Follicular thyroid carcinoma metastasis to the facial skeleton: a systematic review

Follicular Thyroid Carcinoma with Unusual Mandible Metastasis

Follicular thyroid cancer is the second-most common type of thyroid cancer after papillary thyroid cancer. Metastases to the mandible and maxillofacial region are rare. Our study presents a 55-year-old patient who underwent total thyroidectomy for follicular thyroid cancer and subsequent radioactive iodine therapy. Sixteen years after diagnosis, elevated thyroglobulin levels suggested disease recurrence. Using advanced imaging techniques - Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan, bone scintigraphy, and posttreatment I-131 scan-an unexpected metastatic site was identified: the left mandibular condyle. A biopsy confirmed the presence of metastatic follicular thyroid cancer.

Metastatic thyroid follicular carcinoma presenting as pathological left clavicle fracture: An unusual skeletal metastasis at the time of diagnosis

INTRODUCTION

Thyroid carcinoma is the most common endocrine malignancy, accounting for 3 % of recent malignancies in world wide. Differentiated thyroid carcinoma constitutes 90 % thyroid malignancies, within that follicular type constitutes 10-15 %.

CLINICAL PRESENTATION

A 55-year-old female presented with left-sided neck pain and swelling over medial end of clavicle, following normal manual work. Physical examination revealed swelling on medial end of left clavicle and palpable nodule in left thyroid lobe. Imaging studies showed two nodules in both thyroid lobes with left level IV lymphadenopathy and osteolytic lesion with pathological fracture in medial end of clavicle. Histopathological evaluation confirmed well-differentiated follicular thyroid carcinoma with clavicular metastasis. The patient underwent total thyroidectomy, followed by radioiodine therapy for medial end of left clavicle.

DISCUSSION

Follicular thyroid carcinoma (FTC) is metastasis through the bloodstream, predominantly to flat bones and upper end of long bones, but clavicular deposits are very rarely reported. FNAC only diagnosed the follicular neoplasm. Further tissue evaluation needed to confirm the malignancy. Therefore, hemithyroidectomy of the lesion side is usually carried out for histopathological diagnosis. But in this case, follicular thyroid carcinoma was confirmed through core biopsy from medial end of clavicle, leading to total thyroidectomy and left cervical block dissection, followed by radioiodine therapy for metastatic clavicular involvement.

CONCLUSION

Clavicular metastasis of follicular thyroid carcinoma is very rare. Early detection and proper management of suspicious thyroid carcinoma in uncommon skeletal sites, like the clavicle, is crucial for enhancing patient outcomes, despite the rarity of follicular carcinoma metastasis to this area.

Agrin is a novel oncogenic protein in thyroid cancer

Agrin (AGRN) is a matricellular glycoprotein involved in extracellular signal transduction. AGRN is involved in tumorigenesis and cancer progression; however, the role of AGRN in thyroid cancer (TC) remains unclear. In the present study, using cell lines derived from various subtypes of TC including CGTH, FTC-133 and BcPAP and transcriptomic data from patients with TC, the role of AGRN in TC was analyzed by migration, invasion, viability and proliferation assays as well as Western blot with EMT markers. AGRN expression was significantly increased in thyroid tumors and cell lines derived from various TC subtypes. The highest AGRN expression was found in follicular and papillary thyroid carcinoma subtypes. Immunocytochemistry revealed nuclear AGRN localization in normal (NTHY) and TC cells. Silencing of AGRN decreased viability, proliferation, migration and invasion of TC cell lines by upregulating vimentin and downregulating N-cadherin and E-cadherin. Furthermore, the expression of AGRN was associated with neutrophil infiltration in thyroid tumors. In conclusion, the present results indicated that increased AGRN expression promoted tumorigenic phenotypes of TC cells, while AGRN expression was associated with immune infiltration in thyroid tumors. AGRN may represent a target for future cancer therapy and requires further evaluation.

Mandibular metastasis of follicular thyroid carcinoma

ABSTRACT

The orofacial region may be the first site for the dissemination of malignancies from the remote regions in the jawbones. The most common location of metastatic lesions in the jawbones is the mandible, with the molar region the most frequently involved site. Radiotherapy, chemotherapy, and surgical resection can be an approach in the treatment protocol depending upon patient age and growth of tumor mass. This case report presents a case of follicular variant thyroid carcinoma, infiltrative type, pT1bN0Mx with mandibular metastasis affecting both hard and soft tissue in a 55-year-old female.

Metastatic Follicular Thyroid Carcinoma of the Mandible: A Case Report at Tertiary Care Rural Centre

The most common endocrine cancer is thyroid carcinoma, however it seldom spreads to the oral cavity. Follicular thyroid carcinoma is the second most common type of thyroid cancer after papillary thyroid carcinoma. Thyroid carcinoma-related mandibular metastases is not very common, and there aren't many cases reported in the literature. We are describing a case in which the underlying cancer was diagnosed before the metastatic mandibular lesion was found. Total thyroidectomy and excision of the affected structures, with or without adjuvant therapy, appear to be the most effective treatments.

Modulatory role of miRNAs in thyroid and breast cancer progression and insights into their therapeutic manipulation

Over the past few decades, thyroid cancer has become one of the most common types of endocrine cancer, contributing to an increase in prevalence. In the year 2020, there were 586,202 newly diagnosed cases of thyroid cancer around the world. This constituted approximately 3.0% of all patients diagnosed with cancer. The World Health Organization reported that there will be 2.3 million women receiving treatment for breast cancer in 2020, with 685,000. Despite the fact that carcinoma is one of the world's leading causes of death, there is still a paucity of information about its biology. MicroRNAs (miRNAs; miRs) are non-coding RNAs that can reduce gene expression by cleaving the 3' untranslated regions of mRNA. These factors make them a potential protein translation inhibitor. Diverse biological mechanisms implicated in the genesis of cancer are modulated by miRNA. The investigation of global miRNA expression in cancer showed regulatory activity through up regulation and down-regulation in several cancers, including thyroid cancer and breast cancer. In thyroid cancer, miRNA influences several cancers related signaling pathways through modulating MAPK, PI3K, and the RAS pathway. In breast cancer, the regulatory activity of miRNA was played through the cyclin protein family, protein kinases and their inhibitors, and other growth promoters or suppressors, which modulated cell proliferation and cell cycle progression. This article's goal is to discuss key miRNA expressions that are involved in the development of thyroid and breast cancer as well as their therapeutic manipulation for these two specific cancer types.

Orbital metastases as the initial clinical manifestation of thyroid carcinoma: A case series

Thyroid carcinoma rarely metastasizes to the orbit. Approximately only 2%-7% of orbital metastatic lesion were found originally from thyroid carcinoma. We present three cases to increase the awareness of orbital metastases as the initial manifestation of thyroid carcinoma. Three female patients aged 28-65 years old presented with initial complaint of orbital mass. Further examination discovered an asymptomatic lump on every patient's neck. However, one patient was unaware of her lump. Examination revealed that all lesions were metastases from papillary thyroid carcinoma. These cases conclude several similarities. First, prominent unilateral proptosis, orbital mass in the superior quadrant, limited eyeball movement, and orbital bone destruction were found in every patient. Second, all the orbital computed tomography scan showed extraconal solid masses involving adjacent structures and expanding intra-cranially or intrasinusly. These findings should raise one's suspicion of a metastatic lesion primarily caused by thyroid carcinoma. Despite the rarity of orbital metastases, thyroid carcinoma must be considered as a potential primary tumor in patients with initial presentation of orbital mass. Thorough physical examination is important to determine the origin of metastases.

Incidence and Predictors of Synchronous Bone Metastasis in Newly Diagnosed Differentiated Thyroid Cancer: A Real-World Population-Based Study

Background

Clinical and sociodemographic characteristics of differentiated thyroid cancer (DTC) patients with synchronous bone metastasis (SBM) remain unclear. This real-world study aimed to elucidate the incidence and prognosis of DTC patients with SBM using population-based data.

Methods

Data of patients with newly diagnosed DTC from 2010 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was utilized to identify predictors of developing SBM in patients with DTC and was further evaluated by receiver operator characteristics (ROC) analysis. Multivariable Cox regression was applied to identify prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS).

Results

A total of 67,176 patients with DTC were screened from the database, with 0.36% (244/67,176) developed SBM. The age-adjusted incidence of SBM in patients with DTC was relatively stable during the study period with an average annual percentage change (AAPC) of 2.52. Multivariable logistic regression analysis recognized seven factors (older age, male gender, black race, other races, follicular histology, the American Joint Committee on Cancer (AJCC) T2, T3, T4 staging, and N1 staging) as predictors of developing SBM among the entire cohort, with the value of area under the curve (AUC) of 0.931 (95% CI: 0.915–0.947). The median survival time of DTC patients with SBM was 22 months (interquartile range, 7–47 months). The multivariable Cox regression analysis indicated multiple metastatic sites, surgical procedures, and chemotherapy as predictors for the survival of patients.

Conclusions

Predictors and prognostic factors of SBM in patients with DTC were identified in this study. Patients with risk factors should be given more attention in clinical practice.

Mandibular metastasis of follicular thyroid carcinoma: A case report along with the concise review of literature

Metastasis is one of the most common consequences of malignant tumors, and it is one of the leading causes of morbidity and mortality. Metastatic cancers to oral cavity are extremely rare. Moreover, the true incidence has yet to be determined. Despite their rarity, they are important clinically, since they can be the first and the only evidence of spread in many situations. Breast, kidney, lung, prostate and gastrointestinal tract are the most common sources of metastases in the oral cavity. Thyroid carcinoma is the most prevalent type of endocrine cancer, yet it rarely spreads to the oral cavity. After papillary thyroid carcinoma, follicular thyroid carcinoma is the second-most frequent kind of thyroid cancer. Jawbones are more commonly affected than soft tissues. Literature research revealed that till date, 44 cases of metastatic follicular thyroid cancer to the jawbones have been documented with mandibular preponderance (40 cases). With the rising occurrence of oral metastatic tumors in recent years, it has become increasingly important to diagnose them early to avoid future consequences. We present here an unusual case of metastatic follicular thyroid cancer in the mandible of an elderly adult along with a comprehensive review of the literature.

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study

Introduction:

Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions.

Methods:

A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used.

Results:

Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Grave's disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions.

Conclusions:

Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.

Solitary metastatic deposit in the mandible from follicular thyroid carcinoma

Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid, after papillary carcinoma. Oral metastasis arising from FTC is very rare. Mandible is more commonly affected than maxilla, with the premolar–molar region being the most frequent site of metastasis. We present the case of a 68yearold female, with swelling in the region of the parotid gland, complaining of periodic rightsided pain in the temporomandibular joint, which occurred most often in the morning with numbness and pain, and difficulty in opening the mouth. After ultrasound and X-ray, the patient was operated and the pathohistological finding was in favor of metastasis of FTC. After 3 months, a total thyroidectomy was performed, and FTC was detected in the right thyroid lobe. Laboratory results were as follows: FT₄ = 9.92 pmol/L, thyroid-stimulating hormone = 9.9 mIU/L, and hTG >300 μg/L. Bone scan showed no bone metastasis. Radioablation with ¹³¹I of 150 mCi was given to the patient, followed by substitutional therapy with levothyroxine. Mandible metastasis as a single skeletal deposit from follicular thyroid carcinomas is a rare clinical finding. Maxillofacial surgeons should consider and rule out thyroid pathology before performing operation of tumor formation in the mandible region. If feasible, surgical-based treatment options offer the best survival outcomes.

Lenvatininb as Treatment for Naïve Patients with Aggressive Thyroid Cancer Bone Metastases and Bad Performance Status

Lenvatinib is an oral multityrosine kinase inhibitor (TKI) with proven effectiveness in the treatment of radioactive iodine- (RAI-) refractory and/or unresectable differentiated thyroid carcinoma (DTC). The present study reports the case of a 41-year-old male who underwent hemithyroidectomy in June 2015 due to a thyroid nodule with fine-needle aspiration follicular neoplasm cytology and no evidence of malignancy in the histopathological exam. Three years later, acute disabling clinical symptoms emerged, mainly high skeletal pain conditioned with an important performance status decrease. PET/CT scan displayed several metastatic bone lesions in this context, located in the vertebral bodies, sternum, ribs, iliac crest, right acetabulum, and both necks of the femur. Histological study and immunohistochemistry confirmed DTC metastases, as they were strongly positive for thyroglobulin and TTF-1. At this point, the patient was unfit for conventional management that would have included completion of surgery and RAI treatment as first options. Thus, it was decided to start systemic treatment with TKI, Lenvatinib. Within the first week of treatment, the patient was almost asymptomatic and his performance status moved from 3 to 0. This allowed the patient to undergo resection of the thyroid gland remnant plus RAI treatment. Unfortunately, RAI refractory illness was confirmed so Lenvatinib treatment should be continued in this case until the evidence of no further clinical benefit. Despite drug adverse events, the patient continues with treatment one year later, remaining asymptomatic and with normal functional capacity.

Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review

Trismus refers to a person's inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.

MicroRNA-574-5p directly targets FOXN3 to mediate thyroid cancer progression via Wnt/β-catenin signaling pathway

OBJECTIVE

Thyroid cancer is the most common endocrine tumor. A large number of thyroid cancer-related miRNAs have been studied and identified. However, the detailed roles of miR-574-5p in thyroid cancer remain poorly understood. This work mainly aimed to investigate the role of miR-574-5p/FOXN3 axis and its mechanism in the thyroid cancer progression.

METHODS

MiR-574-5p, FOXN3, Wnt/β-catenin pathway, and apoptosis-related markers were measured by quantitative real-time PCR (qRT-PCR) and western blotting analysis, respectively. Luciferase reporter assay was employed to validate the direct targeting of FOXN3 by miR-574-5p. MTT, flow cytometry, wound healing and transwell experiments were applied to analyze the functions of FOXN3 and miR-574-5p in thyroid cancer cells.

RESULTS

Knockdown of miR-574-5p up-regulated FOXN3 expression and miR-574-5p directly targeted FOXN3 in thyroid cancer cells. Biological function experiments showed that knockdown of miR-574-5p inhibited proliferation, migration, invasion and promoted apoptosis of thyroid cancer cells. The activation of Wnt/β-catenin pathway was suppressed by MiR-574-5p silencing. FOXN3 silencing reversed the effects of miR-574-5p inhibitor on FOXN3 level and Wnt/β-catenin singling pathway, also reversed the effects on cell migration, proliferation, invasion and apoptosis.

CONCLUSION

The miR-574-5p/FOXN3 axis is a novel molecular mechanism that promotes thyroid cancer progression, suggesting their potential for clinical therapy of thyroid cancer.

Distant metastasis of follicular thyroid carcinoma to the mandible: a rare case report

Treatment of metastatic carcinoma of the oral cavity can be a challenge due to its rarity. The current case report details metastatic carcinoma of the mandible originating from follicular thyroid carcinoma, which is the second most prevalent tumor of the thyroid. As the mandibular lesion developed, the primary thyroid lesion of thyroid. Here, we report a case of metastatic carcinoma of the mandible in a 67-year-old female that was treated with partial mandibulectomy and fibular free flap.

Metastatic papillary thyroid carcinoma of the mandible: Case report and literature review

The oral cavity is not a usual site for metastasis including about one percent of all oral tumors. Metastatic papillary thyroid carcinoma (PTC) is uncommon and usually occurs in regional lymph nodes of neck, so mandibular metastasis is a rare event. We present a case with swelling in the right mandible that has been diagnosed metastatic tumor of PTC. The clinical features, radiographic aspect and treatment plan are discussed. Furthermore, a thorough review of literature revealed 77 published cases of metastatic thyroid carcinoma to the oral cavity with their summarized features.

Fracture after radiation therapy for femoral metastasis: incidence, timing and clinical features

We analyzed 428 femoral metastases initially treated with radiotherapy between 2002 and 2011 to clarify the clinical details of post-irradiation fractures of femoral metastasis. Patients included 161 men and 167 women, with a mean age of 62 years. Fracture incidence, fracture site, fracture risk based on X-ray images before radiotherapy, and interval from completion of radiotherapy to fracture occurrence were assessed. In addition, 24 pathological specimens obtained during 27 surgeries for these fractures were examined. Fractures occurred in 7.7% of 428 femoral metastases (total 33: 28 actual fractures and five virtual fractures with progressive pain and bone destruction). The fracture rate was 7.8% in the proximal femur and 1.5% in the shaft (P = 0.001). Fractures occurred a median of 4.4 months after radiotherapy, with 39.4% occurring within 3 months and 63.6% within 6 months. Among femurs with high fracture risk according to Harrington's criteria or Mirels' score, the fracture rate was 13.9% and 11.8%, respectively. Viable tumor cells were detected in all five patients with painful virtual fracture, in 85.7% of femurs with actual fractures that occurred within 3 months, and in only 25.0% of actual fractures occurring after 3 months. Post-irradiation fractures of femoral metastasis most frequently occurred within 3 months after radiotherapy, and were more common in the peritrochanteric area than in the shaft. Radiological evidence of impending fracture did not correlate with a high fracture rate. Actual fractures occurring after more than 3 months were likely caused by post-irradiation fragility of the femur, without viable tumor cells.