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Bove A, Manunzio R, Palone G, Di Renzo RM, Calabrese GV, Perpetuini D, Barone M, Chiarini S, Mucilli F. Incidence and Clinical Relevance of Incidental Papillary Carcinoma in Thyroidectomy for Multinodular Goiters. J Clin Med 2023; 12:jcm12082770. [PMID: 37109106 PMCID: PMC10144475 DOI: 10.3390/jcm12082770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Patients undergoing a total thyroidectomy for multinodular goiter typically have a long clinical history of the disease. They often come to surgery for compression symptoms, with no suspicion of neoplastic disease. For these patients, the incidence of microcarcinomas is high, even though we know that this does not affect subsequent therapies and long-term survival. On the other hand, when a true incidental carcinoma is present, the patient requires specific therapy and long-term follow-up. The purpose of the study was to identify the incidence of incidental carcinomas in the high prevalence region of goiter, the clinical-pathological characteristics of the tumor, and the therapeutic implications. METHOD This is a retrospective study, from January 2010 to December 2020, on a case series of 1435 total thyroidectomies for goiters. All patients had a preoperative diagnosis of a benign disease. Gender, mean age, and mean duration from the initial diagnosis of goiter were evaluated along with the number and frequency of fine needle aspirations carried out. On the basis of the histological examination, the incidence of incidental carcinoma was then assessed (diameter ≥ 10 mm) as well as the incidence of microcarcinoma (diameter < 10 mm), the pathological characteristics (multifocality, capsular invasion), and the subsequent prescribed therapies. RESULTS Patients with incidental carcinoma numbered 41 (2.8%%), 34 women and 7 men. The mean age was 53.5 years, while the patients diagnosed with microcarcinoma were 88 (6.1%). The mean duration of the disease from initial diagnosis was 7.8 years. On average, these patients underwent 1.8 fine needle aspirations during the course of the disease, almost exclusively in the first four years. The mean diameter of the tumor was 1.35 cm (±0.3). Multifocality was present in six patients, while only one patient presented capsular invasion. The chi-square test delivered a significant dependence on gender in terms of the incidental diagnosis after Yates correction (chi-stat = 5.064; p = 0.024), highlighting a higher incidence in the female population. All patients underwent subsequent metabolic radiotherapy. The mean follow-up was 6.3 years and in the 35 patients examined, none displayed any recurrence of the disease. CONCLUSIONS Incidental carcinoma is not uncommon in patients who have undergone total thyroidectomy for goiters. It must be differentiated from microcarcinoma for its therapeutic implications and the follow-up of the patient. Statistical analysis has shown that the only significant variable is gender. In a goiter area, the careful monitoring of patients is required to highlight suspicious clinical-instrumental aspects that may appear even several years after the initial diagnosis.
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Affiliation(s)
- Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Roberto Manunzio
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Gino Palone
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Raffaella Marina Di Renzo
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Valeria Calabrese
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - David Perpetuini
- Department of Neuroscience and Imaging, Institute for Advanced Biomedical Technologies, University G. D'Annunzio of Chieti-Pescara, Via Luigi Polacchi 13, 66100 Chieti, Italy
| | - Mirko Barone
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Stella Chiarini
- Department of Medicine and Ageing Sciences, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Felice Mucilli
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
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Clinical features and therapeutic outcomes of patients with papillary thyroid microcarcinomas and larger tumors. Nucl Med Commun 2019; 40:477-483. [PMID: 30973839 DOI: 10.1097/mnm.0000000000000991] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to identify clinical features and therapeutic outcomes of patients with papillary thyroid cancer (PTC) according to tumor diameter and evaluate the correlation of neck lymph node (LN) involvement of papillary thyroid microcarcinoma (PTMC) according to patients' age. PATIENTS AND METHODS We divided 467 patients into two groups according to tumor diameter: PTMC group (≤1 cm) and non-PTMC group (>1 cm). The clinical data were analyzed retrospectively. Thereafter, we divided the PTMC patients into three subgroups according to age: young subgroup (<45 years), middle subgroup (45-54 years), and old subgroup (≥55 years). A further study about clinical features, especially the neck LN involvement in three subgroups, was analyzed. RESULTS All patients received radioiodine ablation at least once. There were more patients with a single cancer lesion and cancer in the unilateral lobe, less number of neck LN involvement, fewer patients with neck lymph node metastasis (LNM), and more patients with Hashimoto's thyroiditis in PTMC group than in non-PTMC group. At the further evaluation, 58.03% patients maintained clinical remission, which was more in the PTMC group than in non-PTMC group. There was no significant difference in recurrence, but the disease-free survival rate of patients in the PTMC group was higher than in the non-PTMC group. In the PTMC group, the radioactive iodine curative ratio in younger patients is lower than that in the other two subgroups. Both the LNM and central LNM (CLNM) rates were significantly higher in young patients compared with older patients. In addition, the LNM-positive group had more male patients, larger tumor size, and higher thyroglobulin antibody level. Both LNM and the CLNM rates were significantly higher in the young subgroup than in the older subgroup. Young and middle age and extrathyroid extension were independent risk factors for neck LNM. Unlike LNM, young age, extrathyroid extension, and male sex were independent risk factors for CLNM. CONCLUSION Some PTMCs were less aggressive and the therapeutic outcomes of them were better than non-PTMC. Moreover, PTMCs in young patients were more aggressive, especially in LNM. Hence, clinicians should consider an individualized treatment according to tumor characteristics and age to achieve better therapeutic efficacy.
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Abdullah MI, Junit SM, Ng KL, Jayapalan JJ, Karikalan B, Hashim OH. Papillary Thyroid Cancer: Genetic Alterations and Molecular Biomarker Investigations. Int J Med Sci 2019; 16:450-460. [PMID: 30911279 PMCID: PMC6428975 DOI: 10.7150/ijms.29935] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/04/2018] [Indexed: 11/05/2022] Open
Abstract
Papillary thyroid cancer (PTC) is the most prevalent form of malignancy among all cancers of the thyroid. It is also one of the few cancers with a rapidly increasing incidence. PTC is usually contained within the thyroid gland and generally biologically indolent. Prognosis of the cancer is excellent, with less than 2% mortality at 5 years. However, more than 25% of patients with PTC developed a recurrence during a long term follow-up. The present article provides an updated condensed overview of PTC, which focuses mainly on the molecular alterations involved and recent biomarker investigations.
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Affiliation(s)
- Mardiaty Iryani Abdullah
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Sarni Mat Junit
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khoon Leong Ng
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Jaime Jacqueline Jayapalan
- University of Malaya Centre for Proteomics Research, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Barani Karikalan
- Perdana University, Jalan MAEPS Perdana, Serdang 43400, Selangor, Malaysia
| | - Onn Haji Hashim
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- University of Malaya Centre for Proteomics Research, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Guo S, Xu P, Zhou A, Wang G, Chen W, Mei J, Xiao F, Liu J, Zhang C. Contrast-Enhanced Ultrasound Differentiation Between Low- and High- Grade Bladder Urothelial Carcinoma and Correlation With Tumor Microvessel Density. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2287-2297. [PMID: 28556470 DOI: 10.1002/jum.14262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Time-intensity curves (TICs) of contrast-enhanced ultrasound (CEUS) were analyzed retrospectively to differentiate between low-grade and high-grade bladder urothelial carcinoma, and to investigate correlation with tumor microvessel density (MVD). METHODS The data of 105 patients with pathologically confirmed bladder urothelial carcinoma (55 low-grade and 50 high-grade) were reviewed. Lesions were examined before surgery using conventional ultrasound and CEUS with TIC analysis. The TIC parameters time from peak to one-half the signal intensity (TPH) and the corresponding descending slope (DS) of the low-grade and high-grade groups were compared, and receiver operating characteristic curves constructed. The MVDs of the resectioned tissue specimens were quantified via immunohistochemistry for CD34. RESULTS Based on conventional ultrasound, the low-grade and high-grade groups were similar in tumor shape, number, topography, internal echo, height, width, and vascularity. The TPH of the high-grade group was significantly longer than that of the low-grade group, and the DS was lower. The cutoff points of TPH and DS for differentiating low-grade and high-grade bladder urothelial carcinoma were 48.06 seconds and 0.15 dB/seconds, respectively (area under the receiver operating characteristic curve = 0.79 for both). The mean MVDs per high-power field of the low-grade and high-grade groups were 41.39 16.65 and 51.03 20.16, respectively (P = .009). The TPH correlated linearly with MVD (P < .01), as did the DS (P < .01). CONCLUSIONS Contrast-enhanced ultrasound can be used to differentiate low from high-grade bladder urothelial carcinoma. The TIC parameters of CEUS reflect the MVD of bladder urothelial tumors and may be helpful for evaluating tumor angiogenesis, with implications for clinical diagnosis, treatment, and prognosis.
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Affiliation(s)
- Suping Guo
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pan Xu
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Aiyun Zhou
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weimin Chen
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinhong Mei
- Department of Pathology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fan Xiao
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Juan Liu
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng Zhang
- Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China
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Partyka KL, Wu HH. Fine-needle aspirates of thyroid microcarcinoma. J Am Soc Cytopathol 2017; 6:236-241. [PMID: 31043293 DOI: 10.1016/j.jasc.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/25/2017] [Accepted: 06/27/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Widespread use of ultrasound allows for detection of smaller thyroid nodules and preoperative evaluation with fine-needle aspiration (FNA). Both incidental and non-incidental microcarcinoma can be found, leading to uncertainty with clinical management. MATERIALS AND METHODS A retrospective analysis of thyroid FNAs performed at our institution was conducted for the 5-year period from 2010 to 2014. Aspirates were categorized using the Bethesda System for Reporting Thyroid Cytopathology. Cytologic diagnoses were then correlated with final histopathology. Among samples with malignancy on surgical resection, nodules were stratified by size. RESULTS A total of 2531 thyroid FNAs were identified; 587 samples had histologic correlation, and 259 malignancies were reported. They were separated into nodules >1 cm (n = 144, 56%) and ≤1 cm (n = 115, 44%). Microcarcinoma was further subdivided into incidental (size ≤0.5 cm, n = 55, 48%) and non-incidental (size >0.5 cm and ≤1 cm, n = 60, 52%). The preoperative cytologic diagnoses for incidental microcarcinoma were: benign (B, n = 11, 20%), follicular lesion of undetermined significance (FLUS, n = 15, 27%), follicular neoplasm (FN, n = 11, 20%), suspicious for malignancy (SM, n = 7, 13%), malignant (M, n = 8, 15%), and nondiagnostic (ND, n = 3, 5%). The FNA categories for non-incidental microcarcinoma were: B (n = 13, 22%), FLUS (n = 3, 5%), FN (n = 3, 5%), SM (n = 10, 17%), M (n = 29, 48%), and ND (n = 2, 3%). CONCLUSIONS Incidental microcarcinoma is not an uncommon entity, making up 21% (55 of 259) of malignant nodules on thyroidectomy. Indeterminate diagnoses (FLUS + FN + SM) accounted for the majority (60%) of preoperative FNAs for incidental microcarcinoma, compared with 27% for those of non-incidental microcarcinoma (P < 0.05, χ2 test).
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Affiliation(s)
- Kristen L Partyka
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Abdullah MI, Lee CC, Mat Junit S, Ng KL, Hashim OH. Tissue and serum samples of patients with papillary thyroid cancer with and without benign background demonstrate different altered expression of proteins. PeerJ 2016; 4:e2450. [PMID: 27672505 PMCID: PMC5028788 DOI: 10.7717/peerj.2450] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/16/2016] [Indexed: 01/08/2023] Open
Abstract
Background Papillary thyroid cancer (PTC) is mainly diagnosed using fine-needle aspiration biopsy. This most common form of well-differentiated thyroid cancer occurs with or without a background of benign thyroid goiter (BTG). Methods In the present study, a gel-based proteomics analysis was performed to analyse the expression of proteins in tissue and serum samples of PTC patients with (PTCb; n = 6) and without a history of BTG (PTCa; n = 8) relative to patients with BTG (n = 20). This was followed by confirmation of the levels of proteins which showed significant altered abundances of more than two-fold difference (p < 0.01) in the tissue and serum samples of the same subjects using ELISA. Results The data of our study showed that PTCa and PTCb distinguish themselves from BTG in the types of tissue and serum proteins of altered abundance. While higher levels of alpha-1 antitrypsin (A1AT) and heat shock 70 kDa protein were associated with PTCa, lower levels of A1AT, protein disulfide isomerase and ubiquitin-conjugating enzyme E2 N seemed apparent in the PTCb. In case of the serum proteins, higher abundances of A1AT and alpha 1-beta glycoprotein were detected in PTCa, while PTCb was associated with enhanced apolipoprotein A-IV and alpha 2-HS glycoprotein (AHSG). The different altered expression of tissue and serum A1AT as well as serum AHSG between PTCa and PTCb patients were also validated by ELISA. Discussion The distinctive altered abundances of the tissue and serum proteins form preliminary indications that PTCa and PTCb are two distinct cancers of the thyroid that are etiologically and mechanistically different although it is currently not possible to rule out that they may also be due other reasons such as the different stages of the malignant disease. These proteins stand to have a potential use as tissue or serum biomarkers to discriminate the three different thyroid neoplasms although this requires further validation in clinically representative populations.
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Affiliation(s)
- Mardiaty Iryani Abdullah
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Ching Chin Lee
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Sarni Mat Junit
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Centre for Proteomics Research, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khoon Leong Ng
- Department of Surgery, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia
| | - Onn Haji Hashim
- Department of Molecular Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; University of Malaya Centre for Proteomics Research, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Liu X, Zhu L, Wang Z, Cui D, Chen H, Duan Y, Shen M, Lu H, Zhang Z, Chen J, Alexander EK, Yang T, Wang X. Evolutionary features of thyroid cancer in patients with thyroidectomies from 2008 to 2013 in China. Sci Rep 2016; 6:28414. [PMID: 27328631 PMCID: PMC4916471 DOI: 10.1038/srep28414] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/31/2016] [Indexed: 01/21/2023] Open
Abstract
To evaluate the characteristics of thyroid carcinoma over time, we carried out a retrospective study to illustrate the evolutionary features of thyroid carcinoma. All records of thyroidectomies from the First Affiliated Hospital of Nanjing Medical University from 2008 to 2013 were obtained focusing on pathological diagnosis, size, local lymph node metastasis (LNM) of the tumors. The thyroid cancer detection rate increased from 24.6% to 41.5% significantly (P < 0.05). Papillary thyroid carcinoma (PTC) remained to be the most common type counting 86.4% of all thyroid carcinomas. In all 1,704 PTCs, microPTC (mPTC) with maximum diameter less than or equal to 10 mm has become the dominant form taking up 56.5% of all PTCs in 2013 while only 43.1% in 2008. The mean maximum tumor size has decreased from 17.8 mm to 12.2 mm significantly (P < 0.05). However, the average age, female dominance, and local LNM remained similarly in the past six years. Logistic regression test showed that the determinants for local LNM were age, gender and tumor size. mPTC has become the most common form of thyroid carcinoma detected during thyroidectomies in China while other features of thyroid carcinoma remained similarly in the recent years.
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Affiliation(s)
- Xiaoyun Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lijun Zhu
- Department of Children's Health care, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dai Cui
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huanhuan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Duan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meiping Shen
- Department of Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Lu
- Department of Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhihong Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiawei Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Erik K Alexander
- Thyroid Unit, Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Brigham &Women's Hospital and Harvard Medical School, Boston, USA
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaodong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area. J Thyroid Res 2016; 2016:1784397. [PMID: 26949559 PMCID: PMC4754481 DOI: 10.1155/2016/1784397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022] Open
Abstract
Clinical and pathological characteristics of incidental papillary thyroid microcancer cases, surgical, medical, and nuclear treatment methods, and patients' outcome were studied during follow-up period of 102 months. We studied 37 patients with incidental papillary thyroid microcancer (I-PTM). The surgical procedure was total thyroidectomy in 29 and hemithyroidectomy in 8 patients. Size, multifocality, and bilateralism of PTM foci, thyroid capsule invasion, and presence of lymphovascular invasion were histopathological parameters. We analysed adjuvant medical and nuclear treatment and patients' outcome during follow-up period of 102 (61-144) months. The prevalence rates of I-PTM were 9.4% in 395 thyroidectomy cases. Histopathological examination reported unifocal disease in 30 and multifocal disease in 7 (18%) patients. Multifocal disease was bilateral in 6 (20.1%) patients. The mean size of the PTM foci was 4.88 mm. The rate of thyroid capsule invasion was 5.4%. All patients received a suppressive dose of LT4 to achieve a low serum TSH level. Adjuvant surgical and nuclear treatment was not performed in our cases. We did not find any negative changes in blood chemistry and ultrasound imaging, and any unfavourable events as locoregional and systemic recurrence. In conclusion, diagnosis of I-PTM is common that multifocality and bilateralism appear as pathologic features. The prognosis is excellent after surgical treatment and TSH suppression. Routine adjuvant nuclear treatment is unnecessary in majority of patients.
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Albasri A, Sawaf Z, Hussainy AS, Alhujaily A. Histopathological patterns of thyroid disease in Al-Madinah region of Saudi Arabia. Asian Pac J Cancer Prev 2015; 15:5565-70. [PMID: 25081665 DOI: 10.7314/apjcp.2014.15.14.5565] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to characterize the histopathological pattern of thyroid lesions among Saudi patients and to highlight the age and gender variations of these lesions as base line data. MATERIALS AND METHODS We retrospectively analyzed the data from thyroid specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. RESULTS The 292 thyroidectomy specimens received during the study period came from 230 (78.8%) females and 62 (21.2%) males giving a female: male ratio of 3.7:1. Age of the patients ranged from 14 to 95 years with a mean age 39.7 years. Two hundred and eleven (72.3%) cases were found to be non-neoplastic and 81 (27.7%) cases were neoplastic. The non-neoplastic group included: colloid goiter, including both diffuse and nodular goiter (170 cases; 58.2%), nodular hyperplasia (28 cases; 9.6%), Hashimoto/chronic lymphocytic thyroiditis (12 cases; 4.1%), and Grave's disease (1 case; 0.3%). In neoplastic lesions, there were 7 benign tumors and 74 malignant tumors. Among the benign tumors, 5 were follicular adenomas and 2 were Hurthle cell adenomas. Papillary carcinoma was the commonest malignant tumor accounting for 87.8% of all thyroid malignancies, followed by lymphoma, follicular carcinoma and medullary carcinoma. The size of papillary carcinoma was more than 2 cm in 40 cases (76.9%). CONCLUSIONS Non-neoplastic thyroid lesions were more common than neoplastic ones. Colloid goiter was the most common lesion. Follicular adenoma was the commonest benign tumor and papillary carcinoma was the commonest malignant lesion. There appears to be a slightly increased trend of papillary carcinoma diagnosis, most being diagnosed at an advanced stage.
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Affiliation(s)
- Abdulkader Albasri
- Department of Pathology, Taibah University, Madinah, Saudi Arabia E-mail :
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Zhou Q, Jiang J, Shang X, Zhang HL, Ma WQ, Xu YB, Wang H, Li M. Correlation of contrast-enhanced ultrasonographic features with microvessel density in papillary thyroid carcinomas. Asian Pac J Cancer Prev 2015; 15:7449-52. [PMID: 25227857 DOI: 10.7314/apjcp.2014.15.17.7449] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the correlation of contrast-enhanced ultrasonographic (CEUS) features with microvessel density (MVD) in papillary thyroid carcinomas (PTCs). MATERIALS AND METHODS Contrast-enhanced ultrasonography (CEUS) was performed in 62 patients (17 men and 45 women) with PTC. Tomtec software was applied to analyze the time intensity curve of CEUS. Immunohistochemistry was performed to evaluate the level of MVD in papillary thyroid carcinoma. Then the relationship between quantitative feature and the level of MVD was analyzed using SPSS 16.0 software. RESULTS The mean peak intensity of PTC tissues was lower than that of peripheral thyroid parenchyma (61.9 ± 11.8% vs 100%, p < 0.05). The MVDs of CD34 and CD31 antibodies staining were 38.0 ± 6.1 and 37.9 ± 5.1 respectively in 62 PTC samples. A significantly positive correlation was observed between peak intensity and MVD in PTC tissues (PCD34 < 0.01, rCD34 = 0.838, PCD31 < 0.01, rCD31 = 0.837). CONCLUSIONS The peak intensity in CEUS could reflect the MVD in PTC tissues. Therefore, quantification of CEUS seems to be helpful for assessment of MVD in PTC tissues.
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Affiliation(s)
- Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China E-mail :
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Fayek IS. Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients. Asian Pac J Cancer Prev 2015; 16:4211-4. [PMID: 26028074 DOI: 10.7314/apjcp.2015.16.10.4211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prognostic value of prophylactic level VII nodal dissection in papillary thyroid carcinoma has been highlighted. MATERIALS AND METHODS A total of 27 patients with papillary thyroid carcinoma with N0 neck underwent total thyroidectomy with level VI and VII nodal dissection through same collar neck incision. Multicentricity, bilaterality, extrathyroidal extension, level VI and VII lymph nodes were studied as separate and independent prognostic factors for DFS at 24 months. RESULTS 21 females and 6 males with a mean age of 34.6 years old, tumor size was 5-24 mm. (mean 12.4 mm.), multicentricity in 11 patients 2-4 foci (mean 2.7), bilaterality in 8 patients and extrathyroidal extension in 8 patients. Dissected level VI LNs 2-8 (mean 5 LNs) and level VII LNs 1-4 (mean 1.9). Metastatic level VI LNs 0-3 (mean 1) and level VII LNs 0-2 (mean 0.5). Follow-up from 6-51 months (mean 25.6) with 7 patients showed recurrence (3 local and 4 distant). Cumulative DFS at 24 months was 87.8% and was significantly affected in relation to bilaterality (p-value<0.001), extrathyroidal extension (p-value<0.001), level VI positive ((p-value<0.001) and level VII positive ((p-value<0.001) LNs. No recurrences were detected during the follow-up period in the absence of level VI and level VII nodal involvement. CONCLUSIONS Level VII prophylactic nodal dissection is an important and integral prognostic factor in papillary thyroid carcinoma. A larger multicenter study is crucial to reach a satisfactory conclusion about the necessity and safety of this approach.
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Affiliation(s)
- Ihab Samy Fayek
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt E-mail :
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Pagni F, Jaconi M, Delitala A, Garancini M, Maternini M, Bono F, Giani A, Smith A. Incidental papillary thyroid carcinoma: diagnostic findings in a series of 287 carcinomas. Endocr Pathol 2014; 25:288-96. [PMID: 24997780 DOI: 10.1007/s12022-014-9323-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The recent increase in the detection of papillary thyroid carcinoma (PTC) has been influenced by the finding of incidental tumours. To this group, carcinomas measuring less than 1 cm (the so-called microcarcinomas) as well as those above 1 cm belong. Analyzing a case series from our own experience, this paper focuses on the current pre-operative diagnostic challenges that can lead to PTC incidental discovery. For this retrospective study, 287 patients with a PTC diagnosis were selected. For each, the following variables were analysed: sex, age, ultrasound (US) appearance, number of thyroid nodules, PTC size, PTC variants and presence of other associated pathology. Pre-operative fine needle aspiration (FNA) results were classified according to the five-tiered SIAPEC system. For 281 patients, the US-guided FNA results were available. Cytohistological correlation was evaluated in terms of FNA sensitivity and false negative rate. An incidental PTC was found in 45.2 % of patients. The majority of these were due to unsuccessful US detection of malignant nodules (103 cases); incorrect cytological diagnosis was responsible for the other 24 cases. The most powerful clinical confounding factors were: multinodular background versus single nodule presentations (p < 0.001) and histotype (follicular vs conventional variant, p < 0.05). Of course, tumour size remains a strongly influential feature on pre-operative diagnosis, with greater difficulties arising for carcinomas <5 mm. Moreover, FNA sensitivity was lower also in large PTCs (>2 cm) due to tumour heterogeneity. Although with limitations related to the tumour's intrinsic features and the thyroid background, US-guided FNA, especially if performed by a dedicated multidisciplinary team, is a powerful diagnostic tool for detecting malignant thyroid nodules. To the state of the art, we propose a practical clinical-pathological cut-off for this procedure, setting it at 5 mm.
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Affiliation(s)
- Fabio Pagni
- Department of Surgery and Translational Medicine, Section of Pathology, University Milan Bicocca, San Gerardo Hospital, 20900, Monza, Italy,
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