Poorly Differentiated Thyroid Carcinoma: Single Centre Experience and Review of the Literature

Poorly Differentiated Thyroid Carcinoma in a 19-Year-Old Young Female Patient: A Case Report

Poorly differentiated thyroid carcinoma (PDTC) is a rare type of thyroid carcinoma that develops from follicular epithelial cells. In terms of morphology and prognosis, PDTC falls between well-differentiated thyroid carcinoma (WDTC) and anaplastic thyroid carcinoma (ATC). The spectrum of malignant thyroid tumors originating from follicles ranges from the fatal ATC at one end to the indolent WDTC at the other. We present a case of a 19-year-old female patient complaining of swelling on the right side of the neck. Computed tomography revealed a solid cystic lesion within the right lobe of the thyroid gland. The diagnosis of PDTC was made through histopathological examination. In this case, we evaluated the histological characteristics of the right lobe of the thyroid gland and presented a case report of PDTC in a young female.

The Long Journey towards Personalized Targeted Therapy in Poorly Differentiated Thyroid Carcinoma (PDTC): A Case Report and Systematic Review

BACKGROUND

Poorly differentiated thyroid carcinoma (PDTC) has an intermediate prognosis between indolent well-differentiated thyroid carcinoma (TC) and anaplastic carcinoma. Herein, we present a case report with a PDTC component, along with a systematic review of the literature.

CASE REPORT

We report a case of a 45-year-old man diagnosed with a PDTC component, along with hobnail and tall-cell variant features positive for BRAFV600E mutation, after a total thyroidectomy and neck dissection. Radioactive iodine (RAI)-131 therapy was applied, but an early recurrence led to complementary surgeries. The anti-Tg rise, the presence of new lymph nodes, and the negative whole-bodyradioiodine scan were suggestive of a radioiodine-resistant tumor. Lenvatinib, sorafenib, dabrafenib/trametinib, cabozantinib and radiotherapy were all administered, controlling the tumor for a period of time before the patient ultimately died post-COVID infection. Systematic Review: We searched PubMed, Scopus, and WebofScience to identify studies reporting clinicopathological characteristics, molecular marker expression, and management of non-anaplastic TC with any proportion of PDTC in adult patients. Of the 2007 records retrieved, 82were included in our review (PROSPERO-ID545847).

CONCLUSIONS

Our case, together with the systematic review, imply that a combination of molecular-targetedtreatments may be safe and effective in patients with RAI-resistantBRAF-mutated advanced PDTC when surgery has failed to control tumor progression.

A Comprehensive Review and Insights into the New Entity of Differentiated High-Grade Thyroid Carcinoma

Differentiated high-grade thyroid carcinoma (DHGTC) is a new subset within the spectrum of thyroid malignancies. This review aims to provide a comprehensive overview of DHGTC, focusing on its historical perspective, diagnosis, clinical characteristics, molecular profiles, management, and prognosis. DHGTC demonstrates an intermediate prognosis that falls between well-differentiated thyroid carcinoma and anaplastic thyroid carcinoma. Previously unenumerated, this entity is now recognized for its significant impact. Patients with DHGTC often present at an older age with advanced disease and exhibit aggressive clinical behavior. Molecularly, DHGTC shares similarities with other thyroid malignancies, harboring driver mutations such as BRAFV600E and RAS, along with additional late mutations. The unique behavior and histologic features of DHGTC underscore the necessity of precise classification for prognostication and treatment selection. This highlights the critical importance of accurate diagnosis and recognition by pathologists to enrich future research on this entity further.

Poorly differentiated thyroid carcinoma: molecular, clinico-pathological hallmarks and therapeutic perspectives

Poorly differentiated thyroid carcinoma (PDTC) is a rare and extremely aggressive tumor, accounting for about 2-15% of all thyroid cancer. PDTC has a distinct biological behavior compared to well-differentiated and anaplastic thyroid carcinoma and, in last years, it has been classified as a separate entity from both anatomopathological and clinical points of view. Nevertheless, there is still a lack of consensus among clinicians regarding inclusion criteria and definition of PDTC that affects its diagnosis and clinical management. Due to its rarity and difficulty in classification compared to other tumors, very few studies are available to date and series often include different histotypes in addition to PDTC. This review focuses on main studies concerning PDTC summarizing the evolution in the definition of its diagnosis criteria, clinicopathological features, management, and outcome. The data available confirm that the pathological evaluation and classification of PDTC are crucial and should therefore be standardized. Since the clinical presentation and prognosis of PDTC may vary widely depending on the different stage of the disease at diagnosis, the patient's management may differ in treatment and should be tailored to each patient. Finally, this review discusses advances in molecular insights of PDTC that, together with the implementation of both in vitro and in vivo models, will provide valuable insights into biological mechanisms of progression, metastasis, and invasion of this aggressive thyroid carcinoma. Further studies on larger, carefully selected series are needed to better assess the peculiar features of PDTC and to better define its management by focusing on the best diagnostic and therapeutic approaches.

Werner syndrome associated with poorly differentiated thyroid carcinoma and systemic sclerosis-like skin manifestations: A case report

Werner syndrome (WS) is an autosomal recessive disorder characterised by premature ageing. WS patients often experience scleroderma-like manifestation including skin sclerosis and skin ulcer, making it difficult to differentiate WS from systemic sclerosis (SSc). Moreover, there is a high incidence of malignancy and arteriosclerosis-related disease in WS patients. We herein describe a 36-year-old woman with WS who had poorly differentiated thyroid carcinoma, one of the rare phenotypes of thyroid tumour. This case suggested the importance to distinguish WS from SSc and early diagnosis of malignancy.

Update on current diagnosis and management of anaplastic thyroid carcinoma

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.

Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology

Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer.

Clinical characteristics and prognostic nomogram for patients with insular thyroid carcinoma: a population-based analysis

BACKGROUND

Insular thyroid carcinoma (ITC) is an uncommon poorly differentiated thyroid malignancy. Due to its rarity, its demographic and clinicopathological features and survival remains unclear. The present study aimed to describe the features and survival of ITC, determine its prognostic factors, and establish a prognostic nomogram.

METHODS

Patients with ITC were identified in the Surveillance, Epidemiology, and End Results database from 2004 to 2019. The features and survival of patients with ITC and other thyroid carcinomas were compared after balancing the baseline characteristics using propensity score matching (PSM). Univariate and multivariate Cox analyses were used to identify the prognostic factors for ITC. Moreover, overall survival (OS)- or cancer-specific survival (CSS)-specific nomograms were established to predict ITC prognosis.

RESULTS

A total of 206 patients with ITCs were identified. The 1-, 2-, 5-, and 10-year OS rates of 206 patients with ITC were 90.3%, 82.0%, 62.2%, and 42.5%, respectively. The median OS was 93 months (95% CI, 73.0-140.0), while the median CSS was 141 months (95% CI, 93.0-173.0). After PSM analysis, the survival analysis of the matched cohort revealed that ITC had a worse clinical outcome than papillary thyroid cancer and follicular thyroid cancer, and better survival than anaplastic thyroid carcinoma. Multivariate Cox regression analysis demonstrated that age, N stage, M stage, and surgery were independent prognostic factors for both OS and CSS in ITC patients. The C-indices for the OS- and CSS-specific nomograms were 0.778 (95% CI, 0.724-0.832) and 0.808 (95% CI, 0.754-0.862), respectively. The calibration curve and ROC analysis indicated that the nomogram models exhibited a good discriminative ability. Decision curve analysis suggested that the nomogram models had a significant positive net benefit and were better than the traditional TNM staging system at predicting survival.

CONCLUSION

ITC has distinct clinicopathological characteristics and survival compared to other thyroid carcinomas, and the established nomogram could predict the survival probability of patients with ITC accurately with a higher net benefit.

Case report: Visibly curative effect of dabrafenib and trametinib on advanced thyroid carcinoma in 2 patients

Background

Differentiated thyroid cancer accounts for the majority of thyroid cancers and has a good prognosis after standard treatment. However, there are still some complex and refractory thyroid cancers, including locally advanced differentiated thyroid carcinoma and medullary carcinoma (MTC), poorly differentiated thyroid carcinoma (PDTC), and anaplastic thyroid carcinoma (ATC). Here, we report the therapeutic response of 2 advanced thyroid carcinoma patients treated with dabrafenib and trametinib.

Case presentation

Two elderly females presented to the clinic with neck masses, dyspnea, and dysphagia. Signs of the trachea and esophageal compression were markedly visible in computed tomography (CT) scan and ultrasonography. Pathologic diagnoses of PDTC were confirmed for both patients through ultrasound-guided fine-needle aspiration (US-FNA). Both patients were significantly relieved from dyspnea and dysphagia after a course of treatment with dabrafenib and trametinib, and their tumors gradually shrank during the follow-up period.

Conclusion

Overall, this treatment modality is rare, but effective. By sharing these 2 case reports, we hope to provide a reference for the treatment of clinically similar patients with advanced thyroid carcinoma.

Aggressive variants of follicular cell-derived thyroid carcinoma: an overview

PURPOSE

The incidence of thyroid carcinoma has increased globally in the past years. Papillary thyroid carcinoma (PTC) is the most frequent neoplasm of the thyroid gland comprehending the 90% of the thyroid carcinoma and has an indolent clinical behaviour. However, some variants of follicular cell-derived thyroid carcinoma, including variants of classic of PTC, have been identified that show a more aggressive biological behaviour. An accurate diagnosis of these entities is crucial for planning a more aggressive treatment and improving patients' prognosis of patients. The aim of this review is to present the main clinical, histological, and molecular features of aggressive variants of follicular cell-derived thyroid carcinoma, and to provide useful histological parameters for determining the most suitable therapeutic strategy for patients affected by these forms.

RESULTS

Variants of classic PTC such as the diffuse sclerosing variant (DSV), the tall cell variant (TCV), the columnar cell variant (CCV), the solid/trabecular variant (STV) and the hobnail variant (HV), and other variants of follicular cell-derived thyroid carcinoma, such as poorly differentiated thyroid carcinoma (PDTC), and anaplastic thyroid carcinoma (ATC), are associated with aggressive behaviour.

CONCLUSIONS

The correct identification and diagnosis of aggressive variants of follicular cell-derived thyroid carcinoma is important, as they allow the clinician to adopt the most refined therapeutic strategies in order to the survival of the patients.

Thyroid and renal cancers: A bidirectional association

There is a deep interrelation between the thyroid gland and the kidney parenchyma, with dysfunction of the first leading to significant changes in renal metabolism and vice versa. Given the recognition of cancer as a systemic disease, the raise of thyroid tumors and the common association of several malignancies, such as breast cancer, prostate cancer, colorectal cancer, and other, with an increased risk of kidney disease, public health alert for these conditions is warranted. A systematic review of the current evidence on the bidirectional relationship between thyroid and renal cancers was conducted including 18 studies, highlighting patient’s characteristics, histology, time for secondary malignancy to develop from the first diagnosis, treatment, and follow-up. A total of 776 patients were identified; median age was 64 years (range: 7–76 years). Obesity and family history were identified as the most common risk factors, and genetic susceptibility was suggested with a potential strong association with Cowden syndrome. Controversy on chemo and radiotherapy effects was found, as not all patients were previously exposed to these treatments. Men were more likely to develop kidney cancer after a primary thyroid malignancy, with 423/776 (54%) experiencing renal disease secondarily. Median time after the first malignancy was 5.2 years (range: 0–20 years). With the advancement of current oncological therapy, the prognosis for thyroid cancer patients has improved, although there has been a corresponding rise in the incidence of multiple secondary malignancy within the same population, particularly concerning the kidney. Surgery can achieve disease-free survival, if surveillance follow-up allows for an early localized form, where radical treatment is recommended.

Artificial Intelligence for Thyroid Nodule Characterization: Where Are We Standing?

Simple Summary

In the present review, an up-to-date summary of the state of the art of artificial intelligence (AI) implementation for thyroid nodule characterization and cancer is provided. The opinion on the real effectiveness of AI systems remains controversial. Taking into consideration the largest and most scientifically valid studies, it is possible to state that AI provides results that are comparable or inferior to expert ultrasound specialists and radiologists. Promising data approve AI as a support tool and simultaneously highlight the need for a radiologist supervisory framework for AI provided results. Therefore, current solutions might be more suitable for educational purposes.

Abstract

Machine learning (ML) is an interdisciplinary sector in the subset of artificial intelligence (AI) that creates systems to set up logical connections using algorithms, and thus offers predictions for complex data analysis. In the present review, an up-to-date summary of the current state of the art regarding ML and AI implementation for thyroid nodule ultrasound characterization and cancer is provided, highlighting controversies over AI application as well as possible benefits of ML, such as, for example, training purposes. There is evidence that AI increases diagnostic accuracy and significantly limits inter-observer variability by using standardized mathematical algorithms. It could also be of aid in practice settings with limited sub-specialty expertise, offering a second opinion by means of radiomics and computer-assisted diagnosis. The introduction of AI represents a revolutionary event in thyroid nodule evaluation, but key issues for further implementation include integration with radiologist expertise, impact on workflow and efficiency, and performance monitoring.