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Hamidi S, Dadu R, Zafereo ME, Ferrarotto R, Wang JR, Maniakas A, Gunn GB, Lee A, Spiotto MT, Iyer PC, Sousa LG, Akhave NS, Ahmed S, Learned KO, Lu C, Lai SY, Williams M, Hosseini SM, Busaidy NL, Cabanillas ME. Initial Management of BRAF V600E-Variant Anaplastic Thyroid Cancer: The FAST Multidisciplinary Group Consensus Statement. JAMA Oncol 2024:2821028. [PMID: 38990526 DOI: 10.1001/jamaoncol.2024.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Importance BRAF/MEK inhibitors revolutionized the treatment of BRAF V600E-variant anaplastic thyroid carcinoma (BRAFv-ATC), offering improved outcomes for patients with this previously incurable disease. Observations Anaplastic thyroid carcinoma (ATC) accounts for approximately half of thyroid cancer-related deaths. It presents as a rapidly growing tumor that often invades locoregional structures and spreads to distant sites early; therefore, prompt diagnosis, staging, and treatment initiation are of the essence in the treatment of ATC. Although most oncologists will encounter a patient with ATC in their practice, the rarity of this disease makes treatment challenging, particularly because those with BRAFv-ATC no longer have a dismal prognosis. BRAF/MEK kinase inhibitors have transformed the outlook and treatment of BRAFv-ATC. Therefore, molecular profiling to identify these patients is critical. More recently, the addition of immunotherapy to BRAF/MEK inhibitors as well as the use of the neoadjuvant approach were shown to further improve survival outcomes in BRAFv-ATC. Many of these recent advances have not yet been incorporated in the currently available guidelines, allowing for disparities in the treatment of patients with BRAFv-ATC across the US. With the increasing complexity in the management of BRAFv-ATC, this Consensus Statement aims to formulate guiding recommendations from a group of experts to facilitate therapeutic decision-making. Conclusions and Relevance This Consensus Statement from the FAST (Facilitating Anaplastic Thyroid Cancer Specialized Treatment) group at MD Anderson Cancer Center emphasizes that rapid identification of a BRAF V600E pathogenic variant and timely initiation of sequential therapy are critical to avoid excess morbidity and mortality in patients with BRAFv-ATC. In the past decade, remarkable progress has been made in the treatment of patients with BRAFv-ATC, justifying these new evidence-based recommendations reached through a consensus of experts from a high-volume center.
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Affiliation(s)
- Sarah Hamidi
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer, Houston
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer, Houston
| | - Mark E Zafereo
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer, Houston
| | - Renata Ferrarotto
- Department of Thoracic-Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Jennifer R Wang
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer, Houston
| | - Anastasios Maniakas
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer, Houston
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Anna Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Michael T Spiotto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Priyanka C Iyer
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer, Houston
| | - Luana G Sousa
- Department of Thoracic-Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Neal S Akhave
- Department of Thoracic-Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Salmaan Ahmed
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston
| | - Kim O Learned
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston
| | - Charles Lu
- Department of Thoracic-Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Stephen Y Lai
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer, Houston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer, Houston
| | - S Mohsen Hosseini
- Department of Pathology, The University of Texas MD Anderson Cancer, Houston
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer, Houston
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer, Houston
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Priantti JN, Rodrigues NMV, de Moraes FCA, da Costa AG, Jezini DL, Heckmann MIO. Efficacy and safety of BRAF/MEK inhibitors in BRAFV600E-mutated anaplastic thyroid cancer: a systematic review and meta-analysis. Endocrine 2024:10.1007/s12020-024-03845-w. [PMID: 38709445 DOI: 10.1007/s12020-024-03845-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Approximately 45% of anaplastic thyroid cancer (ATC) patients harbor a BRAFV600E mutation and are eligible for target therapy (TT) with BRAF and MEK inhibitors (BRAFi/MEKi), nevertheless, few data advocate for this. Hence, we've conducted a systematic review and meta-analysis investigating the effectiveness and safety of BRAFi/MEKi in BRAFV600E ATC patients. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for BRAFi/MEKi TT in BRAFV600E ATC patients. Outcomes included objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), duration of response (DOR) and adverse events (AEs). RESULTS Nine studies with 168 patients were included. Median follow-up ranged from 2.0 to 47.9 months. 75% of patients had stage IVc. In a pooled analysis, ORR was 68.15% (95% CI 55.31-80.99, I2 = 47%) and DCR was 85.39% (95% CI 78.10-92.68, I2 = 0), with a median DOR of 14.4 months (95% CI 4.6-14.4) and a median PFS of 6.7 months (95% CI 4.7-34.2). Moreover, 1-year OS rate was 64.97% (95% CI 48.76-81.17, I2 = 84%) and 2-years OS rate was 52.08% (95% CI 35.71-68.45, I2 = 79%). Subgroup analysis showed patients in the neoadjuvant setting had higher rates of 1 and 2-years OS and observational studies tended to report higher rates of ORR than clinical trials. No new or unexpected adverse events were found. CONCLUSIONS Our study demonstrated BRAFi/MEKi have a decent activity for BRAFV600E ATC patients, especially in the neoadjuvant setting, with a tolerable safety profile. However, further clinical trials are warranted to investigate these findings.
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Affiliation(s)
- Jonathan N Priantti
- Department of Internal Medicine, School of Medicine, Federal University of Amazonas - UFAM, Manaus, AM, 69020-160, Brazil.
| | | | | | | | - Deborah Laredo Jezini
- Department of Internal Medicine, School of Medicine, Federal University of Amazonas - UFAM, Manaus, AM, 69020-160, Brazil
- Department of Education and Research, Hospital Universitário Getúlio Vargas, Manaus, AM, 69020-170, Brazil
| | - Maria Izabel Ovellar Heckmann
- Department of Education and Research, Hospital Universitário Getúlio Vargas, Manaus, AM, 69020-170, Brazil
- Institute of Biological Sciences, Federal University of Amazonas - UFAM, Manaus, AM, 69080-900, Brazil
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Ghafouri AM, Alzaidi S, Al-Kaabi BB, Awadh MA, Bakhsh D, Alharbi A. Thyroid B-Cell Lymphoma in the Background of Hashimoto's Thyroiditis: A Case Report and Literature Review. Cureus 2024; 16:e57359. [PMID: 38694416 PMCID: PMC11061538 DOI: 10.7759/cureus.57359] [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] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Primary thyroid lymphoma (PTL) is a rare type of thyroid cancer, comprising less than 5% of all thyroid cancer cases. PTL includes subtypes like diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue lymphoma (MALT). The connection between PTL and autoimmune diseases of the thyroid, particularly Hashimoto's thyroiditis, has gained recognition in recent years. Studies have indicated an increased incidence of PTL among individuals with Hashimoto's thyroiditis. However, effectively recognizing and managing PTL in the context of autoimmune thyroid diseases remains challenging. Further research and clinical experience are needed to develop comprehensive strategies for early detection and optimal management of this complex condition. In a case involving an 88-year-old female diagnosed with diffuse large B-cell lymphoma, she presented with a complaint of persistent neck swelling for five years. The patient also experienced symptoms such as dysphagia, hoarseness of voice, obstructive sleep apnea, and choking attacks. Surgical resection of the neck swelling was successfully performed, and the patient was referred to the oncology department for further treatment. Thyroid B-cell lymphoma is an exceedingly rare form of thyroid cancer, typically identified in individuals who have a history of Hashimoto's thyroiditis. The prognosis for thyroid B-cell lymphoma is generally unfavorable, and surgical intervention remains the primary treatment approach for such cases.
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Affiliation(s)
- Abdullah M Ghafouri
- Department of Otolaryngology, Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Suzan Alzaidi
- Department of Otolaryngology, Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
| | | | - Mohammed A Awadh
- College of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Dohaa Bakhsh
- Department of Otolaryngology, Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Abdullah Alharbi
- Department of Pathology, King Fahad Armed Forces Hospital, Jeddah, SAU
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Sakhri S, Zemni I, Ayadi MA, Kamoun S, Chargui R, Ben Dhiab T. Primary thyroid lymphoma: a case series. J Med Case Rep 2024; 18:108. [PMID: 38395921 PMCID: PMC10893725 DOI: 10.1186/s13256-024-04434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Primary Thyroid Lymphoma (PTL) is defined as lymphoma involving the thyroid gland alone or the thyroid gland and adjacent neck lymph nodes without contiguous spread or distant metastases at the time of diagnosis. Most thyroid lymphomas are B cell lymphomas, and 98% of all PTL cases are non-Hodgkin's lymphoma. It is a rare disease accounting for around 5% of the thyroid neoplasms and 2% of extranodal lymphomas. If properly diagnosed and treated, the prognosis is favorable. CASE PRESENTATION Five cases (three men and two women) of PTL were diagnosed and treated in our institute between January 2005 and September 2019. These are 5 cases of Caucasian origin. The mean age was 76.2 (range: 63-95 years); one patient had associated hypothyroid. One patient had a medical history of breast cancer; one was hypothyroid, and four were euthyroid at the diagnosis. In 4 of these patients, PTL started with compressive symptoms. No patients underwent fine needle aspiration cytology (FNAC) or biopsy for the diagnostic only. In sonography, two cases showed bilateral nodules with goiter; in the three cases it showed nodules in the lobe and isthmus. Technetium-99m scintigraphy was performed on only two patients. Bone Marrow Biopsy (BMB) showed normal cellularity in 4 cases and only one case showed tumor cells. LDH levels were increased in all cases. The extension was evaluated in all patients with cervical and thoracic CT scans, Bone Marrow Biopsy (BMB), beta-2 microglobulin, and serum lactate dehydrogenase (LDH) levels. Three cases were staged as IE and two cases as IIE. Three patients underwent total thyroidectomy; two of them underwent cervical lymph node dissection. Two patients underwent lobectomy. All were diagnosed with lymphoma postoperatively and all were diffuse large B cell lymphoma (DLBCL). One patient completed treatment with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), and two cases received adjuvant chemo-radiotherapy (30 Gy). Two patients died immediately after surgery. CONCLUSION PTL is a rare disease whose diagnosis should be considered in cases of rapidly growing goitres. Timely needle biopsy in suspected cases can avoid unnecessary surgery. Systemic treatment is required, depending on the stage of the tumour.
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Affiliation(s)
- Saida Sakhri
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Zemni
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
- LMBA (LR03ES03), Sciences Faculty of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Ali Ayadi
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- LMBA (LR03ES03), Sciences Faculty of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Salma Kamoun
- Department of Pathology, Salah Azaïz Institute, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Riadh Chargui
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tarek Ben Dhiab
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Pavlidis ET, Galanis IN, Pavlidis TE. Update on current diagnosis and management of anaplastic thyroid carcinoma. World J Clin Oncol 2023; 14:570-583. [PMID: 38179406 PMCID: PMC10762533 DOI: 10.5306/wjco.v14.i12.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 12/22/2023] Open
Abstract
Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%. However, the undifferentiated or anaplastic type accounting for < 0.2%, usually in elderly individuals, exhibits a dismal prognosis with rapid growth and disappointing outcomes. It is the most aggressive form of thyroid carcinoma, with a median survival of 5 mo and poor quality of life (airway obstruction, dysphagia, hoarseness, persistent pain). Early diagnosis and staging are crucial. Diagnostic tools include biopsy (fine needle aspiration, core needle, open surgery), high-resolution ultrasound, computed tomography, magnetic resonance imaging, [(18)F]fluoro-D-glucose positron emission tomo-graphy/computed tomography, liquid biopsy and microRNAs. The BRAF gene (BRAF-V600E and BRAF wild type) is the most often found molecular factor. Others include the genes RET, KRAS, HRAS, and NRAS. Recent management policy is based on surgery, even debulking, chemotherapy (cisplatin or doxorubicin), radiotherapy (adjuvant or definitive), targeted biological agents and immunotherapy. The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients. Anti-programmed death-ligand 1 antibody immunotherapy, stem cell targeted therapies, nanotechnology achievements and artificial intelligence imple-mentation provide novel promising alternatives. Genetic mutations determine molecular pathways, thus indicating novel treatment strategies such as anti-BRAF, anti-vascular endothelial growth factor-A, and anti-epidermal growth factor receptor. Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care. This neoadjuvant treatment followed by surgery ensures a two-year overall survival of 80%. Prognostic factors for improved outcomes have been found to be younger age, earlier tumor stage and radiation therapy. A multidisciplinary approach is necessary, and the therapeutic plan should be individualized based on surveillance and epidemiology end results.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Ioannis N Galanis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Jia HY, Chen J, Zhai ZX, Fan WW, Yuan SJ, Liu Q, Yan XH, Shen QQ, Liu LP. Characterization of thyroid metastasis from clear cell renal cell carcinoma on ultrasonography: a report of three cases and literature review. Eur Thyroid J 2023; 12:e230121. [PMID: 37992281 PMCID: PMC10762583 DOI: 10.1530/etj-23-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/22/2023] [Indexed: 11/24/2023] Open
Abstract
Introduction Thyroid metastasis from clear cell renal cell carcinoma (ccRCC) is relatively rare, so ultrasound doctors lack experience with the disease, which can easily lead to misdiagnosis. We describe three cases of thyroid metastasis from ccRCC detected 12, 8, and 7 years after nephrectomy. Case presentation The first patient, a 78-year-old woman, was admitted to our institution for hoarseness and progressive dyspnea. Ultrasonography revealed bilateral thyroid nodules and abnormal cervical lymph nodes. Fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) of the thyroid was nondiagnostic. The other two patients, a 54-year-old man and a 65-year-old man, were admitted to our institution for a goiter pressing on the trachea. In each case, ultrasonography revealed a partially cystic nodule of the left lobe of the thyroid gland. Histological examination of three patients after thyroidectomy showed thyroid metastasis from ccRCC. Discussion/Conclusion For patients with a history of ccRCC, long-term follow-up and routine thyroid ultrasonography should be performed. If a new thyroid nodule is found during the examination, metastases should be highly suspected. FNAB should be performed, even if benign ultrasound features seem to be in evidence. If the diagnosis of FNAB is incorrect and inconclusive, CNB should be performed.
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Affiliation(s)
- Hai-Yan Jia
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Juan Chen
- Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Zi-Xin Zhai
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wen-Wen Fan
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Si-Jie Yuan
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qiong Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiao-Hui Yan
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qian-Qian Shen
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Li-Ping Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Li J, He S, Xu J, Xue G. Coexistence of primary thyroid diffuse large B cell lymphoma and papillary thyroid carcinoma in a patient with Hashimoto's thyroiditis: a case report and literature review. Front Oncol 2023; 13:1248830. [PMID: 37869091 PMCID: PMC10585257 DOI: 10.3389/fonc.2023.1248830] [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: 06/27/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid malignancy and also has an excellent prognosis. Primary thyroid lymphoma (PTL) is rare and has a poor prognosis. The co-occurrence of both malignancies is extremely rare, and the preoperative diagnosis is rather difficult. We report the case of a patient with both PTC and PTL in the setting of Hashimoto's thyroiditis (HT). A 59-year-old female patient was referred to our department for progressive enlargement of the thyroid gland over a few months. The imaging results demonstrated an enlarged thyroid and a mass in the thyroid. Total thyroidectomy and bilateral central neck node dissection were conducted. The final diagnosis of the coexistence of thyroid diffuse large B cell lymphoma and PTC was confirmed by histopathology and immunohistochemistry. The patient received radiation therapy and six cycles of chemotherapy combined with targeted therapy, including rituximab, cyclophosphamide, doxorubicin, vindesine, and prednisone (R-CHOP). After 6 months of follow-up, neither tumor has recurred. It is important for physicians to keep PTL in mind for differential diagnosis in HT patients with sudden thyroid enlargement.
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Affiliation(s)
| | | | | | - Gang Xue
- Department of Thyroid and Breast Surgery, General Hospital of Western Theater Command of Chinese People’s Liberation Army, Chengdu, China
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Marcy PY, Bauduer F, Thariat J, Gisserot O, Ghanassia E, Chetaille B, Boudin L, Morvan JB. Fast Track Management of Primary Thyroid Lymphoma in the Very Elderly Patient. Curr Oncol 2023; 30:5816-5827. [PMID: 37366918 DOI: 10.3390/curroncol30060435] [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: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
A rapid growing cervical mass mobile while swallowing is the most common clinical presentation of severe thyroid malignancy. A 91-year-old female patient with a history of Hashimoto thyroiditis presented with clinical compressive neck symptoms. The patient had gastric Maltoma diagnosed that was surgically resected thirty years ago. A straightforward process was needed to reach full histological diagnosis and initiate prompt therapy. Ultrasound (US) showed a 67 mm hypoechoic left thyroid mass with reticulated pattern without signs of locoregional invasion. Percutaneous trans isthmic US-guided 18G core needle biopsy (CNB) disclosed diffuse large B cell lymphoma of the thyroid gland. FDG PET revealed two distinct thyroid and gastric foci (both SUVmax 39.1). Therapy was initiated rapidly to decrease clinical symptoms in this aggressive stage III primitive malignant thyroid lymphoma. The prognostic nomogram was calculated by using a seven-item scale, which disclosed a one-year overall survival rate of 52%. The patient underwent three R-CVP chemotherapy courses, then refused further treatment and died within five months. Real-time US-guided CNB approach led to rapid patient's management that was tailored to patient's characteristics. Transformation of Maltoma into diffuse large B cell lymphoma (DLBCL) into two body areas is deemed to be extremely rare.
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Affiliation(s)
- Pierre Yves Marcy
- Radiodiagnostics and Interventional Radiology Department, Polyclinics ELSAN Medipole Sud, Quartier Quiez, 83189 Ollioules, France
| | - Frederic Bauduer
- Department of Hematology, Centre Hospitalier de la côte Basque, College of Health Sciences, Bordeaux University, 64100 Bayonne, France
| | - Juliette Thariat
- Department of Radiation Therapy, Francois Baclesse Cancer Research Institute, Laboratoire de Physique Corpusculaire IN2P3/ENSI CAEN/CNRS UMR 6534, Normandy University, 3 Avenue General Harris, 14076 Caen, France
| | - Olivier Gisserot
- Department of Medical Oncology, CH Sainte Musse, 54 Rue Sainte-Claire Deville, 83100 Toulon, France
| | - Edouard Ghanassia
- Department of Endocrinology, PolyClinics Sainte Therese, 06 quai du mas Coulet, 33200 Sete, France
| | - Bruno Chetaille
- MEDIPATH Toulon, Pathology Center, 146 Avenue Foch, 83300 Toulon, France
| | - Laurys Boudin
- Department of Medical Oncology, University Military Hospital Sainte Anne, 2 Boulevard Sainte Anne, BP 600, 83300 Toulon, France
| | - Jean Baptiste Morvan
- Department of Head & Neck Surgery, University Military Hospital Sainte Anne, 2 Boulevard Sainte Anne, BP 600, 83000 Toulon, France
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Xing Y, Wang Y, Wu X. Radiotherapy combined with immunotherapy successfully treated one case of anaplastic thyroid cancer: A case report. Front Oncol 2023; 13:1125226. [PMID: 37256174 PMCID: PMC10225731 DOI: 10.3389/fonc.2023.1125226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 06/01/2023] Open
Abstract
Background Anaplastic thyroid cancer (ATC) is a rare but highly fatal form of thyroid cancer. This highly malignant tumor progresses rapidly and is prone to relapse and metastasis, with a poor prognosis. Novel treatments have improved survival in recent years, but the outcome of treatment is not satisfactory. Case presentation We report a case of multiple postoperative recurrences of papillary thyroid carcinoma that later transformed into undifferentiated carcinoma. The patient's neck mass was huge and the operation was unsuitable. Then, she achieved remarkable tumor shrinkage by tislelizumab immunotherapy combined with radiotherapy. Conclusion This case indicates that radiotherapy combined with immunotherapy is a promising treatment for ATC. Such a combined approach warrants further study.
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Affiliation(s)
- Yurou Xing
- Thoracic Oncology Ward, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongsheng Wang
- Thoracic Oncology Ward, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Wu
- Head and Neck Oncology Ward, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Abstract
PURPOSE OF REVIEW To highlight recent advances in our understanding of the epidemiology, incidence, evaluation, management and outcomes of primary thyroid lymphoma (PTL), and highlight the indications and limitations of surgery. RECENT FINDINGS The differential diagnosis of a rapidly enlarging thyroid mass with or without obstructive symptoms should include PTL and anaplastic thyroid cancer. When PTL is suspected, initial investigations should include blood tests and ultrasound-guided biopsy preferably core need biopsy to allow tissue typing and immunohistochemistry analysis. Systemic imaging with FDG PET-CT is required for staging. Surgery is not recommended for treatment purposes and should be reserved for diagnosis and airway management. Treatment includes chemotherapy and radiotherapy and offer an excellent prognosis. SUMMARY PTL is a rare malignancy making diagnosis and management challenging. Initial investigations of suspected PTL should include blood tests and ultrasound-guided biopsy, preferably core needle biopsy and systemic imaging is required for staging. Surgery is reserved for diagnosis and airway management. Chemotherapy and radiotherapy are the treatment of choice.
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