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Dolidze DD, Bagatelia ZA, Lukin AY, Сovantsev SD, Shevyakova TV, Pichugina NV, Skripnichenko DM, Mulaeva KA. The possibilities of ultrasound imaging in the diagnosis of follicular neoplasia of the thyroid gland. HEAD AND NECK TUMORS (HNT) 2023; 13:81-90. [DOI: 10.17650/2222-1468-2023-13-1-81-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Thyroid cancer is the most common cancer of the endocrine system. The diagnosis of thyroid cancer has taken a step forward due to the introduction of fine-needle biopsy of the thyroid gland with subsequent evaluation of cytological material using the Bethesda system. One category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the neoplasia as benign or malignant and requires surgical intervention. The traditional informative and widely used method for diagnosing thyroid tumors is ultrasound. However, the sensitivity and specificity of the method varies over a wide range. This review analyzes the literature on the possibilities of ultrasound diagnostics in assessing the malignant potential of follicular tumors of the thyroid gland.
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Affiliation(s)
- D. D. Dolidze
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - Z. A. Bagatelia
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - A. Yu. Lukin
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - S. D. Сovantsev
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - T. V. Shevyakova
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - N. V. Pichugina
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | | | - K. A. Mulaeva
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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2
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Dolidze DD, Shabunin AV, Сovantsev SD, Bagateliya ZA, Kobzev YN, Rotin DL, Mulaeva KA, Kovaleva MV. Molecular profile of follicular tumors of the thyroid gland. HEAD AND NECK TUMORS (HNT) 2023; 13:102-109. [DOI: 10.17650/2222-1468-2023-13-1-102-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
More than 90 % of newly diagnosed cases of endocrine cancer occur in the thyroid gland. Introduction of fine needle puncture of the thyroid gland, with the classification of cytological material according to the Bethesda system, has become the cornerstone of the diagnosis of malignant neoplasms of the thyroid gland. However, traditionally in this classification there remains a weak link called a follicular tumor (category IV). The detection of a follicular tumor in the cytological material does not allow one to reliably classify the mass as benign or malignant and requires surgical intervention with morphological verification. In recent years, the possibilities of molecular genetic testing have improved markedly. Follicular tumors tend to accumulate mutations, which over time can lead to malignant transformation, but can also be used as a method of timely diagnosis. This review analyzes the literature on the possibilities of molecular genetic testing in assessing the malignant potential of follicular formations of the thyroid gland.
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Affiliation(s)
- D. D. Dolidze
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - A. V. Shabunin
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - S. D. Сovantsev
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - Z. A. Bagateliya
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - Yu. N. Kobzev
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - D. L. Rotin
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - K. A. Mulaeva
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - M. V. Kovaleva
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Luvhengo TE, Bombil I, Mokhtari A, Moeng MS, Demetriou D, Sanders C, Dlamini Z. Multi-Omics and Management of Follicular Carcinoma of the Thyroid. Biomedicines 2023; 11:biomedicines11041217. [PMID: 37189835 DOI: 10.3390/biomedicines11041217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid gland, accounting for up to 20% of all primary malignant tumors in iodine-replete areas. The diagnostic work-up, staging, risk stratification, management, and follow-up strategies in patients who have FTC are modeled after those of papillary thyroid carcinoma (PTC), even though FTC is more aggressive. FTC has a greater propensity for haematogenous metastasis than PTC. Furthermore, FTC is a phenotypically and genotypically heterogeneous disease. The diagnosis and identification of markers of an aggressive FTC depend on the expertise and thoroughness of pathologists during histopathological analysis. An untreated or metastatic FTC is likely to de-differentiate and become poorly differentiated or undifferentiated and resistant to standard treatment. While thyroid lobectomy is adequate for the treatment of selected patients who have low-risk FTC, it is not advisable for patients whose tumor is larger than 4 cm in diameter or has extensive extra-thyroidal extension. Lobectomy is also not adequate for tumors that have aggressive mutations. Although the prognosis for over 80% of PTC and FTC is good, nearly 20% of the tumors behave aggressively. The introduction of radiomics, pathomics, genomics, transcriptomics, metabolomics, and liquid biopsy have led to improvements in the understanding of tumorigenesis, progression, treatment response, and prognostication of thyroid cancer. The article reviews the challenges that are encountered during the diagnostic work-up, staging, risk stratification, management, and follow-up of patients who have FTC. How the application of multi-omics can strengthen decision-making during the management of follicular carcinoma is also discussed.
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Affiliation(s)
- Thifhelimbilu Emmanuel Luvhengo
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa
| | - Ifongo Bombil
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Arian Mokhtari
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Maeyane Stephens Moeng
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa
| | - Demetra Demetriou
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield 0028, South Africa
| | - Claire Sanders
- Department of Surgery, Helen Joseph Hospital, University of the Witwatersrand, Auckland Park, Johannesburg 2006, South Africa
| | - Zodwa Dlamini
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield 0028, South Africa
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4
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Radzina M, Ratniece M, Putrins DS, Saule L, Cantisani V. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers (Basel) 2021; 13:5469. [PMID: 34771632 PMCID: PMC8582579 DOI: 10.3390/cancers13215469] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and "fast-in and slow-out" are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.
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Affiliation(s)
- Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
| | - Davis Simanis Putrins
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy;
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Ito Y, Hirokawa M, Fujishima M, Masuoka H, Higashiyama T, Kihara M, Onoda N, Miya A, Miyauchi A. Prognostic significance of vascular invasion and cell-proliferation activity in widely invasive follicular carcinoma of the thyroid. Endocr J 2021; 68:881-888. [PMID: 33746136 DOI: 10.1507/endocrj.ej21-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Widely invasive follicular thyroid carcinoma (wi-FTC) is regarded as having an aggressive character and a dire prognosis, but it has not been known whether all wi-FTCs have a dire prognosis. Herein we retrospectively analyzed the cases of 133 patients with wi-FTCs to determine the prognostic significance of vascular invasion and cell-proliferation activity based on the Ki-67 labeling index (LI). Of the 119 patients without distant metastasis (M0), 11 (9.2%) showed recurrence during the postoperative follow-up. In a univariate analysis, the recurrence-free survival (RFS) rates of the M0 patients with vascular invasion and those with a Ki-67 LI ≥5% were significantly poorer (p = 0.0013 and p = 0.0268, respectively) than those of the patients without vascular invasion or with a Ki-67 LI <5%. Other clinicopathological factors such as patient age, gender, tumor size, and oxyphilic tumor were not significantly related to the patients' RFS. In a multivariate analysis, positive vascular invasion independently affected the RFS (p = 0.0133), but Ki-67 >5% did not (p = 0.1348). To date, only five patients have died of their thyroid carcinoma; four cases were M1. In conclusion, although M0 wi-FTC generally has a favorable prognosis, cases with positive vascular invasion or a high Ki-67 LI are likely to recur, and careful postoperative follow-up is necessary.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Mitsuhiro Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Makoto Fujishima
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Hiroo Masuoka
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | | | - Minoru Kihara
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
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Badulescu CI, Piciu D, Apostu D, Badan M, Piciu A. FOLLICULAR THYROID CARCINOMA - CLINICAL AND DIAGNOSTIC FINDINGS IN A 20-YEAR FOLLOW UP STUDY. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:170-177. [PMID: 33029233 DOI: 10.4183/aeb.2020.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Follicular thyroid carcinomas (FTC) represent 6-10 % of all thyroid carcinomas; the evolution of FTC is quite controversial, partly due to frequent changes of the histopathological definition (minimally invasive-MIFTC or widely invasive carcinoma-WIFTC) and treatment strategies adjustments. Objective This research aims to examine the diagnostic procedure, therapeutic attitude and survival rates of patients with FTC, over a period of 16 years in the same institution, with a follow-up of at least 4 years, by analyzing correlations between histology subtype, treatments and the rate of recurrent disease. Subjects and methods We have studied 5891 patients with thyroid carcinomas who have undergone surgical or oncological treatment within the institution, between 1st January 2000 - 31st December 2015; among them we found 133 patients (2.25%) with "pure" follicular thyroid carcinoma: 114 (86%) women and 19 (14%) men, with a female-male ratio of 6:1. The age of the patients ranged from 10 to 76 years, with an average of 47.8 years. Statistical analysis was done comparing differences among groups of MIFTC and WIFTC. Results There was an unexpected high percentage of WIFTC and also an increased number of biochemically persistent and/or recurrent disease in patients with MIFTC. A stronger correlation was observed with the tumour dimensions, rather than with the histopathological subtype. Conclusions This research observed that overall survival was associated with tumour size rather than histopathological subtype and there is an important need to perform further studies to assess the effectiveness of treatment strategies.
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Affiliation(s)
- C I Badulescu
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Morphological Sciences, Cluj-Napoca, Romania
| | - D Piciu
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Medical Oncology, Cluj-Napoca, Romania.,"Iuliu Hațieganu" University of Medicine and Pharmacy - "Prof.Dr.Ion Chiricuta" Institute of Oncology - Nuclear Medicine, Cluj-Napoca, Romania
| | - D Apostu
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Orthopedy, Cluj-Napoca, Romania
| | - M Badan
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Morphological Sciences, Cluj-Napoca, Romania
| | - A Piciu
- "Iuliu Hațieganu" University of Medicine and Pharmacy - Medical Oncology, Cluj-Napoca, Romania
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Salivary-Like Tumors of the Thyroid: A Comprehensive Review of Three Rare Carcinomas. Head Neck Pathol 2020; 15:212-224. [PMID: 32562215 PMCID: PMC8010008 DOI: 10.1007/s12105-020-01193-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
Abstract
Thyroid carcinomas represent 3.2% of all new cases of cancer in the United States. Whereas most thyroid tumors arise from follicular cells or, less commonly, parafollicular cells, the derivation of some rare primary thyroid carcinoma subtypes is less clear and represents an area of evolving knowledge. Primary thyroid carcinomas that resemble neoplasms characteristic of the salivary glands ("salivary-like" primary thyroid carcinomas) arguably represent some of the most unusual primary thyroid tumors. Herein, we have undertaken a review of the literature in order to present a comprehensive overview of salivary-like primary thyroid carcinomas including: mucoepidermoid carcinoma, sclerosing mucoepidermoid carcinoma with eosinophilia, and secretory carcinoma. Awareness of these unusual, distinct primary tumors is important for timely diagnosis and optimal patient management. This review highlights these three salivary-like carcinomas, with special emphasis on developments since publication of the World Health Organization (WHO) 2017 Classification of Tumours of Endocrine Organs.
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Segkos K, Porter K, Senter L, Ringel MD, Nabhan FA. Neck Ultrasound in Patients with Follicular Thyroid Carcinoma. Discov Oncol 2018; 9:433-439. [PMID: 30088223 DOI: 10.1007/s12672-018-0345-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/22/2018] [Indexed: 02/06/2023] Open
Abstract
There are limited data on the role of neck ultrasound (US) in the surveillance of patients with follicular thyroid cancer (FTC). Here, we analyze the likelihood of US to find structural disease in patients with FTC and evaluate if initial American Thyroid Association (ATA) risk stratification and the response to therapy categories [the latter based on thyroglobulin (Tg) levels] modify that likelihood. We conducted a retrospective cohort study of 32 patients with FTC in our institution. We included all patients with well-differentiated FTC who underwent total thyroidectomy and radioactive iodine (RAI) treatment without neck structural disease at the time of RAI and with Tg and US at least 6 months after RAI. After a median follow-up of 4.3 years, two patients (6.3%) had structural disease by US. None of the 18 patients with initial ATA low-risk disease had structural disease by US in contrast to higher, but not significant, frequency of 18.2% (2/11) in patients with initial ATA high-risk disease (p = 0.14). Based on Tg levels, 24/32 patients had excellent response to therapy and 8/32 had biochemical incomplete/indeterminate response. None of the patients with excellent response had structural disease by US versus 2/8 (25%) patients with biochemical incomplete/indeterminate response all of whom had other sites of structural disease (p = 0.054). Our findings suggest that neck US in FTC is unlikely to find structural disease with initial low-risk ATA or excellent response to therapy but can detect structural disease in some patients with initial ATA high-risk or incomplete/indeterminate responses to therapy.
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Affiliation(s)
- Konstantinos Segkos
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center and Arthur G. James Cancer Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH, 43210, USA.,Thyroid Institute of Utah, 1055 N 300 W Ste 303, Provo, UT, 84604, USA
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University and Arthur G. James Cancer Center, Columbus, OH, USA
| | - Leigha Senter
- Division of Human Genetics, The Ohio State University and Arthur G. James Cancer Center, Columbus, OH, USA
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center and Arthur G. James Cancer Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - Fadi A Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University Wexner Medical Center and Arthur G. James Cancer Center, 5th Floor McCampbell Hall, 1581 Dodd Drive, Columbus, OH, 43210, USA.
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Acute paraparesis as presentation of an occult follicular thyroid carcinoma: A case report. Int J Surg Case Rep 2018; 41:498-501. [PMID: 29546026 PMCID: PMC5723273 DOI: 10.1016/j.ijscr.2017.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/20/2017] [Accepted: 11/23/2017] [Indexed: 11/23/2022] Open
Abstract
Follicular thyroid carcinoma is usually confined to the thyroid gland, but can metastasize. Signs and symptoms associated with bone metastasis are rare as first clinical manifestations. Complementary imaging studies, as TC and MRI, are very important, especially if bone metastases are suspected. Surgical procedure and ablative radioactive iodine therapy in these cases are key to achieve a better outcome. A low suspicion threshold for thyroid neoplasms must be taken into account when investigating metastasis to the bone.
Introduction Follicular thyroid carcinoma is the second most frequent type of well differentiated thyroid tumours. It is usually confined to the thyroid gland, however it can metastasize in a later stage of the disease. Signs and symptoms associated with bone metastasis are rare as first clinical manifestations. Case report An 84-year-old female complained with acute paraparesis. Magnetic resonance imaging revealed an extensive intraosseous infiltrating lesion compatible with a bone metastasis from an occult tumour. Biopsy samples were compatible with bone metastasis from a follicular thyroid carcinoma. The patient was submitted to total thyroidectomy followed by iodine ablative therapy. Discussion Follicular thyroid carcinoma presentation with symptoms related to bone metastasis is rare. Patients with bone lesions, such as pathological fractures or compressive symptoms should be studied since they may have clinically unapparent lesions from an unknown tumour. Patients with FTC should be submitted to total thyroidectomy. Bone lesions may be addressed to improve quality of life however this decision depends on disease extent. Conclusion Acute paraparesis is a rare form of presentation of thyroid carcinoma. These neoplasms must be taken into account when investigating metastasis to the bone from unknown neoplasms.
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Der EM. Follicular Thyroid Carcinoma in a Country of Endemic Iodine Deficiency (1994-2013). J Thyroid Res 2018; 2018:6516035. [PMID: 29682275 PMCID: PMC5845486 DOI: 10.1155/2018/6516035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/16/2018] [Accepted: 01/30/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Follicular thyroid cancer (FTC) has historically been linked to iodine deficiency. Although Ghana is among the iodine deficient regions of the world, the proportions, trends, and the clinical features of FTCs have not been studied as a single disease entity. The aim of this study was to determine the relative frequencies, trends, and the clinicopathological characteristics of FTCs among all thyroid malignancies in our institution. MATERIALS AND METHODS This was a retrospective study from January 1994 to December 2013. Data were analysed using SPSS software version 23 (Chicago) and Graph pad prism version 5.00. RESULTS Follicular thyroid cancer was the second thyroid malignancy (35.0%) and showed a gradual rise in relative proportions over the period. The male-female ratio was 1 : 1.5. The mean ages were 46.9 (SD ±17.3) for males and 46.4 (SD ±13.3) years for females. Enlarged palpable anterior neck swelling was the commonest symptom in males (86.7%) and females (91.3%) (P = 0.730). Hurthle cell carcinoma was the commonest variant of FTC, with 26.7% males and 10.6% females (P = 0.116). Distant spread was found in 23.3% of males compared to 19.1% of females (P = 0.633). The common sites of distant spread were bones (57.2%) in males and cervical lymph nodes (44.4%) in females (P = 0.106). CONCLUSION Follicular thyroid cancer was the second common thyroid malignancy (35.0%) with a gradual rise in trend over the study period and male-female ratio of 1.5 : 1. Large anterior neck swelling was the commonest clinical presentation of FTC.
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Affiliation(s)
- Edmund Muonir Der
- Department of Pathology, Korle-Bu Teaching Hospital, P.O. Box 77, Korle-Bu, Accra, Ghana
- Department of Pathology, University for Development Studies, P.O. Box 1883, Tamale, Ghana
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Makazlieva T, Vaskova O, Majstorov V, Stojanoski S, Manevska N, Jovanovic R. Demographic and Clinical Features of Thyroid Carcinomas in Republic of Macedonia (1999-2010). Open Access Maced J Med Sci 2017; 5:1005-1010. [PMID: 29362636 PMCID: PMC5771271 DOI: 10.3889/oamjms.2017.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Thyroid carcinomas (TC) are the most common endocrine malignancies. In some parts of the world, the incidence of TCs has increased over the past few decades, especially in females according to some studies. AIM: We have set as the objective for our study to analyse the demographic, ultrasound features, thyroid hormonal status and frequency of thyroid carcinomas in the Republic of Macedonia according to histopathological type. MATERIALS AND METHODS: Retrospective analysis of medical data from all diagnosed and treated patients with TC at the Institute of Pathophysiology and Nuclear Medicine for the period 1999-2010 was performed. Demographic characteristics: age at diagnosis, gender, histopathological type of TC and from clinical features: US findings and thyroid hormonal state at initial examination and their distribution in eight state regions were evaluated. RESULTS: Total number of 204 patients with TC in the Republic of Macedonia was registered. Papillary thyroid carcinoma (PTC) was the most frequent with 131 pts (64.21%), follicular (FTC) with 13 pts (6.37%) was second thyroid malignoma, followed by medullary (MTC) with 12 pts (5.88%), anaplastic (ATC) 11 pts (5.39%) and the rarest types were Hurtle cell carcinoma and intrathyroid sarcoma with only 1 diagnosed case. Age varied widely from 7 yrs to 88 yrs age (average 47.9 ± 16.6 yrs). PTC was more prevalent in younger age groups, while ATC was diagnosed in elderly patients. In all of the eight-country regions, the prevalence rate was higher for females than males (3:1) or 15.21/105 female to 5.03/105 male prevalence rate. According to US appearance mostly TC was unilateral in 42.65% and multifocal in 7.84% with dimensions from 15 to 50 mm. CONCLUSION: There is an increase in incidence and prevalence rate of TCs in our country, mostly PTC, while reduction exists in the number of diagnosed cases of ATC and FTC, comparing with previous studies before iodine prophylaxis program. Different from described in the literature is female: male (4:1) ratio for ATC. According to US features, we can conclude that introduction of more detailed reporting system may improve diagnostic accuracy.
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Affiliation(s)
- Tanja Makazlieva
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Olivija Vaskova
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Venjamin Majstorov
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Sinisha Stojanoski
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Nevena Manevska
- Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Rubens Jovanovic
- Institute of Pathology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Teo KW, Yuan NK, Tan WB, Parameswaran R. Comparison of prognostic scoring systems in follicular thyroid cancer. Ann R Coll Surg Engl 2017; 99:479-484. [PMID: 28660822 PMCID: PMC5696982 DOI: 10.1308/rcsann.2017.0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Many studies have addressed the accuracy of prognostic scoring systems in the treatment of differentiated thyroid cancers as a whole but few have addressed this issue in patients with follicular thyroid cancer (FTC) alone. The aim of this study was to establish the accuracy of the various scoring systems in determining the overall and disease free survival of FTC patients in Singapore. METHODS Retrospective review was undertaken of 82 patients with FTC treated at a single tertiary institution between January 2000 and December 2014. Demographic, clinical, pathological and treatment outcomes were analysed. Prognostic scoring systems evaluated for the cohort included TNM (Tumour, Nodes, Metastases), AGES (Age, Grade, Extent, Size), MACIS (Metastases, Age, Completeness of resection, Invasion, Size), AMES (Age, Metastases, Extent, Sex) and EORTC (European Organisation for Research and Treatment of Cancer). Statistical analysis was performed by plotting Kaplan-Meier survival curves and using the Cox proportional hazards model. RESULTS There were 29 male and 53 female patients with a mean age of 48 years. The mean follow-up duration was 88 months and there were 7 deaths (9%). The ten-year overall survival rate was 90%. Factors predictive of survival on univariate analysis were age, size of tumour, invasiveness, completeness of resection, metastasis, external beam radiotherapy, and risk scores using the AGES and MACIS scoring systems (p<0.05). On multivariate analysis, AGES and MACIS provided the best prognostic information. CONCLUSIONS MACIS is the best prognostic scoring system currently available for FTC and it is superior to other scoring systems in term of guiding management. The scoring systems require further development to accommodate variations in clinical practice globally and to improve the prognostic accuracy.
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Affiliation(s)
- K W Teo
- National University Hospital , Singapore
| | - N K Yuan
- National University Hospital , Singapore
| | - W B Tan
- National University Hospital , Singapore
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Glomski K, Nosé V, Faquin WC, Sadow PM. Metastatic Follicular Thyroid Carcinoma and the Primary Thyroid Gross Examination: Institutional Review of Cases from 1990 to 2015. Endocr Pathol 2017; 28:177-185. [PMID: 28444500 DOI: 10.1007/s12022-017-9483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of follicular-patterned carcinomas, including follicular thyroid carcinoma, oncocytic (Hürthle cell) carcinoma, and the encapsulated follicular variant of papillary thyroid carcinoma, requires evidence of capsular and/or vascular invasion. With minimally invasive carcinomas classified often within less than a millimeter of tissue segregating them from adenomas and non-invasive follicular thyroid neoplasms with papillary-like nuclear features, opinions vary internationally over how much of the capsule to submit in order to deem it well enough represented, considering that even if grossly entirely submitted in microcassettes, without leveling through each tissue block, the capsule is truly never entirely examined microscopically. Here, we retrospectively examine submission practices and outcomes at a single, high-volume institution over a 25-year period. Our results indicate that the vast majority of lesions with poor outcomes are those with wide invasion, and tumors lacking gross evidence of capsular perturbation rarely lead to recurrence or metastasis, an unsurprising result that should prompt re-evaluation of our grossing methods and approach to follicular-patterned tumors in a time of cost restraint, molecular diagnostics, and low biological potential of encapsulated, circumscribed neoplasia of the thyroid.
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Affiliation(s)
- Krzysztof Glomski
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Vania Nosé
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - William C Faquin
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Peter M Sadow
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
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Podda M, Saba A, Porru F, Reccia I, Pisanu A. Follicular thyroid carcinoma: differences in clinical relevance between minimally invasive and widely invasive tumors. World J Surg Oncol 2015; 13:193. [PMID: 26041024 PMCID: PMC4458056 DOI: 10.1186/s12957-015-0612-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/22/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evidence on the biological behavior and clinical courses of minimally invasive and widely invasive follicular thyroid carcinoma (MI-FTC, WI-FTC) is still debatable. The current study was conducted to identify differences between MI and WI tumors and those prognostic parameters influencing late outcome such as local recurrence and survival. METHODS From January 1998 to October 2013, 71 patients were operated on in our department because of a FTC. A retrospective cohort study was carried out to compare 42 MI-FTC and 29 WI-FTC. The comparison involved evaluation of patient characteristics, tumor characteristics, tumor staging, and risk assessment. RESULTS A diameter greater than 4.0 cm, the presence of vascular invasion, the TNM stage III-IVA, and the high risk at AMES system risk stratification were independent factors significantly related to the presence of a WI-FTC. The only independent predictor of recurrence and disease-free survival at 10-year follow-up was a tumor size greater than 4.0 cm. CONCLUSIONS More attention must be paid in the postoperative tumor re-staging of those patients with tumor size larger than 4.0 cm, which was the only parameter predicting recurrence and influencing disease-free survival. Nevertheless, definitive recommendations cannot be made without a longer follow-up.
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Affiliation(s)
- Mauro Podda
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Alessandra Saba
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Federica Porru
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Isabella Reccia
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Adolfo Pisanu
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
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