Multi-Omics and Management of Follicular Carcinoma of the Thyroid

Diagnostic significance of ultrasound characteristics in discriminating follicular thyroid carcinoma from adenoma

BACKGROUND

Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid gland and has a greater propensity for haematogenous metastasis. However, the preoperative differentiation of FTC from follicular thyroid adenoma (FTA) is not well established. Certain ultrasound characteristics are associated with an increased risk of thyroid malignancy, but mainly for papillary thyroid cancers and not for FTC.

OBJECTIVES

This retrospective study aimed to evaluate the ultrasound characteristics of FTC and the value of ultrasound characteristics in differentiating FTC from FTA.

METHODS

A total of 96 patients with pathologically confirmed FTC or FTA who underwent preoperative thyroid ultrasound were included in this study. The ultrasound and pathological characteristics were evaluated.

RESULTS

Our data revealed that the incidences of lesions with tubercle-in-nodule, spiculated/microlobulated margins, mixed vascularization, egg-shell calcification, central stellate scarring, extension toward the capsule and chronic lymphocytic thyroiditis were significantly higher in the FTC group (all p < 0.05). After adjusting for confounding factors, lesions with mixed vascularization (odds ratio [OR]: 2.038, P = 0.019), central stellate scarring (OR: 87.992, P = 0.007), extension toward the capsule (OR: 22.587, P = 0.010), and chronic lymphocytic thyroiditis (OR: 9.195, P = 0.006) were independently associated with FTC. Furthermore, combined with chronic lymphocytic thyroiditis, mixed vascularization, central stellate scarring, and extension toward the capsule showed high discriminatory accuracy in predicting FTC (AUC: 0.914; sensitivity: 96.5%; specificity: 71.8%; p < 0.001).

CONCLUSIONS

In combination with chronic lymphocytic thyroiditis, mixed vascularization, central stellate scarring, and extension toward the capsule have greater accuracy in differentiating FTCs from FTAs.

COL4A2 enhances thyroid cancer cell proliferation through the AKT pathway

Objectives

Thyroid cancer (THCA) is the most common malignant tumor in endocrine system and the incidence has been increasing worldwide. And the number of patients dying from THCA has also gradually risen because the incidence continues to increase, so the mechanisms related to effective targets is necessary to improve the survival. This study was to preliminarily investigate the effects of the COL4A2 gene on the regulation of thyroid cancer (THCA) cell proliferation and the associated pathways.

Methods

Bioinformatics analysis revealed that COL4A2 was closely associated with cancer development. COL4A2 expression in THCA tissues was analyzed using immunohistochemistry, and survival information was determined via Kaplan‒Meier curves. The expression of COL4A2 and AKT pathway-related genes were analyzed using qPCR and western blot analyses. Colony formation as well as CCK-8 assays exhibited the cell proliferation level and cell activity, respectively. Downstream of COL4A2 was identified by Gene set enrichment analysis (GSEA). The effects of the COL4A2 and AKT pathways on THCA tumor growth in vivo were determined using a mouse model.

Results

Bioinformatics analysis exhibited that COL4A2 plays a significant role in cancer and that the AKT pathway is downstream of COL4A2. THCA patients with high COL4A2 expression had shorter recurrence-free survival. Upregulation of COL4A2 gene expression in 2 THCA cell lines promoted tumor cell growth and activity. The use of AKT pathway blockers also restrained the growth and activity of the 2 THCA cell lines. The use of AKT pathway blockers reduced tumor volume and mass and prolonged mouse survival.

Conclusions

COL4A2 can promote the growth as well as development of THCA through the AKT pathway and COL4A2 could be used as a target for THCA.

Advances in the Diagnosis and Treatment of Follicular Thyroid Carcinoma: A Comprehensive Review

Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer, presenting unique diagnostic and therapeutic challenges. This review provides a comprehensive analysis of the recent advancements in the diagnosis and treatment of FTC, emphasizing the significance of these developments in improving patient outcomes. We discuss the evolution of diagnostic techniques, including advancements in imaging modalities, fine needle aspiration biopsy, and molecular diagnostics, which have enhanced the accuracy of FTC detection and differentiation from benign conditions. The review also evaluates current treatment strategies, including surgical interventions, radioactive iodine therapy, and targeted therapies, examining their effectiveness and impact on patient prognosis. Additionally, we address ongoing challenges in FTC management, such as variability in treatment guidelines and disparities in care. Finally, the review explores emerging therapies and future research directions, highlighting innovations that may further optimize FTC management. By synthesizing current knowledge and identifying future research opportunities, this review aims to contribute to refining diagnostic and therapeutic approaches for FTC.

Pulmonary Metastatic Follicular Thyroid Carcinoma Without Intrathyroidal Primary Thyroid Cancer

Background/Objective

Follicular thyroid cancer without an intrathyroidal primary cancer is rare. We present a patient with multifocal pulmonary metastatic follicular thyroid cancer without apparent cancer within her thyroid.

Case Report

A 44-year-old woman was referred to the thyroid cancer clinic via telemedicine for evaluation of intrapulmonary thyroid tissue. Her past medical history included Roux-en-Y gastric bypass and hysterectomy with bilateral oophorectomy. Six months prior, abdominal computed tomography (CT) showed incidental bilateral lung nodules. Chest CT demonstrated 4 solid left and 1 solid right lung nodules. Lung nodule core biopsy revealed benign thyroid tissue. Thyroid ultrasound showed bilateral subcentimeter anechoic nodules. Chest CT 6 months after initial CT demonstrated stable lung nodules. The levels of thyroid-stimulating hormone, serum thyroglobulin, and thyroglobulin antibody were 1.63 mIU/L (reference range, 0.3-5.5 mIU/L), 40.9 ng/mL (reference range, 0-35 ng/mL), and <1 IU/mL (reference range, <4), respectively. Positron emission tomography/CT showed fluorodeoxyglucose-avid lung lesions measuring 1.5, 1.1, and 2.2 cm and other subcentimeter pulmonary nodules. Repeat lung core biopsy showed thyroid tissue with microfollicular architecture, favoring metastatic follicular carcinoma with neuroblastoma-RAS gene (NRAS) mutation. Total thyroidectomy performed showed multinodular hyperplasia without thyroid cancer. Her postoperative radioiodine scan demonstrated bilateral iodine-avid pulmonary nodules, a serum thyroglobulin level of 179.8 ng/mL, a thyroid-stimulating hormone level of 151.3 mIU/L, and undetectable serum thyroglobulin antibody. She received 261 mCi of radioactive iodine. Fourteen months later, chest CT revealed decreased lung nodules and a serum thyroglobulin level of 0.7 ng/mL.

Discussion

Approximately 2 cases of multifocal pulmonary follicular thyroid cancer without a primary source and no other site of metastasis have been reported.

Conclusion

Pulmonary follicular thyroid cancer without a primary source and no other site of metastasis is extremely rare.

Thyroid Cancer Radiomics: Navigating Challenges in a Developing Landscape

In a review from 2021 by Cao et al [...].