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Alam IS, Patel KN. Management of Poorly Differentiated Thyroid Cancer and Differentiated High-Grade Thyroid Carcinoma. Surg Clin North Am 2024; 104:751-765. [PMID: 38944496 DOI: 10.1016/j.suc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Thyroid carcinoma of follicular cell origin exists on a histopathologic and clinical spectrum. The authors focus on the category of tumors that fall between the very favorable well-differentiated thyroid carcinomas and the very unfavorable anaplastic thyroid carcinomas. These intermediately aggressive tumors include poorly differentiated thyroid carcinoma and the newly defined differentiated high-grade thyroid carcinoma. Both diagnoses require certain histopathologic requirements be met in order to accurately identify these tumors post-operatively. Management remains primarily surgical though adjunctive treatments such as molecular targeted therapies (eg, tyrosine kinase inhibitors) and differentiation therapy (to restore tumor response to radioactive iodine) are also becoming available.
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Affiliation(s)
- Iram S Alam
- Department of Surgery, NYU Langone Health, 530 First Avenue, 12th Floor, New York, NY 10016, USA.
| | - Kepal N Patel
- Faculty Development, Division of Endocrine Surgery, NYU Langone Health, 530 First Avenue, 12th Floor, New York, NY 10016, USA
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Violetis O, Konstantakou P, Spyroglou A, Xydakis A, Kekis PB, Tseleni S, Kolomodi D, Konstadoulakis M, Mastorakos G, Theochari M, Aller J, Alexandraki KI. The Long Journey towards Personalized Targeted Therapy in Poorly Differentiated Thyroid Carcinoma (PDTC): A Case Report and Systematic Review. J Pers Med 2024; 14:654. [PMID: 38929875 PMCID: PMC11205159 DOI: 10.3390/jpm14060654] [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: 05/20/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Poorly differentiated thyroid carcinoma (PDTC) has an intermediate prognosis between indolent well-differentiated thyroid carcinoma (TC) and anaplastic carcinoma. Herein, we present a case report with a PDTC component, along with a systematic review of the literature. CASE REPORT We report a case of a 45-year-old man diagnosed with a PDTC component, along with hobnail and tall-cell variant features positive for BRAFV600E mutation, after a total thyroidectomy and neck dissection. Radioactive iodine (RAI)-131 therapy was applied, but an early recurrence led to complementary surgeries. The anti-Tg rise, the presence of new lymph nodes, and the negative whole-bodyradioiodine scan were suggestive of a radioiodine-resistant tumor. Lenvatinib, sorafenib, dabrafenib/trametinib, cabozantinib and radiotherapy were all administered, controlling the tumor for a period of time before the patient ultimately died post-COVID infection. Systematic Review: We searched PubMed, Scopus, and WebofScience to identify studies reporting clinicopathological characteristics, molecular marker expression, and management of non-anaplastic TC with any proportion of PDTC in adult patients. Of the 2007 records retrieved, 82were included in our review (PROSPERO-ID545847). CONCLUSIONS Our case, together with the systematic review, imply that a combination of molecular-targetedtreatments may be safe and effective in patients with RAI-resistantBRAF-mutated advanced PDTC when surgery has failed to control tumor progression.
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Affiliation(s)
- Odysseas Violetis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Panagiota Konstantakou
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Ariadni Spyroglou
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Antonios Xydakis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | | | - Sofia Tseleni
- Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece;
| | - Denise Kolomodi
- European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Ekpa-Laiko Center, 11527 Athens, Greece;
- IATROPOLIS Private Medical Center, 11521 Athens, Greece
| | - Manousos Konstadoulakis
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - George Mastorakos
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
| | - Maria Theochari
- Department of Oncology, Ippokrateio Athens General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Javier Aller
- Endocrinology Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Krystallenia I. Alexandraki
- 2nd Department of Surgery, Aretaieio Athens Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece (A.S.)
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3
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Cirello V, Gambale C, Nikitski AV, Masaki C, Roque J, Colombo C. Poorly differentiated thyroid carcinoma: molecular, clinico-pathological hallmarks and therapeutic perspectives. Panminerva Med 2024; 66:155-173. [PMID: 38576304 DOI: 10.23736/s0031-0808.23.05040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Poorly differentiated thyroid carcinoma (PDTC) is a rare and extremely aggressive tumor, accounting for about 2-15% of all thyroid cancer. PDTC has a distinct biological behavior compared to well-differentiated and anaplastic thyroid carcinoma and, in last years, it has been classified as a separate entity from both anatomopathological and clinical points of view. Nevertheless, there is still a lack of consensus among clinicians regarding inclusion criteria and definition of PDTC that affects its diagnosis and clinical management. Due to its rarity and difficulty in classification compared to other tumors, very few studies are available to date and series often include different histotypes in addition to PDTC. This review focuses on main studies concerning PDTC summarizing the evolution in the definition of its diagnosis criteria, clinicopathological features, management, and outcome. The data available confirm that the pathological evaluation and classification of PDTC are crucial and should therefore be standardized. Since the clinical presentation and prognosis of PDTC may vary widely depending on the different stage of the disease at diagnosis, the patient's management may differ in treatment and should be tailored to each patient. Finally, this review discusses advances in molecular insights of PDTC that, together with the implementation of both in vitro and in vivo models, will provide valuable insights into biological mechanisms of progression, metastasis, and invasion of this aggressive thyroid carcinoma. Further studies on larger, carefully selected series are needed to better assess the peculiar features of PDTC and to better define its management by focusing on the best diagnostic and therapeutic approaches.
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Affiliation(s)
- Valentina Cirello
- Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carla Gambale
- Department of Clinical and Experimental Medicine, Endocrine Unit, University Hospital of Pisa, Pisa, Italy
| | - Alyaksandr V Nikitski
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - João Roque
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Carla Colombo
- Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy -
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Chatterjee S, Mair M, Shaha AR, Paleri V, Sawhney S, Mishra A, Bhandarkar S, D'Cruz AK. Current evidences in poorly differentiated thyroid carcinoma: a systematic review and subsection meta-analysis for clinical decision making. Endocrine 2024:10.1007/s12020-024-03771-x. [PMID: 38504051 DOI: 10.1007/s12020-024-03771-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Poorly differentiated thyroid carcinoma (PDTC) is a distinct entity with intermediate prognosis between indolent follicular thyroid cancers and anaplastic carcinoma. The management guidelines are not standardized for these cancers due its low prevalence and limited available literature. Therefore, we did this systematic review with emphasis on current evidence on diagnosis, imaging, molecular markers, and management of these carcinomas. MATERIALS AND METHODS We searched four databases, PubMed, Medline, EMBASE, and Emcare to identify studies published till October 2023. All studies reporting diagnostic tests, imaging, molecular marker expression and management of PDTC were included in the review. The meta-analysis was conducted on expression of molecular markers in these cancers following recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects meta-analysis was used to calculate pooled estimated prevalence with 95% confidence intervals. Based on the inclusion criteria, 62 articles were selected to be incorporated for the review. Differences in pathological diagnostic criteria of PDTC was noted in literature which was addressed in WHO 2022 diagnostic terminologies with expansion of the definition. Surgical management is uniformly recommended for early stage PDTC. However, literature is divided and anecdotal for recommendations on radioactive iodine (RAI), extent of neck dissection and adjuvant treatment in PDTC. Evidence for Next Generation Sequencing (NGS), novel theragnostic approaches, immunotherapy targets are evolving. Based on the subset analysis for expression of molecular markers, we found the most common markers expressed were TERT (41%), BRAF (28%) and P 53 (25%). CONCLUSION Poorly differentiated thyroid carcinomas have a high case fatality rate (up to 31%). Eighty-five % of the patients who succumb to the disease have distant metastasis. Even though under-represented in literature, evidence-based management of these aggressive tumors can help personalize the treatment for optimal outcomes.
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Affiliation(s)
- Sataksi Chatterjee
- Apollo Hospitals Group, Department of Oncology, Navi Mumbai, Maharashtra, India
| | - Manish Mair
- Department of Otorhinolaryngology, University Hospitals of Leicester, Leicester, UK
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Shikhar Sawhney
- Amrita Institute of Medical Sciences and Research Center, Faridabad, India
| | - Aananya Mishra
- Apollo Hospitals Group, Department of Oncology, Navi Mumbai, Maharashtra, India
| | | | - Anil Keith D'Cruz
- Apollo Hospitals Group, Department of Oncology, Navi Mumbai, Maharashtra, India.
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Oh Y, Park JH, Djunadi TA, Shah Z, Chung LIY, Chae YK. Deep response to a combination of mTOR inhibitor temsirolimus and dual immunotherapy of nivolumab/ipilimumab in poorly differentiated thyroid carcinoma with PTEN mutation: a case report and literature review. Front Endocrinol (Lausanne) 2024; 15:1304188. [PMID: 38356955 PMCID: PMC10864638 DOI: 10.3389/fendo.2024.1304188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Treating advanced thyroid cancer presents challenges due to its resistance to various treatment modalities, thereby limiting therapeutic options. To our knowledge, this study is the first to report the efficacy of temsirolimus in conjunction with dual immunotherapy of nivolumab/ipilimumab to treat heavily treated advanced PDTC. A 50-year-old female initially presented with a rapidly enlarging mass on her right neck. Subsequent diagnosis revealed poorly differentiated thyroid carcinoma, leading to a total thyroidectomy followed by post-operative radioablation therapy. After four years, an examination for persistent cough revealed a recurrence of the disease within multiple mediastinal nodes. Genetic analysis of blood samples uncovered somatic mutations in the tumor, specifically involving PTEN and TP53. The disease progressed despite palliative radiation, lenvatinib, and nivolumab/ipilimumab therapy. Consequently, temsirolimus, functioning as an mTOR inhibitor, was introduced as an adjunct to the nivolumab/ipilimumab regimen. This combination approach yielded remarkable clinical improvement and disease control for a duration of approximately six months. Temsirolimus likely suppressed the aberrantly activated PI3K/AKT/mTOR signaling pathway, facilitated by the PTEN genetic alteration, thus engendering an effective treatment response. This synergy between targeted agents and immunotherapy presents a promising therapeutic strategy for advanced PDTC patients with limited treatment alternatives. In previous clinical trials, mTOR inhibitors have demonstrated the ability to maintain stable disease (SD) in 65% to 74% for advanced thyroid cancer patients, including those with PDTC. When combined with other targeted therapies, the observed SD or partial response rates range from 80% to 97%. Many of these trials primarily involved differentiated thyroid carcinoma, with diverse genetic mutations. Thyroid cancer patients with alterations in the PI3K/mTOR/Akt appeared to benefit most from mTOR inhibitors. However, no clear association between the efficacy of mTOR inhibitors and specific histologies or genetic mutations has been established. Future studies are warranted to elucidate these associations.
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Affiliation(s)
- Youjin Oh
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States
| | - Joo Hee Park
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Trie Arni Djunadi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Zunairah Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Liam Il-Young Chung
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Young Kwang Chae
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Zarkesh M, Arab N, Abooshahab R, Heydarzadeh S, Sheikholeslami S, Nozhat Z, Salehi Jahromi M, Fanaei SA, Hedayati M. CpG island status as an epigenetic alteration for NIS promoter in thyroid neoplasms; a cross-sectional study with a systematic review. Cancer Cell Int 2022; 22:310. [PMID: 36221112 PMCID: PMC9555109 DOI: 10.1186/s12935-022-02720-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gene silence via methylation of the CpG islands is cancer's most common epigenetic modification. Given the highly significant role of NIS in thyroid cancer (TC) differentiation, this cross-sectional study aimed to investigate the DNA methylation pattern in seven CpG islands (CpG1-7 including +846, +918, +929, +947, +953, +955, and +963, respectively) of the NIS promoter in patients diagnosed with papillary (PTC), follicular (FTC), and multinodular goiter (MNG). Additionally, a systematic review of the literature was conducted to compare our results with studies concerning methylation of the NIS gene promoter. METHODS Thyroid specimens from 64 patients met the eligibility criteria, consisting of 28 PTC, 9 FTC, and 27 benign MNG cases. The mRNA of NIS was tested by qRT-PCR. The bisulfite sequencing PCR (BSP) technique was performed to evaluate the promoter methylation pattern of the NIS gene. Sequencing results were received in chromatograph, FASTA, SEQ, and pdf formats and were analyzed using Chromas. The methylation percentage at each position and for each sample was calculated by mC/(mC+C) formula for all examined CpGs; following that, the methylation percentage was also calculated at each CpG site. Besides, a literature search was conducted without restricting publication dates. Nine studies met the eligibility criteria after removing duplicates, unrelated articles, and reviews. RESULTS NIS mRNA levels decreased in tumoral tissues of PTC (P = 0.04) and FTC (P = 0.03) patients compared to their matched non-tumoral ones. The methylation of NIS promoter was not common in PTC samples, but it was frequent in FTC (P < 0.05). Significant differences were observed in the methylation levels in the 4th(+ 947), 6th(+ 955), and 7th(+ 963) CpGs sites in the forward strand of NIS promoter between FTC and MNG tissues (76.34 ± 3.12 vs 40.43 ± 8.42, P = 0.004, 69.63 ± 3.03 vs 23.29 ± 6.84, P = 0.001 and 50.33 ± 5.65 vs 24 ± 6.89, P = 0.030, respectively). There was no significant correlation between the expression and methylation status of NIS in PTC and FTC tissues. CONCLUSION Perturbation in NIS promoter's methylation individually may have a potential utility in differentiating MNG and FTC tissues. The absence of a distinct methylation pattern implies the importance of other epigenetic processes, which may alter the production of NIS mRNA. In addition, according to the reversibility of DNA methylation, it is anticipated that the design of particular targeted demethylation medicines will lead to a novel cancer therapeutic strategy.
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Affiliation(s)
- Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noman Arab
- Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shabnam Heydarzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sheikholeslami
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Nozhat
- Institute of Smart Biomedical Materials, School of Materials Science and Engineering, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Marziyeh Salehi Jahromi
- Department of Physiology and Pharmacology, Center for Diabetes and Endocrine Research, College of Medicine, University of Toledo, Toledo, OH, USA
| | | | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box: 19395-4763, Tehran, Iran.
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Tong J, Ruan M, Jin Y, Fu H, Cheng L, Luo Q, Liu Z, Lv Z, Chen L. Poorly differentiated thyroid carcinoma: a clinician's perspective. Eur Thyroid J 2022; 11:e220021. [PMID: 35195082 PMCID: PMC9010806 DOI: 10.1530/etj-22-0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Poorly differentiated thyroid carcinoma (PDTC) is a rare thyroid carcinoma originating from follicular epithelial cells. No explicit consensus can be achieved to date due to sparse clinical data, potentially compromising the outcomes of patients. In this comprehensive review from a clinician's perspective, the epidemiology and prognosis are described, diagnosis based on manifestations, pathology, and medical imaging are discussed, and both traditional and emerging therapeutics are addressed as well. Turin consensus remains the mainstay diagnostic criteria for PDTC, and individualized assessments are decisive for treatment option. The prognosis is optimal if complete resection is performed at early stage but dismal in nearly half of patients with locally advanced and/or distant metastatic diseases, in which adjuvant therapies such as 131I therapy, external beam radiation therapy, and chemotherapy should be incorporated. Emerging therapeutics including molecular targeted therapy, differentiation therapy, and immunotherapy deserve further investigations to improve the prognosis of PDTC patients with advanced disease.
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Affiliation(s)
- Junyu Tong
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Hao Fu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Lin Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Qiong Luo
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Zhiyan Liu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zhongwei Lv
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
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Sun Z, Yuan X, Du P, Chen P. High Expression of PDE8B and DUOX2 Associated with Ability of Metastasis in Thyroid Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2362195. [PMID: 34966441 PMCID: PMC8712144 DOI: 10.1155/2021/2362195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/27/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Hormone is an independent factor that induces differentiation of thyroid cancer (TC) cells. The thyroid-stimulating hormone (TSH) could promote the progression and invasion in TC cells. However, few genes related to hormone changes are studied in poorly differentiated metastatic TC. This study is aimed at constructing a gene set's coexpression correlation network and verifying the changes of some hub genes involved in regulating hormone levels. METHODS Microarray datasets of TC samples were obtained from public Gene Expression Omnibus (GEO) databases. R software and bioinformatics packages were utilized to identify the differentially expressed genes (DEGs), important gene module eigengenes, and hub genes. Subsequently, the Gene Ontology (GO) enrichment analysis was constructed to explore important biological processes that are associated with the mechanism of poorly differentiated TC. Finally, some hub gene expressions were validated through real-time PCR and immunoblotting. RESULTS Gene chip with category number GSE76039 was analyzed, and 1190 DEGs were screened with criteria of P < 0.05 and ∣log2foldchange | >2. Our analysis showed that human dual oxidase 2 (DUOX2) and phosphodiesterase 8B (PDE8B) are the two important hub genes in a coexpression network. In addition, the validated experimental results showed that the expression levels of both DUOX2 and PDE8B were elevated in poorly differentiated metastatic TC tissues. CONCLUSION This study identified and validated that DUOX2 and PDE8B were significantly associated with the metastasis ability of thyroid carcinoma.
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Affiliation(s)
- Zhenguo Sun
- Department of Nuclear Medicine, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang City 222000, China
| | - Xiaoshuai Yuan
- Department of Nuclear Medicine, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang City 222000, China
| | - Peng Du
- Department of Nuclear Medicine, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang City 222000, China
| | - Peng Chen
- Department of Nuclear Medicine, The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang City 222000, China
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TURAN G, ERUYAR A, KİRAZ U. Az Diferansiye Tiroid Karsinomlarının Turin ve “Memorial Sloan Kettering Kanser Merkezi” Kriterlerine Göre Retrospektif Değerlendirilmesi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.940859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Boutzios G, Papaoiconomou E, Pikoulis A, Nastos K, Pouloudi D, Pikouli A, Koukoulioti E, Lazaris A, Pikoulis E. p53 protein expression in synchronously occurring dedifferentiating stages of thyroid cancer in a patient with neurofibromas: A case report. Mol Clin Oncol 2021; 15:200. [PMID: 34462656 DOI: 10.3892/mco.2021.2362] [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: 04/16/2020] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma (ATC) have been hypothesized to arise from well-differentiated thyroid carcinoma (WDTC) due to frequently reported synchronous and metachronous occurrence. Loss of normal p53 function has been implicated in this dedifferentiation process. The current case report presents a 60-year-old male with multiple neurofibromas who underwent total thyroidectomy due to multiple palpable thyroid nodules. Histopathological examination revealed three foci of predominantly papillary, but also follicular carcinoma growth pattern, and two lesions with histological features of insular and trabecular variant, with the larger one showing foci of anaplastic transition. Nuclear p53 protein accumulation, corresponding to mutant abnormally stabilized p53, was higher in more aggressive variants compared with WDTC. The somatic molecular events and downstream pathways of this dedifferentiation course have not been unraveled yet. The present case report demonstrated the simultaneous presence of three divergent histological subtypes in a single thyroid gland, with progressive enhancement of nuclear p53 protein expression, associated with mutant p53 protein, in the more aggressive variants. This is a rare case of progressive enhancement of mutant nuclear p53 protein expression in multifocal thyroid tumor areas consisting of WDTC, PDTC and ATC histological types, highlighting the possibility that WDTC can progress to PDTC and then ATC through an intricate procedure, involving loss of normal p53 function.
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Affiliation(s)
- Georgios Boutzios
- Department of Pathophysiology, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Papaoiconomou
- Department of Pathophysiology, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Nastos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Despoina Pouloudi
- First Department of Pathology Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasia Pikouli
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Eleni Koukoulioti
- Department of Pathophysiology, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas Lazaris
- First Department of Pathology Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Zhang M, Lei S, Chen Y, Wu Y, Ye H. The role of lymph node status in cancer-specific survival and decision-making of postoperative radiotherapy in poorly differentiated thyroid cancer: a population-based study. Am J Transl Res 2021; 13:383-390. [PMID: 33527032 PMCID: PMC7847507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/14/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to investigate the prognostic value of lymph node (LN) status for patients with poorly differentiated thyroid cancer (PDTC), and to develop a reliable nomogram to predict the 3-, 5- and 10-year cancer-specific survival (CSS) and assist the decision-making of postoperative radiotherapy (PORT). METHODS The Surveillance, Epidemiology, and End Results (SEER) database was utilized to screen eligible patients who were diagnosed between 2004 and 2016. The optimal values of age, metastatic lymph node ratio (LNR), and the number of metastatic lymph nodes (MLN) were determined and incorporated into the construction of a nomogram. The performance of the model was evaluated by generating a calibration curve and calculating the consistency index (C-index). Based on the nomogram, patients were classified into three risk cohorts. The prognostic efficacy of PORT was evaluated in each cohort. RESULTS A total of 522 PDTC patients were included in this study. The LN status-associated parameters (MLN and LNR) were independent risk factors for CSS of PDTC patients. Based on MLN, LNR, and other clinical characteristics (age and T stage), an individualized nomogram was constructed that showed an acceptable predictive performance. Furthermore, we proposed a novel risk-classification system to stratify PDTC patients and to assess the prognostic efficacy of PORT. Only patients in high-risk cohort were found eligible to benefit from PORT. CONCLUSION LN status is statistically associated with the prognosis of PDTC patients. In addition, the individualized nomogram may be a significant tool to assist the evaluation of patients' long-term prognosis and to guide the decision-making for PORT.
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Affiliation(s)
- Maojie Zhang
- Clinical Medical College, Guizhou Medical UniversityGuiyang 550001, Guizhou, China
- Department of Thyroid Surgery, The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550001, Guizhou, China
| | - Siyi Lei
- Clinical Medical College, Guizhou Medical UniversityGuiyang 550001, Guizhou, China
| | - Yuanyi Chen
- Guizhou First People’s HospitalGuiyang, China
| | - Yuzhou Wu
- Gui Hang Group Guiyang 300 HospitalGuiyang, China
| | - Hui Ye
- Department of Thyroid Surgery, The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550001, Guizhou, China
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Clinicopathological Characteristics and Prognosis of Poorly Differentiated Thyroid Carcinoma Diagnosed According to the Turin Criteria. Endocr Pract 2020; 27:401-407. [PMID: 33934750 DOI: 10.1016/j.eprac.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/26/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Poorly differentiated thyroid carcinoma (PDTC) is the primary cause of death in patients with nonanaplastic follicular cell-derived thyroid carcinoma. We purposed to identify the clinical and pathological characteristics of PDTC and their relationship with prognosis. METHODS A retrospective analysis was conducted on patients diagnosed with PDTC at our institution from 2010 to 2018. All of their histopathology slides were reviewed by 2 experienced pathologists based on the Turin criteria. Furthermore, information regarding clinical characteristics, pathological characteristics, treatment strategy, and follow-up events were collected. The Kaplan-Meier method was used for survival analysis, while the log-rank test was used to compare survival curves. Then, the Cox proportional hazards model was used to perform univariate and multivariate analyses. RESULTS Twenty-six patients with PDTC who met the Turin criteria were enrolled in this study. The median follow-up period of the included 26 patients was 76 months, while the 3- and 5-year survival rates were 40% and 18%, respectively. Notably, univariate analysis revealed that tumor size >4 cm (P = .038), extrathyroidal extension (ETE) (P = .020), distant metastases (P = .047), poorly differentiated areas >60% (P = .049), and Ki-67 labeling index >30% (P = .040) were associated with poor prognosis. On the other hand, multivariate analysis identified ETE (P = .007) and distant metastases (P = .031) as independent risk factors for poor prognosis. CONCLUSION PDTC is a rare carcinoma with high invasiveness and poor prognosis. Patients with ETE or distant metastases may have adverse outcomes.
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Tang Y, Meng X, Yu X, Shang H, Chen S, Liao L, Dong J. Inhibition of microRNA-875-5p promotes radioiodine uptake in poorly differentiated thyroid carcinoma cells by upregulating sodium-iodide symporter. J Endocrinol Invest 2020; 43:439-450. [PMID: 31612419 DOI: 10.1007/s40618-019-01125-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/25/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Poorly differentiated thyroid carcinoma (PDTC) is an endocrine malignancy that is challenging to treat due to its limited radioiodine uptake. microRNAs (miRNAs or miRs) have been shown to be useful in treating many types of tumors, including PDTC. This study aims to evaluate the potential effect of miR-875-5p on the radioiodine uptake of PDTC and to clarify the underlying mechanisms. METHODS Expression of miR-875-5p and sodium-iodide symporter (NIS) in tissues and cell lines was determined using RT-qPCR. The binding relationship between miR-875-5p and NIS was predicted through in silico analysis and verified by dual-luciferase reporter gene assay. A series of miR-875-5p mimic, miR-875-5p inhibitor, shRNA against NIS, and overexpressed NIS plasmids were introduced into PDTC cells. We then evaluated the cell viability, colony formation, apoptosis, and radioiodine uptake of each PDTC sample via CCK-8 assay, clonogenic assay, flow cytometry, and γ counter, respectively. RESULTS miR-875-5p was found to be highly expressed, but NIS was poorly expressed in DTC tissues and PDTC cell lines. NIS was verified to be a target gene of miR-875-5p. Upregulation of miR-875-5p was found to induce PDTC cell proliferation, and reduce apoptosis and radioiodine uptake in vitro through down-regulation of NIS. In an in vivo orthotopic model, the enhancement of miR-875-5p led to the reduction of NIS expression and radioiodine uptake in the thyroid tumors. CONCLUSIONS Altogether, the findings of the current study suggest that down-regulated miR-875-5p expression could promote its target gene NIS to increase radioiodine uptake in PDTC, constituting a preventive strategy against PDTC.
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Affiliation(s)
- Y Tang
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan, 250014, Shandong Province, People's Republic of China
- Department of Endocrinology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, People's Republic of China
| | - X Meng
- Department of Endocrinology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, People's Republic of China
| | - X Yu
- Department of Endocrinology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, People's Republic of China
| | - H Shang
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan, 250014, Shandong Province, People's Republic of China
| | - S Chen
- Department of Endocrinology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, People's Republic of China
| | - L Liao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan, 250014, Shandong Province, People's Republic of China.
| | - J Dong
- Department of Endocrinology, Qilu Hospital of Shandong University, No. 107, Wenhua West Road, Jinan, 250012, Shandong Province, People's Republic of China.
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Fleeman N, Houten R, Bagust A, Richardson M, Beale S, Boland A, Dundar Y, Greenhalgh J, Hounsome J, Duarte R, Shenoy A. Lenvatinib and sorafenib for differentiated thyroid cancer after radioactive iodine: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-180. [PMID: 31931920 PMCID: PMC6983913 DOI: 10.3310/hta24020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Thyroid cancer is a rare cancer, accounting for only 1% of all malignancies in England and Wales. Differentiated thyroid cancer (DTC) accounts for ≈94% of all thyroid cancers. Patients with DTC often require treatment with radioactive iodine. Treatment for DTC that is refractory to radioactive iodine [radioactive iodine-refractory DTC (RR-DTC)] is often limited to best supportive care (BSC). OBJECTIVES We aimed to assess the clinical effectiveness and cost-effectiveness of lenvatinib (Lenvima®; Eisai Ltd, Hertfordshire, UK) and sorafenib (Nexar®; Bayer HealthCare, Leverkusen, Germany) for the treatment of patients with RR-DTC. DATA SOURCES EMBASE, MEDLINE, PubMed, The Cochrane Library and EconLit were searched (date range 1999 to 10 January 2017; searched on 10 January 2017). The bibliographies of retrieved citations were also examined. REVIEW METHODS We searched for randomised controlled trials (RCTs), systematic reviews, prospective observational studies and economic evaluations of lenvatinib or sorafenib. In the absence of relevant economic evaluations, we constructed a de novo economic model to compare the cost-effectiveness of lenvatinib and sorafenib with that of BSC. RESULTS Two RCTs were identified: SELECT (Study of [E7080] LEnvatinib in 131I-refractory differentiated Cancer of the Thyroid) and DECISION (StuDy of sorafEnib in loCally advanced or metastatIc patientS with radioactive Iodine-refractory thyrOid caNcer). Lenvatinib and sorafenib were both reported to improve median progression-free survival (PFS) compared with placebo: 18.3 months (lenvatinib) vs. 3.6 months (placebo) and 10.8 months (sorafenib) vs. 5.8 months (placebo). Patient crossover was high (≥ 75%) in both trials, confounding estimates of overall survival (OS). Using OS data adjusted for crossover, trial authors reported a statistically significant improvement in OS for patients treated with lenvatinib compared with those given placebo (SELECT) but not for patients treated with sorafenib compared with those given placebo (DECISION). Both lenvatinib and sorafenib increased the incidence of adverse events (AEs), and dose reductions were required (for > 60% of patients). The results from nine prospective observational studies and 13 systematic reviews of lenvatinib or sorafenib were broadly comparable to those from the RCTs. Health-related quality-of-life (HRQoL) data were collected only in DECISION. We considered the feasibility of comparing lenvatinib with sorafenib via an indirect comparison but concluded that this would not be appropriate because of differences in trial and participant characteristics, risk profiles of the participants in the placebo arms and because the proportional hazard assumption was violated for five of the six survival outcomes available from the trials. In the base-case economic analysis, using list prices only, the cost-effectiveness comparison of lenvatinib versus BSC yields an incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained of £65,872, and the comparison of sorafenib versus BSC yields an ICER of £85,644 per QALY gained. The deterministic sensitivity analyses show that none of the variations lowered the base-case ICERs to < £50,000 per QALY gained. LIMITATIONS We consider that it is not possible to compare the clinical effectiveness or cost-effectiveness of lenvatinib and sorafenib. CONCLUSIONS Compared with placebo/BSC, treatment with lenvatinib or sorafenib results in an improvement in PFS, objective tumour response rate and possibly OS, but dose modifications were required to treat AEs. Both treatments exhibit estimated ICERs of > £50,000 per QALY gained. Further research should include examination of the effects of lenvatinib, sorafenib and BSC (including HRQoL) for both symptomatic and asymptomatic patients, and the positioning of treatments in the treatment pathway. STUDY REGISTRATION This study is registered as PROSPERO CRD42017055516. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Nigel Fleeman
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rachel Houten
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Adrian Bagust
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Marty Richardson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Juliet Hounsome
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Aditya Shenoy
- The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
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15
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Walczyk A, Kopczyński J, Gąsior-Perczak D, Pałyga I, Kowalik A, Chrapek M, Hejnold M, Góźdź S, Kowalska A. Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System (eighth edition). Clin Endocrinol (Oxf) 2019; 91:331-339. [PMID: 30525210 DOI: 10.1111/cen.13910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Poorly differentiated thyroid cancer (PDTC) is a rare, but aggressive thyroid cancer (TC) and a main cause of death from non-anaplastic follicular cell-derived TC. Assessing the risk of PDTC-related death and the risk of recurrence is important for clinicians. The recent American Thyroid Association (ATA) 2015 guidelines and the updated 8th edition of the American Joint Committee on Cancer/Tumor-Node-Metastasis (AJCC/TNM) staging system should support clinicians in the management approach to PDTC patients. PATIENTS Forty-six consecutive PDTC patients treated in a single oncologic centre, 2000-2017. MEASUREMENTS Retrospective analysis of TNM stage, initial risk, response-to-therapy categories, follow-up and final disease status incorporating the ATA 2015 criteria and the 8th AJCC/TNM staging system. Disease-specific survival (DSS) using the Kaplan-Meier method. RESULTS Of the 46 PDTC 21 (45.6%) were ATA high risk (HR), 22 (47.8%), 17 (37%) and seven (15.2%) were TNM stages I, II, and III-IV, respectively. During a median follow-up of 55.5 months, two (4.3%) patients were recurrent, 18 (39.1%) died of PDTC. The 5-/10-year DSS were 65/57%, respectively. According to the AJCC/TNM, the 5-/10-year DSS of I, II, and III-IV stage were 83/83%; 77/55%, and 0/0%, respectively. According to the 2015 ATA initial risk, the 5-/10-year DSS were 91/72% for ATA intermediate risk and 38/38% for ATA HR patients. CONCLUSIONS In PDTC patients, the updated AJCC/TNM staging system accurately predicts a high risk of death in stage III-IV, whereas it seems to be inadequate for predicting a very low or low risk of death expected for differentiated TC in stage I-II. The ATA initial HR may be also used to predict a high risk of PDTC-related death.
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Affiliation(s)
- Agnieszka Walczyk
- Department of Endocrinology, Holycross Cancer Center, Kielce, Poland
| | - Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | | | - Iwona Pałyga
- Department of Endocrinology, Holycross Cancer Center, Kielce, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland
| | - Magdalena Chrapek
- Faculty of Mathematics and Natural Sciences, Department of Probability Theory and Statistics Institute of Mathematics, Jan Kochanowski University, Kielce, Poland
| | - Maria Hejnold
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Stanisław Góźdź
- Department of Clinical Oncology, Holycross Cancer Center, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Center, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Impact factors for the outcome of the first 131I radiotherapy in patients with papillary thyroid carcinoma after total thyroidectomy. Ann Nucl Med 2018; 33:177-183. [DOI: 10.1007/s12149-018-01321-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/11/2018] [Indexed: 12/14/2022]
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17
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Li G, Lei J, Song L, Jiang K, Wei T, Li Z, Gong R, Zhu J. Radioiodine refractoriness score: A multivariable prediction model for postoperative radioiodine-refractory differentiated thyroid carcinomas. Cancer Med 2018; 7:5448-5456. [PMID: 30264548 PMCID: PMC6246937 DOI: 10.1002/cam4.1794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The purpose of the present study was to evaluate the clinical features of patients with radioiodine refractory (RAIR) differentiated thyroid carcinoma (DTC) and establish an effective risk score for postoperative radioiodine refractoriness. SUBJECTS AND METHODS Data were retrospectively collected from 5163 patients admitted to our center after thyroid surgery. Radioiodine refractoriness was defined according to criteria used in the 2015 American Thyroid Association guidelines. The scoring system was established by independent risk factors identified by univariate and multivariate analyses. The optimal index points for predicting the prevalence of radioiodine refractoriness and the model discriminatory power were assessed by receiver operating characteristic (ROC) curves. RESULTS One hundred and twelve (2.2%) patients developed RAIR DTC. Smoking, tumor type (follicular thyroid cancer), extrathyroid extension, lymph node metastasis number (≥4), lymph node metastasis rate (≥53%), and pN stage (N1) were highly positively correlated with the prevalence of RAIR DTC. The cutoff value of seven points was found to be the best for predicting the prevalence of RAIR DTC, and the scoring system presented better discrimination than other single independent predictors. CONCLUSIONS Based on our multivariable prediction model, patients with ≥7 index points may need to undergo more active surveillance or aggressive treatment due to the high risk of RAIR DTC.
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Affiliation(s)
- Genpeng Li
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Linlin Song
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Ke Jiang
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Tao Wei
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Zhihui Li
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Rixiang Gong
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery CenterWest China Hospital of Sichuan UniversityChengduChina
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Magalhães D, Costa C, Furtado I, Matos MJ, Santos AP, Duarte H, Afonso M, Lobo J, Torres I. Seemingly Harmless Differentiated Thyroid Carcinoma Presenting as Bone Metastasis. Case Rep Endocrinol 2018; 2018:8749075. [PMID: 29967702 PMCID: PMC6008661 DOI: 10.1155/2018/8749075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 02/08/2023] Open
Abstract
Thyroid carcinoma is the most common endocrine neoplasia. Differentiated thyroid carcinomas (DTCs) represent the majority of cases, which usually follow an indolent clinical course with low mortality rates. The authors describe two cases of well DTC without classic histological poor prognosis features, presenting as extensive and unresectable osteolytic bone metastases. DTCs are considered harmless tumours, due to their benign and silent behaviour. The authors want to underline the importance of clinical awareness during follow-up in cases of DTC, which can be aggressive in presentation and behaviour. Timely identification and diagnosis of these tumours are essential for prompt treatment initiation and improvement of overall survival.
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Affiliation(s)
- D. Magalhães
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - C. Costa
- Endocrinology Department, Instituto Português de Oncologia, Porto, Portugal
| | - I. Furtado
- Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
| | - M. J. Matos
- Endocrinology Department, Instituto Português de Oncologia, Porto, Portugal
| | - A. P. Santos
- Endocrinology Department, Instituto Português de Oncologia, Porto, Portugal
| | - H. Duarte
- Nuclear Medicine Department, Instituto Português de Oncologia, Porto, Portugal
| | - M. Afonso
- Pathology Department, Instituto Português de Oncologia, Porto, Portugal
| | - J. Lobo
- Pathology Department, Instituto Português de Oncologia, Porto, Portugal
- Cancer Biology and Epigenetics Group, Research Center, Instituto Português de Oncologia, Porto, Portugal
- Pathology and Molecular Immunology Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - I. Torres
- Endocrinology Department, Instituto Português de Oncologia, Porto, Portugal
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Yang H, Chen Z, Wu M, Lei T, Yu H, Ge M. Remarkable response in 2 cases of Advanced Poorly Differentiated Thyroid Carcinoma with liposomal doxorubicin plus cisplatin. Cancer Biol Ther 2017; 17:693-7. [PMID: 27302615 DOI: 10.1080/15384047.2016.1167295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Poorly Differentiated Thyroid Carcinoma (PDTC), especially advanced PDTC, is an aggressive disease and displays a much poorer prognosis compared with well differentiated thyroid carcinoma. Surgery is the recommended treatment in the early stage of PDTC, however, no effective treatment modalities are currently available for advanced PDTCMethods: Two advanced PDTC patients with no radioiodine uptake adopted a cytotoxic chemotherapy with liposomal doxorubicin (35 mg/m(2), day 1) plus cisplatin (75 mg/m(2), day1-3) every 3 weeks. Computer tomography (CT) was performed after 6 cycles (case 1) or 5 cycles (case 2) of chemotherapy RESULTS Our patients achieved remarkable response with one a Complete Remission (CR) and the other a very good Partial Remission (PR)Conclusion: Our findings indicate that liposomal doxorubicin-based chemotherapy regimens might produce response in PDTC patients, and improve their overall survival and quality of life. Hence we believe this result is very important for oncologists in treating PDTC.
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Affiliation(s)
- Haiyan Yang
- a Chemotherapy Center, Zhejiang Province Cancer Hospital , Hangzhou , PR China
| | - Zhongjian Chen
- b Laboratory of Clinical Pharmacy, Zhejiang Province Cancer Hospital , Hangzhou , PR China
| | - Meijuan Wu
- c Department of Pathology , Zhejiang Province Cancer Hospital , Hangzhou , PR China
| | - Tao Lei
- a Chemotherapy Center, Zhejiang Province Cancer Hospital , Hangzhou , PR China
| | - Haifeng Yu
- a Chemotherapy Center, Zhejiang Province Cancer Hospital , Hangzhou , PR China
| | - Minghua Ge
- d Department of Head and Neck Surgery , Zhejiang Province Cancer Hospital , Hangzhou , PR China
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Yu MG, Rivera J, Jimeno C. Poorly Differentiated Thyroid Carcinoma: 10-Year Experience in a Southeast Asian Population. Endocrinol Metab (Seoul) 2017; 32:288-295. [PMID: 28685518 PMCID: PMC5503875 DOI: 10.3803/enm.2017.32.2.288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/27/2017] [Accepted: 05/08/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND No previous studies have been published on poorly differentiated thyroid carcinoma (PDTC) in Southeast Asia. METHODS We included all adult PDTC patients diagnosed using the Turin criteria at the Philippine General Hospital from 2006 to 2015. The data collected included demographics, clinical presentation, histopathology, treatment, and outcomes. Tests of association were employed to compare these data with foreign studies on PDTC, as well as with local studies on well differentiated thyroid carcinoma (WDTC) and anaplastic thyroid carcinoma (ATC). RESULTS Eighteen PDTC cases were identified. The median age was 62 years old, with the majority being females. All patients had goiter on presentation, and most were stage IV at the time of diagnosis. In terms of PDTC subtype, insular and trabecular patterns were equally common. Extrathyroidal extension was documented in eight patients, while five patients each had nodal and distant metastasis. All but one patient underwent surgery; however, less than half received adjuvant radioiodine therapy. The 5-year survival rate was 83%. Three patients (16.7%) died at a median of 12 months after diagnosis. Nine (50%) are still alive with persistent and/or recurrent disease at a median of 39 months after diagnosis. CONCLUSION The behavior of PDTC in this Southeast Asian population was found to be similar to patterns observed in other regions, and exhibited intermediate features between WDTC and ATC. Appropriate surgery provided excellent 5-year survival rates, but the role of adjuvant therapy remains unclear. Larger studies are needed to identify prognostic factors in this population.
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Affiliation(s)
- Marc Gregory Yu
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Philippine General Hospital, Manila, Philippines.
| | - Jonathan Rivera
- Department of Pathology, Philippine General Hospital, Manila, Philippines
| | - Cecilia Jimeno
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Philippine General Hospital, Manila, Philippines
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Feffer JB, Usera GL, Schulman RC. Unilateral Exophthalmos Due To Metastasis Of Poorly Differentiated Thyroid Carcinoma To The Left Sphenoid Wing With Intra-Orbital Extension. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161276.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Murphy C, Schwalb H, Berlangieri S, Eek R. Intraluminal Superior Vena Cava Metastasis in a Patient With Poorly Differentiated Thyroid Carcinoma. J Clin Oncol 2015; 33:e119-21. [PMID: 24752048 DOI: 10.1200/jco.2013.51.8753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Caitlin Murphy
- Albury Base Hospital, Albury, New South Wales; Border Medical Oncology, Wodonga, Victoria, Australia
| | | | | | - Richard Eek
- Albury Base Hospital, Albury, New South Wales; Border Medical Oncology, Wodonga, Victoria, Australia
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Cherkaoui GS, Guensi A, Taleb S, Idir MA, Touil N, Benmoussa R, Baroudi Z, Chikhaoui N. Poorly differentiated thyroid carcinoma: a retrospective clinicopathological study. Pan Afr Med J 2015; 21:137. [PMID: 26327974 PMCID: PMC4546773 DOI: 10.11604/pamj.2015.21.137.6720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/19/2015] [Indexed: 11/11/2022] Open
Abstract
Poorly differentiated thyroid carcinoma (PDTC) is an independent thyroid cancer histotype. In spite of its scarcity, it represents the main cause of death from non-anaplastic follicular cell-derived thyroid cancer. However, given the newness of this entity, few data are available on its clinical behaviour and no explicit consensus sets its treatment. To report the experience of a tertiary medical centre in morocco with PDTC over a period of 7 years. Retrospective study selecting all patients treated for thyroid carcinoma in Nuclear Medicine Department of a tertiary medical centre in Casablanca over seven years period. Patient's files were reviewed for background data, clinico-pathological characteristics, treatment and outcome. Seven patients were included in the study. Patient's average age was 60 years old (30-81) including six women and one man. All patients underwent a total thyroidectomy completed by cervical lymph node dissection in 57% of cases. Mean primary tumour size was 4cm (1-9cm). Patients were classified pT3 in 70% of cases, pT1 and pT2 in 15% each. Vascular invasion was found in 85% of cases. Pathological subtypes found were "insular carcinoma" in 85% of cases. Radioiodine therapy (RIT) was indicated in all cases. Follow-up period ranged between 10 months and 6 years. It showed a complete remission in 57% of cases, persistent disease in 28% of cases and a progressive disease in 15% of cases with a local recurrence. To date, the survival rate is 85%. PDTC is an aggressive thyroid cancer histotype. Treatment remains surgical followed by RIT if the tumour is radioavid. Multimodality therapy is indicated depending on the case and close monitoring is always indicated given the high risk of relapse.
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Affiliation(s)
- Ghofrane Salhi Cherkaoui
- Nuclear Medicine Department, Ibn Rochd University Hospital, Université Hassan II, Casablanca, Morocco
| | - Amal Guensi
- Nuclear Medicine Department, Ibn Rochd University Hospital, Université Hassan II, Casablanca, Morocco
| | - Sara Taleb
- Nuclear Medicine Department, Ibn Rochd University Hospital, Université Hassan II, Casablanca, Morocco
| | - Malika Ait Idir
- Nuclear Medicine Department, Ibn Rochd University Hospital, Université Hassan II, Casablanca, Morocco
| | - Najwa Touil
- Emergency Radiology Department, Ibn Rochd University Hospital, Université Hassan II Casablanca, Morocco
| | - Rita Benmoussa
- Emergency Radiology Department, Ibn Rochd University Hospital, Université Hassan II Casablanca, Morocco
| | - Zaineb Baroudi
- Emergency Radiology Department, Ibn Rochd University Hospital, Université Hassan II Casablanca, Morocco
| | - Nabil Chikhaoui
- Emergency Radiology Department, Ibn Rochd University Hospital, Université Hassan II Casablanca, Morocco
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Papp S, Asa SL. When thyroid carcinoma goes bad: a morphological and molecular analysis. Head Neck Pathol 2015; 9:16-23. [PMID: 25804379 PMCID: PMC4382495 DOI: 10.1007/s12105-015-0619-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
Abstract
Thyroid carcinomas of follicular epithelial derivation are common and generally well-behaved malignancies with excellent cure and survival rates. However, a subset of these carcinomas, whether well-differentiated, poorly differentiated, or anaplastic, is highly aggressive, manifesting with local invasion, recurrence, and distant metastasis. The recognition of dedifferentiation is of paramount importance. In addition, the challenge for Pathologists is to identify the rare aggressive differentiated carcinomas so that treatment may be tailored appropriately. Thus, histological subtyping and documentation of other aggressive features such as widespread invasion and angioinvasion are critical. Mutational analyses in the past decade have delineated the molecular alterations responsible for thyroid carcinogenesis and progression, allowing greater sub-classification and prognostication of thyroid carcinomas. This review article highlights important aggressive morphologic features and molecular mutations associated with thyroid carcinoma.
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Affiliation(s)
- Sylvia Papp
- Department of Pathology, Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON M5G 2C4 Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Sylvia L. Asa
- Department of Pathology, Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON M5G 2C4 Canada ,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
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Abstract
PURPOSE OF REVIEW Poorly differentiated thyroid carcinomas (PDTCs) comprise a small subset of heterogeneous thyroid tumors, occupying an intermediate area between well differentiated follicular or papillary carcinoma and anaplastic carcinomas, from both a histopathogenetic and a clinical point of view. PDTCs are more aggressive than the well differentiated, but less aggressive than the anaplastic thyroid cancers. They have a distinct biological behavior, and the classification of these tumors into a separate group appears justified. RECENT FINDINGS The criteria used to diagnose PDTC have been an area of controversy. The multiple definitions of PDTC make the literature difficult to interpret. No clinical features can accurately diagnose PDTCs. Thus, the results of histocytology, immunohistochemistry, and molecular genetics tests aid in diagnosis. Given the aggressiveness of PDTCs, with increased recurrence and decreased survival rates, a multimodality treatment approach is required. SUMMARY We conducted a comprehensive review of the current diagnostic and therapeutic tools in the management of patients with PDTCs. The present article aims to review the various aspects of this tumor type, from morphology to immunohistochemistry, and molecular abnormalities from a practical and daily practice-oriented point of view.
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Glassmann A, Winter J, Kraus D, Veit N, Probstmeier R. Pharmacological suppression of the Ras/MAPK pathway in thyroid carcinoma cells can provoke opposite effects on cell migration and proliferation: The appearance of yin-yang effects and the need of combinatorial treatments. Int J Oncol 2014; 45:2587-95. [PMID: 25269412 DOI: 10.3892/ijo.2014.2668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/01/2014] [Indexed: 11/06/2022] Open
Abstract
A major challenge in tumor therapy is the decrease or even the halting of cell proliferation and migration of cancerous cells. In the present study, we have analyzed the impact of a pharmacological blockade of the PI3K/Akt and MAPK/ERK1/2 signaling pathways on cell migration, proliferation and cell death in three human thyroid tumor cell lines that represent the main types of malignant thyroid carcinomas (B-CPAP, follicular; Cal-62, anaplastic; FTC-133, papillary thyroid carcinoma cells) and in which these pathways are constitutively activated. In general, pharmacological perturbation of PI3/Akt (application of MK-2206) and MEK/ERK1/2 (application of PD0325901 or U0126) signaling led to a cell line and drug-specific decrease in the proliferation and migration potential of thyroid carcinoma cells, although to a varying extent. However, one exception became apparent: in Cal-62 cells inhibition of the MEK/ERK1/2 module increased the migration rate up to 50%. This effect could be prevented by a simultaneous suppression of the PI3/Akt pathway, but also by application of the multiple kinase inhibitor sorafenib, a treatment that did not change the activation state of Akt. Thus, a pharmacological perturbation of canonical signaling pathways in thyroid carcinoma may induce drug-dependent yin-yang effects that are characterized by a simultaneous suppression of one (i.e., proliferation) and the activation of another (i.e., migration) cellular process. The appearance of such phenomena should be taken into account when therapy plans are established.
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Affiliation(s)
| | - Jochen Winter
- Oral Cell Biology Group, Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Dominik Kraus
- Department of Prosthodontics, Preclinical Education and Material Science, University of Bonn, Bonn, Germany
| | - Nadine Veit
- Neuro- and Tumor Cell Biology Group, Department of Nuclear Medicine, University Hospital of Bonn, Bonn, Germany
| | - Rainer Probstmeier
- Neuro- and Tumor Cell Biology Group, Department of Nuclear Medicine, University Hospital of Bonn, Bonn, Germany
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Sabih Q, Spafford MF, Dietl CA. Poorly differentiated thyroid carcinoma with sternal invasion. A case report and review of the literature. Int J Surg Case Rep 2014; 5:816-20. [PMID: 25308189 PMCID: PMC4245677 DOI: 10.1016/j.ijscr.2014.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022] Open
Abstract
Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction have been reported. We report a 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion who underwent total thyroidectomy and partial sternal resection and chest wall reconstruction. In previous case reports the sternal tumor was not in continuity with the thyroid tumor. Despite developing an early local recurrence, there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively.
INTRODUCTION Surgical resection of poorly differentiated thyroid carcinoma with direct invasion of the sternum has not been previously reported. Only 4 cases of concomitant thyroidectomy and sternal resection and reconstruction for sternal metastases have been published. PRESENTATION OF CASE A 66-year-old female with a poorly differentiated thyroid carcinoma and direct sternal invasion underwent total thyroidectomy and resection of the manubrium and both clavicular heads, and chest wall reconstruction with polypropylene mesh and bilateral myocutaneous pectoralis major muscle flaps. Postoperatively, the patient received radioactive iodine ablation. She developed a local recurrence, requiring additional ablation with radioactive iodine and external beam radiation therapy. Although there was no clinical or radiographic evidence of recurrent disease 5-years postoperatively, a possible local recurrence was discovered 4 months later. DISCUSSION In previous case reports the sternal metastases were not in continuity with the thyroid tumor. In our patient, however, there was evidence of direct extension between the thyroid tumor and the sternal mass that were connected together with cords of tumor. CONCLUSION In our patient with poorly differentiated thyroid carcinoma invading the sternum, total thyroidectomy and resection of the manubrium with sternal reconstruction, combined with adjuvant radioactive iodine ablation and external beam radiation therapy was associated with prolonged survival after 5 years despite a small local recurrence.
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Affiliation(s)
- Quaratulain Sabih
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Michael F Spafford
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Charles A Dietl
- Division of Cardiothoracic Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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Lote H, Bhosle J, Thway K, Newbold K, O'Brien M. Epidermal growth factor mutation as a diagnostic and therapeutic target in metastatic poorly differentiated thyroid carcinoma: a case report and review of the literature. Case Rep Oncol 2014; 7:393-400. [PMID: 25076890 PMCID: PMC4107819 DOI: 10.1159/000364856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Poorly differentiated cancers are a diagnostic and therapeutic challenge in oncology. New therapies are needed for patients with poorly differentiated thyroid carcinoma (PDTC) or anaplastic thyroid cancer, as these patients often present with advanced disease and effective systemic treatment options are currently limited. Epidermal growth factor (EGFR) mutations may occur in PDTC more often than previously thought. However, there are fewer than 6 cases reported in the literature where EGFR tyrosine kinase inhibitors (TKIs) (such as erlotinib or gefitinib) were used to target EGFR mutations in PDTC. Here, we present the case of a 79-year-old male with metastatic PDTC with an EGFR mutation who responded to treatment with the selective EGFR TKI erlotinib, with a progression-free survival of more than 11 months. A lung primary rather than a thyroid primary was initially detected. We suggest that the EGFR status should be analysed at diagnosis in any patient with a poorly differentiated tumour. The presence of an EGFR mutation may provide an effective therapeutic pathway for these patients. This pathway requires further investigation and consideration in the future.
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Affiliation(s)
- Hazel Lote
- Royal Marsden Hospital, Sutton, Surrey, UK
| | | | - Khin Thway
- Royal Marsden Hospital, Sutton, Surrey, UK
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Bruixola G, Segura Á, Caballero J, Andrés A, Reche E, Escoín C, Díaz-Beveridge R. Heart failure as first sign of development of cardiac metastases in a patient with diagnosis of papillary thyroid carcinoma on treatment with tyrosine-kinase inhibitors: differential diagnoses and clinical management. Case Rep Oncol 2014; 7:591-9. [PMID: 25298765 PMCID: PMC4178319 DOI: 10.1159/000366192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac metastases from papillary thyroid carcinoma are very uncommon. Their incidence is rising due to improvements in survival and diagnosis; nevertheless, our patient is the fourth case reported up to date. There are no clinical trials available in this scenario. Therefore, treatment choice is made based on clinical experience and case reports; notably, the largest case report series was prior to the approval for using tyrosine-kinase inhibitors in thyroid cancer. PATIENT A 73-year-old lady had dedifferentiated papillary thyroid cancer with ongoing sorafenib. After 9 months on this treatment, she presented with dyspnea and heart failure. Differential diagnosis included infection, progression of disease and cardiotoxicity. After a comprehensive assessment (echocardiography, computed tomography, PET, magnetic resonance), we found progression of lung disease, and the appearance of heart metastases. RESULTS After recovering from the basal status, she started on second-line treatment with sunitinib, which was well-tolerated. She achieved stable disease with a decrease in tumor marker levels. CONCLUSIONS We should include cardiac metastases in the differential diagnosis of heart failure in cancer patients. Magnetic resonance imaging is the gold standard for assessment. Sorafenib is the mainstay of the first-line therapy in metastatic thyroid cancer, achieving long-term disease control with good tolerance. Sunitinib could be a safe second-line treatment option (not cardiotoxicity related) with promising results. Therefore, our report presents a sequence of treatment with tyrosine-kinase inhibitors in metastatic thyroid carcinoma with an encouraging outcome, which deserves further investigation.
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Affiliation(s)
- Gema Bruixola
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ángel Segura
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Javier Caballero
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana Andrés
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Encarnación Reche
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Corina Escoín
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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