Papillary thyroid carcinoma with tracheal invasion: A case report

Papillary thyroid carcinoma with invasion of the trachea

Introduction

Papillary thyroid carcinoma typically has a favourable survival rate and a low recurrence rate. However, extrathyroidal extension has a significant negative impact on survival. Among the extrathyroidal extensions, invasion of the trachea by papillary thyroid carcinoma is rare and serves as a marker of more aggressive tumour behaviour. This case report aims to highlight the unusual clinical course of papillary thyroid carcinoma.

Case presentation

A 75-year-old female patient from Gaza has been diagnosed with papillary thyroid carcinoma in 2020. With mediastinal lymph node invasion. she underwent total thyroidectomy and neck dissection and mediastinal lymph node dissection. After the surgery, the patient did not follow up regularly or receive radioiodine treatment. On 2023 presented with hemoptysis, shortness of breath computed tomography (CT) and bronchoscopy reveal thyroid cancer with tracheal invasion, which has invaded the trachea to the left side. The authors treat the patient by bronchoscopy debulking and sent for oncological management.

Discussion

Papillary thyroid carcinoma is the most common type of thyroid cancer and generally has a good prognosis. Tumour staging through various imaging techniques is crucial for determining the next steps. Cases involving tracheal invasion should undergo bronchoscopy for tumour debulking. Surgical management followed by iodine therapy has shown positive outcomes.

Conclusion

When patients with Papillary thyroid carcinoma have haemoptysis, and the imaging examinations reveal a space-occupying lesion in airway, clinicians should focus on Papillary thyroid carcinoma with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.

A Case on Papillary Thyroid Carcinoma With Intraluminal Tracheal Extension: A Malaysian Experience and Literature Review

Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of PTC with tracheal involvement and a literature review on the latest surgical options. A 56-year-old gentleman presented with an anterior neck swelling of 3 x 3 cm for 3 months. Flexible endoscopy showed irregular mass in the subglottic region. Subsequent aspiration for cytology confirmed a diagnosis of PTC. Neck contrast enhanced computed tomography showed an ill-defined lesion in the right thyroid (3.1 x 3.8 x 2.9 cm) with a subtle irregularity of the adjacent tracheal wall suggestive of infiltration. The findings indicated a clinical staging of cT4aN0M0 (Stage III) with Shin's staging of Stage IV. The patient underwent a total thyroidectomy and a single-stage partial cricoid-tracheal resection with anastomosis. There were no immediate post-operative complications reported. Unfortunately, the patient suffered from pulmonary embolism, which eventually resulted in his demise. A subsequent histopathology report confirmed the diagnosis of PTC. Surgical planning for such cases may be complicated. The risk of recurrent laryngeal nerve injury is increased as the site of resection is close to the nerve. Multiple intraoperative nerve monitoring systems may be required. Meticulous planning of intraoperative airway management is needed as a large intraluminal tumor may interfere with intubation. Generally, extensive tracheal invasion would require radical surgical approaches such as circumferential resection and total laryngectomy. Less extensive cases can be treated with shave excision or window resection. PTC with tracheal invasion is an uncommon condition, and surgical excision is indicated for cases with high Shin's staging.

Papillary Thyroid Carcinoma Presenting with Chronic Cough and Hemoptysis in Primary Care: A Case Report

BACKGROUND The article discusses an unusual case of papillary thyroid carcinoma in which chronic cough and hemoptysis were the predominant symptoms. While the more common causes of hemoptysis are pulmonary in origin, extrapulmonary etiologies have been reported, including thyroid carcinoma. The clinical presentation of thyroid malignancy in this case mimics many other common disorders, such as pulmonary tuberculosis, bronchogenic carcinoma, bronchiectasis, and chronic obstructive pulmonary disease. Hence, making it challenging to suspect early when patients present to primary care. CASE REPORT A 54-year-old woman presented with a chronic cough and hemoptysis in our Primary Care Medicine Clinic. While initial assessments in the primary care medicine clinic yielded no remarkable findings, a subsequent high-resolution computed tomography scan of the thorax uncovered a thyroid lesion. Subsequent evaluation in the hospital setting included an ultrasound examination, revealing multiple thyroid nodules, and fine needle aspiration that confirmed papillary thyroid carcinoma. She underwent total thyroidectomy with central and left lateral neck dissection, complicated by left vocal cord palsy. She received 2 cycles of periodic radioactive iodine therapy and injection laryngoplasty postoperatively. There was no evidence of iodin avid disease and recurrence of hemoptysis after surgery. CONCLUSIONS This case report emphasizes the significance of considering papillary thyroid carcinoma when assessing hemoptysis in the primary care setting, as early detection and treatment of it would result in a better outcome.

Expression Levels of MicroRNA-300/BCL2L11 in Papillary Thyroid Cancer and Their Clinical Diagnostic Values

INTRODUCTION

This research aims to explore the expression levels of microRNA (miRNA)-300/BCL-2-like protein 11 (BCL2L11) and their values in the clinical diagnosis of papillary thyroid cancer (PTC).

METHODS

Pathological tissues that were surgically removed for thyroid disease were selected. miR-300 and BCL2L11 expression levels in the samples were measured. Receiver operating characteristic (ROC) curves were plotted to analyze miR-300 and BCL2L11 predictive values for PTC. Upon silencing miR-300 and silencing BCL2L11 in PTC cells, the corresponding miR-300 and BCL2L11 expression levels were tested, followed by examining PTC cell activities. The targeting relationship of miR-300 and BCL2L11 was detected by the bioinformatics website and luciferase activity assay.

RESULTS

miR-300 expression levels were elevated and BCL2L11 expression levels were reduced in PTC tissues. miR-300 and BCL2L11 expression levels in PTC tissues had a correlation with TNM stage and lymph node metastasis. The results of ROC curve revealed that both miR-300 and BCL2L11 had clinical predictive values for PTC. Mechanistically, miR-300 negatively regulated BCL2L11. The functional assays unveiled that silencing miR-300 impeded PTC cell activities, and silencing BCL2L11 induced PTC cell activities. In the rescue experiment, silencing BCL2L11 reversed the impacts of silencing miR-300 on PTC cell development.

CONCLUSION

This study underlines that miR-300 expression is increased and BCL2L11 expression is declined in PTC. miR-300 and BCL2L11 both have clinical predictive values for diagnosing PTC.

Bioinformatics analysis identifies potential ferroptosis key genes in the pathogenesis of diabetic peripheral neuropathy

Background

Diabetic peripheral neuropathy (DPN) is a serious complication in Diabetes Mellitus (DM) patients and the underlying mechanism is yet unclear. Ferroptosis has been recently intensively researched as a key process in the pathogenesis of diabetes but there yet has been no related bioinformatics-based studies in the context of DPN.

Methods

We used data mining and data analysis techniques to screen differentially expressed genes (DEGs) and immune cell content in patients with DPN, DM patients and healthy participants (dataset GSE95849). These DEGs were then intersected with the ferroptosis dataset (FerrDb) to obtain ferroptosis DEGs and the associated key molecules and miRNAs interactions were predicted.

Results

A total of 33 ferroptosis DEGs were obtained. Functional pathway enrichment analysis revealed 127 significantly related biological processes, 10 cellular components, 3 molecular functions and 30 KEGG signal pathways. The biological processes that were significantly enriched were in response to extracellular stimulus and oxidative stress. Key modules constructed by the protein-protein interaction network analysis led to the confirmation of the following genes of interest: DCAF7, GABARAPL1, ACSL4, SESN2 and RB1. Further miRNA interaction prediction revealed the possible involvement of miRNAs such as miR108b-8p, miR34a-5p, mir15b-5p, miR-5838-5p, miR-192-5p, miR-222-3p and miR-23c. Immune-environment content of samples between DM and DPN patients revealed significant difference in the levels of endothelial cells and fibroblasts, which further speculates their possible involvement in the pathogenesis of DPN.

Conclusion

Our findings could provide insight for investigations about the role of ferroptosis in the development of DPN.

Management of papillary thyroid cancer with tracheal invasion and lung cancer: A case report

The present study reports the case of a 64-year-old patient with papillary thyroid cancer (PTC) and tracheal invasion, along with primary lung cancer. Firstly, the patient received tumor electrocautery under tracheoscopy to enlarge the space for tracheal intubation. Next, the patient received one-stage radical thyroidectomy, with window resection of the trachea and thoracoscopic radical resection of the lung cancer. The patient was discharged safely after several days of therapy. To the best of our knowledge, this case is the first reported case of a one-stage radical thyroidectomy with a window resection of the trachea and thoracoscopic radical resection of the lung cancer in the literature. Simultaneous surgery for PTC with tracheal invasion and lung cancer is a great challenge for the patient and the surgeon. Appropriate surgical management of the tracheal invasion is of great importance to the operation and prognosis. This case may provide reference for surgeons in similar situations.

m6A Writer METTL3-Mediated lncRNA LINC01125 Prevents the Malignancy of Papillary Thyroid Cancer

BACKGROUND

Long non-coding RNA (lncRNA) LINC01125 is an anti-tumor factor in a variety of tumors, and regulates cancer cell function. However, its function and mechanism of N6-methyladenosine (m6A) modification in papillary thyroid cancer (PTC) tumorigenesis remain unclear.

AIMS

This study aimed to reveal the function and m6A modification of LINC01125 in PTC tumorigenesis.

METHODS

The LINC01125 and methyltransferase-like 3 (METTL3) levels in PTC cells and tissues was assessed by qRT-PCR. The binding relationship among LINC01125 and METTL3 was determined by MeRIP, Pearson, bioinformatics, and RNA stabilization analysis. Transwell assays were performed to confirm the changes of PTC cell migration and invasion. Cell proliferation was revealed by CCK-8 as well as colony formation assays.

RESULTS

Low expression of LINC01125 and METTL3 was identified in PTC. LINC01125 was a downstream target of METTL3-mediated m6A modification and was stably upregulated via METTL3. Cell invasion, migration, viability, and colony formation levels were decreased when LINC01125 or METTL3 was upregulated. Inhibition of LINC01125 had the opposite impact, promoting cell proliferation and metastasis, and reversing METTL3 overexpression-resulted cell malignancy suppression.

CONCLUSIONS

Overall, this study proved that the m6A modification of LINC01125 was mediated by METTL3 and LINC01125 inhibited cell invasion, migration and proliferation, thereby suppressing the development of PTC. This points to the LINC01125-m6A-METTL3 axis as a possible prospective target for future treatment of PTC.

Bronchoscopy Laser and Silicone Y-Stents as Emergency Airway Management in Central Airway Stenosis Due to Secondary Thyroid Carcinoma: A Case Report

Total airway obstruction in thyroid cancer is rare and has high morbidity and mortality. Airway management in such cases is challenging, especially in cases in which thyroid masses cannot be totally resected. It is important to choose the appropriate airway treatment modality. Currently, therapeutic rigid bronchoscopy procedures and endoluminal lasers, as well as airway stent insertion, are a management modality of near-total malignant airway obstruction. We report a rigid bronchoscopy procedure combined with laser and Y-stent silicone insertion in thyroid cancer with extension infiltration, as well as compression in the trachea covering the subglottic tracheal area up to the main carina and tracheo-bronchomalacia, manifesting as acute respiratory failure.

Transcription Factor E2F1 Exacerbates Papillary Thyroid Carcinoma Cell Growth and Invasion via Upregulation of LINC00152

Background

Papillary thyroid carcinoma (PTC) is the most common thyroid neoplasm, whereas transcription factor E2F1 has been previously implicated in PTC progression. The current study sought to elucidate the underlying mechanism of E2F1 in PTC cell biological activities via regulation of long intergenic noncoding RNA 152 (LINC00152).

Methods

Firstly, the expression patterns of LINC00152 and E2F1 in PTC were determined. Besides, TPC-1 and IHH-4 cells were adopted to carry out a series of experiments. Cell proliferation was detected by means of a cell counting kit-8 assay and colony formation assay, while cell migration and invasion abilities were assessed using a Transwell assay. Next, the interaction between E2F1 and LINC00152 was certified. Lastly, xenograft transplantation was carried out to validate the effects of E2F1 depletion on PTC.

Results

Both LINC00152 and E2F1 were highly expressed in PTC cells. Knockdown of LINC00152 led to reduced cell activity, while LINC00152 overexpression brought about the opposing trends. Likewise, E2F1 knockdown quenched cell proliferation, migration, and invasion. However, the combination of E2F1 knockdown and LINC00152 overexpression resulted in augmented cell growth. In addition, E2F1 induced LINC00152 overexpression, which accelerated cell proliferation, migration, and invasion by activating the PI3K/AKT axis, whereas the administration of LY294002, the inhibitor of PI3K, led to reversal of the same. Finally, xenograft transplantation validated that E2F1 inhibition could suppress LY294002, thereby discouraging tumor growth.

Conclusion

Our findings highlighted that E2F1 augmented PTC cell proliferation and invasion by upregulating LINC00152 and the PI3K/AKT axis. Our discovery provides therapeutic implications for PTC alleviation.

CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay

The tracheobronchial tree is a system of airways that allows the passage of air to aerate the lungs and entire body. Several pathological conditions can affect this anatomical region. Multidetector CT (MDCT) helps identify and characterize various large airway diseases. Post-processing tools, such as virtual bronchoscopy and automatic lung analysis, can help enhance the performance of imaging studies. In this pictorial essay review, we provide imaging findings of various bronchial lesions manifested as wall thickening and endoluminal nodules on conventional MDCT and advanced image visualization and analysis.

Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways

OBJECTIVES

To evaluate the efficacy of radiofrequency ablation (RFA) in patients with recurrent thyroid cancer invading the airways.

METHODS

We reviewed patients who had undergone RFA for recurrent thyroid cancer in the central compartment after total thyroidectomy between January 2008 and December 2018. All tumors were classified according to their association with the laryngeal structure and trachea. The volume reduction rate (VRR) and complete disappearance rate were calculated, and their differences were determined relative to the association between the tumor and trachea. Complication rates associated with RFA were evaluated.

RESULTS

The study population included 119 patients with 172 recurrent tumors. Mean VRR was 81.2% ± 55.7%, with 124 tumors (72.1%) completely disappearing after a mean follow-up of 47.9 ± 35.4 months. The complete disappearance rate of recurrent tumors not in contact with the trachea was highest, followed by tumors forming acute angles, right angles, and obtuse angles with the trachea, and tumors with intraluminal tracheal invasion (p value < 0.001). The overall complication rate was 21.4%.

CONCLUSIONS

RFA is effective and safe for the local control of recurrent tumors in the central neck compartment after total thyroidectomy, even for tumors invading the airways, and may be considered an alternative to surgical resection. The inverse relationship between RFA efficacy and airway invasion suggests that early RFA may benefit patients with recurrent tumors in the central neck compartment.

KEY POINTS

• RFA achieved a mean VRR of 81.2% ± 55.7% and complete disappearance of 124 tumors (72.1%) after a mean follow-up of 47.9 ± 35.4 months. • The complete disappearance rate of recurrent tumors not in contact with the trachea was the highest, followed by tumors forming acute angles, right angles, and obtuse angles with the trachea, and tumors with intraluminal tracheal invasion. • Stent-assisted RFA may be a good alternative for palliative treatment of recurrent tumors with intraluminal tracheal invasion.