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Hirokawa M, Suzuki A. "Immunocytochemistry in Cytology: Myth or Reality": Unraveling the Myth - Immunocytochemistry Applications in Thyroid Lesions. Acta Cytol 2024:1-9. [PMID: 39004076 DOI: 10.1159/000540366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Fine-needle aspiration cytology serves as an important preoperative diagnostic tool for thyroid nodules. Despite its excellent diagnostic accuracy, diagnoses based solely on morphological observation can be challenging. Therefore, various ancillary diagnostic techniques have been applied, including immunocytochemistry (ICC). This review discusses the application and evaluation of ICC in thyroid fine needle aspiration. SUMMARY Currently, three immunostaining preparation methods are available for cytological materials: liquid-based cytology, cell block, and cell transfer. ICC proves valuable in scenarios such as tumour diagnosis, assessment of differentiation and grading of carcinomas, estimation of primary organs in metastatic carcinomas, and detection of gene abnormalities. However, ICC, while useful, is not as accurate as immunohistochemistry and is more difficult to evaluate. KEY MESSAGES If the pitfalls and limitations are understood and effectively navigated, ICC could play a significant role in decreasing the non-diagnostic rate, thus leading to more accurate and valuable diagnoses and reductions in the re-aspiration rate.
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Affiliation(s)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
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2
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Crescenzi A, Baloch Z. Immunohistochemistry in the pathologic diagnosis and management of thyroid neoplasms. Front Endocrinol (Lausanne) 2023; 14:1198099. [PMID: 37324272 PMCID: PMC10266214 DOI: 10.3389/fendo.2023.1198099] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
The use of immunohistochemistry cannot be underestimated in the everyday practice of thyroid pathology. It has evolved over the years beyond the traditional confirmation of thyroid origin to molecular profiling and the prediction of clinical behavior. In addition, immunohistochemistry has served to implement changes in the current thyroid tumor classification scheme. It is prudent to perform a panel of immunostains, and the immunoprofile should be interpreted in light of the cytologic and architectural features. Immunohistochemistry can also be easily performed in the limited cellularity specimen preparation generated from thyroid fine-needle aspiration and core biopsy; however, it will require laboratory validation of immunostains specific to these preparations to avoid diagnostic pitfalls. This review discusses the application of immunohistochemistry in thyroid pathology with a focus on limited cellularity preparations.
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Affiliation(s)
- Anna Crescenzi
- Pathology, University Campus Bio-Medico of Rome, Fondazione Policlinico, Rome, Italy
| | - Zubair Baloch
- Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, PA, United States
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3
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Velez Torres JM, Tjendra Y, Kerr DA. A Triumvirate:: Correlating Thyroid Cytopathology, Molecular Testing, and Histopathology. Surg Pathol Clin 2023; 16:1-14. [PMID: 36739157 DOI: 10.1016/j.path.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Risk stratification is essential in the preoperative evaluation and management of thyroid nodules, most of which are benign. Advances in DNA and RNA sequencing have shed light on the molecular drivers of thyroid cancer. Molecular testing of cytologically indeterminate nodules has helped refine risk stratification, triage patients for surgery, and determine the extent of surgery. Molecular platforms with high negative predictive values can help identify nodules that may be spared surgery and can be managed conservatively. Here we discuss the importance of integrating cytomorphologic, molecular, and histologic features to help avoid errors and improve patient management.
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Affiliation(s)
- Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12(th) Avenue, Miami, FL 33136, USA. https://twitter.com/JaylouVelez
| | - Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12(th) Avenue, Miami, FL 33136, USA. https://twitter.com/Y_Tjendra
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
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4
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Lubin DJ, Sadow PM. Development and validation of an RNA sequencing-based classifier for medullary thyroid carcinoma on thyroid FNA. Cancer Cytopathol 2023; 131:154-157. [PMID: 36047747 PMCID: PMC10294123 DOI: 10.1002/cncy.22643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
This commentary describes the development and validation of the Afirma RNA sequencing–based classifier for medullary thyroid carcinoma (MTC). The importance of the early diagnosis of MTC is discussed along with the limitations of cytomorphology alone.
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Affiliation(s)
- Daniel J. Lubin
- Department of Pathology, Emory University Hospital Midtown,
Atlanta, GA, USA
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital,
Boston, MA, USA
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5
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Nikas IP, Kazamias G, Vrontaki M, Rapti AS, Mastorakis E. Medullary thyroid carcinoma diagnosed with liquid-based cytology and immunocytochemistry. J Immunoassay Immunochem 2022; 43:502-515. [PMID: 35475413 DOI: 10.1080/15321819.2022.2070025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy that arises from the parafollicular cells (C cells) secreting calcitonin. This study summarizes our experience in the diagnosis of MTC with ultrasound-guided thyroid FNA, subsequently processed with liquid-based cytology (LBC) and immunocytochemistry (ICC). We searched our laboratory archives for thyroid FNA cases with an interpretation of positive or suspicious for MTC, during the period 2004-2018. A total of 20 cases (18 thyroid FNAs; two lymph node FNAs) were selected and included in this study. These displayed high cellularity and a discohesive pattern, with a few loose syncytial groups. There was some variation in the cell size and shape both across and within our cases. Most MTCs (n = 15) exhibited a predominant plasmacytoid/epithelioid cell morphology, whereas five of our cases showed a spindle cell pattern. Of interest, none of eight MTC microcarcinomas (≤1 cm) showed a spindle cell morphology. Amyloid was found in 11/20 cases (55%), while binucleation/multinucleation in 17/20 (85%), and nuclear pseudoinclusions in 3/20 MTC cases (15%). Nuclei exhibited a granular, "salt and pepper" chromatin in all cases. ICC was performed in 18/20 cases (90%). Calcitonin, CEA, TTF1, and Chromogranin were positive wherever applied, whereas thyroglobulin and CK19 were negative. In conclusion, ultrasound-guided thyroid FNA - processed with LBC and ICC - is a reliable modality to detect MTC preoperatively, facilitating the management of such patients.
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Affiliation(s)
- Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Georgios Kazamias
- Department of Pathology, "Venizeleio-Pananeio" General Hospital, Heraklion, Crete, Greece
| | - Maria Vrontaki
- Department of Cytopathology, "Venizeleio-Pananeio" General Hospital, Heraklion, Crete, Greece
| | - Aleka S Rapti
- Department of Pathology, "Venizeleio-Pananeio" General Hospital, Heraklion, Crete, Greece.,Department of Cytopathology, "Venizeleio-Pananeio" General Hospital, Heraklion, Crete, Greece
| | - Emmanouil Mastorakis
- Department of Cytopathology, "Venizeleio-Pananeio" General Hospital, Heraklion, Crete, Greece
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6
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Mason D, Leimbach R, Kitz R, Vietor R, Vietor N. Calcitonin-secreting pancreatic neuroendocrine tumor in a patient with elevated thyroid fine-needle aspirate calcitonin washout: A case report and review of the literature. Clin Case Rep 2022; 10:e05296. [PMID: 35106164 PMCID: PMC8784917 DOI: 10.1002/ccr3.5296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
We report the unique case of a patient with previously proven non-functional PanNET and Graves' disease with thyroid nodules. The patient had elevated intranodular calcitonin, but no MTC or c-cell hyperplasia on thyroidectomy. They were found to have calcitonin secreting PanNET. This case presents a false-positive intranodular calcitonin.
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Affiliation(s)
- Darryl Mason
- F. Edward Hebert School of MedicineUniformed Services UniversityBethesdaMarylandUSA
| | - Robert Leimbach
- Department of EndocrinologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Robert Kitz
- Department of PathologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Robert Vietor
- F. Edward Hebert School of MedicineUniformed Services UniversityBethesdaMarylandUSA
| | - Nicole Vietor
- Department of EndocrinologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
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7
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Liu Z, Zhou W, Han R, Zhou W, Zhang J, Li H, Wan Z, Jin Y, Shen L, Zhou Y, Wang S, Chen X, Ye L. Cytology versus calcitonin assay in fine-needle aspiration biopsy wash-out fluid (FNAB-CT) in diagnosis of medullary thyroid microcarcinoma. Endocrine 2021; 74:340-348. [PMID: 34028648 DOI: 10.1007/s12020-021-02759-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Widespread use of sensitive ultrasound examination led to an increasing detection of medullary thyroid microcarcinoma (micro-MTC). This prospective study evaluated the diagnostic accuracy of Fine-needle Aspiration Biopsy Cytology (FNAB-C) and calcitonin assay in Fine-needle Aspiration Biopsy wash-out fluid (FNAB-CT) in thyroid nodules less than 1 cm with elevated serum calcitonin(sCT). METHODS 87 thyroid nodules from 60 patients with elevated sCT (>10 pg/ml) were included and 51 were thyroid nodules less than 1cm. FNAB-CT and FNAB-C were performed to distinguish medullary thyroid carcinoma (MTC) lesions before surgery, histopathologic diagnoses served as main reference standards. RESULTS FNAB-CT had a greater performance over FNAB-C for preoperative diagnosis of MTC (diagnostic accuracy: 98.85 vs 61.90%, sensitivity: 98.55 vs 55.07%, specificity: 100 vs 97.44%), especially for micro-MTC: FNAB-C established a sensitivity and diagnostic accuracy of 48.78 and 58% respectively, while FNAB-CT reached 97.56% sensitivity and 98.04% diagnostic accuracy. CONCLUSIONS FNAB-CT demonstrated high diagnostic accuracy in diagnosing micro-MTC. Patients with microscopic thyroid nodules and elevated sCT level should perform FNAB-CT to exclude the diagnosis of MTC lesions.
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Affiliation(s)
- Ziyuan Liu
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wenzhong Zhou
- Shanghai Institute of Endocrine & Metabolic Diseases, Shanghai, China
| | - Rulai Han
- Shanghai Institute of Endocrine & Metabolic Diseases, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie Zhang
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haorong Li
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhihan Wan
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Jin
- Shanghai Institute of Endocrine & Metabolic Diseases, Shanghai, China
| | - Liyun Shen
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yulin Zhou
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shu Wang
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xi Chen
- Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Lei Ye
- Shanghai Clinical Center for Endocrine & Metabolic Diseases, Department of Endocrine & Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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8
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de Oliveira DHA, Huning LP, Belim MC, Rodrigues PF, Nagai HM, Graf H. Is there a place for measuring serum calcitonin prior to thyroidectomy in patients with a non-diagnostic thyroid nodule biopsy? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:40-48. [PMID: 33444493 PMCID: PMC10528694 DOI: 10.20945/2359-3997000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To verify the cytopathological Bethesda System classification of thyroid nodule fine-needle aspiration biopsy (FNAB) in MTC patients and to assess the role of preoperative serum calcitonin (CT) levels in the investigation of this neoplasm in medullary thyroid cancer (MTC) patients under observation at the Uopeccan (União Oeste Paranaense de Estudos e Combate ao Câncer). METHODS This is a cross-sectional review of medical records of patients monitored at the thyroid cancer outpatient clinic of Uopeccan. Clinical and demographic data, laboratory tests, ultrasound images, and cytopathological findings of MTC patients were evaluated. RESULTS Among the 360 patients with thyroid cancer monitored in the outpatient clinic, 5.2% (n: 19/360) had MTC. The hereditary form was more prevalent (63.2%), and there was no sex preference. The most common ultrasound findings were hypoechogenicity, solid appearance and microcalcifications. The FNAB diagnoses showed a sensitivity of 47.1%, and the most common cytopathological report was Bethesda category III. Serum CT levels showed good sensitivity (84.6%) for the diagnosis of MTC, and sensitivity levels were directly associated with the size of the nodule and distant metastases. CONCLUSION Bethesda category III was more prevalent in this group of MTC patients. Serum CT levels were more sensitive than cytopathology for diagnosis of this neoplasm and were able to identify all patients who could not be diagnosed by FNAB.
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Affiliation(s)
| | - Luiz Pierre Huning
- Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, PR, Brasil
| | | | | | | | - Hans Graf
- Serviço de Endocrinologia e Metabologia, Hospital de Clínicas, Universidade Federal do Paraná (SEMPR), Curitiba, PR, Brasil
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9
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Liu CY, Chen CC, Bychkov A, Agarwal S, Zhu Y, Hang JF, Lai CR, Na HY, Park SY, Li W, Liu Z, Jain D, Suzuki A, Hirokawa M, Chia N, Nga ME, Jitpasutham T, Keelawat S, Satoh S, Gunawardena D, Kumarasinghe P, Jung CK, Kakudo K. Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods. Diagnostics (Basel) 2021; 11:diagnostics11081396. [PMID: 34441330 PMCID: PMC8392035 DOI: 10.3390/diagnostics11081396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Accurate preoperative identification of medullary thyroid carcinoma (MTC) is challenging due to a spectrum of cytomorphologic features. However, there is a scarcity of studies describing the cytomorphologic features as seen on fine-needle aspiration (FNA) smears prepared using different staining methods. (2) Methods: We performed a retrospective study on MTC cases with available FNA slides from 13 hospitals distributed across 8 Asia-Pacific countries. The differences in the constitutive cytomorphologic features of MTC with each cytopreparatory method were recorded. A comparative analysis of cytologic characteristics was carried out with appropriate statistical tests. (3) Results: Of a total of 167 MTC samples retrospectively recruited, 148 (88.6%) were interpreted as MTC/suspicious for MTC (S-MTC). The staining methods used were Papanicolaou, hematoxylin-eosin, and Romanowsky stains. Seven out of the eleven cytologic criteria can be readily recognized by all three cytopreparatory methods: high cellularity, cellular pleomorphism, plasmacytoid cells, round cells, dyshesive cells, salt-and-pepper chromatin, and binucleation or multinucleation. An accurate diagnosis was achieved in 125 (84.5%) of the 148 samples whose FNAs exhibited five or more atypical features. Conclusions: The present work is the first study on MTC to compare the morphological differences among the cytologic staining techniques. We investigated the constitutive features and the reliability of diagnostic parameters. A feasible scoring system based upon cytomorphologic data alone is proposed to achieve a high degree of diagnostic accuracy.
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Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City 221, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 221, Taiwan
- Correspondence: ; Tel.: +886-226482121-3741
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 600, Taiwan;
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan;
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India; (S.A.); (D.J.)
| | - Yun Zhu
- Department of Pathology, Jiangsu Institution of Nuclear Medicine, Wuxi 214063, China;
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (J.-F.H.); (C.-R.L.)
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (J.-F.H.); (C.-R.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (H.Y.N.); (S.Y.P.)
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (H.Y.N.); (S.Y.P.)
| | - Weiwei Li
- Department of Pathology, Shandong University School of Basic Medical Sciences, Jinan 250012, China;
| | - Zhiyan Liu
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China;
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India; (S.A.); (D.J.)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan; (A.S.); (M.H.)
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan; (A.S.); (M.H.)
| | - Noel Chia
- Department of Pathology, National University Hospital, Singapore 119074, Singapore; (N.C.); (M.E.N.)
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore 119074, Singapore; (N.C.); (M.E.N.)
| | - Tikamporn Jitpasutham
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (T.J.); (S.K.)
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; (T.J.); (S.K.)
| | - Shinya Satoh
- Department of Endocrine Surgery, Yamashita Thyroid and Parathyroid Clinic, Fukuoka 812-0034, Japan;
| | - Dilini Gunawardena
- School of Pathology & Laboratory Medicine, University of Western Australia, Perth, WA 6009, Australia; (D.G.); (P.K.)
| | - Priyanthi Kumarasinghe
- School of Pathology & Laboratory Medicine, University of Western Australia, Perth, WA 6009, Australia; (D.G.); (P.K.)
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Osaka 594-0073, Japan;
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10
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Leimbach RD, Hoang TD, Shakir MKM. Diagnostic Challenges of Medullary Thyroid Carcinoma. Oncology 2021; 99:422-432. [PMID: 33878761 DOI: 10.1159/000515373] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) comprises 1-2% of all thyroid cancers, yet 15% of all thyroid cancer-related deaths. While up to 20% of cases may be predicted due to autosomal dominant germline mutations, 80% of cases are sporadic. However, due to non-specific presenting symptoms and diagnostic imaging, prompt diagnosis and treatment has remained elusive. This article will further investigate the limitations of MTC diagnosis and look into future areas for diagnostic improvement. METHODS Relevant articles were identified using a systematic PubMed and Google Scholar search. RESULTS Prophylactic total thyroidectomy for the 20% of MTC cases that are present in autosomal dominant disorder provides definitive treatment. Serum calcitonin (Ctn) screening has several technical limitations due to population variability and laboratory assay interference, but advances in laboratory technology and combined use with fine needle aspiration increase its sensitivity. Other serum assays such as carcinoembryonic antigen and procalcitonin have limited applicability. Thyroid ultrasound remains the gold standard for the initial diagnostic planning, with limited application for CT, MRI, and PET imaging. CONCLUSION With complete surgical resection the only definitive treatment, early MTC diagnosis has presented an elusive challenge, mainly due to its relative rarity and difficulty in finding an economic screening strategy. Careful family history combined with fine needle aspiration with serum Ctn analysis can improve diagnostic sensitivity and specificity to greater than 95%.
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Affiliation(s)
- Robert D Leimbach
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Thanh D Hoang
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mohamed K M Shakir
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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11
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Workman AD, Soylu S, Kamani D, Nourmahnad A, Kyriazidis N, Saade R, Ren Y, Wirth L, Faquin WC, Onenerk AM, Nikiforov YE, Al-Qurayshi Z, Kandil E, Kloos RT, Eldeiry L, Lubitz C, Stathatos N, Randolph GW. Limitations of preoperative cytology for medullary thyroid cancer: Proposal for improved preoperative diagnosis for optimal initial medullary thyroid carcinoma specific surgery. Head Neck 2020; 43:920-927. [PMID: 33269526 DOI: 10.1002/hed.26550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/13/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Preoperative diagnosis of medullary thyroid carcinoma (MTC) is often difficult, given the poor sensitivity of fine-needle aspiration (FNA) cytology for MTC. This study investigates this issue and presents recommendations for improving preoperative diagnostic paradigms in MTC cases. DESIGN/METHOD Histopathologically confirmed MTC patients with preoperative cytologic assessment of index nodules were enrolled. FNA diagnosis, final pathology, and surgery details were collected. RESULTS Out of 71 patients, 49 (69%) were diagnosed by FNA as either definitive MTC (35, 49%) or suspected MTC (14, 20%) and 22 (31%) patients had no indication of MTC on FNA. CONCLUSION In a tertiary-care setting, one-third of subjects had an FNA interpretation that did not suggest the possibility of MTC. The limitations of preoperative diagnosis are especially problematic for MTC as they can cause delayed or incomplete treatment. Additional testing is proposed to improve preoperative diagnosis and surgical care of MTC patients.
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Affiliation(s)
- Alan D Workman
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Selen Soylu
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Natalia Kyriazidis
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Saade
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Yin Ren
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Wirth
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ayşe M Onenerk
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zaid Al-Qurayshi
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Richard T Kloos
- Department of Medical Affairs, Veracyte Inc., South San Francisco, California, USA
| | - Leslie Eldeiry
- Harvard Vanguard Medical Associates, Atrius Health, Boston, Massachusetts, USA
| | - Carrie Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikolaos Stathatos
- Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA.,Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Takenobu M, Moritani S, Kawamoto K, Yoshioka K, Kitano H. Parathyroid carcinoma coexisting with multiple parathyroid adenomas: a case report. Endocr J 2020; 67:963-967. [PMID: 32475867 DOI: 10.1507/endocrj.ej20-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary hyperparathyroidism is usually caused by parathyroid adenoma; however, parathyroid carcinoma is a rare cause. We report a rare case of 74-year-old female of primary hyperparathyroidism caused by parathyroid carcinoma (PC) and coexisting multiple parathyroid adenomas. She was referred to our hospital for primary hyperparathyroidism and a suspected thyroid tumor. She had no family history of malignant tumor. Computed tomography (CT) and ultrasonography of the neck revealed some masses posterior to both thyroid lobes. Those masses were believed to be parathyroid lesions. However, another mass located posterior to the right upper thyroid lobe seemed to be heterogeneous, which indicated a malignant thyroid tumor as well as parathyroid tumor. The preoperative diagnosis was multiple parathyroid adenoma and suspicious incidental thyroid carcinoma. Therefore, the patient underwent total parathyroidectomy and thyroidectomy. The histopathological diagnosis was parathyroid carcinoma coexisting with multiple parathyroid adenomas. There was no evidence of recurrence at 1 year after the surgery. It was difficult to diagnose PC preoperatively. Few rare cases of PC coexisting with parathyroid adenoma in multiple endocrine neoplasia type 1 (MEN1) have been reported. Therefore, careful follow-up was necessary considering the possibility of MEN1, though she did not wish for a genetic examination.
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Affiliation(s)
- Masao Takenobu
- Kusatsu General Hosipital, Otolaryngology Head and Neck Thyroid Surgery, Shiga 525-8585, Japan
| | - Sueyoshi Moritani
- Kusatsu General Hosipital, Otolaryngology Head and Neck Thyroid Surgery, Shiga 525-8585, Japan
| | - Katsuyuki Kawamoto
- Kusatsu General Hosipital, Otolaryngology Head and Neck Thyroid Surgery, Shiga 525-8585, Japan
| | - Kana Yoshioka
- Kusatsu General Hosipital, Otolaryngology Head and Neck Thyroid Surgery, Shiga 525-8585, Japan
| | - Hiroya Kitano
- Kusatsu General Hosipital, Otolaryngology Head and Neck Thyroid Surgery, Shiga 525-8585, Japan
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Liu CY, Bychkov A, Agarwal S, Zhu Y, Hang JF, Lai CR, Na HY, Li W, Liu Z, Jain D, Suzuki A, Hirokawa M, Chia N, Nga ME, Jitpasutham T, Keelawat S, Park SY, Satoh S, Chen CC, Gunawardena D, Kumarasinghe P, Jung CK, Kakudo K. Cytologic diagnosis of medullary thyroid carcinoma in the Asia-Pacific region. Diagn Cytopathol 2020; 49:60-69. [PMID: 32827355 DOI: 10.1002/dc.24586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/20/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The accurate preoperative identification of medullary thyroid carcinoma (MTC) is challenging due to the rarity of tumor and variable cytologic appearance. The Asian experience with diagnosing MTC by fine-needle aspiration (FNA) was scarcely reported. METHODS Cases of MTC with available FNA slides were enrolled from 13 hospitals representing 8 Asia-Pacific countries. Clinicopathological information, including sample preparation technique, staining method, original cytologic diagnosis and review diagnosis were collected. RESULTS Of a total of 145 MTC cases retrospectively recruited, 99 (68.3%) were initially interpreted as MTC/suspicious for MTC (S-MTC). The distribution of original FNA diagnostic categories was not associated with the staining method or sample preparation technique. The staining methods used were Papanicolaou, hematoxylin-eosin and Romanowsky stains. Liquid-based cytology (LBC) was used only in three countries. After reviewing all cases, the diagnostic rate of MTC/S-MTC increased to 91.7% (133/145). Cases with initially unrecognized MTC had either marked pleomorphism or cytology mimicking papillary carcinoma or follicular neoplasm. Although LBC provided certain benefits, there was no significant difference in diagnostic accuracy between conventional smear and LBC. Immunocytochemistry was available in 38 cases (26.2%), all of which were correctly recognized as MTC. CONCLUSION Our report summarizes how MTC is handled in contemporary Asian thyroid FNA practice. Although the detection rate of MTC by cytology alone is less satisfactory, integration with ancillary tests could achieve an excellent performance. The recognition of constitutive cytomorphologic features is needed for each cytopreparatory method, which may result in a lower threshold to initiate further workup for MTC.
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Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Yun Zhu
- Department of Pathology, Jiangsu Institution of Nuclear Medicine, Wuxi, Jiangsu Province, China
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Weiwei Li
- Department of Pathology, Shandong University School of Basic Medical Sciences, Jinan, Shandong, China
| | - Zhiyan Liu
- Department of Pathology, Shandong University School of Basic Medical Sciences, Jinan, Shandong, China
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | | | - Noel Chia
- Department of Pathology, National University Hospital, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
| | - Tikamporn Jitpasutham
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Shinya Satoh
- Department of Endocrine Surgery, Yamashita Thyroid and Parathyroid Clinic, Fukuoka, Japan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Dilini Gunawardena
- School of Pathology & Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Priyanthi Kumarasinghe
- School of Pathology & Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Osaka, Japan
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14
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Chowsilpa S, Jones R, Hang JF, Ali SZ. Characterization of "suspicious for malignancy" for non-papillary carcinoma diagnoses on thyroid fine-needle aspiration. J Am Soc Cytopathol 2020; 10:148-154. [PMID: 32773337 DOI: 10.1016/j.jasc.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate the incidence, risk of malignancy, and management of "suspicious for malignancy" (SFM) for non-papillary carcinoma diagnoses according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). MATERIALS AND METHODS A retrospective search was performed for all thyroid fine-needle aspirations (FNAs) with an SFM diagnosis in the electronic Pathology database at The Johns Hopkins Hospital from 2000 to 2019. During this period, a total of 644 cases were diagnosed as SFM. Of these, 55 cases of "suspicious for non-papillary thyroid carcinoma" (SNPTC) were identified. These 55 cases were then compared with 65 random cases of "suspicious for papillary thyroid carcinomas" (SPTC) diagnoses as a control group. RESULTS The SNPTC subgroup consisted of 28 cases of "suspicious for medullary thyroid carcinoma" (SMTC) (50.91%), 4 cases of "suspicious for metastasis" (SMET) (7.27%), 3 cases of "suspicious for malignant lymphoma" (SML) (5.45%), 2 cases of "suspicious for poorly-differentiated thyroid carcinoma" (SPDC) (3.64%), and 18 cases of "suspicious for malignancy, not otherwise specified" (SNOS) (32.73%). When compared to SPTC, SNPTC patients' average age was older (P = 0.004). Ancillary studies assisted in diagnosing SNPTC more so than SPTC (P < 0.001). Immunohistochemical studies were performed for 11 cases, molecular studies for 6 cases, and needle rinse calcitonin level for 1 case. When correlated with surgical follow-ups, the risk of malignancy (ROM) was 91.18% for SNPTC compared to 93.75 for SPTC%. CONCLUSIONS SNPTC was rarely diagnosed when compared with SPTC. SMTC was the most commonly diagnosed SNPTC subgroup, followed by SNOS. The ROM of SNPTC was slightly lower than that of SPTC. Ancillary studies and previous clinical history, in addition to cytomorphology, was helpful when rendering the diagnosis of SNPTC.
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Affiliation(s)
- Sayanan Chowsilpa
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Robert Jones
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jen-Fan Hang
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland.
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15
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Liang X, Zhu J, Cai M, Dai Z, Fang L, Chen H, Yu L, Lin Y, Lin E, Wu G. ProGRP AS A NOVEL BIOMARKER FOR THE DIFFERENTIAL DIAGNOSIS OF MEDULLARY THYROID CARCINOMA IN PATIENTS WITH THYROID NODULES. Endocr Pract 2020; 26:514-522. [PMID: 32045291 DOI: 10.4158/ep-2019-0396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the release of progastrin-releasing peptide (ProGRP) in patients with thyroid nodules and the value of ProGRP in fine-needle aspirate washout fluid (FNA-ProGRP) in the differential diagnosis between medullary thyroid carcinoma (MTC) and non-MTC thyroid nodules. Methods: We investigated 2,446 healthy persons and 212 patients with 235 thyroid nodules. They were classified into healthy, nodular goiter, chronic thyroiditis, thyroid follicular neoplasm, papillary thyroid carcinoma, follicular thyroid carcinoma, and medullary thyroid carcinoma. The serum ProGRP and FNA-ProGRP were measured. Results: The serum ProGRP median concentration in MTC was 124.40 pg/mL, significantly higher than in other groups. The cutoff value of serum ProGRP was 68.30 pg/mL, leading to 53.85% sensitivity, 96.98% specificity, and 0.51 kappa value in MTC. The FNA-ProGRP median concentration in MTC nodules was 2,096.00 pg/mL, significantly higher than in other groups. A receiver operating characteristic analysis of MTC nodules and non-MTC nodules indicated that the cutoff value was 22.77 pg/mL, leading to 94.12% sensitivity, 98.27% specificity, and 0.85 kappa value. Conclusion: FNA-ProGRP measurement could be served as an ancillary method for the differential diagnosis between MTC and non-MTC thyroid nodules. Abbreviations: CEA = carcinoembryonic antigen; CT = calcitonin; FNAC = fine-needle aspiration cytology; FNA-CT = calcitonin in fine-needle aspirate washout fluid; FNA-ProGRP = ProGRP in fine-needle aspirate washout fluid; MTC = medullary thyroid carcinoma; ProGRP = progastrin-releasing peptide; SCLC = small-cell lung cancer; TM = tumor marker.
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16
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Marques B, Cunha N, Martins RG, Elvas AR, Couto J, Santos J, Martins T, Moniz AP, Ilhéu O, Valido F, Rodrigues F. Lymph Node Metastases of Medullary Thyroid Cancer: Role of Calcitonin in the Washout Fluid of Fine-Needle Aspiration. Int J Endocrinol 2020; 2020:9267972. [PMID: 32322267 PMCID: PMC7160716 DOI: 10.1155/2020/9267972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/29/2019] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The diagnostic value of calcitonin (CT) measurement in fine-needle aspirate washout (FNA-CT) for medullary thyroid cancer (MTC) lymph node (LN) metastases remains to be determined. It may increase the diagnostic sensitivity, but data on this subject is sparse. OBJECTIVE Our study aimed to evaluate the utility of FNA-CT in the diagnosis of LN metastases of MTC. METHODS We retrospectively investigated, in our institutional database, 69 consecutive FNA LN cytology from 42 patients who underwent FNA cytology and CT measurement in needle washout for suspicious LN between 2012 and 2017. RESULTS From the total of 69 FNA, 30 (43.4%) were performed in patients with personal history of MTC. MTC was detected in 19 FNA cytology (27.5%), and CT was detectable in needle washout in 23 cases (median = 2014 pg/mL; interquartile range = 490-15111 pg/mL). Based on the combined results of FNA-CT and FNA cytology, LN surgical resection was performed in 33 cases (47.8%). Histology reported MTC LN metastases in 21 lesions (63.6%). Regarding the diagnosis of MTC LN metastases, FNA cytology showed sensitivity of 81.8% and specificity of 97.9%, and FNA-CT demonstrated sensitivity of 100% and specificity of 97.9%. We determined through ROC analysis an optimal FNA-CT cut-off value of 23 pg/mL for the diagnosis of LN metastases (sensitivity 100%; specificity 100%). CONCLUSIONS FNA-CT may be a valuable diagnostic tool for detection of MTC LN metastases, along with FNA cytology, and it should be included in the clinical workup of neck adenopathies in patients with MTC or with thyroid nodules.
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Affiliation(s)
- Bernardo Marques
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Nuno Cunha
- Laboratory Medicine Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Raquel G. Martins
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Ana Rita Elvas
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Joana Couto
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Jacinta Santos
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Teresa Martins
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Ana Paula Moniz
- Pathology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Olga Ilhéu
- Pathology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Frederico Valido
- Laboratory Medicine Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
| | - Fernando Rodrigues
- Endocrinology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil, EPE, Coimbra, Portugal
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Sukpanich R, Khanafshar E, Suh I, Gosnell J. Case report of a neuroendocrine tumor of the thyroid gland with limited calcitonin expression: a diagnostic challenge. AME Case Rep 2019; 3:12. [PMID: 31231713 DOI: 10.21037/acr.2019.05.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a malignant tumor of the parafollicular cells, which produce calcitonin. As a result, calcitonin is an important tool for diagnosing MTC. When there is focal or no calcitonin staining, diagnosis of MTC can be challenging as this may suggest differences in cell origin and in prognosis and recurrence of the disease. The prognosis and guidelines for management and follow up for MTC remain inconclusive. Here, we present a case of primary neuroendocrine tumor of the thyroid gland with only focal calcitonin staining on immunohistochemistry and low serum calcitonin level despite a tumor size of almost 4 cm. The assumption of C-cell origin was made from positive staining for carcinoembryonic agent (CEA), thyroid transcription factor 1 (TTF-1) and paired box 8 (PAX8) without expression of thyroglobulin (Tg). The patient underwent thyroid lobectomy and follow-up monitoring with ultrasound and measurements of calcitonin and CEA levels, without any further surgical intervention. Few cases of neuroendocrine tumors with limited calcitonin expression have been published and the etiology and prognosis are still unknown. Our case suggests that limited calcitonin expression cannot completely exclude the diagnosis of MTC. This rare type of MTC should be differentiated from the typical presentation of MTC. Treatment and post-operative surveillance should be tailored based on the individual.
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Affiliation(s)
- Rupporn Sukpanich
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA, USA.,Department of Surgery, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Elham Khanafshar
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Insoo Suh
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA, USA
| | - Jessica Gosnell
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, CA, USA
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18
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Guo QQ, Zhang SH, Niu LJ, Zhang YK, Li ZJ, Chang Q. Comprehensive evaluation of medullary thyroid carcinoma before surgery. Chin Med J (Engl) 2019; 132:834-841. [PMID: 30829709 PMCID: PMC6595859 DOI: 10.1097/cm9.0000000000000160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) is a rare disease, but it exhibits more aggressive behaviors. The aim of this study was to improve the diagnostic accuracy of MTC before surgery by analyzing the clinical and ultrasonic data of patients with MTC. METHODS The study included 71 patients (96 lesions) with histopathologically proven MTC between April 2011 and September 2016 in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. The clinical characteristics and sonographic findings were retrospectively reviewed and compared between the ultrasonic correct diagnosis group and the ultrasonic misdiagnosis group with the t test or Mann-Whitney U test for quantitative parameters and the χ test or Fisher exact test for qualitative parameters. RESULTS Compared with the ultrasonic correct diagnosis group, the proportion of the cystic change in the ultrasonic misdiagnosed group was high (25.0% vs. 4.2%), the uncircumscribed margin and irregular shape proportions were low (20.8%, 58.3% vs. 74.7%, 87.3%), calcification was relatively rare (20.8% vs. 56.3%), and rich vascularity was relatively rare (25.0% vs. 78.9%). CONCLUSIONS In the case of atypical MTC, such as cystic change, circumscribed margin, regular shape, no calcification, no rich vascularity, and normal cervical lymph nodes, MTC is easily misdiagnosed as benign by ultrasound. Therefore, ultrasound, cytology and serum calcitonin should be comprehensively evaluated for a preoperative diagnosis of MTC.
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Affiliation(s)
- Qian-Qian Guo
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shao-Hang Zhang
- Department of Ultrasound, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, Beijing 100080, China
| | - Li-Juan Niu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Kang Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Zheng-Jiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qing Chang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Silvestre C, Sampaio Matias J, Proença H, Bugalho MJ. Calcitonin Screening in Nodular Thyroid Disease: Is There a Definitive Answer? Eur Thyroid J 2019; 8:79-82. [PMID: 31192146 PMCID: PMC6514514 DOI: 10.1159/000494834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Calcitonin (Ctn) is a hormone secreted by thyroid "C" cells and is considered an excellent marker for medullary thyroid carcinoma (MTC). However, the use of Ctn to screen patients with nodular thyroid disease (NTD) remains controversial. OBJECTIVE The aim of this work was to define the frequency of hypercalcitoninemia among NTD patients followed at a tertiary referral hospital. METHODS A retrospective analysis was made of basal Ctn measurements and corresponding patients' records between January 2011 and December 2015. Hypercalcitoninemia was defined as > 10 pg/mL. Depending on the Ctn value, three groups were considered: G1, ≤10 pg/mL; G2, 10-100 pg/mL; G3, ≥100 pg/mL. RESULTS Ctn was requested in an NTD context for 1,504 patients, 69 of whom had hypercalcitoninemia. Of these, 20 underwent surgery (G2, 11; G3, 9), and a histological diagnosis of MTC was established in 12 (G2, 3/27%; G3, 9/100%). Surgery was chosen based solely on Ctn levels in 7 cases, since only 5 had a positive cytology. CONCLUSIONS Hypercalcitoninemia was found in 4.6% of NTD patients. Ctn levels ≥100 pg/mL were associated with a greater CMT risk than values between 10 and 100 pg/mL, reinforcing results from other groups. The need for an adequate interpretation of results as well as an appropriate selection of patients to surgery stresses the importance of endocrinologists requesting and interpreting results.
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Affiliation(s)
- Catarina Silvestre
- Department of Endocrinology, Diabetes and Metabolism, Santa Maria Hospital, Lisbon, Portugal
| | | | - Helena Proença
- Department of Laboratorial Medicine, Santa Maria Hospital, Lisbon, Portugal
| | - Maria João Bugalho
- Department of Endocrinology, Diabetes and Metabolism, Santa Maria Hospital, Lisbon, Portugal
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Kihara M, Hirokawa M, Kudo T, Hayashi T, Yamamoto M, Masuoka H, Higashiyama T, Fukushima M, Ito Y, Miya A, Miyauchi A. Calcitonin measurement in fine-needle aspirate washout fluid by electrochemiluminescence immunoassay for thyroid tumors. Thyroid Res 2018; 11:15. [PMID: 30450128 PMCID: PMC6208047 DOI: 10.1186/s13044-018-0059-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose For the differential diagnosis of medullary thyroid carcinoma (MTC) on thyroid nodules, ultrasound-guided fine-needle aspiration cytology is a useful and safe procedure, but its diagnostic accuracy is not high enough. As an ancillary method to accurately diagnose MTC, the calcitonin in fine-needle aspirate washout fluid (FNA-Ct) is used. However, no data are available about cut-off values of FNA-Ct using the currently available electrochemiluminescence immunoassay (ECLIA). Methods We investigated 180 thyroid nodules in 141 patients. After smearing, the syringe and needle used for the FNA were rinsed with normal saline (0.5 mL). The calcitonin in the washout was measured by ECLIA. Results The FNA-Ct in the non-MTC nodules of MTC patients, non-MTC nodules of non-MTC patients, and MTC nodules were 10.6-2100 pg/mL (median 24.6 pg/mL), < 0.5-21.0 pg/mL (median < 0.5 pg/mL), and 94.9-4,070,000 pg/mL (median 177,000 pg/mL), respectively. A receiver operating characteristic analysis of the MTC nodules and the non-MTC nodules of the non-MTC patients indicated that the cut-off value was 21.0 pg/mL, leading to 100% sensitivity and 100% specificity. Conclusions This is the first study to determine the cut-off value of FNA-Ct with an ECLIA, and we propose that the optimal cut-off value is 21.0 pg/mL.
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Affiliation(s)
- Minoru Kihara
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Mitsuyoshi Hirokawa
- 2Departments of Diagnostic Pathology, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Takumi Kudo
- 3Departments of Internal Medicine, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Toshitetsu Hayashi
- 2Departments of Diagnostic Pathology, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Masatoshi Yamamoto
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Hiroo Masuoka
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Takuya Higashiyama
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Mitsuhiro Fukushima
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Yasuhiro Ito
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Akihiro Miya
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
| | - Akira Miyauchi
- 1Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo 650-0011 Japan
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