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Yuang K, Al-Bahadili H, Chang A. An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule. JCEM CASE REPORTS 2023; 1:luad052. [PMID: 37908574 PMCID: PMC10580452 DOI: 10.1210/jcemcr/luad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Indexed: 11/02/2023]
Abstract
Poorly differentiated thyroid carcinoma (PDTC) is a rare entity of thyroid cancer with an intermediate clinical behavior between differentiated and anaplastic thyroid cancer. Here we present a patient who was referred to the endocrinology clinic for evaluation of hyperthyroidism and multinodular goiter. Due to presence of right toxic thyroid nodules and compressive symptoms, the patient underwent right lobectomy and isthmectomy, where surgical pathology revealed PDTC in the right thyroid lobe. Based on this unusual case of malignancy within a toxic nodule, we propose further evaluation of hot nodules with concerning features such as growth rate. Furthermore, exploration of relative sodium iodine symporter (NIS) expression in PDTC may help us better understand how iodine uptake changes as PDTC develops, which may impact our approach to assessing and treating PDTC in the future.
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Affiliation(s)
- Kimberly Yuang
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Huda Al-Bahadili
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Alan Chang
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Stony Brook University Hospital, Stony Brook, NY 11794, USA
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Esmati E, Aleyasin A, Ghalehtaki R, Jafari F, Farhan F, Aghili M, Haddad P, Kazemian A. The role of external beam radiation therapy in the management of thyroid carcinomas: A retrospective study in Iran Cancer Institute. Cancer Rep (Hoboken) 2022; 6:e1652. [PMID: 35691611 PMCID: PMC9875639 DOI: 10.1002/cnr2.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thyroid cancers are histologically classified into three types; differentiated thyroid carcinoma (DTC), medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC). Among the several therapeutic strategies for treatment and management of thyroid cancer, surgical resection in combination with radioactive iodine therapy (RAI) is indicated for moderate to high-risk differentiated thyroid cancer (DTC) patients- according to current guidelines. However, external radiation therapy (EBRT) can be a viable alternative treatment option for these patients and scarce evidence is available regarding the efficacy and effectiveness of EBRT on thyroid cancer. AIM This study aims at evaluating the role of EBRT in the management of thyroid carcinomas. METHODS AND RESULTS In this retrospective cohort study, the records of 59 patients with thyroid cancer were accessed who were treated by EBRT from 2008 to 2016. The indications for EBRT included unresectable primary (definitive) or loco-regional recurrences (salvage) not suitable for RAI, palliation for local disease or metastatic foci (palliative), and the adjuvant treatment for suspected residual disease following resection. Progression-free survival (PFS) and overall survival (OS) were calculated for different types of cancer. PFS was measured from the start of EBRT to the last uneventful follow-up, recurrence, or death. Kaplan-Meier model was used for the survival analysis. Fifty-nine patients were evaluated. The histopathology of the tumors was differentiated and poorly-differentiated, medullary and anaplastic thyroid carcinomas in 22 and 6, 15 and 16 patients, respectively. Twenty-seven patients received external beam radiotherapy (EBRT) as adjuvant therapy and 18 of the cases as palliative therapy while the remaining received salvage or definitive primary EBRT. The stage of patients' cancer was as follows: stage II in 3 and III in 1, IVA in 18 and IVB in 18 and IVC in 19. Stage-based median overall survival was 26 months for IVA, 44 for IVB, and 29 for IVC. The median PFS was 18, 22 and 21 months for stages IVA, IVB and IVC, respectively. CONCLUSION Based on our findings, EBRT may still play a role in the management of patients with thyroid carcinoma and should be considered in the armamentarium against thyroid cancers.
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Affiliation(s)
- Ebrahim Esmati
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
| | - Alireza Aleyasin
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Reza Ghalehtaki
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
| | - Fatemeh Jafari
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
| | - Farshid Farhan
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
| | - Mahdi Aghili
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
| | - Peiman Haddad
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Kazemian
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran,Radiation Oncology Research Center (RORC), Cancer Research InstituteTehran University of Medical SciencesTehranIran
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Johansson K, Stenman A, Paulsson JO, Wang N, Ihre-Lundgren C, Zedenius J, Juhlin CC. Development of metastatic poorly differentiated thyroid cancer from a sub-centimeter papillary thyroid carcinoma in a young patient with a germline MET mutation - association or random chance? Thyroid Res 2021; 14:19. [PMID: 34389035 PMCID: PMC8364030 DOI: 10.1186/s13044-021-00110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thyroid cancer dedifferentiation is an unusual observation among young patients and is poorly understood, although a recent correlation to DICER1 gene mutations has been proposed. Case presentation A 28-year old patient presented with a sub-centimeter cytology-verified primary papillary thyroid carcinoma (PTC) and a synchronous lateral lymph node metastasis. Following surgery, histopathology confirmed a 9 mm oxyphilic PTC and a synchronous metastasis of poorly differentiated thyroid carcinoma (PDTC). Extensive molecular examinations of both lesions revealed wildtype DICER1 sequences, but identified a somatic ETV6-NTRK3 gene fusion and a MET germline variant (c.1076G > A, p.Arg359Gln). MET is an established oncogene known to be overexpressed in thyroid cancer, and this specific alteration was not reported as a single nucleotide polymorphism (SNP), suggestive of a mutation. Both the primary PTC and the metastatic PDTC displayed strong MET immunoreactivity. A validation cohort of 50 PTCs from young patients were analyzed using quantitative real-time PCR, revealing significantly higher MET gene expression in tumors than normal thyroid controls, a finding which was particularly pronounced in BRAF V600E mutated cases. No additional tumors apart from the index case harbored the p.Arg359Gln MET mutation. Transfecting PTC cell lines MDA-T32 and MDA-T41 with a p.Arg359Gln MET plasmid construct revealed no obvious effects on cellular migratory or invasive properties, whereas overexpression of wildtype MET stimulated invasion. Conclusions The question of whether the observed MET mutation in any way influenced the dedifferentiation of a primary PTC into a PDTC metastasis remains to be established. Moreover, our data corroborate earlier studies, indicating that MET is aberrantly expressed in PTC and may influence the invasive behavior of these tumors. Supplementary Information The online version contains supplementary material available at 10.1186/s13044-021-00110-4.
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Affiliation(s)
- Klara Johansson
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, SE-17164, Solna, Sweden
| | - Adam Stenman
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, SE-17164, Solna, Sweden.,Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan O Paulsson
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, SE-17164, Solna, Sweden
| | - Na Wang
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, SE-17164, Solna, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Ihre-Lundgren
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Zedenius
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, Visionsgatan 4, SE-17164, Solna, Sweden. .,Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
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Kersting D, Seifert R, Kessler L, Herrmann K, Theurer S, Brandenburg T, Dralle H, Weber F, Umutlu L, Führer-Sakel D, Görges R, Rischpler C, Weber M. Predictive Factors for RAI-Refractory Disease and Short Overall Survival in PDTC. Cancers (Basel) 2021; 13:cancers13071728. [PMID: 33917322 PMCID: PMC8038667 DOI: 10.3390/cancers13071728] [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: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The clinical phenotype of poorly differentiated thyroid cancer (PDTC) can vary substantially. We aim to evaluate risk factors for radioiodine refractory (RAI-R) disease and reduced overall survival (OS). METHODS We retrospectively screened our institutional database for PDTC patients. For the assessment of RAI-R disease, we included patients who underwent dual imaging with 18F-FDG-PET and 124I-PET/131I scintigraphy that met the internal standard of care. We tested primary size, extrathyroidal extension (ETE), and age >55 years as risk factors for RAI-R disease at initial diagnosis and during the disease course using uni- and multivariate analyses. We tested metabolic tumor volume (MTV), total lesion glycolysis (TLG) on 18F-FDG-PET, and the progression of stimulated thyroglobulin within 4-6 months of initial radioiodine therapy as prognostic markers for OS. RESULTS Size of primary >40 mm and ETE were significant predictors of RAI-R disease in the course of disease in univariate (81% vs. 27%, p = 0.001; 89% vs. 33%, p < 0.001) and multivariate analyses. Primary tumor size was an excellent predictor of RAI-R disease (AUC = 0.90). TLG/MTV > upper quartile and early thyroglobulin progression were significantly associated with shorter median OS (29.0 months vs. 56.9 months, p < 0.05; 57.8 months vs. not reached p < 0.005, respectively). DISCUSSION PDTC patients, especially those with additional risk factors, should be assessed for RAI-R disease at initial diagnosis and in the course of disease, allowing for early implementation of multimodal treatment. Primary tumor size >40 mm, ETE, and age >55 are significant risk factors for RAI-R disease. High MTV/TLG is a significant risk factor for premature death and can help identify patients requiring intervention.
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Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Sarah Theurer
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Tim Brandenburg
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (T.B.); (D.F.-S.)
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.D.); (F.W.)
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.D.); (F.W.)
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Dagmar Führer-Sakel
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (T.B.); (D.F.-S.)
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
- Correspondence: ; Tel.: +49-201-723-2032; Fax: +49-201-723-5658
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