged from 1 to 9 cm (median, 3 cm). Extrathyroid tumor growth was found in 19 patients, lymph node metastases in 13 patients, and distant metastases in 2 patients. Primary treatment consisted of total or near-total thyroidectomy (39 patients), lobectomy (2 patients), radioiodine ablation of the thyroid remnant (37 patients), external irradiation (14 patients), and chemotherapy (3 patients). Locoregional recurrence was diagnosed in four patients, and dissemination in 1 patient during the follow-up period of 0.75-20 years (median, 5.5 years). Three patients died of thyroid carcinoma during the follow-up period. The 5-year and 10-year survivals were 94% and 87%, respectively. The 5-year and 10-year disease-free intervals were 93% and 81%, respectively. The factors correlated with the survival were: age, extrathyroid tumor growth, primary tumor stage, and regional and distant metastases. Although extrathyroidal tumor growth was found in 45% of the patients with HCPTC, our patients had a favorable prognosis. Long-term survival and locoregional control of disease are likely after the radical tumor resection, radioiodine ablation of the thyroid remnant, and external irradiation.
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Affiliation(s)
- N Besic
- Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia.
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Al-Khatib K, Sieunarine K, Lindsay I, Smith JR. Metastatic Hurthle cell carcinoma in the abdomen masquerading as a primary ovarian tumor: a case report. Int J Gynecol Cancer 2006; 16:429-32. [PMID: 16445671 DOI: 10.1111/j.1525-1438.2006.00484.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hurthle cell carcinoma, a variant of follicular carcinoma of the thyroid, has been regarded as an aggressive type of differentiated thyroid cancer. It is diagnosed histologically and regarded as a carcinoma by the presence of vascular invasion or capsular invasion. In this case report, a patient with a history of thyroid Hurthle cell carcinoma presented with what seemingly appeared to be a pelvic mass of gynecological origin, with a raised risk-of-malignancy index of 567. She underwent a laparotomy which revealed the presence of multiple masses in the form of nodules and lumps attached to her small bowel, sigmoid colon, omentum, and infracolic region, without the involvement of her pelvic organs or para-aortic lymph nodes. At frozen section, the masses were reported to be high-grade metastatic tumor, possibly a melanoma, unlikely to be a female genital tract tumor. These masses were resected along with a 15-cm section of small bowel and analyzed. They were diagnosed to be secondary lesions of Hurthle cell carcinoma of the thyroid. Hurthle cell carcinoma of the thyroid has not been known to be associated with the elevation of CA125 nor has it been known to metastasize to the small bowel and sigmoid colon.
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Affiliation(s)
- K Al-Khatib
- Department of Gynaecology, Chelsea and Westminster Hospital at Imperial College School of Medicine, London, United Kingdom
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Besic N, Zgajnar J, Hocevar M, Frkovic-Grazio S. Is patient's age a prognostic factor for follicular thyroid carcinoma in the TNM classification system? Thyroid 2005; 15:439-48. [PMID: 15929665 DOI: 10.1089/thy.2005.15.439] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The knowledge of prognostic factors is essential for an optimal treatment of patients. The aim of our study was to find out if age is an independent prognostic factor for patients with follicular or Hürthle cell carcinoma. This retrospective study was carried out in 261 patients (median age, 62 years) with follicular or Hürthle cell thyroid carcinoma treated at our institute from 1972-2002. For all patients the follow-up was performed at our institute at least once per year. The data on gender and age of the patients, disease history, extent of disease, morphologic characteristics, mode of therapy, outcome, and survival were collected. Statistical correlation between possible prognostic factors and cause-specific survival was analyzed by univariate and Cox's multivariate survival analysis. The 10-year and 20-year survival of all 261 patients were 70% and 42%, respectively. Even 10 of 49 (20%) of our patients who were under 45 years of age (i.e., in stage II of the tumor, node, metastases [TNM] classification system) died of disease. Multivariate analysis showed that primary tumor size and distant metastases were independent prognostic factors for survival. Lymph node metastases as well as the age of patients were not found to be independent prognostic factors. Therefore, the patients with distant metastases or tumor stage T4 who are under 45 years of age cannot be considered to have favorable prognosis.
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MESH Headings
- Adenoma, Oxyphilic/classification
- Adenoma, Oxyphilic/epidemiology
- Adenoma, Oxyphilic/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Aging/physiology
- Carcinoma, Papillary, Follicular/classification
- Carcinoma, Papillary, Follicular/epidemiology
- Carcinoma, Papillary, Follicular/pathology
- Child
- Female
- Humans
- Iodine/administration & dosage
- Lymphatic Metastasis/pathology
- Male
- Middle Aged
- Neoplasm Metastasis/pathology
- Prognosis
- Slovenia/epidemiology
- Sodium Chloride, Dietary
- Survival Analysis
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, Ljubljana, Slovenia.
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42
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Furlan JC, Bedard YC, Rosen IB. Role of Fine-needle Aspiration Biopsy and Frozen Section in the Management of Papillary Thyroid Carcinoma Subtypes. World J Surg 2004; 28:880-5. [PMID: 15593461 DOI: 10.1007/s00268-004-6953-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since fine-needle aspiration biopsy (FNAB) was introduced, the value of frozen section (FS) has been questioned. This study compares FNAB and FS sensitivities among the usual form of papillary thyroid cancer (uPTC) and variants of PTC such as tall cell (tcPTC), follicular (fPTC), and Hurthle cell (HcPTC). A total of 257 patients who underwent preoperative FNAB, intraoperative FS, and thyroidectomy for PTC were, randomly selected from a database of a university teaching hospital in Toronto. There were 218 females (84.8%) and 39 males (15.2%), from 19 to 89 years of age (mean of 44 years), having uPTC (n = 212), fPTC (n = 24), HcPTC (n = 14), and tcPTC (n = 7). Data were analyzed using chi2 test. Sensitivities were calculated by division of true positives and by the sum of true positives and false negatives. True positives had to reflect a conclusive diagnosis of cancer. The FNAB sensitivities were uPTC (39.2%), fPTC (25%), HcPTC (42.9%), tcPTC (85.7%), similar to FS sensitivities (p = 0.497) for uPTC (44.3%), fPTC (16.7%), HcPTC (42.9%), and tcPTC (71.4%). Use of FS following FNAB increased sensitivities for uPTC to 56.1%, fPTC to 29.2%, and tcPTC to 100%. In addition, FS did not increase FNAB sensitivity in HcPTC. Combination FNAB plus FS failed in 43.9% of uPTC, 70.8% of fPTC, and 57.1% of HcPTC. We concluded that FNAB and FS sensitivity vary with PTC subtype and are still necessary for selection and treatment. The recognition of morphologic subtypes of PTC from the FNAB could optimize the selection of patients for intraoperative FS, enhance the preoperative assessment of prognosis, facilitate the surgical planning, and simplify the preparation of postoperative adjuvant therapy.
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Affiliation(s)
- Julio C Furlan
- Department of Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Suite 1521, Toronto, Ontario M5G 1X5, Canada.
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43
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Kauffmann PR, Dejax C, de Latour M, Dauplat J. The meaning and predictivity of Hürthle cells in fine needle aspiration cytology for thyroid nodular disease. Eur J Surg Oncol 2004; 30:786-9. [PMID: 15296995 DOI: 10.1016/j.ejso.2004.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2004] [Indexed: 11/24/2022] Open
Abstract
AIMS The significance of Hürthle cells in thyroid nodule fine needle aspiration cytology (FNAC) samples remains uncertain. This study aims to clarify the meaning and the predictivity of this kind of cells. METHODS One hundred and ten patients with Hürthle cells in FNAC of thyroid nodules were reviewed. Histopathology was correlated with cytological findings. RESULTS The density of Hürthle cells in FNACs ranged from 20 to 100%. Eighty-nine patients had benign nodular disease (Hürthle cell or follicular adenoma), and 21 patients had malignant tumours. The presence of more than 50% Hürthle cells in FNAC correlated with benign or malignant Hürthle cell neoplasm. Hürthle cell carcinomas displayed more than 90% Hürthle cells in FNAC. CONCLUSIONS Surgery is indicated for all nodular lesions with more than 50% Hürthle cells in FNAC.
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Affiliation(s)
- P R Kauffmann
- Centre Jean Perrin, 58 rue Montalembert, B.P. 392, 63011 Clermont-Ferrand 1, France.
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44
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Abstract
The traditional approach to oncocytic thyroid lesions classified these as a separate entity, and applied criteria that are somewhat similar to those used for follicular lesions of the thyroid. In general, the guidelines to distinguish hyperplasia from neoplasia, and benign from malignant were crude and unsubstantiated by scientific evidence. In fact, there is no basis to separate oncocytic lesions from other classifications of thyroid pathology. The factors that result in mitochondrial accumulation are largely unrelated to the genetic events that result in proliferation and neoplastic transformation of thyroid follicular epithelial cells. The concept of classifying oncocytic lesions, including follicular variant papillary carcinomas, based on nuclear morphology, immunohistochemical profiles, and molecular markers may pave the way for a better understanding of the biology of oncocytic lesions of the thyroid.
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Affiliation(s)
- S L Asa
- Department of Pathology, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9.
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45
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Affiliation(s)
- Sylvia L Asa
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
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46
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Foote RL, Brown PD, Garces YI, McIver B, Kasperbauer JL. Is there a role for radiation therapy in the management of Hürthle cell carcinoma? Int J Radiat Oncol Biol Phys 2003; 56:1067-72. [PMID: 12829143 DOI: 10.1016/s0360-3016(03)00199-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the role that radiation therapy may have in the management of resected, unresectable, and metastatic Hürthle cell carcinoma. METHODS AND MATERIALS Retrospective review of 18 patients receiving radiation therapy for Hürthle cell carcinoma of the thyroid gland. The diagnosis was established in 10 men and 8 women between November 1943 and January 1995. Median age was 57.9 years. Initially, 5 patients received adjuvant radiation therapy, 7 received salvage radiation therapy for unresectable recurrent disease, and 6 received palliative radiation therapy for distant metastases. Median follow-up was 107.1 months (range 15.7-351 months). The Kaplan-Meier method was used to calculate and estimate overall survival, cause-specific survival, and locoregional tumor control rate. RESULTS The 5-year overall and cause-specific survival rates were 66.7% (SE 11.1%) and 71.8% (SE 10.7%), respectively. Adjuvant radiation therapy was successful in preventing recurrence in 4 of 5 patients. Salvage radiation therapy was successful in 3 of 5 patients treated with external beam radiation therapy. Palliative radiation therapy provided sustained symptomatic relief at 67% of irradiated sites. CONCLUSIONS Hürthle cell carcinoma of the thyroid gland is a radiosensitive tumor. Radiation therapy may provide palliative relief from symptomatic metastases, control recurrent tumors, and prevent recurrence of advanced resected tumors.
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Affiliation(s)
- Robert L Foote
- Division of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Anwar F. The phenotype of Hurthle and Warthin-like papillary thyroid carcinomas is distinct from classic papillary carcinoma as to the expression of retinoblastoma protein and E2F-1 transcription factor. Appl Immunohistochem Mol Morphol 2003; 11:20-7. [PMID: 12610352 DOI: 10.1097/00129039-200303000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Retinoblastoma protein plays an important role in controlling cell cycle progression. The active form of retinoblastoma protein binds to E2F-1 and inhibits transcription of S phase genes. Overexpression of E2F-1 has been suggested as an important factor in carcinogenesis. The Hurthle cell (HPCA) and Warthin-like (WLPCA) variants of papillary carcinoma are two closely related entities that arise in association with Hashimoto's thyroiditis and share the presence of oxyphilic changes in the lining of epithelial cells and the presence of papillary nuclear features. The current study included formalin-fixed, paraffin-embedded tissues from 58 cases of thyroid papillary carcinoma: 20 HPCA, 6 WLPCA, 22 conventional papillary carcinomas (PCA), and 10 follicular variants of papillary carcinoma (FVPCA). The immunohistochemical studies were performed for retinoblastoma (Rb-1) and E2F-1, (KH95) after heat-induced epitope retrieval. None of the PCA or FVPCA cases were in the positive range for Rb-1. All cases of HPCA and WLPCA of the thyroid showed reactivity in 50% or more of the nuclei in the neoplastic cell population. As for E2F-1, all cases of HPCA and WLPCA showed positive reactivity, whereas none of the PCA or FVPCA cases were in the positive range. In conclusion, HPCA and WLPCA are Rb-positive and E2F-1-positive; PCA and FVPCA are Rb-negative and E2F1-negative. Hurthle metaplastic epithelium in Hashimoto's thyroiditis is Rb-positive and E2F-1-negative. This phenotypic difference is also helpful in distinguishing hyperplastic Hurthle cell proliferation in Hashimoto's thyroiditis from HPCA or WLPCA.
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Affiliation(s)
- Faten Anwar
- Medical Center, New York University, New York, NY, USA.
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48
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Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordoñez NG, Sherman SI. Prognostic factors in patients with Hürthle cell neoplasms of the thyroid. Cancer 2003; 97:1186-94. [PMID: 12599224 DOI: 10.1002/cncr.11176] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hürthle cell neoplasms, often considered a variant of follicular thyroid neoplasms, represent 3% of thyroid carcinomas. Only a handful of publications have focused on the biologic behavior, prognostic factors, and treatment outcomes of Hürthle cell carcinoma. The objective of the current study was to identify the clinical and pathologic features of Hürthle cell carcinomas that predict disease progression or death. METHODS The authors reviewed medical records of patients who were treated for Hürthle cell carcinoma (HCC) and Hürthle cell adenoma (HCA) at The University of Texas M. D. Anderson Cancer Center from March 1944 to February 1995, including follow-up information. The pathologic diagnosis was confirmed by one of the authors. RESULTS The authors identified 127 patients with Hürthle cell neoplasms, 89 patients with HCC and 38 patients with HCA. Seven patients with HCC had foci of anaplastic thyroid carcinoma. Survival for this subgroup was worse compared with the overall group and was analyzed separately. The HCC group was significantly older (age 51.8 years vs. age 43.1. years) and had larger tumors (4.3 cm vs. 2.9 cm) compared with the HCA group. No differences were seen in gender or previous radiation exposure. Forty percent of patients in the HCC group died of thyroid carcinoma, whereas no patients in the HCA group died of the disease. There has been no improvement in all-cause and disease specific mortality in the past 5 decades for patients with these neoplasms. Conventional staging systems predicted mortality with minor differences. Of the patients with known metastasis, 38% showed radioiodine uptake. Univariate analysis identified older age, higher disease stage, tumor size, extraglandular invasion, multifocality, lymph node disease, distant metastasis, extensive surgery, external beam radiation therapy, and chemotherapy as factors that were associated with decreased survival. Tumor encapsulation was associated with improved survival. Although radioactive iodine treatment had no overall effect on survival, subgroup analysis showed that patients who received radioactive iodine for adjuvant ablation therapy had better outcomes compared either with patients who did not receive radioactive iodine or with patients who received radioactive iodine as treatment for residual disease. Multivariate analysis indicated that older age and larger tumor size predicted worse survival through an association with worse behaving tumors (multifocal, less encapsulated, and with extraglandular invasion). The decreased survival in patients with lymph node metastases may be explained by its association with distant metastases. The association of extensive surgery, external beam radiation therapy, and chemotherapy with worse survival also disappeared once those factors were analyzed together with other prognostic factors, such as distant metastases. CONCLUSIONS Several clinical and pathologic prognostic factors were identified in patients with HCC and HCA. Older age and larger tumor size predicted reduced survival. Radioactive iodine therapy may confer a survival benefit when it is used for adjuvant ablation therapy, but not when residual disease is present. The authors could not demonstrate a survival benefit for the use of extensive surgery, external beam radiation therapy, or chemotherapy.
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Affiliation(s)
- Luis Lopez-Penabad
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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49
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Pak H, Gourgiotis L, Chang WI, Guthrie LC, Skarulis MC, Reynolds JC, Merino MJ, Schrump DS, Libutti SK, Alexander HR, Sarlis NJ. Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. J Surg Oncol 2003; 82:10-8. [PMID: 12501164 DOI: 10.1002/jso.10189] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES We studied the impact of metatasectomy on disease outcome in 29 advanced nonmedullary thyroid carcinoma (ThyrCa) patients who were operated on between 1969 and 2001 at NIH to further define its role in the management of this malignancy. METHODS Data were extracted by retrospective chart review. A Kaplan-Meyer survival curve was constructed, and comparative stratification for various parameters was performed. RESULTS During 47 surgeries, the following lesions were resected from mid-mediastinum/hila, 17; lung parenchyma, 12; skeleton, 14; kidneys, 2; and brain, 2. All patients received multiple radioiodine (RAI) treatments. External-beam radiotherapy, chemotherapy and other palliative measures were used in selected patients. Six patients (21%) died within 74.7 +/- 54.7 months after the first distant metastasectomy. The outcome of the remaining patients was as follows: complete remission, 3; partial remission, 10; and 10: progressive disease, 10, with a follow-up of 175 patient-years. Metastasectomy led to a decrease of 38% in thyroglobulin levels in 23 patients. Cumulative survival rates were 78.5 +/- 8.4% at 5 years and 50.2 +/- 12.5% at 10 years (mean +/-SEM) after initial distant metastasectomy. CONCLUSIONS Our data show that extensive targeted metastasectomy in the setting of a tertiary center can be beneficial to patients with disseminated ThyrCa with persistent or recurrent distant disease, when used in conjunction with nonsurgical treatment modalities.
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Affiliation(s)
- Ho Pak
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1758, USA
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50
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Hung W, Sarlis NJ. Current controversies in the management of pediatric patients with well-differentiated nonmedullary thyroid cancer: a review. Thyroid 2002; 12:683-702. [PMID: 12225637 DOI: 10.1089/105072502760258668] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Current treatment strategies for pediatric patients with nonmedullary, well-differentiated thyroid carcinoma (WDTC) are derived from single-institution clinical cohorts, reports of extensive personal experience, and extrapolation of several common therapeutic practices for this tumor in adults. Because pediatric WDTC is an uncommon malignancy, the issues of its optimal initial and subsequent long-term treatment and follow-up remain controversial. Pediatric patients with WDTC can be divided into two groups: children younger than 10 years of age and teenagers/adolescents between 10 and 18 years of age because these groups have different recurrence and mortality rates. We hereby present our views and interpret them in the light of the pertinent literature. Our recommendations on treatment strategies are more relevant for younger children. After midpuberty, optimal treatment is adequately addressed in the relevant literature on adults. For the majority of patients, total/near-total thyroidectomy is currently recommended as the standard initial therapy for WDTC. This is commonly followed by administration of radioiodine (RAI; (131)I) therapy to destroy residual normal thyroid tissue (remnant). Routine (131)I remnant ablation has been shown to: (1). decrease the risk of local recurrences, (2) increase the sensitivity of subsequent diagnostic RAI whole-body scanning (WBS), and (3) render serum thyroglobulin (Tg) a highly sensitive marker for recurrent/residual disease during long-term follow-up. We recognize that the above practices are not universally adhered to in children and adolescents, because the risk stratification and intensity of applied therapeutic measures are influenced by institutional traditions and personal experience. In our view, aggressive initial management, followed by evaluations at regular intervals after thyroidectomy and (131)I remnant ablation, in conjunction with long-term thyroid hormone suppressive therapy (THST), result in decreased recurrence rates in pediatric patients with WDTC. Follow-up examinations should include a diagnostic RAI ((131)I or (123)I) WBS and measurement of serum Tg, both performed under conditions of TSH stimulation, as well as neck ultrasonography (US). Our strategy is corroborated by data from retrospective clinical cohort studies. In this malignancy, no evidence of disease (NED) status can be defined as the combination of a negative diagnostic WBS and the presence of undetectable or low serum Tg levels, both tested under TSH stimulation. These findings should be accompanied by the absence of anatomically definable disease by standard imaging modalities, e.g., neck US or chest computed tomography (CT). Although the long-term survival rates are good overall in this disease, selected patients may require further surgery or (131)I therapy for the eradication or clinical control of metastases. Finally, and importantly, because the duration of follow-up is lifelong, the care of children with prior diagnosis of WDTC should be transferred to an adult endocrinologist after they reach adulthood, even if they have achieved NED status by that time.
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Affiliation(s)
- Wellington Hung
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1758, USA
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