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Chiefari E, Innaro N, Gervasi R, Mirabelli M, Giuliano S, Donnici A, Obiso S, Brunetti FS, Foti DP, Brunetti A. Incidental thyroid carcinoma in an endemic goiter area in Italy: histopathological features and predictors of a common finding. Endocrine 2024; 84:589-597. [PMID: 38217773 PMCID: PMC11076372 DOI: 10.1007/s12020-023-03659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/10/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The occurrence and histopathological features of incidental thyroid carcinoma (ITC) vary considerably among populations from different geographical regions. The aim of this study is to assess the prevalence and histopathological characteristics of ITC in patients who underwent thyroid surgery for apparently benign thyroid diseases in an endemic goiter area in Italy. METHODS A total of 649 consecutive patients (531 females and 118 males; mean age, 52.9 ± 11.0 years), who underwent thyroid surgery at the Endocrine Surgery Unit of the tertiary care "Renato Dulbecco" University Hospital (Catanzaro, Italy) in the period between years 2017 and 2022, were included in this retrospective study. A comprehensive histopathological examination was performed on surgically excised thyroid tissue. Logistic regression analysis was employed to identify potential predictors of ITC. RESULTS The histopathological examination revealed the presence of ITC in 81 patients, accounting for 12.5% of the total study population. The female to male ratio was found to be 6.4 to 1. Among the patients with ITC, 72 had papillary carcinoma (PTC), with 53 of these tumors being microcarcinomas (microPTC). Additionally, 5 patients had follicular thyroid carcinoma, 2 patients had low-risk follicular cell-derived thyroid neoplasms, 1 patient had an oncocytic carcinoma, and 1 patient had a medullary thyroid carcinoma. Logistic regression analysis demonstrated a significant association between female sex and incidental microPTC. CONCLUSIONS These findings provide further evidence of the common occurrence of ITC, typically in the form of microPTC, among individuals who undergo thyroid surgery for apparently benign thyroid diseases.
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Affiliation(s)
- Eusebio Chiefari
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Nadia Innaro
- Operative Unit of Endocrine Surgery, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Rita Gervasi
- Operative Unit of Endocrine Surgery, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Maria Mirabelli
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Stefania Giuliano
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Alessandra Donnici
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Stefania Obiso
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy
| | - Francesco S Brunetti
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Daniela Patrizia Foti
- Department of Experimental and Clinical Medicine, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University of "Magna Græcia" Catanzaro, 88100, Catanzaro, Italy.
- Operative Unit of Endocrinology, University Hospital "Renato Dulbecco", 88100, Catanzaro, Italy.
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Gedamu D, Shimels T, Kassie D, Chanyalew Z, Eyasu M. Thyroid Malignancy in Patients Who Underwent Thyroidectomy for Multinodular Goiter and Solitary Thyroid Nodule. JCO Glob Oncol 2024; 10:e2300322. [PMID: 38815179 DOI: 10.1200/go.23.00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/06/2024] [Accepted: 01/29/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Worldwide, incidence of thyroid malignancy is increasing. The purpose of this study was to evaluate the pattern and magnitude of nodule types. METHODS A cross-sectional retrospective study was performed at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, among patients who underwent thyroidectomy from May 2018 to June 2022. Data were extracted using a structured format. Descriptive statistics were performed using SPSS version 26 software. Results were presented in terms of percentages and frequencies. RESULTS During a 4-year period, 1,476 patients had thyroidectomies and histopathologic information of 212 malignant cases was studied. Within multinodular goiter (MNG), thyroid cancer accounted for 69.8% (n = 148) of patients, whereas in solitary nodules, it accounted for 30.2%. From the total, 160 participants (75.5%) were female, and the female:male ratio was 3.1 (mean, 41.72; ± standard deviation [SD], 16.44) years, and age range of 12-88 years versus men, who have a mean of 44.71 (±SD, 14.91) years and an age range of 21-78 years. The mean age of male cases with solitary nodule and MNG was 40.6 and 46.5 years, respectively. The most frequent cancer in both types of nodules, accounting for 59% of patients, was papillary carcinoma, which was found in 64% of solitary nodules and 57.4% of multinodular nodules. Overall, 14.1% of tumors had multiple centers (17.4% in multinodular nodules and 6.9% in solitary nodules). In 7.1% of patients, microcarcinoma (<1 cm) was found, with papillary carcinoma accounting for 91.7% of the total. CONCLUSION Compared with men, women with cancer typically manifested at a younger age. Males with malignancy in solitary nodules had a lower mean age than those with MNGs. The most frequent and significant cause of multicentric presentation is papillary carcinoma.
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Affiliation(s)
- Desalew Gedamu
- Department of Pathology, St Paul's Hospital Millennium Medical College, School of Medicine, Addis Ababa, Ethiopia
| | - Tariku Shimels
- St Paul's Hospital Millennium Medical College, School of Medicine, Addis Ababa, Ethiopia
| | - Daniel Kassie
- Department of Pathology, Gondar Medical College, School of Medicine, Addis Ababa, Ethiopia
| | - Zewditu Chanyalew
- Department of Pathology, St Paul's Hospital Millennium Medical College, School of Medicine, Addis Ababa, Ethiopia
| | - Mebrahtu Eyasu
- Department of Pharmacology, St Paul's Hospital Millennium Medical College, School of Medicine, Addis Ababa, Ethiopia
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Peng B, Zhang S, Du F. Risk Factors and Prediction Models for Postoperative Pathologically Malignant TI-RADS 3 Thyroid Nodules. EAR, NOSE & THROAT JOURNAL 2024:1455613241228078. [PMID: 38380607 DOI: 10.1177/01455613241228078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Objective: Our goal was to detect the risk factors for malignant TI-RADS 3 nodule and to construct a predictive model. Patients and Methods: All 199 patients with TI-RADS 3 nodule underwent first-time thyroid surgery from January 2018 to September 2021. Univariate analysis identified potential risk covariates and then incorporated these covariates into multivariate logistic regression to determine the risk factors for malignant TI-RADS 3 nodule and construct a predictive model. Results: Binary logistic regression analysis showed that age [odds ratio (OR): 0.926, 95% CI: 0.865-0.992; P = .029), low level of parathyroid hormone (OR: 0.940, 95% CI: 0.890-0.993; P = .027), and preoperative ultrasound features of TI-RADS 3 nodule, such as echogenicity (OR: 8.496, 95% CI: 1.377-52.406; P = .021), echogenic foci (OR: 8.611, 95% CI: 1.484-49.957; P = .016), and maximum tumor diameter (OR: 0.188, 95% CI: 0.040-0.888; P = .035) were independent risk factors for malignant TI-RADS 3 nodule. Based on these independent risk factors, a logistic regression model was established. The area under curve of the prediction model for TI-RADS 3 thyroid cancer was 0.921 (95% CI: 0.856-0.986, P < 0.001). The maximum Youden index was 0.698. The cut-off value, sensitivity, and specificity were 0.074, 84.6%, and 85.2%, respectively. Conclusion: Young age, iso/hypo/very hypo echo, echogenic foci, nodule diameter <30 mm, and low level of PTH are independent risk factors for TI-RADS 3 thyroid carcinomas. This prediction model has a high sensitivity and specificity. A prediction model value of more than 0.074 implies that the TI-RADS 3 nodule has undergone a malignant transformation, and fine needle aspiration is recommended in these cases.
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Affiliation(s)
- Bin Peng
- Department of Emergency Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Shaofeng Zhang
- Department of Emergency Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Fei Du
- Department of Oncological Surgery, Affiliated Hospital of Qinghai University, Xining, China
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Bove A, Manunzio R, Palone G, Di Renzo RM, Calabrese GV, Perpetuini D, Barone M, Chiarini S, Mucilli F. Incidence and Clinical Relevance of Incidental Papillary Carcinoma in Thyroidectomy for Multinodular Goiters. J Clin Med 2023; 12:jcm12082770. [PMID: 37109106 PMCID: PMC10144475 DOI: 10.3390/jcm12082770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Patients undergoing a total thyroidectomy for multinodular goiter typically have a long clinical history of the disease. They often come to surgery for compression symptoms, with no suspicion of neoplastic disease. For these patients, the incidence of microcarcinomas is high, even though we know that this does not affect subsequent therapies and long-term survival. On the other hand, when a true incidental carcinoma is present, the patient requires specific therapy and long-term follow-up. The purpose of the study was to identify the incidence of incidental carcinomas in the high prevalence region of goiter, the clinical-pathological characteristics of the tumor, and the therapeutic implications. METHOD This is a retrospective study, from January 2010 to December 2020, on a case series of 1435 total thyroidectomies for goiters. All patients had a preoperative diagnosis of a benign disease. Gender, mean age, and mean duration from the initial diagnosis of goiter were evaluated along with the number and frequency of fine needle aspirations carried out. On the basis of the histological examination, the incidence of incidental carcinoma was then assessed (diameter ≥ 10 mm) as well as the incidence of microcarcinoma (diameter < 10 mm), the pathological characteristics (multifocality, capsular invasion), and the subsequent prescribed therapies. RESULTS Patients with incidental carcinoma numbered 41 (2.8%%), 34 women and 7 men. The mean age was 53.5 years, while the patients diagnosed with microcarcinoma were 88 (6.1%). The mean duration of the disease from initial diagnosis was 7.8 years. On average, these patients underwent 1.8 fine needle aspirations during the course of the disease, almost exclusively in the first four years. The mean diameter of the tumor was 1.35 cm (±0.3). Multifocality was present in six patients, while only one patient presented capsular invasion. The chi-square test delivered a significant dependence on gender in terms of the incidental diagnosis after Yates correction (chi-stat = 5.064; p = 0.024), highlighting a higher incidence in the female population. All patients underwent subsequent metabolic radiotherapy. The mean follow-up was 6.3 years and in the 35 patients examined, none displayed any recurrence of the disease. CONCLUSIONS Incidental carcinoma is not uncommon in patients who have undergone total thyroidectomy for goiters. It must be differentiated from microcarcinoma for its therapeutic implications and the follow-up of the patient. Statistical analysis has shown that the only significant variable is gender. In a goiter area, the careful monitoring of patients is required to highlight suspicious clinical-instrumental aspects that may appear even several years after the initial diagnosis.
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Affiliation(s)
- Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Roberto Manunzio
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Gino Palone
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Raffaella Marina Di Renzo
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Valeria Calabrese
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - David Perpetuini
- Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, University G. D'Annunzio of Chieti-Pescara, Via Luigi Polacchi 13, 66100 Chieti, Italy
| | - Mirko Barone
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Stella Chiarini
- Department of Medicine and Ageing Sciences, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Felice Mucilli
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
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Semerci O, Gucer H. The Significance of Unsampled Microscopic Thyroid Carcinomas in Multinodular Goiter. Endocr Pathol 2023; 34:119-128. [PMID: 36527546 DOI: 10.1007/s12022-022-09743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Thorough gross examination and appropriate sampling of the thyroidectomy specimens are fundamental to the diagnosis and clinical risk management of patients. This study aims to investigate the frequency and clinical significance of initially unsampled microscopic thyroid carcinomas in total thyroidectomy specimens with presumed benign multinodular thyroid disease. Seventy-two total thyroidectomy specimens belonging to multinodular goiter patients were randomly selected and included in this prospectively designed study. Inclusion criteria were set as no suspicion of malignancy before surgery as well as lack of intra-parenchymal primary thyroid carcinoma after histopathological evaluation of slides generated from initial sampling. Subsequently, the remaining thyroidectomy specimens were submitted for microscopic examination and sign-outs were finalized following the microscopic examination of the entire thyroid tissue. Microcarcinomas, with a maximum diameter of 3.5 mm, were detected in 29 cases (40.2%) after the whole gland sampling. Although most of these tumors were low-risk papillary microcarcinomas confined to the thyroid, one specimen also showed a medullary microcarcinoma measuring 1.5 mm. Three had micrometastatic nodal disease. There was no local recurrence or distant metastatic disease during the follow-up (mean 51.4 months). This study further supports microscopic carcinomas, including papillary microcarcinoma, and medullary microcarcinoma might stay hidden in thyroidectomy specimens. Increased glandular weight, male gender, and advanced age were significant risk factors in the detection of microcarcinomas in this series. While each multinodular thyroidectomy specimen is unique, we recommend dynamic extensive sampling (rather than bare-minimum approach) strategy based on careful gross and initial histologic examination findings as well as by taking into consideration risk factors.
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Affiliation(s)
- Orhan Semerci
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Hasan Gucer
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
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Zhang L, Zhang J, Fan S, Zhong Y, Li J, Zhao Y, Ni S, Liu J, Wu Y. A case-control study of urinary concentrations of bisphenol A, bisphenol F, and bisphenol S and the risk of papillary thyroid cancer. CHEMOSPHERE 2023; 312:137162. [PMID: 36347349 DOI: 10.1016/j.chemosphere.2022.137162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The incidence of thyroid cancer (TC), especially papillary thyroid cancer (PTC), has dramatically increased globally. Whereas some endocrine disruptors have been linked to neoplastic processes, the associations between human exposure to bisphenol analogs and the risk of TC remain unclear. This present case-control study examined the associations between the urinary concentrations of bisphenol A (BPA) and other bisphenols, namely bisphenol F (BPF) and bisphenol S (BPS), and the risk of PTC. After adjusting for confounders and creatinine standardization, significantly positive associations were observed for BPF (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.27-2.54), but negative associations observed for BPA (OR = 0.38, 95% CI = 0.19-0.77) and BPS (OR = 0.63, 95% CI = 0.43-0.93), in the total population. However, after stratification by age and smoking, statistical significance was retained only in non-smoking women, suggesting the adverse effects of BPF exposure on PTC risk, especially in women. These findings require replication and confirmation in further research.
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Affiliation(s)
- Lei Zhang
- Research Unit of Food Safety, Chinese Academy of Medical Sciences (No. 2019RU014); NHC Key Lab of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment (CFSA), Beijing 100022, China
| | - Jiahuai Zhang
- Center for Clinical Laboratory, Capital Medical University, Beijing 100069, China
| | - Sai Fan
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing 100013, China
| | - Yuxin Zhong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jingguang Li
- Research Unit of Food Safety, Chinese Academy of Medical Sciences (No. 2019RU014); NHC Key Lab of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment (CFSA), Beijing 100022, China
| | - Yunfeng Zhao
- Research Unit of Food Safety, Chinese Academy of Medical Sciences (No. 2019RU014); NHC Key Lab of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment (CFSA), Beijing 100022, China
| | - Song Ni
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100021, China; Department of Head and Neck Surgery, Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang 065001, China.
| | - Jiaying Liu
- Department of Nutrition and Health, China Agricultural University, Beijing 100083, China.
| | - Yongning Wu
- Research Unit of Food Safety, Chinese Academy of Medical Sciences (No. 2019RU014); NHC Key Lab of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment (CFSA), Beijing 100022, China
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Chen WH, Chen CY. Clinicopathologic characteristics of incidental thyroid carcinoma in euthyroid patients receiving total thyroidectomy for multinodular goiter: A retrospective cohort study. J Chin Med Assoc 2022; 85:839-844. [PMID: 35648159 DOI: 10.1097/jcma.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Total thyroidectomy is the treatment of choice for multinodular goiter (MNG). In some of these cases, incidental thyroid cancer (ITC) is detected postoperatively. Papillary thyroid microcarcinoma (PTMC), the most common type of ITC, has clinical factors and pathologic similarities with ITC that have not been well clarified previously. We investigated the incidence and characteristics of ITC and PTMC in euthyroid patients undergoing total thyroidectomy for MNG. METHODS We retrospectively investigated the data of 151 euthyroid patients who underwent total thyroidectomy for MNG between January 2016 and December 2020. Patients with PTMC were then selected from among those with ITC for further data analysis. RESULTS The incidence rates of ITC and PTMC were 31.1% (47/151) and 21.1% (32/151), respectively. The mean age of patients with ITC was 52.8 ± 11.7 years, which was younger than that of patients with benign MNG (57.2 ± 12.5 years, p < 0.05). Bilateral cancer was observed in 17 patients with ITC (17/47, 36.2%) and nine with PTMC (9/32, 28.1%). The numbers of patients in the ITC and PTMC groups whose cancer was not on the side comprising the dominant tumor were 15 (15/47, 31.9%) and 13 (13/32, 40.6%), respectively. The multivariate analysis demonstrated that younger age was a clinical factor associated with ITC and PTMC. CONCLUSION Younger age is a clinical factor for ITC and PTMC. We recommend taking considering clinical factors and pathologic characteristics of ITC and PTC when considering total thyroidectomy in euthyroid patients with MNG.
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Affiliation(s)
- Wei-Hsin Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taichung Veterans General, Hospital, Taichung, Taiwan, ROC
| | - Chih-Yi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
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Cappellacci F, Canu GL, Lai ML, Lori E, Biancu M, Boi F, Medas F. Association between hashimoto thyroiditis and differentiated thyroid cancer: A single-center experience. Front Oncol 2022; 12:959595. [PMID: 35965566 PMCID: PMC9366466 DOI: 10.3389/fonc.2022.959595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/30/2022] [Indexed: 12/29/2022] Open
Abstract
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the iodine-sufficient areas of the world. Differentiated thyroid cancer is the most common thyroid cancer subtype, accounting for more than 95% of cases, and it is considered a tumor with a good prognosis, although a certain number of patients experience a poor clinical outcome. Hashimoto’s thyroiditis has been found to coexist with differentiated thyroid cancer in surgical specimens, but the relationship between these two entities has not yet been clarified. Our study aims to analyze the relationship between these two diseases, highlighting the incidence of histological diagnosis of Hashimoto thyroiditis in differentiated thyroid cancer patients, and assess how this autoimmune disorder influences the risk of structural disease recurrence and recurrence rate.
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Affiliation(s)
- Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
- *Correspondence: Federico Cappellacci,
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maria Letizia Lai
- Department of Cytomorphology, University of Cagliari, Cagliari, Italy
| | - Eleonora Lori
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - Miriam Biancu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Francesco Boi
- Endocrinology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Graceffa G, Salamone G, Contino S, Saputo F, Corigliano A, Melfa G, Proclamà MP, Richiusa P, Mazzola S, Tutino R, Orlando G, Scerrino G. Risk Factors for Anaplastic Thyroid Carcinoma: A Case Series From a Tertiary Referral Center for Thyroid Surgery and Literature Analysis. Front Oncol 2022; 12:948033. [PMID: 35875085 PMCID: PMC9303013 DOI: 10.3389/fonc.2022.948033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is a very rare and extremely aggressive disease with a very poor prognosis. Several risk factors have been hypothesized, but there is no clear-cut literature data on it. We reviewed the literature concerning risk factors for ATC and analyzed the institutional database from 2005 to 2022. In total, 15 papers were suitable for review, while the retrospective data collection search, conducted on our institutional database, provided 13 results. In our experience, in agreement with literature data, ATC seems to be a neoplasm peculiar to old age (in our database, mean age is 72 years), with a higher prevalence in subjects with a low level of education and a long history of multinodular goiter (MNG). The role of cigarette smoking and blood group, hypothesized on some literature data, was more uncertain, although the small sample size evaluated probably had a great influence on these results. The higher incidence of the disease in individuals with a history of MNG could suggest more aggressive choices in the treatment of a benign disease, in contrast to current practice. However, this may be a highly questionable point considering that ATC accounts for no more than 2% of all thyroid neoplasms in surgical departments, even those dedicated to endocrine neck surgery. Further studies are therefore necessary for a step forward in this direction.
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Affiliation(s)
- Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Silvia Contino
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Federica Saputo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Alessandro Corigliano
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Giuseppina Melfa
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Maria Pia Proclamà
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Pierina Richiusa
- Section of Endocrinology-Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone” University of Palermo, Palermo, Italy
| | - Roberta Tutino
- Department of General and Specialized Surgery, City of Health and Science Hospital of Turin, Turin, Italy
| | - Giuseppina Orlando
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
- *Correspondence: Giuseppina Orlando,
| | - Gregorio Scerrino
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
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10
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Cocco P. Time for Re-Evaluating the Human Carcinogenicity of Ethylenedithiocarbamate Fungicides? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052632. [PMID: 35270318 PMCID: PMC8909994 DOI: 10.3390/ijerph19052632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
Background. In January 2021, the European Union ended the license of Mancozeb, the bestselling ethylenedithiocarbamate (EBDC) fungicide, because of some properties typical of human carcinogens. This decision contrasts the IARC classification of EBDC fungicides (Group 3, not classifiable as to human carcinogenicity). A systematic review of the scientific literature was conducted to explore the current evidence. Methods. Human and experimental studies of cancer and exposure to EBDC fungicides (Mancozeb, Maneb, Zineb, and others) and ethylene thiourea (ETU), their major metabolite, published in English as of December 2021, were retrieved using PubMed, the list of references of the relevant reports, and grey literature. Results. The epidemiological evidence of EBDC carcinogenicity is inadequate, with two studies each suggesting an association with melanoma and brain cancer and inconsistent findings for thyroid cancer. Experimental animal studies point at thyroid cancer in rats and liver cancer in mice, while multiple organs were affected following the long-term oral administration of Mancozeb. The mechanism of thyroid carcinogenesis in rats has also been shown to occur in humans. Genotoxic effects have been reported. Conclusions. The results of this systematic review suggest inadequate evidence for the carcinogenicity of EBDC fungicides from human studies and sufficient evidence from animal studies, with positive results on three out of ten key characteristics of carcinogens applying to humans as well. An IARC re-evaluation of the human carcinogenicity of EBDC fungicides is warranted.
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Affiliation(s)
- Pierluigi Cocco
- Centre for Occupational and Environmental Health, Division of Population Health, University of Manchester, Manchester M13 9PL, UK
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