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He S, Lu W, Ding X, Zhou J, Liu D, Zhu Y, Yang F, Fu Z. Clinical responses to vemurafenib in postoperative recurrence of papillary thyroid carcinoma with esophageal fistula: A case report. Medicine (Baltimore) 2024; 103:e37513. [PMID: 38489728 PMCID: PMC10939696 DOI: 10.1097/md.0000000000037513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND While papillary thyroid carcinoma (PTC) generally exhibits a favorable prognosis post-surgery, the poorly differentiated subtype presents elevated rates of postoperative recurrence. Certain aggressive cases demonstrate invasive behavior, compromising adjacent structures and leading to a poor prognosis. This study delineates a unique case of postoperative PTC recurrence, complicated by esophageal fistula, that showed favorable outcomes following brief Vemurafenib treatment. PATIENT DESCRIPTION A 64-year-old female patient underwent surgical resection for PTC, subsequently experiencing rapid tumor recurrence and development of an esophageal fistula. DIAGNOSIS The patient was confirmed to have locally advanced PTC through intraoperative cytopathology. The cancer recurred postoperatively, culminating in the formation of an esophageal fistula. METHODS The patient was administered Vemurafenib at a dosage of 960 mg twice daily following tumor recurrence. RESULTS A 12-month regimen of targeted Vemurafenib therapy led to a substantial reduction in tumor size. Concurrently, the esophageal fistula underwent complete healing, facilitating successful removal of the gastrostomy tube. The tumor response was classified as stable disease. CONCLUSION SUBSECTIONS Vemurafenib demonstrates potential as a targeted therapeutic strategy for recurrent PTC harboring the BRAFV600E mutation. This approach may effectively mitigate tumor dimensions and the associated risk of esophageal and tracheal fistulas.
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Affiliation(s)
- Sicheng He
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Lu
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xun Ding
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Zhou
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Di Liu
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Zhu
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fugang Yang
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zanmei Fu
- The Interventional Diagnostic and therapeutic Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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Kaliszewski K, Diakowska D, Miciak M, Jurkiewicz K, Kisiel M, Makles S, Dziekiewicz A, Biernat S, Ludwig M, Ludwig B, Sutkowska-Stępień K, Sebastian M, Domosławski P, Sutkowski K, Wojtczak B. The Incidence Trend and Management of Thyroid Cancer-What Has Changed in the Past Years: Own Experience and Literature Review. Cancers (Basel) 2023; 15:4941. [PMID: 37894308 PMCID: PMC10605595 DOI: 10.3390/cancers15204941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Because of ambiguous and widely debated observations concerning the incidence, trend, and management of TC, we performed this analysis. We drew attention to some events, such as "cancer screening activity", introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, possibility of papillary thyroid microcarcinoma (PTMC) active surveillance (AS), occurrence of personalized medicine in TC management, and, finally, COVID-19 pandemic time. Because of the opinion that all changes have been made mostly by PTC, we compared it to the remaining types of TC in terms of incidence, clinical and pathological characteristics, and treatment. We analyzed patients treated in a single surgical center in eastern Europe (Poland). The prevalence of TC significantly increased from 5.15% in 2008 to 13.84% in 2015, and then significantly decreased to 1.33% in 2022 when the COVID-19 pandemic lasted (p < 0.0001). A similar trend was observed for PTC, when the incidence significantly increased to 13.99% in 2015 and then decreased to 1.38% in 2022 (p < 0.0001). At that time, the NIFTP category was introduced, and observation of PTMC began. The prevalence of FTC and MTC also increased until 2015 and then decreased. Significant differences in age, types of surgery, necessity of reoperation, and pTNM between PTCs and other types of TCs were observed. The average age was significantly lower in PTC patients than in patients with the remaining types of TC (p < 0.0001). Four milestones, including NIFTP introduction, the possibility of PTMC AS, personalized cancer medicine, and the COVID-19 pandemic, may have influenced the general statistics of TC.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Dorota Diakowska
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, 50-367 Wrocław, Poland;
| | - Michał Miciak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Krzysztof Jurkiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Michał Kisiel
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Szymon Makles
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Karolina Sutkowska-Stępień
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Paweł Domosławski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
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Kotanidou EP, Giza S, Tsinopoulou VR, Margaritis K, Papadopoulou A, Sakellari E, Kolanis S, Litou E, Serbis A, Galli-Tsinopoulou A. The Prognostic Significance of BRAF Gene Analysis in Children and Adolescents with Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13061187. [PMID: 36980495 PMCID: PMC10047331 DOI: 10.3390/diagnostics13061187] [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: 02/25/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Thyroid cancer represents the prominent endocrine cancer in children. Papillary thyroid cancer (PTC) constitutes its most frequent (>90%) pediatric histological type. Mutations energizing the mitogen-activated-protein kinase (MAPK) pathway are definitely related to PTC. Its most common genetic alteration is in proto-oncogene B-Raf (BRAF). Mutated BRAF is proposed as a prognostic tool in adult PTC. We conducted a systematic review and meta-analysis evaluating the association of mutated BRAF gene and prognostic clinicopathological characteristics of PTC in children/adolescents. Systematic search for relevant studies included PubMed, MEDLINE, Scopus, clinicaltrials.gov and Cochrane Library. Pooled estimates of odds ratios for categorical data and mean difference for continuous outcomes were calculated using random/fixed-effect meta-analytic models. BRAFV600E mutation presents a pooled pediatric/adolescent prevalence of 33.12%. Distant metastasis is significantly associated with mutated BRAF gene (OR = 0.32, 95% CI = 0.16-0.61, p = 0.001). Tumor size (MD = -0.24, 95% CI = -0.62-0.135, p = 0.21), multifocality (OR = 1.13, 95% CI = 0.65-2.34, p = 0.74), vascular invasion (OR = 1.17, 95% CI = 0.67-2.05, p = 0.57), lymph node metastasis (OR = 0.92, 95% CI = 0.63-1.33, p = 0.66), extra-thyroid extension (OR = 0.78, 95% CI = 0.53-1.13, p = 0.19) and tumor recurrence (OR = 1.66, 95% CI = 0.68-4.21, p = 0.376) presented no association or risk with BRAF mutation among pediatric/adolescent PTC. Mutated BRAF gene in children and adolescents is less common than in adults. Mutation in BRAF relates significantly to distant metastasis among children/adolescents with PTC.
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Affiliation(s)
- Eleni P Kotanidou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Styliani Giza
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Vasiliki Rengina Tsinopoulou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Kosmas Margaritis
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Anastasia Papadopoulou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Eleni Sakellari
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Savvas Kolanis
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Eleni Litou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
| | - Anastasios Serbis
- Department of Pediatrics, School of Medicine, Faculty of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | - Assimina Galli-Tsinopoulou
- Unit of Pediatric Endocrinology and Metabolism, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636 Thessaloniki, Greece
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4
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Geropoulos G, Psarras K, Papaioannou M, Giannis D, Meitanidou M, Kapriniotis K, Symeonidis N, Pavlidis ET, Pavlidis TE, Sapalidis K, Ahmed NM, Abdel-Aziz TE, Eddama MMR. Circulating microRNAs and Clinicopathological Findings of Papillary Thyroid Cancer: A Systematic Review. In Vivo 2022; 36:1551-1569. [PMID: 35738604 PMCID: PMC9301440 DOI: 10.21873/invivo.12866] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a rising incidence. There is a need for a non-invasive preoperative test to enable better patient counselling. The aim of this systematic review was to investigate the potential role of circulating microRNAs (miRNAs) in the diagnosis and prognosis of PTC. MATERIALS AND METHODS A systematic literature search was performed using MEDLINE, Cochrane, and Scopus databases (last search date was December 1, 2021). Studies investigating the expression of miRNAs in the serum or plasma of patients with PTC were deemed eligible for inclusion. RESULTS Among the 1,533 screened studies, 39 studies met the inclusion criteria. In total, 108 miRNAs candidates were identified in the serum, plasma, or exosomes of patients suffering from PTC. Furthermore, association of circulating miRNAs with thyroid cancer-specific clinicopathological features, such as tumor size (13 miRNAs), location (3 miRNAs), extrathyroidal extension (9 miRNAs), pre- vs. postoperative period (31 miRNAs), lymph node metastasis (17 miRNAs), TNM stage (9 miRNAs), BRAF V600E mutation (6 miRNAs), serum thyroglobulin levels (2 miRNAs), 131I avid metastases (13 miRNAs), and tumor recurrence (2 miRNAs) was also depicted in this study. CONCLUSION MiRNAs provide a potentially promising role in the diagnosis and prognosis of PTC. There is a correlation between miRNA expression profiles and specific clinicopathological features of PTC. However, to enable their use in clinical practice, further clinical studies are required to validate the predictive value and utility of miRNAs as biomarkers.
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Affiliation(s)
- Georgios Geropoulos
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K.;
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Psarras
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Dimitrios Giannis
- Department of Surgery, North Shore University Hospital, Manhasset, NY, U.S.A
| | - Maria Meitanidou
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Symeonidis
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios T Pavlidis
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- 2 Propedeutical Department of Surgery, Hippokration Hospital, School of Medicine,Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3 General Surgery Department, "AHEPA" University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nada Mabrouk Ahmed
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K
- Department of Pathology, University of Alexandria, Alexandria, Egypt
| | - Tarek Ezzat Abdel-Aziz
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K
| | - Mohammad M R Eddama
- Department of General and Endocrine Surgery, University College London Hospitals, London, U.K
- Research Department of Surgical Biotechnology, University College London, London, U.K
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5
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Tao Y, Wang F, Shen X, Zhu G, Liu R, Viola D, Elisei R, Puxeddu E, Fugazzola L, Colombo C, Jarzab B, Czarniecka A, Lam AK, Mian C, Vianello F, Yip L, Riesco-Eizaguirre G, Santisteban P, O’Neill CJ, Sywak MS, Clifton-Bligh R, Bendlova B, Sýkorová V, Zhao S, Wang Y, Xing M. BRAF V600E Status Sharply Differentiates Lymph Node Metastasis-associated Mortality Risk in Papillary Thyroid Cancer. J Clin Endocrinol Metab 2021; 106:3228-3238. [PMID: 34273152 PMCID: PMC8530728 DOI: 10.1210/clinem/dgab286] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT How lymph node metastasis (LNM)-associated mortality risk is affected by BRAF V600E in papillary thyroid cancer (PTC) remains undefined. OBJECTIVE To study whether BRAF V600E affected LNM-associated mortality in PTC. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed the effect of LNM on PTC-specific mortality with respect to BRAF status in 2638 patients (2015 females and 623 males) from 11 centers in 6 countries, with median age of 46 [interquartile range (IQR) 35-58] years and median follow-up time of 58 (IQR 26-107) months. RESULTS Overall, LNM showed a modest mortality risk in wild-type BRAF patients but a strong one in BRAF V600E patients. In conventional PTC (CPTC), LNM showed no increased mortality risk in wild-type BRAF patients but a robustly increased one in BRAF V600E patients; mortality rates were 2/659 (0.3%) vs 4/321 (1.2%) in non-LNM vs LNM patients (P = 0.094) with wild-type BRAF, corresponding to a hazard ratio (HR) (95% CI) of 4.37 (0.80-23.89), which remained insignificant at 3.32 (0.52-21.14) after multivariate adjustment. In BRAF V600E CPTC, morality rates were 7/515 (1.4%) vs 28/363 (7.7%) in non-LNM vs LNM patients (P < 0.001), corresponding to an HR of 4.90 (2.12-11.29) or, after multivariate adjustment, 5.76 (2.19-15.11). Adjusted mortality HR of coexisting LNM and BRAF V600E vs absence of both was 27.39 (5.15-145.80), with Kaplan-Meier analyses showing a similar synergism. CONCLUSIONS LNM-associated mortality risk is sharply differentiated by the BRAF status in PTC; in CPTC, LNM showed no increased mortality risk with wild-type BRAF but a robust one with BRAF mutation. These results have strong clinical relevance.
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Affiliation(s)
- Yubing Tao
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fei Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaopei Shen
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guangwu Zhu
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rengyun Liu
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Viola
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Efisio Puxeddu
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Laura Fugazzola
- Division of Endocrinology and Metabolism, IRCCS Istituto Auxologico Italiano, Milan and Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Carla Colombo
- Division of Endocrinology and Metabolism, IRCCS Istituto Auxologico Italiano, Milan and Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Barbara Jarzab
- Maria Sklodowska-Curie National Institute of Oncology, Gliwice Branch, Gliwice,Poland
| | - Agnieszka Czarniecka
- Maria Sklodowska-Curie National Institute of Oncology, Gliwice Branch, Gliwice,Poland
| | - Alfred K Lam
- Cancer Molecular Pathology of School of Medicine, Griffith University–Gold Coast, Australia
| | - Caterina Mian
- Department of Medicine, Endocrinology Unit, University of Padua, Padua, Italy
| | | | - Linwah Yip
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Garcilaso Riesco-Eizaguirre
- Department of Endocrinology and Nutrition Hospital Universitario La Paz and Hospital Universitario de Móstoles, Madrid, Spain
- Biomedical Research Institute “Alberto Sols,” Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Madrid, Spain
- Ciberonc, Health Institute Carlos III, Madrid, Spain
| | - Pilar Santisteban
- Biomedical Research Institute “Alberto Sols,” Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid, Madrid, Spain
- Ciberonc, Health Institute Carlos III, Madrid, Spain
| | | | - Mark S Sywak
- Endocrine Surgical Unit, University of Sydney, Sydney, Australia
| | | | - Bela Bendlova
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Vlasta Sýkorová
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Shihua Zhao
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Correspondence: Mingzhao Xing, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21207, USA.
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6
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Patel KB, Cormier N, Fowler J, Partridge A, Theurer J, Black M, Pinto N, Yoo J, Fung K, MacNeil D, Stecho W, Howlett C, Brackstone M, Barrett JW, Nichols A. Detection of Circulating Tumor DNA in Patients with Thyroid Nodules. Int J Endocrinol 2021; 2021:8909224. [PMID: 34475951 PMCID: PMC8407979 DOI: 10.1155/2021/8909224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Detection of circulating tumor DNA (ctDNA) in cancer patients can potentially serve as a noninvasive, sensitive test of disease status. The purpose of this study was to determine the ability to detect BRAF (V600E) mutations in the plasma of patients with thyroid nodules, with the goal of distinguishing between benign and malignant nodules. METHODS Consecutive patients with thyroid nodules who consented for surgery were recruited. Plasma samples were obtained preoperatively and one month postoperatively. Quantitative PCR was used to determine the levels of the BRAF (V600E) mutation preoperatively and postoperatively. RESULTS A total of 109 patients were recruited. On final pathology, 38 (32.8%) patients had benign thyroid nodules, 45 (38.8%) had classical papillary thyroid cancer (PTC), 23 (19.8%) had nonclassical PTC, and 3 (2.6%) had follicular thyroid cancer. 15/109 patients had detectable BRAF (V600E) ctDNA in their preoperative samples-all of them having classical PTC. Higher T-stage and extrathyroidal extension in PTC were associated with positive BRAF (V600E) ctDNA (p < 0.05). Eighty-eight pairs of preoperative and postoperative plasma samples were collected and analyzed. Of these eighty-eight paired samples, a total of 13/88 (14.8%) patients had detectable BRAF (V600E) ctDNA in their preoperative samples-all of them having classical PTC. 12 of these 13 patients had no detectable BRAF (V600E) postoperatively, while one remaining patient had a significant decline in his levels (p < 0.05). CONCLUSION BRAF (V600E) circulating thyroid tumor DNA can be detected in plasma and is correlated with a final diagnosis of the classical variant of PTC. Given that a postoperative drop in BRAF (V600E) ctDNA levels was observed in all cases suggests its utility as a tumor marker.
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Affiliation(s)
- Krupal B. Patel
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Nicholas Cormier
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - James Fowler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Allison Partridge
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Julie Theurer
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Morgan Black
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Nicole Pinto
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - William Stecho
- Department of Pathology, Western University, London, Ontario, Canada
| | | | | | - John W. Barrett
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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7
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Intratumoral Heterogeneity in Differentiated Thyroid Tumors: An Intriguing Reappraisal in the Era of Personalized Medicine. J Pers Med 2021; 11:jpm11050333. [PMID: 33922518 PMCID: PMC8146970 DOI: 10.3390/jpm11050333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
Differentiated thyroid tumors (DTTs) are characterized by significant molecular variability in both spatial and temporal intra-tumoral heterogeneity (ITH), that could influence the therapeutic management. ITH phenomenon appears to have a relevant role in tumor growth, aggressive behavior and drug resistance. Accordingly, characteristics and consequences of ITH in DTTs should be better analyzed and understood in order to guide clinical practice, improving survival. Consequently, in the present review, we investigated morphological and molecular ITH of DTTs in benign, borderline neoplasms and in malignant entities, summarizing the most significant data. Molecular testing in DTTs documents a high risk for recurrence of cancer associated with BRAFV600E, RET/PTC 1/3, ALK and NTRK fusions, while the intermediate risk may be related to BRAFK601E, H/K/N RAS and PAX8/PPARγ. In addition, it may be suggested that tumor genotype is associated with peculiar phenotype.
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8
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Romei C, Elisei R. A Narrative Review of Genetic Alterations in Primary Thyroid Epithelial Cancer. Int J Mol Sci 2021; 22:1726. [PMID: 33572167 PMCID: PMC7915177 DOI: 10.3390/ijms22041726] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/22/2022] Open
Abstract
Thyroid carcinoma is the most frequent endocrine neoplasia. Different types of thyroid carcinoma are described: well-differentiated papillary thyroid carcinoma (PTC), poorly differentiated thyroid carcinoma (PDTC), follicular thyroid carcinoma (FTC), anaplastic thyroid carcinoma (ATC), and medullary thyroid carcinoma (MTC). MTC is inherited as an autosomal dominant trait in 25% of cases. The genetic landscape of thyroid carcinoma has been largely deciphered. In PTC, genetic alterations have been found in about 95% of tumors: BRAF mutations and RET rearrangements are the main genetic alterations. BRAF and RAS mutations have been confirmed to play an important role also in PDTC and ATC, together with TP53 mutations that are fundamental in tumor progression. It has also been clearly demonstrated that telomerase reverse transcriptase (TERT) promoter mutations and TP53 mutations are present with a high-frequency in more advanced tumors, frequently associated with other mutations, and their presence, especially if simultaneous, is a signature of aggressiveness. In MTC, next-generation sequencing confirmed that mutations in the RET gene are the most common molecular events followed by H-RAS and K-RAS mutations. The comprehensive knowledge of the genetic events responsible for thyroid tumorigenesis is important to better predict the biological behavior and better plan the therapeutic strategy for specific treatment of the malignancy based on its molecular profile.
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MESH Headings
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Biomarkers, Tumor/genetics
- Carcinogenesis/genetics
- Carcinoma, Neuroendocrine/genetics
- Carcinoma, Neuroendocrine/pathology
- DNA Mutational Analysis
- Gene Rearrangement
- Humans
- Mutation
- Promoter Regions, Genetic/genetics
- Proto-Oncogene Proteins B-raf/genetics
- Proto-Oncogene Proteins c-ret/genetics
- Proto-Oncogene Proteins p21(ras)/genetics
- Telomerase/genetics
- Thyroid Cancer, Papillary/genetics
- Thyroid Cancer, Papillary/pathology
- Thyroid Carcinoma, Anaplastic/genetics
- Thyroid Carcinoma, Anaplastic/pathology
- Thyroid Gland/pathology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, 56124 Pisa, Italy;
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9
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Muzza M. The clonal origin of multifocal papillary thyroid cancer: intrathyroidal spread or independent tumors? Minerva Endocrinol (Torino) 2020; 46:35-44. [PMID: 33045819 DOI: 10.23736/s2724-6507.20.03302-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multifocality is a common finding in papillary thyroid cancer but the molecular pathogenesis, prognosis and management of multifocal papillary thyroid cancer are debated. The clonal origin of multifocal papillary thyroid cancer represents a controversial aspect, as two opposite viewpoints have been proposed: independent origin or intraglandular spread. Different approaches have been used for inferring the clonality of multifocal papillary thyroid cancer, including X-chromosome inactivation, mutational analysis, determination of loss of heterozygosity and, more recently, next-generation sequencing. Next-generation sequencing, able to provide information on genetic heterogeneity and phylogenetic evolution in multifocal tumors, represents the most reliable approach. While most evidences indicated an independent origin of multifocal papillary thyroid cancer, a minority of studies suggested that multifocal papillary thyroid tumors might be monoclonally derived. This discrepancy may reflect technical limitations; nevertheless, studies based on next-generation sequencing indicated that both independent and clonal origins are possible. The co-existence of multiple tumors implies a high degree of genetic heterogeneity, which may influence the best and targeted therapeutic strategy. On the other hand, intrathyroidal dissemination may indicate metastatic potential of the dominant tumor, thereby prompting more aggressive treatments. In conclusion, data available in the literature indicated that multifocal papillary thyroid cancer may derived from both intraglandular spread and independent tumor foci. The understanding of the clonal origin of multifocal papillary thyroid tumors might represent an important issue in patient treatment.
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Affiliation(s)
- Marina Muzza
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy -
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10
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Chen P, Pan L, Huang W, Feng H, Ouyang W, Wu J, Wang J, Deng Y, Luo J, Chen Y. BRAF V600E and lymph node metastases in papillary thyroid cancer. Endocr Connect 2020; 9:999-1008. [PMID: 33064665 PMCID: PMC7576641 DOI: 10.1530/ec-20-0420] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the relationship between the BRAF V600E mutation in lymph node metastasis (LNM) and its invasive characteristics in papillary thyroid cancer (PTC). MATERIAL AND METHODS A total of 373 PTC patients were enrolled in this study conducted at Zhujiang Hospital of Southern Medical University between January 2017 and December 2018. PTCs with cervical lymph node metastases were verified pathohistologically, and primary tumors and LNM were examined for the BRAF V600E mutation. Patients were excluded from the study if the BRAF V600E mutation was examined only in primary tumors or only in LNM. RESULTS Of the 373 patients examined, BRAF V600E mutation frequency in primary tumors was slightly higher than in LNM (81.5% vs 78.0%, P = 0.000), the intra-class correlation coefficient (ICC) was 0.865 (95% CI 0.835-0.890). The BRAF V600E mutation in both primary tumor and LNM negatively correlated with the size of the largest metastatic focus of LNM (Odds ratio, OR = 0.297, 95% CI 0.143-0.616, P = 0.001; OR = 0.242, 95% CI 0.119-0.492, P = 0.000, respectively). There was no relationship between BRAF V600E mutation in LNM and the number, extranodal extension or stage of LNM (P > 0.05). CONCLUSION The BRAF V600E mutation in LNM may not be related to the invasive characteristics of LNM in PTC.
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Affiliation(s)
- Pan Chen
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Liqin Pan
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wensi Huang
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Huijuan Feng
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
- Correspondence should be addressed to H Feng or W Ouyang: or
| | - Wei Ouyang
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
- Correspondence should be addressed to H Feng or W Ouyang: or
| | - Juqing Wu
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jing Wang
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yuying Deng
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jiaxin Luo
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yanying Chen
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
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11
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San Román Gil M, Pozas J, Molina-Cerrillo J, Gómez J, Pian H, Pozas M, Carrato A, Grande E, Alonso-Gordoa T. Current and Future Role of Tyrosine Kinases Inhibition in Thyroid Cancer: From Biology to Therapy. Int J Mol Sci 2020; 21:E4951. [PMID: 32668761 PMCID: PMC7403957 DOI: 10.3390/ijms21144951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022] Open
Abstract
Thyroid cancer represents a heterogenous disease whose incidence has increased in the last decades. Although three main different subtypes have been described, molecular characterization is progressively being included in the diagnostic and therapeutic algorithm of these patients. In fact, thyroid cancer is a landmark in the oncological approach to solid tumors as it harbors key genetic alterations driving tumor progression that have been demonstrated to be potential actionable targets. Within this promising and rapid changing scenario, current efforts are directed to improve tumor characterization for an accurate guidance in the therapeutic management. In this sense, it is strongly recommended to perform tissue genotyping to patients that are going to be considered for systemic therapy in order to select the adequate treatment, according to recent clinical trials data. Overall, the aim of this article is to provide a comprehensive review on the molecular biology of thyroid cancer focusing on the key role of tyrosine kinases. Additionally, from a clinical point of view, we provide a thorough perspective, current and future, in the treatment landscape of this tumor.
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MESH Headings
- Adenocarcinoma, Follicular/enzymology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/enzymology
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/therapy
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Carcinoma, Medullary/enzymology
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/therapy
- Carcinoma, Papillary/enzymology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/therapy
- Clinical Trials as Topic
- Combined Modality Therapy
- Disease Management
- Forecasting
- Genes, Neoplasm
- Humans
- Immune Checkpoint Inhibitors/therapeutic use
- Immunoconjugates/therapeutic use
- Immunotherapy
- Iodine Radioisotopes/therapeutic use
- Molecular Targeted Therapy
- Multicenter Studies as Topic
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/antagonists & inhibitors
- Oncogene Proteins, Fusion/genetics
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Randomized Controlled Trials as Topic
- Thyroid Neoplasms/enzymology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/therapy
- Tumor Microenvironment/immunology
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Affiliation(s)
- María San Román Gil
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
| | - Javier Pozas
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
| | - Javier Molina-Cerrillo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
- The Ramon y Cajal Health Research Institute (IRYCIS), CIBERONC, 28034 Madrid, Spain
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
| | - Joaquín Gómez
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
- General Surgery Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Héctor Pian
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Miguel Pozas
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
| | - Alfredo Carrato
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
- The Ramon y Cajal Health Research Institute (IRYCIS), CIBERONC, 28034 Madrid, Spain
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
| | - Enrique Grande
- Medical Oncology Department, MD Anderson Cancer Center, 28033 Madrid, Spain;
| | - Teresa Alonso-Gordoa
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
- The Ramon y Cajal Health Research Institute (IRYCIS), CIBERONC, 28034 Madrid, Spain
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
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12
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Intratumoral Genetic Heterogeneity in Papillary Thyroid Cancer: Occurrence and Clinical Significance. Cancers (Basel) 2020; 12:cancers12020383. [PMID: 32046148 PMCID: PMC7072350 DOI: 10.3390/cancers12020383] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/16/2022] Open
Abstract
Intratumoral heterogeneity (ITH) refers to a subclonal genetic diversity observed within a tumor. ITH is the consequence of genetic instability and accumulation of genetic alterations, two mechanisms involved in the progression from an early tumor stage to a more aggressive cancer. While this process is widely accepted, the ITH of early stage papillary thyroid carcinoma (PTC) is debated. By different genetic analysis, several authors reported the frequent occurrence of PTCs composed of both tumor cells with and without RET/PTC or BRAFV600E genetic alterations. While these data, and the report of discrepancies in the genetic pattern between metastases and the primary tumor, demonstrate the existence of ITH in PTC, its extension and biological significance is debated. The ITH takes on a great significance when involves oncogenes, such as RET rearrangements and BRAFV600E as it calls into question their role of driver genes. ITH is also predicted to play a major clinical role as it could have a significant impact on prognosis and on the response to targeted therapy. In this review, we analyzed several data indicating that ITH is not a marginal event, occurring in PTC at any step of development, and suggesting the existence of unknown genetic or epigenetic alterations that still need to be identified.
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13
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Li X, Li E, Du J, Wang J, Zheng B. BRAF mutation analysis by ARMS-PCR refines thyroid nodule management. Clin Endocrinol (Oxf) 2019; 91:834-841. [PMID: 31441082 DOI: 10.1111/cen.14079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of thyroid nodules leads to nearly 25% indeterminate nodules, while BRAFV600E mutation helps to predicting papillary thyroid carcinoma (PTC). However, the clinical validity and utility of the BRAFV600E mutation detected using preoperative FNA samples in a large cohort were rarely reported. AIM To explore the clinical significance of the BRAFV600E mutation on preoperative diagnosis and decision-making in a large FNA cohort in China. DESIGN This was a prospective study of BRAFV600E mutation analysis using an amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in FNA samples. PATIENTS The study involved 2640 samples from 2307 patients undergoing FNA procedures in a Chinese medical centre. RESULTS A high mutation rate of 86.7% was found in the PTC population. For indeterminate thyroid nodules, the malignant rate of BRAFV600E+ and BRAFV600E- was 87.8% and 39.5% in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) III, and 88.2% and 31.8% in the BSRTC IV, respectively. A cost-effective diagnostic model combining both BSRTC grading and BRAFV600E mutation status showed the highest sensitivity of 82.9% and specificity of 85.4%. Central lymph node metastasis (CLNM) was independent of the BRAF mutation status and accounted for 34.2% of the patients with PTC. CT values of BRAFV600E of patients with PTMC were significantly lower in young patients and patients with CLNM. CONCLUSIONS The combined analysis of cytological results and BRAFV600E mutation is highly recommended in BRAFV600E high-prevalence regions, including China. Prophylactic central neck dissection should be performed in selected patients without regard to the BRAF mutation status.
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Affiliation(s)
- Xinyang Li
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Enling Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jing Du
- Department of Ultrasonography, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiadong Wang
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zheng
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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14
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Effect of Sentinel Node Biopsy in Clinically N0, BRAF V600E–Mutated, Small Papillary Thyroid Carcinoma. Clin Nucl Med 2019; 44:359-364. [DOI: 10.1097/rlu.0000000000002465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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Coelho RG, Fortunato RS, Carvalho DP. Metabolic Reprogramming in Thyroid Carcinoma. Front Oncol 2018; 8:82. [PMID: 29629339 PMCID: PMC5876306 DOI: 10.3389/fonc.2018.00082] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/09/2018] [Indexed: 12/20/2022] Open
Abstract
Among all the adaptations of cancer cells, their ability to change metabolism from the oxidative to the glycolytic phenotype is a hallmark called the Warburg effect. Studies on tumor metabolism show that improved glycolysis and glutaminolysis are necessary to maintain rapid cell proliferation, tumor progression, and resistance to cell death. Thyroid neoplasms are common endocrine tumors that are more prevalent in women and elderly individuals. The incidence of thyroid cancer has increased in the Past decades, and recent findings describing the metabolic profiles of thyroid tumors have emerged. Currently, several drugs are in development or clinical trials that target the altered metabolic pathways of tumors are undergoing. We present a review of the metabolic reprogramming in cancerous thyroid tissues with a focus on the factors that promote enhanced glycolysis and the possible identification of promising metabolic targets in thyroid cancer.
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Affiliation(s)
- Raquel Guimaraes Coelho
- Laboratório de Fisiologia Endócrina, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo S. Fortunato
- Laboratório de Radiobiologia Molecular, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise P. Carvalho
- Laboratório de Fisiologia Endócrina, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Predicting 131I-avidity of metastases from differentiated thyroid cancer using 18F-FDG PET/CT in postoperative patients with elevated thyroglobulin. Sci Rep 2018. [PMID: 29531251 PMCID: PMC5847528 DOI: 10.1038/s41598-018-22656-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The quantitative relationship between iodine and glucose metabolism in metastases from differentiated thyroid cancer (DTC) remains unknown. Aim of the prospective study was to establish the value of 18F-FDG PET/CT in predicting 131I-avidity of metastases from DTC before the first radioiodine therapy. A total of 121 postoperative DTC patients with elevated stimulated serum thyroglobulin (ssTg) who underwent 131I adjuvant therapy or therapy after 18F-FDG PET/CT scan were enrolled. The Receiver operating characteristic curve was established to create an optimal cut-off point and evaluate the value of SUVmax for predicting 131I-avidity. In our study, the median SUVmax in 131I-nonavid metastatic target lesions was also significantly higher than that in 131I-avid metastatic target lesions (5.37 vs. 3.30; P = 0.000). At a cut-off value of 4.0 in SUVmax, the area under curve was 0.62 with the sensitivity, specificity, positive predictive value and negative predictive value of 75.3%, 56.7%, 76.1%, and 54.8%, respectively. These results suggest that 18F-FDG PET/CT may be of great value in identifying metastases in postoperative DTC patients with elevated ssTg before 131I administration, leading to an improved management of disease. 18F-FDG positive metastatic DTC with SUVmax of greater than 4.0 possesses higher probability of non-avidity to radioiodine.
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17
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Chmielik E, Rusinek D, Oczko-Wojciechowska M, Jarzab M, Krajewska J, Czarniecka A, Jarzab B. Heterogeneity of Thyroid Cancer. Pathobiology 2018; 85:117-129. [PMID: 29408820 DOI: 10.1159/000486422] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022] Open
Abstract
There are 5 main histological types of thyroid cancers (TCs): papillary, follicular (also known as differentiated), poorly differentiated, anaplastic (the most aggressive form), and medullary TC, and only the latter arises from thyroid C cells. These different forms of TCs show significant variability, both among and within tumours. This great variation is particularly notable among the first 4 types, which all originate from thyroid follicular cells. Importantly, this heterogeneity is not limited to histopathological diversity only but is also manifested as variation in several genetic and/or epigenetic alterations, the numbers of interactions between the tumour and surrounding microenvironment, and interpatient differences, for example. All these factors contribute to the great complexity in the development of a tumour from cancer cells. In the present review, we summarise the knowledge accumulated about the heterogeneity of TCs. Further research in this direction should help to gain a better understanding of the underlying mechanisms contributing to the development and diversity of TCs, paving the way toward more effective treatment strategies.
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Affiliation(s)
- Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Malgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Michal Jarzab
- 3rd Department of Radiotherapy and Chemotherapy, Breast Unit, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
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18
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BRAF and NRAS Mutations in Papillary Thyroid Carcinoma and Concordance in BRAF Mutations Between Primary and Corresponding Lymph Node Metastases. Sci Rep 2017; 7:4666. [PMID: 28680105 PMCID: PMC5498648 DOI: 10.1038/s41598-017-04948-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/23/2017] [Indexed: 11/24/2022] Open
Abstract
Concordance between mutations in the primary papillary thyroid carcinoma (PTC) and the paired x lymph node metastasis may elucidate the potential role of molecular targeted therapy in advanced stages. BRAF and NRAS mutations in primary PTC (n = 253) with corresponding metastatic lymph node (n = 46) were analyzed utilizing StripAssays (ViennaLab Diagnostics). Statistical analysis was performed using (SPSS, Inc.), version 24.0 with a p-value of <0.05, and concordance via kappa agreement. BRAF mutation frequency in conventional PTC (cPTC): 56.8%, papillary thyroid microcarcinoma (PTMC): 36.5%, PTMC-FV: 2.7% and PTC-FV: 4.1%. NRAS mutation frequency in PTC-FV: 28.6%, PTMC: 28.6%, PTMC-FV: 23.8%, and cPTC: 19.0%. BRAF mutation correlation with older age in cPTC (42.6 versus 33.6) years (p < 0.001) was the only significant clinicopathologic parameter. BRAF mutations were concordant in the primary and its corresponding lymph node deposits in PTC with a kappa of 0.77 (p-value < 0.0001). BRAF mutations are predominant in cPTC and PTMC while NRAS mutations in PTC-FV. BRAF mutation is conserved in metastatic lymph node deposits, thus BRAF is an early mutational pathogenetic driver. Therefore, targeted therapy is potential in recurrent and advanced stage disease.
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Shifrin AL, Fischer M, Paul T, Erler B, Gheysens K, Baodhankar P, Song-Yang JW, Taylor S, Timmaraju VA, Topilow A, Mireskandari A, Kumar G. Mutational analysis of metastatic lymph nodes from papillary thyroid carcinoma in adult and pediatric patients. Surgery 2016; 161:176-187. [PMID: 27866718 DOI: 10.1016/j.surg.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Limited data are available on the analysis of somatic mutations in metastatic lymph nodes in adult and pediatric patients with papillary thyroid carcinomas. METHODS A total of 92, microdissected, formalin-fixed, paraffin-embedded tissue specimens from 39 patients were analyzed for the presence of somatic mutations utilizing the ThyGenX next-generation sequencing test. RESULTS Somatic mutations were detected in 67% of papillary thyroid carcinoma specimens. The majority of patients with synchronous and all 6 patients with radioactive iodine-resistant (metachronous) metastatic lymph nodes contained BRAF mutations. Four patients had mutations detected in their metastatic lymph nodes that were not detected in their primary tumors. For the most part, BRAF mutations were seen in adults, and RAS mutations were seen in children. CONCLUSION Findings of different mutations in metastatic lymph nodes compared with the primary papillary thyroid carcinomas are probably the result of tumor heterogeneity. The presence of the BRAF mutation in metastatic lymph nodes might be responsible for the recurrence of papillary thyroid carcinomas and resistance to radioactive iodine therapy. The good prognosis observed in papillary thyroid carcinomas found in pediatric and young adult patients might be explained by the predominance of RAS rather than BRAF mutations.
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Affiliation(s)
| | - Michele Fischer
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Trevor Paul
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Brian Erler
- Department of Pathology, Jersey Shore University Medical Center, Neptune, NJ
| | - Katherine Gheysens
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Prachi Baodhankar
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | | | | | | | - Arthur Topilow
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ
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Kurtulmus N, Ertas B, Saglican Y, Kaya H, Ince U, Duren M. BRAF V600E Mutation: Has It a Role in Cervical Lymph Node Metastasis of Papillary Thyroid Cancer? Eur Thyroid J 2016; 5:195-200. [PMID: 27843810 PMCID: PMC5091266 DOI: 10.1159/000448112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/28/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The BRAFV600E mutation is common in papillary thyroid cancer (PTC). Lymph node metastasis (LNM) may be associated with poor prognosis. However, the LNM mechanism remains unclear. OBJECTIVES Our aim was to evaluate the prevalence of the BRAFV600E mutation in primary tumors and accompanying LNM at the time of diagnosis. METHODS This retrospective study included 51 PTC patients (40 women, 11 men; mean age 40.0 ± 16.5 years; range 6-81) who underwent total thyroidectomy accompanied by a lateral neck dissection due to preoperatively detected LNM. Real-time PCR was used for the detection of the BRAFV600E mutation in specimens from primary thyroid tumors and metastatic lymph node tumors. RESULTS The prevalence of the BRAFV600E mutation was 64.7% (n = 33) in primary tumors and 47.1% (n = 24) in metastatic lymph nodes. Of 33 patients with BRAFV600E-positive primary tumors, 18 (54.5%) had BRAFV600E-positive metastatic lymph nodes. Of 18 patients with BRAFV600E-negative primary tumors, 6 (33.3%) had BRAFV600E-positive metastatic lymph nodes. The presence of the BRAFV600E mutation in the primary tumor did not affect the tumor size, but the diameter of metastatic lymph nodes significantly increased (by nearly 3 mm) with the presence of BRAFV600E in LNM (p = 0.01). CONCLUSIONS In our study, the BRAFV600E mutation did not show a one-to-one correspondence. This indicates that the presence of BRAFV600E in the primary tumor is not clonal and addresses the role of intratumor heterogeneity in PTC tumorigenesis. This supports the theses that mutations occur in the later stages of tumorigenesis, might be subclonal, and develop de novo, or that some other factors may be involved in the development of metastasis.
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Affiliation(s)
- Neslihan Kurtulmus
- Endocrinology and Thyroid Clinic, Acibadem Maslak Hospital, Istanbul, Turkey
- *Prof. Dr. Neslihan Kurtulmus, Endocrinology and Thyroid Clinic, Acibadem Maslak Hospital, Acibadem University, Buyukdere Cad. No. 40 Maslak, TR-34457 Istanbul (Turkey), E-Mail
| | - Burak Ertas
- Otorhinolaryngology, Istanbul, Medical Faculty, Acibadem University, Istanbul, Turkey
| | - Yesim Saglican
- Pathology, Medical Faculty, Acibadem University, Istanbul, Turkey
| | - Hakan Kaya
- Endocrinology and Thyroid Clinic, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Umit Ince
- Pathology, Medical Faculty, Acibadem University, Istanbul, Turkey
| | - Mete Duren
- Endocrinology and Thyroid Clinic, Acibadem Maslak Hospital, Istanbul, Turkey
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Cañadas-Garre M, Becerra-Massare P, Moreno Casares A, Calleja-Hernández MÁ, Llamas-Elvira JM. Relevance of BRAF and NRAS mutations in the primary tumor and metastases of papillary thyroid carcinomas. Head Neck 2016; 38:1772-1779. [PMID: 27299298 DOI: 10.1002/hed.24517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multifocality of papillary thyroid carcinoma (PTC) is common. BRAF and NRAS mutations are the most frequent genetic alterations in PTC. The purpose of this study was to determine the distribution and relevance of BRAFT1799A and NRAS mutations in PTC. METHODS BRAFT1799A and NRAS mutations were evaluated in 195 intrathyroid or metastatic foci from 29 patients with multifocal PTC. RESULTS BRAFT1799A mutation was positive in 46.7% of the 59 intrathyroid and 136 metastatic foci (91/195 foci). Heterogeneous BRAF pattern was observed in 51.7% patients (15/29 patients). Irrespective of BRAF status at diagnosis (thyroid or nodes), all patients with recurrent PTC presented BRAF-mutated metastases during follow-up. All foci were negative for NRAS mutations. CONCLUSION BRAF but not NRAS mutations were heterogeneously distributed among primary tumor, nodal sites, and recurrent disease. The BRAF status of metastases generated during the follow-up can differ from the status of foci at diagnosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1772-1779, 2016.
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Affiliation(s)
- Marisa Cañadas-Garre
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Patricia Becerra-Massare
- UGC Anatomía Patológica, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Antonia Moreno Casares
- Department of Clinical Analysis and Immunology, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Pharmacogenetics Unit, UGC Provincial de Farmacia de Granada, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - José Manuel Llamas-Elvira
- Nuclear Medicine Department, Instituto de Investigación Biosanitaria de Granada, Complejo Hospitalario Universitario de Granada, Granada, Spain
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Sohn SY, Park WY, Shin HT, Bae JS, Ki CS, Oh YL, Kim SW, Chung JH. Highly Concordant Key Genetic Alterations in Primary Tumors and Matched Distant Metastases in Differentiated Thyroid Cancer. Thyroid 2016; 26:672-82. [PMID: 26971368 DOI: 10.1089/thy.2015.0527] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Distant metastases uncommonly occur in differentiated thyroid carcinoma (DTC), but they are a frequent cause of thyroid cancer-related death. Genomic alterations in metastatic tumors, and the relationship with their corresponding primary tumors in DTC, are poorly understood. The objective of this study was to investigate whether genetic alterations in primary tumors are concordant with distant metastases in DTC patients. METHODS Surgical samples from primary and matched distant metastatic tumor pairs from 17 DTC patients, and three additional unpaired metastatic tumors from two patients, were analyzed using targeted next-generation sequencing (Ion Torrent Ampliseq cancer panel) with a focus on known recurrent somatic mutations in thyroid cancer. Additionally, TERT promoter mutations were assessed by direct sequencing. RESULTS BRAF mutations were found in 8/10 patients with papillary thyroid carcinoma (PTC). A NRAS mutation was detected in one patient with follicular variant PTC. TERT promoter mutations were detected in 8/10 patients with PTC, and most were coexistent with a BRAF mutation (7/8 BRAF-positive PTC patients, and one BRAF-negative PTC patient). In follicular thyroid carcinoma, NRAS was the most frequently observed mutation (4/9 patients), followed by HRAS (two patients) and KRAS (one patient). TERT promoter mutations were found in 6/7 RAS-positive follicular thyroid carcinoma patients. Key somatic alterations such as BRAF and RAS mutations were highly concordant between primary and matched metastatic tumors without discrepancies. The BRAF or RAS mutant allelic frequency was higher in matched metastatic tumors than in the corresponding primary tumors (35% vs. 25% for BRAF mutation, p = 0.04; and 40% vs. 34% for RAS mutation, p = 0.002). TERT promoter mutations were also mostly concordant in matched tumors (concordance rate 93%). CONCLUSIONS BRAF, RAS, and TERT mutations are highly prevalent in metastatic DTC, and are concordant between primary and metastatic DTC. This high concordance suggests that primary tumors may reflect the key somatic alterations in matched metastatic DTC. Frequent coexistent TERT promoter and BRAF or RAS mutations in metastatic DTC also suggests its important role in the progression of DTC.
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Affiliation(s)
- Seo Young Sohn
- 1 Department of Endocrinology and Metabolism, Seonam University , Myongji Hospital, Goyang, Korea
| | - Woong Yang Park
- 2 Samsung Genome Institute, Samsung Medical Center , Seoul, Korea
- 3 Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine , Suwon, Korea
| | - Hyun Tae Shin
- 2 Samsung Genome Institute, Samsung Medical Center , Seoul, Korea
| | - Joon Seol Bae
- 2 Samsung Genome Institute, Samsung Medical Center , Seoul, Korea
| | - Chang Seok Ki
- 4 Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Young Lyun Oh
- 5 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Sun Wook Kim
- 6 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jae Hoon Chung
- 6 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
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Li D, Gao M, Li X, Xing M. Molecular Aberrance in Papillary Thyroid Microcarcinoma Bearing High Aggressiveness: Identifying a "Tibetan Mastiff Dog" From Puppies. J Cell Biochem 2016; 117:1491-6. [PMID: 26841328 DOI: 10.1002/jcb.25506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 11/11/2022]
Abstract
Today the most common differentiated thyroid cancer in many countries is papillary thyroid microcarcinoma (PTMC). Although the majority of PTMCs exhibit an indolent clinical course, a few possess high risk for aggressiveness with tumor invasion, metastasis, and even patient mortality. This imposes significant confusion and often dilemma in the clinical management of PTMC. The present review summarizes the molecular pathogenesis, particularly the major genetic alterations, of PTMC that may have prognostic values in assisting risk stratification of this cancer and identification of the most aggressive cases from the many well-behaving cases. J. Cell. Biochem. 117: 1491-1496, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Dapeng Li
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xiaolong Li
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, 77025
| | - Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
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Abstract
Thyroid cancers are largely divided into medullary (MTC) and non-medullary (NMTC) cancers , depending on the cell type of origin. Familial non-medullary thyroid cancer (FNMTC) comprises about 5-15% of NMTC and is a heterogeneous group of diseases, including both non-syndromic and syndromic forms. Non-syndromic FNMTC tends to manifest papillary thyroid carcinoma , usually multifocal and bilateral . Several high-penetrance genes for FNMTC have been identified, but they are often confined to a few or single families, and other susceptibility loci appear to play a small part, conferring only small increments in risk. Familial susceptibility is likely to be due to a combination of genetic and environmental influences. The current focus of research in FNMTC is to characterise the susceptibility genes and their role in carcinogenesis. FNMTC can also occur as a part of multitumour genetic syndromes such as familial adenomatous polyposis , Cowden's disease , Werner's syndrome and Carney complex . These tend to present at an early age and are multicentric and bilateral with distinct pathology. The clinical evaluation of these patients is similar to that for most patients with a thyroid nodule. Medullary thyroid cancer (MTC) arises from the parafollicular cells of the thyroid which release calcitonin. The familial form of MTC accounts for 20-25% of cases and presents as a part of the multiple endocrine neoplasia type 2 (MEN 2) syndromes or as a pure familial MTC (FMTC). They are caused by germline point mutations in the RET oncogene on chromosome 10q11.2. There is a clear genotype-phenotype correlation, and the aggressiveness of FMTC depends on the specific genetic mutation, which should determine the timing of surgery.
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Affiliation(s)
- Gul Bano
- Department of Endocrinology and Diabetes, Thomas Addison Unit, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, UK.
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25
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Rusinek D, Swierniak M, Chmielik E, Kowal M, Kowalska M, Cyplinska R, Czarniecka A, Piglowski W, Korfanty J, Chekan M, Krajewska J, Szpak-Ulczok S, Jarzab M, Widlak W, Jarzab B. BRAFV600E-Associated Gene Expression Profile: Early Changes in the Transcriptome, Based on a Transgenic Mouse Model of Papillary Thyroid Carcinoma. PLoS One 2015; 10:e0143688. [PMID: 26625260 PMCID: PMC4666467 DOI: 10.1371/journal.pone.0143688] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/09/2015] [Indexed: 01/11/2023] Open
Abstract
Background The molecular mechanisms driving the papillary thyroid carcinoma (PTC) are still poorly understood. The most frequent genetic alteration in PTC is the BRAFV600E mutation–its impact may extend even beyond PTC genomic profile and influence the tumor characteristics and even clinical behavior. Methods In order to identify BRAF-dependent signature of early carcinogenesis in PTC, a transgenic mouse model with BRAFV600E-induced PTC was developed. Mice thyroid samples were used in microarray analysis and the data were referred to a human thyroid dataset. Results Most of BRAF(+) mice developed malignant lesions. Nevertheless, 16% of BRAF(+) mice displayed only benign hyperplastic lesions or apparently asymptomatic thyroids. After comparison of non-malignant BRAF(+) thyroids to BRAF(−) ones, we selected 862 significantly deregulated genes. When the mouse BRAF-dependent signature was transposed to the human HG-U133A microarray, we identified 532 genes, potentially indicating the BRAF signature (representing early changes, not related to developed malignant tumor). Comparing BRAF(+) PTCs to healthy human thyroids, PTCs without BRAF and RET alterations and RET(+), RAS(+) PTCs, 18 of these 532 genes displayed significantly deregulated expression in all subgroups. All 18 genes, among them 7 novel and previously not reported, were validated as BRAFV600E-specific in the dataset of independent PTC samples, made available by The Cancer Genome Atlas Project. Conclusion The study identified 7 BRAF-induced genes that are specific for BRAF V600E-driven PTC and not previously reported as related to BRAF mutation or thyroid carcinoma: MMD, ITPR3, AACS, LAD1, PVRL3, ALDH3B1, and RASA1. The full signature of BRAF-related 532 genes may encompass other BRAF-related important transcripts and require further study.
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Affiliation(s)
- Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
- * E-mail:
| | - Michal Swierniak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Genomic Medicine, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Chmielik
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Monika Kowal
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Malgorzata Kowalska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Renata Cyplinska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Wojciech Piglowski
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Joanna Korfanty
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Mykola Chekan
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Sylwia Szpak-Ulczok
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michal Jarzab
- III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Wieslawa Widlak
- III Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
- II Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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BRAFV600E mutation associated with non-radioiodine-avid status in distant metastatic papillary thyroid carcinoma. Clin Nucl Med 2015; 39:675-9. [PMID: 24978326 DOI: 10.1097/rlu.0000000000000498] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE It was reported that BRAF mutation correlates with radioactive iodine refractory papillary thyroid carcinoma (PTC) in local recurrence, whereas its relationship with I uptake status in distant metastatic PTC remains uncertain. This prospective study tried to explore the association between I uptake in distant metastases (DM) of PTC and BRAF mutation status in their primary tumor. METHODS Seventy-three patients with DM were divided into BRAF mutation group (n = 19) and wild-type BRAF group (n = 54) according to the BRAF mutation status. After posttherapy I whole-body scan was performed, the relation between I uptake in DM, BRAF mutation status, and clinicopathological characteristics of 2 groups were compared. RESULTS The mean age of mutation group was older than that of the wild-type group (P < 0.05). In the mutation group, 16 patients (84.2%, 16 of 19) were found to be with non-iodine-avid DM, whereas in wild-type group, only 5.6% (3 of 54) were with non-iodine-avid DM. The sensitivity and specificity of using BRAF mutation for the identification of non-iodine-avid DM were 84.2% and 94.4%, respectively. CONCLUSIONS BRAF mutation in primary tumor might be a promising molecular marker to predict the status of I uptake in distal metastases.
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Muzza M, Colombo C, Rossi S, Tosi D, Cirello V, Perrino M, De Leo S, Magnani E, Pignatti E, Vigo B, Simoni M, Bulfamante G, Vicentini L, Fugazzola L. Telomerase in differentiated thyroid cancer: promoter mutations, expression and localization. Mol Cell Endocrinol 2015; 399:288-95. [PMID: 25448848 DOI: 10.1016/j.mce.2014.10.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 02/01/2023]
Abstract
Telomerase-reverse-transcriptase (TERT) promoter mutations have been recently described in tumors. In the present large series, TERT mutations were found in 12% of papillary thyroid cancers (PTCs) and in 14% of follicular thyroid cancers (FTCs), and were found to significantly correlate with older age at diagnosis and poorer outcome. Interestingly, the prognostic value of TERT mutations resulted to be significantly stronger than that of BRAF(V600E). Moreover, the outcome was not different among tumors with isolated TERT mutation and those with coexistent mutations (TERT/BRAF in PTCs or TERT/RAS in FTCs). TERT rs2853669 polymorphism was found in 44.4% of tumors. At WB, TERT was significantly more expressed in tumors than in normal samples, being the highest levels of expression recorded in TERT mutated cases. At IHC, in tumors and in metastatic lymph-nodes TERT staining was significantly higher in the cytoplasm than in the nucleus, whereas in normal tissue the degree of staining did not differ in the two cellular compartments. In conclusion, TERT mutations were shown to strongly correlate with a poorer outcome in differentiated thyroid tumors, and neither BRAF nor RAS mutation were found to confer an additional effect in the disease persistence. TERT protein was found to be more expressed in neoplastic than in normal tissues, and to display a different cellular localization, suggesting that it could contribute to thyroid cancer progression by mechanisms taking place in the cytoplasm.
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Affiliation(s)
- Marina Muzza
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Carla Colombo
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | | | - Delfina Tosi
- Department of Health Sciences, University of Milan, Italy
| | - Valentina Cirello
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Michela Perrino
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Simone De Leo
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Elisa Magnani
- Azienda USL of Modena, Italy; Department of Biomedicine, Metabolism and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Elisa Pignatti
- Azienda USL of Modena, Italy; Department of Biomedicine, Metabolism and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Beatrice Vigo
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Manuela Simoni
- Azienda USL of Modena, Italy; Department of Biomedicine, Metabolism and Neural Sciences, University of Modena and Reggio Emilia, Italy
| | - Gaetano Bulfamante
- Division of Pathology, San Paolo Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Italy
| | | | - Laura Fugazzola
- Endocrine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy.
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Hussain MRM, Baig M, Mohamoud HSA, Ulhaq Z, Hoessli DC, Khogeer GS, Al-Sayed RR, Al-Aama JY. BRAF gene: From human cancers to developmental syndromes. Saudi J Biol Sci 2014; 22:359-73. [PMID: 26150740 PMCID: PMC4486731 DOI: 10.1016/j.sjbs.2014.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/05/2014] [Accepted: 10/14/2014] [Indexed: 12/20/2022] Open
Abstract
The BRAF gene encodes for a serine/threonine protein kinase that participates in the MAPK/ERK signalling pathway and plays a vital role in cancers and developmental syndromes (RASopathies). The current review discusses the clinical significance of the BRAF gene and other members of RAS/RAF cascade in human cancers and RAS/MAPK syndromes, and focuses the molecular basis and clinical genetics of BRAF to better understand its parallel involvement in both tumourigenesis and RAS/MAPK syndromes—Noonan syndrome, cardio-facio-cutaneous syndrome and LEOPARD syndrome.
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Affiliation(s)
- Muhammad Ramzan Manwar Hussain
- Faculty of Genetic Medicine, King Abdulaziz University, Jeddah, Saudi Arabia ; CAS-Institute of microbiology, University of Chinese Academy of Sciences, Beijing, China
| | - Mukhtiar Baig
- Faculty of Medicine, King Abdulaziz University, Rabigh Branch, Saudi Arabia
| | - Hussein Sheik Ali Mohamoud
- Human Genetics Research Centre, Division of Biomedical Sciences (BMS), St. George's University of London (SGUL), London, UK
| | - Zaheer Ulhaq
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
| | - Daniel C Hoessli
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
| | - Ghaidaa Siraj Khogeer
- Department of Biology, Genomics and Biotechnology Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ranem Radwan Al-Sayed
- Department of Biology, Genomics and Biotechnology Section, King Abdulaziz University, Jeddah, Saudi Arabia
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Renaud F, Gnemmi V, Devos P, Aubert S, Crépin M, Coppin L, Ramdane N, Bouchindhomme B, d'Herbomez M, Van Seuningen I, Do Cao C, Pattou F, Carnaille B, Pigny P, Wémeau JL, Leteurtre E. MUC1 expression in papillary thyroid carcinoma is associated with BRAF mutation and lymph node metastasis; the latter is the most important risk factor of relapse. Thyroid 2014; 24:1375-84. [PMID: 25012490 DOI: 10.1089/thy.2013.0594] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence of papillary thyroid carcinoma (PTC) has increased over the past 30 years in Western countries. PTC is usually associated with a good prognosis, but there is a wide range of aggressiveness, and some patients develop distant metastasis and/or resistance to standard treatment. Early identification of these high-risk tumors is a current challenge for appropriate patient management. MUC1 expression has been studied previously in thyroid cancer, but its prognostic value remains controversial. Here, we correlated MUC1 expression in PTC with clinical and pathological features and with the presence of the BRAF(V600E) mutation. METHODS We performed a clinical and morphological analysis of 190 thyroid tumors (95 PTCs and 95 adenomas). MUC1 immunohistochemistry was carried out on a tissue microarray using different antibodies. The presence of the BRAF(V600E) mutation was investigated by pyrosequencing. MUC1 mRNA levels were assessed by quantitative reverse transcription polymerase chain reaction on a subset of PTC. RESULTS MUC1 expression was observed in 49% of PTCs and was found to correlate with the presence of papillary architecture, a stromal lymphoid infiltrate, aggressive histological subtypes, extrathyroidal extension, lymph node metastasis, nuclear pseudoinclusions, lymphovascular invasion, and the presence of the BRAF(V600E) mutation (p<0.0001). MUC1 was abundant in nuclear pseudoinclusions. Multivariate analysis showed a strong association of MUC1 expression with the presence of the BRAF(V600E) mutation and lymph node metastasis (p<0.0001). Lymph node metastasis was the most important risk factor of relapse. CONCLUSIONS Our study shows an association between MUC1 expression and the presence of the BRAF(V600E) mutation in PTC. Analysis of MUC1 expression could improve the risk stratification of PTCs.
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Affiliation(s)
- Florence Renaud
- 1 Institute of Pathology, Lille University Hospital , Lille, France
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Capelli L, Marfisi C, Puccetti M, Saragoni L, De Paola F, Zaccaroni A, Chiadini E, Gagliardi L, Ferretti G, Zoli W, Ulivi P. Role of BRAF molecular analysis in the management of papillary thyroid carcinoma: analysis of cytological and histological samples. Cytopathology 2014; 26:297-302. [PMID: 25123949 DOI: 10.1111/cyt.12199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although fine needle aspiration (FNA) is the standard diagnostic test for the characterization of a suspicious thyroid nodule, in some cases cytological evaluation is inconclusive. The aim of this study was to determine the role of BRAF mutation in aiding diagnosis and to verify whether archival cytological samples could be suitable for molecular analysis. METHODS Eighty-five patients with suspicious (Thy4) or follicular (Thy3) lesions on cytology were resubmitted to a second FNA for BRAF mutation analysis. Of these, 56 subsequently underwent surgery. The usefulness of archival samples for molecular analysis was also studied in a second cohort of 42 patients with a confirmed diagnosis of papillary thyroid carcinoma for whom both archived paraffin-embedded histological samples and cytological smears were available. A further 15 patients with paired fresh FNA and archived cytological and histological samples were recruited. RESULTS BRAF mutation was found in the fresh FNA samples from 10 of 56 patients who had surgery with previous inconclusive cytology (4/45, 9%, Thy3 and 6/11, 55%, Thy4). The BRAF test showed a specificity and positive predictive value of 100% (26/26 and 10/10, respectively), sensitivity of 33% (10/30) and negative predictive value of 57% (26/46). There was absolute concordance between the BRAF results obtained with 42 histological and cytological archived samples. BRAF analysis on 15 archived cytological samples showed absolute concordance with histology, whereas there was one false negative on the matched fresh FNA. CONCLUSION BRAF analysis is a highly specific test that can facilitate cytological diagnosis in some cases and can also be performed on archived cytological samples.
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Affiliation(s)
- L Capelli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - C Marfisi
- Endocrine Surgery Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - M Puccetti
- Pathology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | - L Saragoni
- Pathology Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - F De Paola
- Pathology Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - A Zaccaroni
- Endocrine Surgery Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - E Chiadini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - L Gagliardi
- Endocrinology Unit, Morgagni-Piernatoni Hospital, Forlì, Italy
| | - G Ferretti
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - W Zoli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - P Ulivi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Yang Y, Chen C, Chen Z, Jiang J, Chen Y, Jin L, Guo G, Zhang X, Ye T. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol (Oxf) 2014; 81:282-8. [PMID: 24483297 DOI: 10.1111/cen.12417] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 11/17/2013] [Accepted: 01/27/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We aimed to determine the predictive factors for central compartment lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). DESIGN AND PATIENTS We undertook a retrospective study of 291 patients treated for PTMC. The following criteria were assessed to predict the presence of central compartment LNM: sex, age, tumour multifocality, tumour size, tumour bilaterality, extracapsular spread (ECS), lateral neck LNM, coexistence of chronic lymphocytic thyroiditis, BRAF(V) (600E) mutation and ultrasonography (US) features. Univariate and multivariate analyses were performed to identify clinicopathological characteristics and US findings in predicting central compartment LNM from PTMC. RESULTS The central compartment LNM affected 133 (45.7%) of 291 patients. With use of univariate and multivariate analyses, male gender (OR 2.020; P = 0.039), tumour size (>5 mm) (OR 3.687; P = 0.015), ESC (OR 2.330; P = 0.044), lateral LNM (OR 15.075; P = 0.000) and BRAF(V) (600E) mutation (OR 2.464; P = 0.000) were independently correlated with central compartment LNM. Age, tumour multifocality, tumour bilaterality, coexistence of chronic lymphocytic thyroiditis and US characteristics were not significantly related to the presence of central compartment LNM. We have also developed a nomogram to predict the probability of central compartment LNM for an individual patient. The sensitivity was 71.9% and specificity was 70.3%, with an under the receiver operating characteristic (ROC) curve of 0.772. CONCLUSIONS A prophylactic neck dissection of the central compartment should be considered particularly in PTMC patients with male gender, a >5 mm tumour size, ECS of the tumours, lateral LNM and positive BRAF(V) (600E) mutation.
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Affiliation(s)
- Yinlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
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Gandolfi G, Sancisi V, Piana S, Ciarrocchi A. Time to re-consider the meaning of BRAF V600E mutation in papillary thyroid carcinoma. Int J Cancer 2014; 137:1001-11. [PMID: 24828987 DOI: 10.1002/ijc.28976] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/02/2014] [Accepted: 05/08/2014] [Indexed: 01/21/2023]
Abstract
The BRAF V600E mutation, resulting from the BRAFT1799A transversion, is the most common genetic mutation in papillary thyroid carcinoma (PTC), with a mean frequency close to 50% among all cases. A large number of studies in the past decade have tried to dissect the relevance and the function of the V600E mutation in controlling oncogenesis and progression of thyroid cancer. However, several works published in the latest years have provided new evidence, in partial conflict with the previous knowledge, suggesting the need of reconsidering the meaning of the BRAF V600E mutation in PTC. In this work, we attempt to discuss some of the most recent molecular, preclinical and clinical evidence to construct a more exhaustive model of function for the BRAF V600E in development, progression and therapeutic approach of thyroid cancer.
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Affiliation(s)
- Greta Gandolfi
- Laboratory of Translational Research, Research and Statistic Infrastructure, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Valentina Sancisi
- Laboratory of Translational Research, Research and Statistic Infrastructure, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Department of Oncology, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Research and Statistic Infrastructure, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
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Cheng SP, Hsu YC, Liu CL, Liu TP, Chien MN, Wang TY, Lee JJ. Significance of allelic percentage of BRAF c.1799T > A (V600E) mutation in papillary thyroid carcinoma. Ann Surg Oncol 2014; 21 Suppl 4:S619-26. [PMID: 24748129 DOI: 10.1245/s10434-014-3723-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Somatic BRAF mutation is frequently observed in papillary thyroid carcinoma (PTC). Recent evidence suggests that PTCs are heterogeneous tumors containing a subclonal or oligoclonal occurrence of BRAF mutation. Conflicting results have been reported concerning the prognostic significance of the mutant allele frequency. Our present aim was to investigate the association between the percentage of BRAF c.1799T > A (p.Val600Glu) alleles and clinicopathological parameters in PTC. METHODS Genomic DNA was extracted from fresh-frozen specimens obtained from 50 PTC patients undergoing total thyroidectomy. The BRAF mutation status was determined by Sanger sequencing. The percentage of mutant BRAF alleles was quantified by mass spectrometric genotyping, pyrosequencing, and competitive allele-specific TaqMan PCR (castPCR). RESULTS Positive rate of BRAF mutation was 72 % by Sanger sequencing, 82 % by mass spectrometric genotying, and 84 % by pyrosequencing or castPCR. The average percentage of mutant BRAF alleles was 22.5, 31, and 30.7 %, respectively. There was a good correlation among three quantification methods (Spearman's rho = 0.87-0.97; p < 0.0001). The mutant allele frequency was significantly correlated with tumor size (rho = 0.47-0.52; p < 0.01) and extrathyroidal invasion. The frequency showed no difference in pathological lymph node metastasis. CONCLUSIONS The percentage of mutant BRAF alleles is positively associated with tumor burden and extrathyroidal invasion in PTC. Relatively good correlations exist among mass spectrometric genotyping, pyrosequencing, and castPCR in quantification of mutant BRAF allele frequency.
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Affiliation(s)
- Shih-Ping Cheng
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
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Walts AE, Pao A, Sacks W, Bose S. BRAF genetic heterogeneity in papillary thyroid carcinoma and its metastasis. Hum Pathol 2014; 45:935-41. [PMID: 24746198 DOI: 10.1016/j.humpath.2013.12.005] [Citation(s) in RCA: 18] [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: 09/11/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022]
Abstract
Intratumoral heterogeneity is widely recognized as an important determinant of a cancer's initial response and its subsequent resistance to targeted therapy. BRAF V600E mutation, common in papillary thyroid carcinoma (PTC), is helpful in fine needle aspiration diagnosis of thyroid nodules and is being evaluated for targeted therapies. This study was designed to assess the presence of BRAF mutation heterogeneity within primary PTCs and between paired primary and metastatic lesions. Genetic heterogeneity was evaluated in 47 PTCs (38 differentiated papillary thyroid carcinomas and 9 poorly differentiated PTCs with anaplastic areas). The differentiated papillary thyroid carcinomas included 16 cases with regional lymph node metastases at thyroidectomy and 9 cases with recurrent metastases to regional lymph nodes more than 5 years post thyroidectomy. Genetic heterogeneity of BRAF was studied by comparing the mutation status in different samples of tumor as follows: (a) 2 separate areas (each >1.5 cm in diameter) within the primary tumor, (b) a more than 1.5 cm area of primary carcinoma and a second 5 mm area simulating a fine needle aspiration sample from a different portion of the primary tumor, (c) primary carcinoma and its lymph node metastasis at thyroidectomy, (d) primary carcinoma and the recurrent metastasis, and (e) differentiated and anaplastic areas in the primary carcinoma. BRAF mutation status was concordant in 95.2% of the 62 paired samples. Discordant BRAF status was detected in only 4.8% of the pairs studied and most frequently involved cases with recurrent metastasis thus suggesting a need for additional testing of these lesions before instituting therapy.
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Affiliation(s)
- Ann E Walts
- Departments of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
| | - Andy Pao
- Departments of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Wendy Sacks
- Department of Internal Medicine, Division of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Shikha Bose
- Departments of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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Clark OH. Controversies in familial thyroid cancer 2014. ULUSAL CERRAHI DERGISI 2014; 30:62-6. [PMID: 25931896 DOI: 10.5152/ucd.2014.125092014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/04/2014] [Indexed: 12/25/2022]
Abstract
Thyroid cancer is the sixth most common cancer in women, and the majority of patients with thyroid cancer has sporadic disease. However, about 25% of patients with medullary thyroid cancer and 5% with papillary thyroid cancer have familial tumors. Currently, there are numerous controversies regarding the mode of inheritance, tumor behavior, extent of surgical resection for optimal results, coexisting thyroid pathology, risk of other cancers, and extent of postoperative treatment of patients with familial thyroid cancer. This review aimed to give insight to surgeons on this interesting topic.
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Affiliation(s)
- Orlo H Clark
- Professor Emeritus of Surgery, Division of General Surgery, San Francisco, USA
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Kim MH, Bae JS, Lim DJ, Lee H, Jeon SR, Park GS, Jung CK. Quantification of BRAF V600E alleles predicts papillary thyroid cancer progression. Endocr Relat Cancer 2014; 21:891-902. [PMID: 25266729 DOI: 10.1530/erc-14-0147] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The BRAF V600E mutation is the most common genetic alteration in thyroid cancer. However, its clinicopathological significance and clonal mutation frequency remain unclear. To clarify the inconsistent results, we investigated the association between the allelic frequency of BRAF V600E and the clinicopathological features of classic papillary thyroid carcinoma (PTC). Tumour tissues from two independent sets of patients with classic PTC were manually microdissected and analysed for the presence or absence of the BRAF mutation and the mutant allelic frequency using quantitative pyrosequencing. For external validation, the Cancer Genome Atlas (TCGA) data were analysed. The BRAF V600E mutation was found in 264 (82.2%) out of 321 classic PTCs in the training set. The presence of BRAF V600E was only associated with extrathyroidal extension and the absence of thyroiditis. In BRAF V600E-positive tumours, the mutant allelic frequency varied from 8 to 41% of the total BRAF alleles (median, 20%) and directly correlated with tumour size and the number of metastatic lymph nodes. Lymph node metastases were more frequent in PTCs with a high (≥20%) abundance of mutant alleles than in those with a low abundance of mutant alleles (P=0.010). These results were reinforced by validation dataset (n=348) analysis but were not reproduced in the TCGA dataset. In a population with prevalent BRAF mutations, quantitative analysis of the BRAF mutation could provide additional information regarding tumour behaviour, which is not reflected by qualitative analysis. Nonetheless, prospective studies are needed before the mutated allele percentage can be considered as a prognostic factor.
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Affiliation(s)
- Min-Hee Kim
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
| | - Ja Seong Bae
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
| | - Hyoungnam Lee
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
| | - So Ra Jeon
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
| | - Gyeong Sin Park
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
| | - Chan Kwon Jung
- Division of Endocrinology and MetabolismDepartment of Internal MedicineDepartment of SurgeryDepartment of Hospital PathologyMedical Life SciencesCollege of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Republic of Korea
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38
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The prognostic significance of the BRAFV600E mutation in papillary thyroid carcinoma detected by mutation-specific immunohistochemistry. Pathology 2013; 45:637-44. [DOI: 10.1097/pat.0000000000000008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kim KB, Cabanillas ME, Lazar AJ, Williams MD, Sanders DL, Ilagan JL, Nolop K, Lee RJ, Sherman SI. Clinical responses to vemurafenib in patients with metastatic papillary thyroid cancer harboring BRAF(V600E) mutation. Thyroid 2013; 23:1277-83. [PMID: 23489023 PMCID: PMC3967415 DOI: 10.1089/thy.2013.0057] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Clinical benefit from cytotoxic chemotherapy for metastatic papillary thyroid carcinoma (PTC) is disappointing, and effective therapeutic approaches for these patients are urgently needed. Because kinase-activating mutations in the BRAF proto-oncogene commonly occur in advanced PTC, and inhibition of BRAF(V600E) has shown promising clinical activity in melanoma, BRAF inhibitor therapy may be an effective strategy to treat metastatic PTC. METHODS The dose escalation portion of a first-in-human, phase I study of vemurafenib, a selective RAF inhibitor, included three patients with metastatic PTC harboring the BRAF(V600E) mutation. Vemurafenib was initially dosed at 240-360 mg twice a day, later escalated to 720 mg twice a day. Response evaluation was performed every 8 weeks per Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS Among the three patients, one had a confirmed partial response with reduction of pulmonary target lesions by 31%, and the duration of response was 7.6 months before the disease progressed in the lungs and the bones. The time to progression was 11.7 months. The other two patients had stable disease, and the time to progression was 13.2 and 11.4 months, respectively. CONCLUSIONS Vemurafenib appears to have a promising clinical activity in patients with metastatic PTC, and our data suggest that the BRAF(V600E) mutant kinase is a relevant target for therapy in this patient population. Further investigation of inhibitors of mutated BRAF kinase in patients with PTC in a phase II study is warranted.
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Affiliation(s)
- Kevin B. Kim
- Department of Melanoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Alexander J. Lazar
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Michelle D. Williams
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Deborah L. Sanders
- Department of Melanoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Joseph L. Ilagan
- Department of Melanoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | | | - Steven I. Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Huang T, Karsy M, Zhuge J, Zhong M, Liu D. B-Raf and the inhibitors: from bench to bedside. J Hematol Oncol 2013; 6:30. [PMID: 23617957 PMCID: PMC3646677 DOI: 10.1186/1756-8722-6-30] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/22/2013] [Indexed: 11/10/2022] Open
Abstract
The B-Raf protein is a key signaling molecule in the mitogen activated protein kinase (MAPK) signaling pathway and has been implicated in the pathogenesis of a variety of cancers. An important V600E mutation has been identified and can cause constitutive B-Raf activation. Recent studies have evaluated a variety of small molecule inhibitors targeting B-Raf, including PLX4032/vemurafenib, dabrafenib, LGX818, GDC0879, XL281, ARQ736, PLX3603 (RO5212054), and RAF265. Therapeutic resistance has been identified and various mechanisms described. This review also discussed the current understanding of B-Raf signaling mechanism, methods of mutation detection, treatment strategies as well as potential methods of overcoming therapeutic resistance.
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Affiliation(s)
- Tiangui Huang
- Department of Pathology, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, USA
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Abstract
Recent molecular studies have described a number of abnormalities associated with the pathogenesis of thyroid carcinoma. These distinct molecular events are often associated with specific stages of tumor development and may serve as prognostic factors and therapeutic targets. A better understanding of the mechanisms involved in thyroid cancer pathogenesis, will hopefully help translate these discoveries to improved patient care.
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Affiliation(s)
- Kepal N Patel
- Thyroid Cancer Interdisciplinary Program, Division of Endocrine Surgery, NYU Langone Medical Center, New York, NY, USA.
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42
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Vitale M. Intratumor BRAFV600E heterogeneity and kinase inhibitors in the treatment of thyroid cancer: a call for participation. Thyroid 2013; 23:517-9. [PMID: 23398043 DOI: 10.1089/thy.2012.0614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Thyroid cancer is a common endocrine malignancy. There has been exciting progress in understanding its molecular pathogenesis in recent years, as best exemplified by the elucidation of the fundamental role of several major signalling pathways and related molecular derangements. Central to these mechanisms are the genetic and epigenetic alterations in these pathways, such as mutation, gene copy-number gain and aberrant gene methylation. Many of these molecular alterations represent novel diagnostic and prognostic molecular markers and therapeutic targets for thyroid cancer, which provide unprecedented opportunities for further research and clinical development of novel treatment strategies for this cancer.
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Affiliation(s)
- Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA.
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Jung CK, Im SY, Kang YJ, Lee H, Jung ES, Kang CS, Bae JS, Choi YJ. Mutational patterns and novel mutations of the BRAF gene in a large cohort of Korean patients with papillary thyroid carcinoma. Thyroid 2012; 22:791-7. [PMID: 22471241 DOI: 10.1089/thy.2011.0123] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND BRAF mutation is the most common genetic event in papillary thyroid carcinoma (PTC); however, the prevalence and patterns of the mutation vary worldwide. We investigated the frequency and type of BRAF mutations based on the histologic subtypes in a large cohort of Korean patients with PTC. METHODS A total of 1041 consecutive PTCs were classified according to histologic subtypes. BRAF mutations were examined by denaturing high-performance liquid chromatography and direct sequencing. Rare complex mutations were confirmed by molecular cloning of polymerase chain reaction amplicons and sequencing of the products. RESULTS BRAF mutations were found in 839 (80.6%) of 1041 patients with PTC. The histologic subtype-specific prevalence of BRAF mutation was as follows: 85.3% (249/292) were classic, 45.8% (11/24) were follicular, 79.9% (576/721) were microcarcinoma, and 75.0% (3/4) were other variants. In addition to the usual c.1799T>A mutation, we identified other four mutation types: c.[1795_1796insA;1770_1795dup26], c.[1742-10T>C;1799T>A] and c.[1796C>G;1799T>A], and c.1799_1800TG>AA, respectively. The former three were novel mutations in thyroid tumors. Within the series of microcarcinoma variants, the BRAF mutation rate was lower in tumors with follicular morphology than those with nonfollicular types (66.7% vs. 80.9%, p=0.0145). CONCLUSION Out of 1041 Korean patients with PTC, 0.4% had rare types of BRAF mutation and three new somatic mutations were identified. The BRAF mutation rate was quite low in PTC with follicular morphology regardless of tumor size. However, the prevalence of BRAF mutation in microcarcinoma and follicular variants of PTC is relatively high in Korea and its analysis may be clinically useful for managing the patients.
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Affiliation(s)
- Chan-Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim SJ, Lee KE, Myong JP, Park JH, Jeon YK, Min HS, Park SY, Jung KC, Koo DH, Youn YK. BRAF V600E mutation is associated with tumor aggressiveness in papillary thyroid cancer. World J Surg 2012; 36:310-7. [PMID: 22190222 DOI: 10.1007/s00268-011-1383-1] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The BRAF(V600E) mutation is the most common genetic alteration found in papillary thyroid cancer (PTC). Recent studies show that this mutation occurs more frequently in patients with PTC showing aggressive clinicopathologic features. The aim of the present study was to evaluate the prevalence of the BRAF(V600E) mutation in tumor samples and its association with high-risk clinicopathologic features prospectively. PATIENTS AND METHODS From February 2009 to January 2010, 547 PTC patients who underwent surgery in Seoul National University Hospital were enrolled in the study. Polymerase chain reaction was used to amplify exon 15 of the BRAF gene from paraffin-embedded thyroid tumor specimens, followed by direct sequencing to detect the BRAF(V600E) mutation. Both univariate and multivariate analyses were performed to analyze associations between the BRAF(V600E) mutation and clinicopathologic features. RESULTS The BRAF(V600E) mutation was found in 381/547 (69.7%) patients with primary PTC. The BRAF(V600E) mutation was significantly associated with age (≥ 45 years), tumor size (>1 cm), extrathyroidal extension, and cervical lymph node metastases (P < 0.05). Multiple logistic regression showed that it was significantly associated with gender (OR = 1.834; 95% CI 1.021-3.463), tumor size (OR = 1.972; 95% CI 1.250-3.103), and extra-thyroidal extension (OR = 2.428; 95% CI 1.484-3.992), but not with age, multifocality, lymph node metastases, and advanced disease stage. The proportion of BRAF(V600E) mutation was significantly associated with the number of high-risk factors of tumor recurrence (P < 0.001). CONCLUSIONS The BRAF(V600E) mutation was associated with high-risk clinicopathologic characteristics in patients with PTC. The BRAF(V600E) mutation may be a potential prognostic factor in PTC patients.
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Affiliation(s)
- Su-jin Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 1435 Jwa-dong, Haeundae-gu, Busan, 612-030, Korea.
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Finkelstein A, Levy GH, Hui P, Prasad A, Virk R, Chhieng DC, Carling T, Roman SA, Sosa JA, Udelsman R, Theoharis CG, Prasad ML. Papillary thyroid carcinomas with and without BRAF V600E mutations are morphologically distinct. Histopathology 2012; 60:1052-9. [PMID: 22335197 DOI: 10.1111/j.1365-2559.2011.04149.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS The BRAF V600E mutation resulting in the production of an abnormal BRAF protein has emerged as the most frequent genetic alteration in papillary thyroid carcinomas (PTCs). This study was aimed at identifying distinctive features in tumours with and without the mutation. METHODS AND RESULTS Thirty-four mutation-positive and 22 mutation-negative tumours were identified by single-strand conformation polymorphism of the amplified BRAF V600E region in the tumour DNA. Mutation-positive tumours were more common in patients older than 45 years (24/33, P = 0.05), in classic (23/30, P = 0.01), tall cell (4/5) and oncocytic/Warthin-like (2/2) variants of PTC, and in subcapsular sclerosing microcarcinomas (4/4). In contrast, all 12 follicular variants (P < 0.0001) and two diffuse sclerosing variants were negative for the mutation. Mutation-positive tumours displayed infiltrative growth (32/34, P = 0.02), stromal fibrosis (33/34, P < 0.001), psammoma bodies (17/34, P = 0.05), plump eosinophilic tumour cells (22/34, P = 0.01), and classic fully developed nuclear features of PTC (33/34, P = 0.0001). Encapsulation was significantly associated with mutation-negative tumours (15/22, P = 0.02). CONCLUSIONS BRAF V600E mutation-positive and negative PTCs are morphologically different. Recognition of their morphology may help in the selection of appropriate tumours for genetic testing.
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Affiliation(s)
- Alexander Finkelstein
- Department of Pathology, Yale School of Medicine, 310 Cedar Street, New Haven, CT06520, USA
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Patel A, Klubo-Gwiezdzinska J, Hoperia V, Larin A, Jensen K, Bauer A, Vasko V. BRAF(V600E) mutation analysis from May-Grünwald Giemsa-stained cytological samples as an adjunct in identification of high-risk papillary thyroid carcinoma. Endocr Pathol 2011; 22:195-9. [PMID: 21948220 DOI: 10.1007/s12022-011-9180-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The BRAF(V600E) mutation is specific for thyroid papillary cancer (PTC) and correlates with PTCs invasiveness. This study investigated whether detection of BRAF(V600E) mutation can be performed on routinely stained FNABs. We also examined if establishment of the BRAF(V600E) mutation could help in identification of patients at higher risk for metastatic disease. DNA was isolated from 134 FNABs samples (20 follicular neoplasm, ten suspicious for malignancy, and 104 malignant) using Pinpoint Slide DNA Isolation System. BRAF(V600E) mutation was detected by PCR followed by sequencing. DNA was successfully extracted from all examined FNABs samples. In follicular neoplasm, suspicious for malignancy and malignant FNABs, BRAF(V600E) mutation was found in 0/20 (0%), 2/10 (20%), and 47/104 (45.2%) of cases, respectively. Extra-thyroidal extension was detected in 35/47 (74.4%) BRAF(V600E) positive and in 24/57 (42.1%) wild-type BRAF cases (p = 0.001). Metastases were detected in 37/47 (78.7%) BRAF(V600E) positive and in 28/57 (49.1%) wild-type BRAF cases (p = 0.002). Our results showed that stained FNAB specimens can be used for DNA extraction and assessment of BRAF(V600E) mutation. Detection of BRAF(V600E) mutation had limited value in diagnoses of malignancy in follicular neoplasms but can ascertain malignancy in subset of suspicious for malignancy FNABs. In malignant FNABs, BRAF(V600E) mutation was significantly associated with presence of extra-thyroidal extension and metastases after surgery.
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MESH Headings
- Biopsy, Fine-Needle/methods
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/genetics
- Carcinoma, Papillary, Follicular/pathology
- DNA, Neoplasm/chemistry
- DNA, Neoplasm/genetics
- Eosine Yellowish-(YS)/chemistry
- Genetic Variation
- Humans
- Methylene Blue/chemistry
- Polymerase Chain Reaction
- Polymorphism, Single Nucleotide
- Proto-Oncogene Proteins B-raf/genetics
- Staining and Labeling/methods
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Aneeta Patel
- Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712, USA
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Lassalle S, Hofman V, Ilie M, Bonnetaud C, Puisségur MP, Brest P, Loubatier C, Guevara N, Bordone O, Cardinaud B, Lebrigand K, Rios G, Santini J, Franc B, Mari B, Al Ghuzlan A, Vielh P, Barbry P, Hofman P. Can the microRNA signature distinguish between thyroid tumors of uncertain malignant potential and other well-differentiated tumors of the thyroid gland? Endocr Relat Cancer 2011; 18:579-94. [PMID: 21778212 DOI: 10.1530/erc-10-0283] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The term 'thyroid tumors of uncertain malignant potential' (TT-UMP) was coined by surgical pathologists to define well-differentiated tumors (WDT) showing inconclusive morphological evidence of malignancy or benignity. We have analyzed the expression of microRNA (miRNA) in a training set of 42 WDT of different histological subtypes: seven follicular tumors of UMP (FT-UMP), six WDT-UMP, seven follicular thyroid adenomas (FTA), 11 conventional papillary thyroid carcinomas (C-PTC), five follicular variants of PTC (FV-PTC), and six follicular thyroid carcinomas (FTC), which led to the identification of about 40 deregulated miRNAs. A subset of these altered miRNAs was independently validated by qRT-PCR, which included 18 supplementary TT-UMP (eight WDT-UMP and ten FT-UMP). Supervised clustering techniques were used to predict the first 42 samples. Based on the four possible outcomes (FTA, C-PTC, FV-PTC, and FTC), about 80% of FTA and C-PTC and 50% of FV-PTC and FTC samples were correctly assigned. Analysis of the independent set of 18 WDT-UMP by quantitative RT-PCR for the selection of the six most discriminating miRNAs was unable to separate FT-UMP from WDT-UMP, suggesting that the miRNA signature is insufficient in characterizing these two clinical entities. We conclude that considering FT-UMP and WDT-UMP as distinct and specific clinical entities may improve the diagnosis of WDT of the thyroid gland. In this context, a small set of miRNAs (i.e. miR-7, miR-146a, miR-146b, miR-200b, miR-221, and miR-222) appears to be useful, though not sufficient per se, in distinguishing TT-UMP from other WDT of the thyroid gland.
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Affiliation(s)
- Sandra Lassalle
- INSERM ERI-21/EA4319, University of Nice Sophia Antipolis, 06107 Nice, France
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So YK, Son YI, Baek CH, Jeong HS, Chung MK, Ko YH. Expression of Sodium–Iodide Symporter and TSH Receptor in Subclinical Metastatic Lymph Nodes of Papillary Thyroid Microcarcinoma. Ann Surg Oncol 2011; 19:990-5. [DOI: 10.1245/s10434-011-2047-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Indexed: 12/22/2022]
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