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A Case of Follicular Tumor of Uncertain Malignant Potential (FT-UMP) with Glomeruloid Features Showing Capsular Mucinous Degeneration. Case Rep Pathol 2021; 2021:1686025. [PMID: 33833889 PMCID: PMC8016592 DOI: 10.1155/2021/1686025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
The most recent revision of the World Health Organization (WHO) Classification of Tumours of Endocrine Organs introduced a new variant of follicular thyroid carcinoma (FTC). It is characterized by a “glomeruloid” architectural pattern of growth. We present a case of follicular tumor with glomeruloid features, with Alcian Blue positive mucinous stromal degeneration in foci of questionable capsular microinvasion. At our knowledge, this the second case of glomeruloid follicular tumor in the literature and the first case in which Alcian Blue staining was used to investigate capsular invasion. Moreover, RAS mutation further supports that this is a variant of follicular tumor with uncertain malignant potential.
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Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M. Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. Endocr Pathol 2020; 31:197-217. [PMID: 32632840 PMCID: PMC7395918 DOI: 10.1007/s12022-020-09638-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
Thyroid pathology encompasses a heterogenous group of clinicopathological entities including rare and diagnostically challenging neoplasms. The review is focused on morphological, immunohistochemical, and molecular features of rare thyroid neoplasms that can pose diagnostic problems. The tumors are organized based on growth patterns including thyroid neoplasms with predominantly papillary, follicular, solid, and spindle cell growth pattern, as well as neoplasms with distinct cytological characteristics. A special section is also dedicated to rare thyroid tumors with peculiar patterns including thyroid carcinoma with Ewing family tumor elements and intrathyroidal thymic-related neoplasms.
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Affiliation(s)
- José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), Santiago de Compostela, Spain.
- Medical Faculty, University of Santiago de Compostela, Santiago de Compostela, Spain.
- Department of Anatomic Pathology, Clinical University Hospital, Travesía Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Catarina Eloy
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Medical Faculty, University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- i3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Medical Faculty, University of Porto, Porto, Portugal
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
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The use of PanDrugs to prioritize anticancer drug treatments in a case of T-ALL based on individual genomic data. BMC Cancer 2019; 19:1005. [PMID: 31655559 PMCID: PMC6815385 DOI: 10.1186/s12885-019-6209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Acute T-cell lymphoblastic leukaemia (T-ALL) is an aggressive disorder derived from immature thymocytes. The variability observed in clinical responses on this type of tumours to treatments, the high toxicity of current protocols and the poor prognosis of patients with relapse or refractory make it urgent to find less toxic and more effective therapies in the context of a personalized medicine of precision. METHODS Whole exome sequencing and RNAseq were performed on DNA and RNA respectively, extracted of a bone marrow sample from a patient diagnosed with tumour primary T-ALL and double negative thymocytes from thymus control samples. We used PanDrugs, a computational resource to propose pharmacological therapies based on our experimental results, including lists of variants and genes. We extend the possible therapeutic options for the patient by taking into account multiple genomic events potentially sensitive to a treatment, the context of the pathway and the pharmacological evidence already known by large-scale experiments. RESULTS As a proof-of-principle we used next-generation-sequencing technologies (Whole Exome Sequencing and RNA-Sequencing) in a case of diagnosed Pro-T acute lymphoblastic leukaemia. We identified 689 disease-causing mutations involving 308 genes, as well as multiple fusion transcript variants, alternative splicing, and 6652 genes with at least one principal isoform significantly deregulated. Only 12 genes, with 27 pathogenic gene variants, were among the most frequently mutated ones in this type of lymphoproliferative disorder. Among them, 5 variants detected in CTCF, FBXW7, JAK1, NOTCH1 and WT1 genes have not yet been reported in T-ALL pathogenesis. CONCLUSIONS Personalized genomic medicine is a therapeutic approach involving the use of an individual's information data to tailor drug therapy. Implementing bioinformatics platform PanDrugs enables us to propose a prioritized list of anticancer drugs as the best theoretical therapeutic candidates to treat this patient has been the goal of this article. Of note, most of the proposed drugs are not being yet considered in the clinical practice of this type of cancer opening up the approach of new treatment possibilities.
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Thyroid tumors with follicular architecture. Ann Diagn Pathol 2019; 38:51-58. [DOI: 10.1016/j.anndiagpath.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
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Simultaneous occurrence of PAX8-PPARg and RET-PTC3 rearrangements in a follicular variant of papillary thyroid carcinoma. Am J Surg Pathol 2012; 36:1415-20. [PMID: 22895275 DOI: 10.1097/pas.0b013e318264bdd6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Specific genotype-phenotype correlations have been identified in conventional-type papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). In contrast, the genetic alterations underlying the pathogenesis of the follicular variant of PTC (FV-PTC), which shares some clinicopathologic and molecular features with both PTC and FTC, remain to be clarified. This entity shows a PAX8-PPARg fusion gene (associated with FTC), more frequently than BRAF or RET-PTC alterations (associated with PTC). Herein, we report, for the first time, an FV-PTC with the simultaneous occurrence of both RET-PTC and PAX8-PPARg alterations. Neoplastic cells were of the wild type for BRAF and H,K,N-RAS, had an apparently normal karyotype by conventional cytogenetics, and had a balanced genome by array comparative genomic hybridization analysis. In fact, submicroscopic chromosome rearrangements producing RET-PTC3 and PAX8-PPARg chimeric genes were found by interphase fluorescence in situ hybridization. We demonstrated that these 2 genetic alterations coexisted in the same tumor and were confined to 2 different clones. Our findings indicate that molecular heterogeneity, although an uncommon phenomenon, may occur in thyroid carcinoma and demonstrate the coexistence in a case of FV-PTC not only of the histologic but also of the molecular features of both PTC (RET-PTC) and FTC (PAX8-PPARg).
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Eloy C, Vinagre J, Cameselle-Teijeiro J, Paiva ME, Soares P, Sobrinho-Simões M. Tumor-in-Tumor of the Thyroid With Basaloid Differentiation: A Lesion With a Solid Cell Nest Neoplastic Component? Int J Surg Pathol 2011; 19:276-80. [DOI: 10.1177/1066896910393506] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study describes an encapsulated thyroid tumor having 3 different concentric appearances in a 70-year-old man. The most peripheral neoplasm showed features of a microfollicular adenoma; the intermediate lesion displayed typical features of the follicular variant of papillary thyroid carcinoma (FVPTC); and the main, central neoplasm, showed a basaloid configuration. At variance with the other neoplasms, the latter component exhibited high mitotic activity. Necrosis, angio-invasion, or capsular invasions were not observed. The centrally located neoplasm was immunoreactive for several cytokeratins, p63, carcinoembryonic antigen, and galectin-3, and negative for thyroid transcription factor 1, thyroglobulin, calcitonin, CD5, and CK20, featuring a phenotype similar to that of thyroid solid cell nests. A N-RAS mutation was found both in the basaloid and in the FVPTC components. The clinicopathological and immunohistochemical data ruled out the alternative possibilities of intrathyroidal metastasis and tumor from ectopic (thymic, parathyroid, or salivary gland) tissues.
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Affiliation(s)
- Catarina Eloy
- Hospital de São João, Porto, Portugal, University of Porto, Porto, Portugal, Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal,
| | - João Vinagre
- University of Porto, Porto, Portugal, Institute of Biomedical Sciences Abel Salazar, Porto, Portugal, Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | | | | | - Paula Soares
- University of Porto, Porto, Portugal, Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- Hospital de São João, Porto, Portugal, University of Porto, Porto, Portugal, Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
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Eberhardt NL, Grebe SKG, McIver B, Reddi HV. The role of the PAX8/PPARgamma fusion oncogene in the pathogenesis of follicular thyroid cancer. Mol Cell Endocrinol 2010; 321:50-6. [PMID: 19883731 PMCID: PMC2849860 DOI: 10.1016/j.mce.2009.10.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/16/2009] [Accepted: 10/21/2009] [Indexed: 11/23/2022]
Abstract
When identified at early stages, most well-differentiated thyroid cancers are readily treated and yield excellent outcomes. Follicular thyroid cancer (FTC) however, when diagnosed at a late stage, may be very resistant to treatment, and exhibits 10-year survival rates less than 40%. Despite substantial progress in recent years, we still have limited understanding of the molecular and biological interrelationships between the various subtypes of benign and malignant follicular thyroid neoplasms. In contrast to the wealth of information available regarding papillary thyroid carcinoma (PTC), the triggering mechanisms of FTC development and the major underlying genetic alterations leading to follicular thyroid carcinogenesis remain obscure. Recent studies have focused on a chromosomal translocation, t(2;3) (q13;p25), fusing PAX8, a transcription factor that is essential for normal thyroid gland development, with the peroxisome proliferator-activated receptor gamma (PPARgamma), a member of the steroid/thyroid nuclear receptor family. This chromatin rearrangement results in the expression of a PAX8/PPARgamma fusion protein, designated PPFP, whose incidence is relatively common in FTC and may represent an initiating event in the genesis of FTC. Here we review progress on the studies of PPFP that assess its involvement in FTC tumorigenesis.
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Affiliation(s)
- Norman L Eberhardt
- Department of Medicine, Division of Endocrinology, Mayo Clinic & Foundation, Rochester, MN 55905, United States.
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Cameselle-Teijeiro J, Menasce LP, Yap BK, Colaco RJ, Castro P, Celestino R, Ruíz-Ponte C, Soares P, Sobrinho-Simões M. Cribriform-morular variant of papillary thyroid carcinoma: molecular characterization of a case with neuroendocrine differentiation and aggressive behavior. Am J Clin Pathol 2009; 131:134-42. [PMID: 19095577 DOI: 10.1309/ajcp7uls0vsisbeb] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
We describe an especially aggressive case of cribriform-morular variant (C-MV) of papillary thyroid carcinoma (PTC) in a 42-year-old man with familial adenomatous polyposis who died with lung and brain metastases 17 months after thyroidectomy. The angioinvasive neoplasm combined a mixture of trabecular, solid, cribriform, and follicular patterns of growth with CD10+ morules. Follicles were devoid of colloid, and the nuclear features typical of PTC were present in some areas and missing in others. Tumor cells were positive for thyroid transcription factor-1 and, in 40% of the tumoral mass, also were positive for chromogranin and synaptophysin and were negative for thyroglobulin and calcitonin. Strong nuclear staining for beta-catenin was found in all tumor cells, as was positivity for p53 and cyclin D1. In addition to the germline heterozygous APC Ex 2-3 duplication mutation, a somatic homozygous silent p. Thr1493Thr gene variant was found in the neoplastic cells along with RET/PTC rearrangement. This tumor represents the first case of C-MV of PTC showing neuroendocrine differentiation.
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Affiliation(s)
- José Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Galician Health Service, Christie Hospital NHS Foundation Trust, Manchester, England
| | - Lia P. Menasce
- Departments of Histopathology, Christie Hospital NHS Foundation Trust, Manchester, England
| | - Beng K. Yap
- Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester, England
| | - Rovel J. Colaco
- Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester, England
| | - Patricia Castro
- Institute of Molecular Pathology and Immunology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ricardo Celestino
- Institute of Molecular Pathology and Immunology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Clara Ruíz-Ponte
- Galician Public Foundation of Genomic Medicine, Genomic Medicine Group, CIBER-ER, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Paula Soares
- Institute of Molecular Pathology and Immunology, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Pathology, Medical Faculty, University of Porto, Hospital São João, Porto, Portugal
| | - Manuel Sobrinho-Simões
- Institute of Molecular Pathology and Immunology, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Pathology, Medical Faculty, University of Porto, Hospital São João, Porto, Portugal
- Department of Pathology, Hospital São João, Porto, Portugal
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