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Alansari H, Mathur N, Ahmadi H, AlWatban ZH, Alamuddin N, Sabra O. Outcomes of Central Neck Dissection for Papillary Thyroid Carcinoma in Primary Versus Revision Setting. Indian J Otolaryngol Head Neck Surg 2024; 76:720-725. [PMID: 38440474 PMCID: PMC10908899 DOI: 10.1007/s12070-023-04261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/02/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction Surgery in the central compartment after previous thyroidectomy involves an increased risk of injury to critical organs, including the parathyroids and recurrent laryngeal nerve. Contrastingly, primary central neck dissection involves a relatively low operative risk. Objective This study aimed to compare the outcomes of central neck dissection in primary versus revision settings with respect to the lymph node yield and complication rates. Methods This single-center prospective study included patients who underwent primary or revision neck dissection surgery for histologically confirmed thyroid malignancy between January 2018 and January 2022. Results We included 30 patients who underwent total thyroidectomy with primary central neck dissection and 29 patients who underwent central neck dissection following remote thyroidectomy with or without previous central dissection. There was no significant between-group difference in postoperative complications, including permanent hypocalcemia and recurrent laryngeal nerve injury. However, both groups showed a significant postoperative decrease in calcium levels even though calcium and parathyroid hormone levels were within reference range. Conclusion Although many surgeons fear revision central neck dissection, it appears to have similar therapeutic outcomes and complication rates as primary neck dissection for papillary thyroid cancer. Specifically, there were no between-group differences in the lymph node yield, hypoparathyroidism, or recurrent laryngeal nerve paralysis. Patients with normocalcemia showed a significant postoperative reduction in calcium levels, suggesting subclinical parathyroid insufficiency.
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Affiliation(s)
- Hasan Alansari
- King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain
| | - Nalin Mathur
- King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain
| | - Husain Ahmadi
- King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain
| | - Zaki Hassan AlWatban
- King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain
- Ministry of Health Riyadh (Kingdom of Saudi Arabia), First Tower (B1) Prince Abdulrahman Bin Abdulaziz Street Riyadh, Riyadh, 12613 Saudi Arabia
| | - Naji Alamuddin
- King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain
- Royal College of Surgeons in Ireland-Bahrain, Building No. 2441, Road 2835, Busaiteen 228, P.O. Box 15503, Adliya, Kingdom of Bahrain
| | - Omar Sabra
- King Hamad University Hospital, Building 2435, Road 2835. Block 228, P.O. Box 24343, Muharraq, Kingdom of Bahrain
- Royal College of Surgeons in Ireland-Bahrain, Building No. 2441, Road 2835, Busaiteen 228, P.O. Box 15503, Adliya, Kingdom of Bahrain
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Tondi Resta I, Gubbiotti MA, Montone KT, Livolsi VA, Baloch ZW. Differentiated high grade thyroid carcinomas: Diagnostic consideration and clinical features. Hum Pathol 2024; 144:53-60. [PMID: 38244615 DOI: 10.1016/j.humpath.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Differentiated high-grade thyroid carcinomas (DHGTCs) are a new diagnostic entity most recently defined in the 2022 World Health Organization's (WHO) Classification of Endocrine and Neuroendocrine Tumors. This new entity has been minimally described in the literature, and additional cases classified as such are missing. MATERIALS AND METHODS Cases of DHGTCs diagnosed at our institution from 2012 to 2022 were identified, and the following were reviewed: cytologic and histologic diagnoses, ancillary testing, immunohistochemical staining, treatments, and patient outcomes. Immunohistochemical staining for Ki67 was performed on selected cases lacking this immunostain. A systematic literature review of the English literature on DHGTCs from 2013 to 2023 was performed using PubMed and Embase. RESULTS Case cohort included 32 cases of DHGTCs, with an average age of 52.6 years (range 17-84 years) and a male:female ratio of 1.3:1. All cases underwent fine needle aspiration (FNA) and were categorized by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) as follows: 14 cases as malignant (43.8 %), 10 as follicular neoplasm (31.3 %), 5 as atypia of undetermined significance (15.6 %), 2 as suspicious for malignancy (6.2 %), and 1 as non-diagnostic (3.1 %). The average tumor size was 5.15 cm, and most were papillary thyroid carcinoma (28, 87.5 %), with classic subtype being the most common. Twenty-one cases revealed tumor necrosis and the mitotic activity in lesions without necrosis averaged to 5.5 mitoses per 2 mm2 (range 0-7). The average Ki67 proliferative index was 5.6 %. Extrathyroidal extension was seen in 17, angioinvasion in 21, lymphatic invasion in 7, and perineural invasion in 1 case. Foci of solid or trabecular growth were identified in five cases. Lymph node metastases at the time of diagnosis were noted in 10 cases and 7 demonstrated distant metastases or locoregional recurrence. To date, 25 patients are alive, and one has died from disease. CONCLUSIONS Our institutional experience demonstrates that DHGTC is a rare, but aggressive thyroid tumor subtype that requires consideration in the setting of a well-differentiated thyroid neoplasm to appropriately assess for possible disease recurrence and determination of patient prognosis.
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Affiliation(s)
- I Tondi Resta
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - M A Gubbiotti
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - K T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - V A Livolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Z W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Raeymaeckers S, Tosi M, Sol B, De Mey J. Sonographic changes in the thyroid gland after sclerotherapy with doxycycline can be mistaken for thyroid cancer. Thyroid Res 2023; 16:33. [PMID: 37592295 PMCID: PMC10433553 DOI: 10.1186/s13044-023-00177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The literature considers sclerotherapy to be a safe and effective treatment for benign thyroid cysts. No subsequent diagnostic problems have been reported as a complication. We report the occurrence of focal inflammation after said therapy, mimicking a thyroid malignancy. CASE PRESENTATION We report a case of a young male with a solitary strongly suspicious lesion in the thyroid. The patient had undergone prior sclerotherapy of a thyroid cyst with Doxycycline. The lesion appeared to be a focal area of inflammation and thus iatrogenic in nature. Systemic use of doxycycline is known to sometimes cause a non-immune chemical thyroiditis, dubbed as black thyroid due to the intense black discoloration of the thyroid. It might be that the instillation of doxycycline was responsible for a similar, more localized area of thyroiditis. CONCLUSIONS For the work-up of a solitary suspicious thyroid lesion, the medical history of the patient should always be considered. In case of prior ipsilateral sclerotherapy, a reactive inflammatory response may mimic thyroid malignancy. A fine needle aspiration should be performed to exclude thyroid cancer. Treatment is not necessary; the process appears to be self-limiting as evidenced in the follow-up of this case.
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Affiliation(s)
- Steven Raeymaeckers
- Department of Radiology, Universitair ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Belgium.
| | - Maurizio Tosi
- Department of Anesthesiology, Universitair ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Belgium
| | - Bastiaan Sol
- Department of Endocrinology, Universitair ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair ziekenhuis Brussel, Laarbeeklaan 101, 1090, Jette, Belgium
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Rana D, Shukla S, Mishra P, Shrivastava P, Parihar P. Metastatic mastery: the uncommon journey of papillary thyroid carcinoma to the brain (a case report). Pan Afr Med J 2023; 45:20. [PMID: 37426464 PMCID: PMC10323818 DOI: 10.11604/pamj.2023.45.20.40017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 07/11/2023] Open
Abstract
Papillary thyroid carcinoma is one of the most common thyroid malignancy, often has excellent prognosis and low incidence of distant metastatic conditions. Brain metastases from papillary thyroid carcinoma has a rare occurrence, with patients presenting with non-specific symptoms such as headaches, cognitive changes etc., and poor survival outcomes. The standard protocol for diagnosis and treatment remains controversial. We report a patient who presented with cerebral metastasis prior to the diagnosis of papillary thyroid carcinoma, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. A 60-year-old hypertensive male presented with lower back pain, bilateral lower limb weakness, occasional episodes of frontal headache and personality changes. The diagnostic evaluation included computed tomography (CT) scan, magnetic resonance imaging (MRI) with and without contrast enhancement, and color Doppler. Intra-axial complex solid cystic mass lesion in the right parieto-occipital region with significant perilesional oedema, and imaging characteristic of neoplastic etiology were observed. He was posted for excision of tumor and underwent right occipital craniotomy. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. Brain metastases from thyroid malignancy is a sign of detrimental prognosis, hence, thorough clinical, radiological and pathological evaluation for rapid detection is critical. Neurosurgical removal along with radiotherapy should be considered as treatment of choice. The information obtained contributes towards better management and overall long-term outcomes.
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Affiliation(s)
- Deeksha Rana
- Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Preeti Mishra
- Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Priyal Shrivastava
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Pratapsingh Parihar
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
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Familiar C, Merino S, Valhondo R, López C, Pérez X, De Los Monteros PE, Hernández F, Pazos M, Pallarés R, Pascual AC. Prevalence and clinical significance in our setting of incidental uptake in the thyroid gland found on 18F-fluordeoxyglucose positron emission tomography-computed tomography (PET-CT). ENDOCRINOL DIAB NUTR 2023; 70:171-178. [PMID: 37030900 DOI: 10.1016/j.endien.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/25/2022] [Indexed: 04/10/2023]
Abstract
INTRODUCTION The expanding use of 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) has resulted in an increased frequency of incidentally discovered areas of FDG uptake within the thyroid gland. In these incidentalomas, high malignancy rates are reported. The study aimed, on the one hand, to determine the prevalence in our setting of thyroid incidentalomas in patients with no previous history of thyroid cancer undergoing an FDG PET-CT as well as the risk of malignancy and, on the other hand, to evaluate the usefulness of the maximum standard uptake value (SUVmax) for detecting thyroid cancer. MATERIAL AND METHODS The FDG PET-CT scans performed at our hospital between June 2013 and December 2020 were retrospectively reviewed. In those incidentalomas with sufficient additional investigation, a diagnosis of benign or malignant was established based on the complementary tests. RESULTS From the 21,594 PET-CT scans performed, 398 (1.8%) patients had an incidental FDG uptake, either focal (n=324) or diffuse (n=74). Among incidentalomas with further investigation, the rate of malignancy was higher in patients with focal FDG uptake than in those with diffuse uptake (26.5% versus 4%, respectively, p<0.05). The SUVmax value was significantly lower in benign focal lesions (5.7 [range: 2.3-66] than in malignant ones 10.6 [range: 3.1-51.2]; p<0.05). Nearly a quarter of malignant diagnoses (23.3%) were related to potentially aggressive tumours. CONCLUSION The high rate of malignant tumours found among PET-CT incidentalomas and the high proportion of aggressive tumours demonstrate the need for a standardised approach in the investigation of incidental focal FDG uptake in the thyroid gland.
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Affiliation(s)
- Cristina Familiar
- Servicio de Endocrinología, Hospital Clínico San Carlos Clínico, Madrid, Spain.
| | - Salomé Merino
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos Clínico, Madrid, Spain
| | - Raquel Valhondo
- Servicio de Medicina Nuclear, Hospital Del Mar, Barcelona, Spain
| | - Celia López
- Servicio de Endocrinología, Hospital Clínico San Carlos Clínico, Madrid, Spain
| | - Xavier Pérez
- Servicio de Endocrinología, Hospital Clínico San Carlos Clínico, Madrid, Spain
| | | | - Fernando Hernández
- Servicio de Endocrinología, Hospital Clínico San Carlos Clínico, Madrid, Spain
| | - Mario Pazos
- Servicio de Endocrinología, Hospital Clínico San Carlos Clínico, Madrid, Spain
| | - Raquel Pallarés
- Servicio de Endocrinología, Hospital Clínico San Carlos Clínico, Madrid, Spain
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Gandhi S, Puneeth PJ, Balushi F. The Rocks Valley: Tracheopathia Osteochondroplastica: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:5703-5705. [PMID: 36742860 PMCID: PMC9895340 DOI: 10.1007/s12070-021-03051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
Tracheopathia Osteochondroplastica is a rare benign tracheobronchial condition. Its unspecific symptoms and high clinical threshold for diagnosis make the condition an incidental diagnosis. We report an incidental tracheopathia osteochondplastica in 66 years old male patient with suspected thyroid malignancy.
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Affiliation(s)
- Sachin Gandhi
- Deenanath Mangeshkar Hospital and Research Centre, Pune, 411004 India
| | - P. J. Puneeth
- Deenanath Mangeshkar Hospital and Research Centre, Pune, 411004 India
| | - Firyal Balushi
- Deenanath Mangeshkar Hospital and Research Centre, Pune, 411004 India
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Cattoni A, Molinari S, Gaiero A, De Lorenzo P, Fichera G, Riva B, Di Marco S, Tommesani C, Mariani E, Medici F, Pagni F, Nicolosi ML, Fraschini D, Napolitano S, Rovelli A, Biondi A, Valsecchi MG, Balduzzi A. Thyroid disorders following hematopoietic stem cell transplantation in childhood: the impact of the conditioning regimen on thyroid dysfunction, volume changes and occurrence of nodules. Transplant Cell Ther 2022; 28:506.e1-506.e12. [PMID: 35660063 DOI: 10.1016/j.jtct.2022.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Thyroid late effects are among the most frequent sequelae reported after pediatric hematopoietic stem cell transplantation (HSCT). Though the detrimental effects of radiotherapy on the developing thyroid gland have been extensively assessed, the role of chemotherapy-only conditioning regimens is still controversial. OBJECTIVE We aimed at describing the occurrence, monitoring and management of thyroid function disorders (i.e. Graves' disease, Hashimoto thyroiditis and non-autoimmune hypothyroidism), nodules and volumetric changes over a 20-year observation period in a single pediatric transplant unit. In addition, we assessed the impact of different conditioning regimens on thyroid health. STUDY design Retrospective observational analysis. The study population included 244 patients transplanted for pediatric malignant or non-malignant diseases between 1999 and 2018 and for whom at least four thyroid function tests and one or more thyroid ultrasound(s) assessed sequentially after HSCT were available. RESULTS The 15-year cumulative incidence (CI) of either autoimmune or non-autoimmune thyroid dysfunctions (34%, SE 5.3%) did not statistically differ between total body irradiation- (TBI-) and chemo-based regimens (p 0.23). Indeed, the CI after busulfan (BU) was overall superimposable to that recorded after TBI (10-year CI: 22.2% versus 25.9%, respectively). Nevertheless, the CI of non-autoimmune hypothyroidism was statistically higher after BU- (12.4%, SE 3.7%) than after other chemotherapy only-based-conditionings (3.1%, SE 3.1%; p 0.02, 5-year CI), treosulfan included. The overall CI of nodules was low for the first 5 years after HSCT (1.9%, SE 0.9%), but it showed a subsequent steep increase over time, with a 15-year CI as high as 52.1% (SE 7.5%). TBI-conditioned patients experienced a higher 15-year CI of nodules (66.8%, SE 9.1%) compared to those receiving chemo-only regimens (33.6%, SE 9.5%; p 0.02), whereas age > 10 years upon transplantation showed a protective effect (HR 0.42, 95% confidence interval 0.2-0.88). Finally, a systematic sonographic follow-up highlighted a progressive statistically significant reduction in thyroid antero-posterior diameter among patients conditioned with TBI (p 0.005), but not after chemo-only regimens. CONCLUSIONS TBI and younger age upon HSCT play a remarkable and statistically demonstrated detrimental role on the occurrence of thyroid nodules, both benign and malignant. TBI and BU expose patients to a higher cumulative incidence of thyroid dysfunctions than other chemo-only regimens, treosulfan included. Accordingly, BU can be regarded as the most thyrotoxic agent among those administered as a part of a chemo-only conditioning regimen. Finally, patients conditioned with TBI, but not with other regimens, show a progressive decrease in thyroid volume over time, as assessed by sequential ultrasounds.
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Affiliation(s)
- A Cattoni
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy.
| | - S Molinari
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Gaiero
- Department of Pediatrics, Ospedale San Paolo, Via Genova 30, 17100 - Savona, Italy
| | - P De Lorenzo
- Tettamanti Research Center, Department of Pediatrics, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900 - Monza, Italy; Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4), School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900 - Monza, Italy
| | - G Fichera
- Department of Pediatrics, Ospedale San Paolo, Via Genova 30, 17100 - Savona, Italy
| | - B Riva
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - S Di Marco
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - C Tommesani
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - E Mariani
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - F Medici
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - F Pagni
- Department of Pathology, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - M L Nicolosi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - D Fraschini
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - S Napolitano
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Rovelli
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Biondi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
| | - M G Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4), School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Via Pergolesi 33, 20900 - Monza, Italy
| | - A Balduzzi
- Department of Pediatrics, Università degli Studi di Milano-Bicocca, Fondazione MBBM, Ospedale San Gerardo, Via Pergolesi 33, 20900 - Monza, Italy
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Kim S, Gray AL, Lao WP, Perez MN, Liu Y, Lee SC. Is it Anaplastic Thyroid Cancer, Primary Thyroid Lymphoma, or Rosai Dorfman Disease? An Elusive Histopathologic Diagnosis of a Thyroid Mass. Head Neck Pathol 2021; 16:507-512. [PMID: 34755265 PMCID: PMC9187825 DOI: 10.1007/s12105-021-01392-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study is to present an elusive case of primary thyroid lymphoma (PTL), initially thought to be anaplastic thyroid carcinoma, then Rosai Dorfman disease, before the final diagnosis of PTL was made. An elderly female with hypothyroidism presented with compressive airway symptoms secondary to an enlarging neck mass. Imaging was suggestive of undifferentiated thyroid cancer. The initial biopsy was unexpectedly consistent with a lymphoproliferative disorder such as Rosai-Dorfman disease. A repeat biopsy with immunohistochemical analysis yielded a diagnosis of diffuse large B-cell lymphoma of germinal center subtype. The patient was spared thyroid surgery and started on appropriate chemotherapy. PTL is within the differential diagnosis that physicians must consider in a patient with a rapidly-enlarging neck mass. A clinical index of suspicion and early accurate diagnosis may spare the patient from unnecessary surgery that is required of most other non-hematopoeitic thyroid malignancies.
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Affiliation(s)
- Stephanie Kim
- Loma Linda University School of Medicine, Loma Linda, CA USA
| | - Austin L. Gray
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Wilson P. Lao
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA USA ,Department of Otolaryngology – Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Mia N. Perez
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Yan Liu
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA USA
| | - Steve C. Lee
- Department of Otolaryngology – Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA USA
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Nasr H, Farghaly H, Alqarni A, Al-Salem S, Sayed M. Characteristics of malignant thyroid lesions on [ 18F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT). Eur J Radiol Open 2021; 8:100373. [PMID: 34458507 DOI: 10.1016/j.ejro.2021.100373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. Methods All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities. Only patients who were found to have FNAB or histopathology were included. Patients with known thyroid malignancy were excluded. Patients were analyzed for age, sex, SUVmax, non-enhanced CT tissue density in mean Hounsfield units (HU), uptake pattern (focal or diffuse) and gland morphology (MNG or diffuse). A control group of 15 patients with normal thyroid glands were used to assess the tissue density in HU for normal thyroid tissue. Sensitivity, specificity, PPV, NPV and accuracy to detect malignancy were calculated. Pearson Chi-square test was used to compare categorical variables while unpaired T-test and one way ANOVA test were used to compare means of continuous variables. ROC analysis was used to assess the best cut off points for SUVmax and HU. Regression analysis was used to detect the independent predictors for malignant lesions. Results Biopsy was unsatisfactory or indeterminate in 4/48 patients (8%). Only 44 patients (mean age 55.2 ± 14.7; 30 females (68 %)) with unequivocal FNAB or histopathology were included for further analysis. MNG was noted in 17/44 patients (38.6 %). Thyroid malignancy was found in 16/44 (36.4 %), benign thyroid lesions in 28/44 (63.6 %). Thyroid malignancies were 12 papillary, 1 follicular, 1 Hurthle cell neoplasm and 2 lymphoma. Benign lesions were 23 benign follicular or colloid nodules and 5 autoimmune thyroiditis. Focal FDG uptake pattern was more frequently associated with malignant lesions compared to benign lesions (75 % vs. 43 %; p = 0.039). The mean SUVmax and tissue density (HU) were both higher in malignant than benign lesions (8.8 ± 8.3 vs. 3.6 ± 1.9, p = 0.024) and (48.9 ± 12.7 vs. 32.9 ± 17.5, p = 0.003) respectively. The mean HU in the control group with normal thyroid tissue was 90 ± 7.4 significantly higher than in both the benign and malignant lesions (p < 0.001). ROC analysis revealed SUVmax cutoff of >4.7 and HU cutoff of >42 to best differentiate malignant from benign lesions. The sensitivity, specificity, PPV, NPV and accuracy to detect malignancy for SUVmax>4.7 were 68.8 %, 78.6 %, 64.8 %, 81.5 & 75.0 % (p = 0.002), for HU > 42 were 81.3.0 %, 75.0 %, 65.0 %, 87.5 & 77.3 % (p = 0.0003) and for both parameters combined were 87.5 %, 60.7 %, 56.0 %, 89.5 % and accuracy of 70.5 % (p = 0.002) respectively. Only HU > 42 and SUVmax>4.7 were independent predictors for malignancy with odd ratios 8.98 and 4.93 respectively. Conclusion A higher tissue density (HU > 42) and SUVmax>4.7 as well as tendency for focal uptake pattern are the most significant characteristics associated with malignant thyroid lesions occasionally detected on PET/CT.
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Abstract
PURPOSE Congenital primary hypothyroidism (CH) is a state of inadequate thyroid hormone production detected at birth, caused either by absent, underdeveloped or ectopic thyroid gland (dysgenesis), or by defected thyroid hormone biosynthesis (dyshormonogenesis). A genetic component has been identified in many cases of CH. This review summarizes the clinical and biochemical features of the genetic causes of primary CH. METHODS A literature review was conducted of gene defects causing congenital hypothyroidism. RESULTS Mutations in five genes have predominantly been implicated in thyroid dysgenesis (TSHR, FOXE1, NKX2-1, PAX8, and NKX2-5), the primary cause of CH (85%), and mutations in seven genes in thyroid dyshormonogenesis (SLC5A5, TPO, DUOX2, DUOXA2, SLC6A4, Tg, and DEHAL1). These genes encode for proteins that regulate genes expressed during the differentiation of the thyroid, such as TPO and Tg genes, or genes that regulate iodide organification, thyroglobulin synthesis, iodide transport, and iodotyrosine deiodination. Besides thyroid dysgenesis and dyshormonogenesis, additional causes of congenital hypothyroidism, such as iodothyronine transporter defects and resistance to thyroid hormones, have also been associated with genetic mutations. CONCLUSION The identification of the underlying genetic defects of CH is important for genetic counseling of families with an affected member, for identifying additional clinical characteristics or the risk for thyroid neoplasia and for diagnostic and management purposes.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics|, University of Patras School of Medicine, Patras, Greece.
| | - Konstantinos Miliordos
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics|, University of Patras School of Medicine, Patras, Greece
| | - Bessie Spiliotis
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics|, University of Patras School of Medicine, Patras, Greece
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Lee JY, Baek JH, Ha EJ, Sung JY, Shin JH, Kim JH, Lee MK, Jung SL, Lee YH, Ahn HS, Yoon JH, Choi YJ, Park JS, Lee YJ, Choi M, Na DG. 2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology. Korean J Radiol 2021; 22:840-860. [PMID: 33660459 PMCID: PMC8076832 DOI: 10.3348/kjr.2020.0578] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chungang University Hospital, Chungang University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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12
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Datar S, Cabanillas M, Dadu R, Ost D, Grosu HB. Pulmonary cavitation in patients with thyroid cancer receiving antiangiogenic agents. BMC Cancer 2020; 20:1181. [PMID: 33267782 PMCID: PMC7709335 DOI: 10.1186/s12885-020-07693-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 11/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Thyroid malignancies are among the most common endocrine cancers worldwide. Owing to the angiogenic nature of these malignancies, tyrosine kinase inhibitors (TKIs) are an attractive potential treatment. However, TKIs have been associated with an increased risk of tumor cavitation, in turn linked to poor outcomes, in patients with malignancies in the lungs, where thyroid cancer commonly metastasizes. Method We performe d a retrospective cohort study of patients with thyroid cancer and evidence of metastatic disease to the lung that were treated with multi-targeted antiangiogenic TKIs. The primary objective of this study was to determine the incidence of pulmonary cavitation. The secondary objective was to evaluate the effect of pulmonary cavitation on survival. Results Of the 83 patients with pulmonary nodules, 10 developed cavitation during treatment. Of these 83 patients, two patients had to stop the treatment due to pneumothorax. Additionally, cavitation did not demonstrate any significant effect on survival. Conclusion In patients with thyroid cancer and evidence of metastatic disease to the chest, the use of multi-targeted TKIs led to cavitations that were not uncommon but clinical consequences were marginal. Treatment was stopped only in two patients that developed pneumothorax, however the small sample is a strong limitation of our study.
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Affiliation(s)
- Saumil Datar
- Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ramona Dadu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - David Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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13
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Roddy S, Biggans T, Raofi AK, Kanodia A, Sudarshan T, Guntur Ramkumar P. Prevalence of incidental thyroid malignancy on routine 18F-fluorodeoxyglucose PET-CT in a large teaching hospital. Eur J Hybrid Imaging 2020; 4:21. [PMID: 34191154 PMCID: PMC8218029 DOI: 10.1186/s41824-020-00089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To quantify incidental thyroid pathology including malignancy on routine 18F-FDG PET-CT scans To compare standardised uptake values (SUVmax) in thyroid malignancy subtypes Methods and materials This is a retrospective study of all 18F-FDG PET-CT scans (n = 6179) performed in a teaching hospital between June 2010 and May 2019. RIS database search of reports for the word “thyroid” was performed. Studies with evidence of thyroid uptake were included. Patient age and gender, primary indication for PET scan (malignant or non-malignant), thyroid result on PET (diffuse or focal tracer uptake, SUVmax), ultrasound and FNAC results were recorded. Results Incidental abnormal thyroid tracer uptake as a proportion of all 18F-FDG PET-CT scans was 4.37% (n = 270). Out of region patients (n = 87) whose records could not be obtained were excluded leaving a study group of n = 183. Ninety-four in this group had focal uptake, and 89 had diffuse uptake. Fifty-five patients in the focal group had undergone further investigations. Of these, 30 were thought to be benign on USS alone, and 25 patients underwent USS/FNAC. Thirteen (24%) malignancies were identified (5 papillary, 6 follicular, 1 poorly differentiated thyroid cancer, 1 metastatic malignancy). Mean SUVmax for papillary carcinoma was noted to be 8.2 g/ml, and follicular carcinoma was 12.6 g/ml. Conclusion Incidental abnormal thyroid 18F-FDG PET-CT uptake in PET-CT scans of 4.37% is in keeping with the known limited literature. Rather similar number of patients was noted in the focal and diffuse tracer uptake categories in the final study group. Around quarter of the focal lesions were identified to be malignant, implying focal lesions should always be further investigated.
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Affiliation(s)
- Shea Roddy
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Thomas Biggans
- Department of Nuclear Medicine, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Ahmad K Raofi
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Avinash Kanodia
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Thiru Sudarshan
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK.,Department of Nuclear Medicine, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Prasad Guntur Ramkumar
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK. .,Department of Nuclear Medicine, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK.
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14
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Battistella E, Pomba L, Mattara G, Franzato B, Toniato A. Metastases to the thyroid gland: review of incidence, clinical presentation, diagnostic problems and surgery, our experience. J Endocrinol Invest 2020; 43:1555-1560. [PMID: 32385850 DOI: 10.1007/s40618-020-01282-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/27/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Metastases to the thyroid gland are uncommon and they represent 1-3% of all thyroid malignancy. The aim of this study is to analyze the diagnostic problems and the role of surgery in metastatic lesions to the thyroid. METHODS We retrospectively analyzed all patients who had undergone thyroidectomy at our Center. Out of more than 5000 thyroidectomies performed, only 9 cases had metastases to the thyroid gland. RESULTS The most common primary tumor arises from kidney and lung. Non-thyroid malignancies diagnosis was obtained with US, FNAC and PET-CT. Surgery was performed in all our series (except for one case) and the expectancy of life after surgery is related to the primary tumor and comorbidities of patients. CONCLUSION The thyroid gland can be a rare site of metastases for many tumors, especially in an abnormal thyroid gland. Surgery is associated with an improved survival and the extension of surgery depends on the extension of the neoplastic lesion.
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Affiliation(s)
- E Battistella
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, Padua, Italy.
| | - L Pomba
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, Padua, Italy
| | - G Mattara
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, Padua, Italy
| | - B Franzato
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, Padua, Italy
| | - A Toniato
- Endocrine Surgery Unit, Department of Surgery, Veneto Institute of Oncology, Padua, Italy
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15
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Gwon HY, Na DG, Noh BJ, Paik W, Yoon SJ, Choi SJ, Shin DR. Thyroid Nodules with Isolated Macrocalcifications: Malignancy Risk of Isolated Macrocalcifications and Postoperative Risk Stratification of Malignant Tumors Manifesting as Isolated Macrocalcifications. Korean J Radiol 2020; 21:605-613. [PMID: 32323506 PMCID: PMC7183826 DOI: 10.3348/kjr.2019.0523] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/19/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the malignancy risk of isolated macrocalcifications (a calcified nodule with complete posterior acoustic shadowing) detected on ultrasonography (US) and to evaluate the postoperative American Thyroid Association (ATA) risk stratification of malignant tumors manifesting as isolated macrocalcifications. Materials and Methods A total of 3852 thyroid nodules (≥ 1 cm) of 3061 consecutive patients who had undergone biopsy between January 2011 and June 2018 were included in this study. We assessed the prevalence, malignancy rate, and size distribution of isolated macrocalcifications and evaluated the histopathologic features and postoperative ATA risk stratification of malignant tumors manifesting as isolated macrocalcifications. Results Isolated macrocalcifications were found in 38 (1.2%) of the 3061 patients. Final diagnosis was established in 30 (78.9%) nodules; seven malignant tumors were diagnosed as papillary thyroid carcinomas (PTCs). The malignancy rate of the isolated macrocalcifications was 23.3% in the 30 nodules with final diagnoses and 18.4% in all nodules. Among the six surgically-treated malignant tumors, five (83.3%) had an extrathyroidal extension (ETE) (minor ETE 1, gross ETE 4), and two (33.3%) had macroscopic lymph node metastasis. Four (66.7%) malignant tumors were categorized as high-risk tumors, one as an intermediate-risk tumor, and one as a low-risk tumor using the ATA risk stratification. Histopathologically, out of the six malignant tumors, ossifications were noted in four (66.7%) and predominant calcifications in two (33.3%). Conclusion The US pattern of isolated macrocalcifications (≥ 1 cm) showed an intermediate malignancy risk (at least 18.4%). All malignant tumors were PTCs, and most showed an aggressive behavior and a high or intermediate postoperative ATA risk.
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Affiliation(s)
- Hye Yun Gwon
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea.
| | - Byeong Joo Noh
- Department of Pathology, GangNeung Asan Hospital, Gangneung, Korea
| | - Wooyul Paik
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
| | - So Jin Yoon
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
| | - Soo Jung Choi
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
| | - Dong Rock Shin
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea
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16
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Perez AR, Perez MEC, Arcilla CE. Radical surgery for primary thyroid lymphoma in a Filipino female: Report of a case and review of literature. Int J Surg Case Rep 2020; 75:302-306. [PMID: 32979830 PMCID: PMC7519239 DOI: 10.1016/j.ijscr.2020.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022] Open
Abstract
Primary Thyroid Lymphomas are rare tumors that must be suspected in progressively enlarging thyroid masses in the background of Hashimoto’s thyroidits. Tissue diagnosis combined with appropriate radiologic imaging may lead to an accurate diagnosis. Preoperative diagnosis is ideal to avoid unnecessary surgery due to the availability of effective multimodal treatment with chemoradiotherapy. Surgery may be appropriate and effective in a select group of patients but must be combined with adjuvant chemoradiotherapy to achieve favorable outcomes.
Introduction Primary thyroid lymphomas are rare. They constitute only 2% of all thyroid malignancies. It is important to distinguish it from other tumors of the thyroid due to the marked difference in approach to management. Preoperative diagnostic confirmation is ideal to allow for appropriate therapeutic management, which consists of chemotherapy with or without radiotherapy and to avoid unnecessary surgery. In a select group of patients, surgery may be of benefit to relieve obstructive symptoms and establish diagnosis. Case presentation Presented herein is a 48 year old female with a progressively enlarging neck mass previously being treated for Hashimoto’s thyroiditis. Obstructive symptoms and a preoperative diagnosis of anaplastic carcinoma prompted surgical intervention. The patient underwent resection of the tumor with a total thyroidectomy and bilateral neck dissection. Post -operative diagnosis of non Hodgkins diffuse large B cell type of lymphoma was made. Discussion Primary thyroid lymphomas are rare tumors that may present similarly with some types of thyroid malignancies. An accurate diagnosis is important because non-surgical treatment options like combination chemotherapy and radiotherapy may be effective while sparing the patient from unnecessary radical surgery. Conclusion Primary thyroid lymphoma must be a differential diagnosis in patients presenting with large thyroid tumors in the background of Hashimoto’s thyroiditis. Although chemoradiotherapy is the preferred treatment approach, there is a role for surgery in cases of tumor obstruction and uncertain diagnosis.
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Affiliation(s)
- Anthony R Perez
- University of the Philippines College of Medicine and Philippine General Hospital, Philippines.
| | - Mary Ellen Chiong Perez
- University of the Philippines College of Medicine and Philippine General Hospital, Philippines
| | - Crisostomo E Arcilla
- University of the Philippines College of Medicine and Philippine General Hospital, Philippines
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Al-Hakami HA, Al-Mohammadi R, Al-Mutairi R, Al-Subaie H, Al Garni MA. McGill Thyroid Nodule Score in Differentiating Thyroid Nodules in Total Thyroidectomy Cases of Indeterminate Nodules. Indian J Surg Oncol 2020; 11:268-73. [PMID: 32523274 DOI: 10.1007/s13193-020-01053-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022] Open
Abstract
Fine-needle aspiration biopsy (FNAB) is the first-line modality in the evaluation of thyroid nodules. However, the results of indeterminate pathology place the thyroid surgeon in difficult management situations. This study evaluates McGill Thyroid Nodule Score (MTNS) to identify thyroid nodules that harbor malignancy in cases of indeterminate FNABs and to guide surgeon about the need and extent of surgery. We conducted a retrospective chart review of 344 patients who underwent total thyroidectomy between January 2013 and January 2018. Patients with FNAB of indeterminate nodules (Bethesda types III, IV, and V) and calculated MTNS were included in the study. Postoperative histopathology was divided into benign and malignant groups. The median and the mean MTNS, the malignancy rate, and the standard deviations were calculated for each subgroup. Of the 344 patient charts reviewed, 106 (30.8%) had an indeterminate FNA biopsy. Eighty-one (76.4%) patients were females and 25 (23.6%) were males. Final pathology revealed malignancy in 69 patients (65.1%). The mean MTNS of patients with malignant pathology (12.81 ± 3.55) was higher than the mean in the benign group (8.32 ± 2.32). 82.4% of thyroid nodules with median MTNS of less than 8 had a benign pathology, and 91.4% of thyroid nodules with median MTNS equal or more than 11 had a malignant pathology (p = 0.002). The rate of malignancy in our series of indeterminate FNABs was 65.1%. The MTNS can be of value to thyroid surgeons in preoperative decision-making when dealing with an indeterminate thyroid nodule.
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18
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Dualim DM, Loo GH, Suhaimi SNA, Md Latar NH, Muhammad R, Abd Shukor N. The 'CASTLE' tumour: An extremely rare presentation of a thyroid malignancy. A case report. Ann Med Surg (Lond) 2019; 44:57-61. [PMID: 31312445 PMCID: PMC6609788 DOI: 10.1016/j.amsu.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/22/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022] Open
Abstract
Thyroid carcinoma showing thymic-like differentiation (CASTLE) is a rare malignancy of the thyroid gland, and it accounts for 0.1–0.15% of all thyroid cancers. As the name suggests, it has a histological and immunophenotypic resemblance to thymic carcinoma. Preoperative diagnosis of CASTLE can be difficult as its clinical manifestations, and histological characteristic resembles other aggressive and advanced thyroid carcinomas. It is essential to distinguish CASTLE from other aggressive neoplasms as the former has a more favourable prognosis. Immunohistochemical staining with CD5 can help to differentiate thyroid CASTLE from other aggressive thyroid neoplasms. Due to the rarity of this disease, there is no clear definitive treatment strategy. Surgical resection of CASTLE is usually attempted initially. Nodal involvement and extrathyroidal extension are shown to be the main prognostic factors that influenced the survival of patients. Therefore, complete resection of the tumour is vital to reduce local recurrence rates and to improve the chance of long-term survival. Radiotherapy (RT) for CASTLE is an effective treatment. Curative surgery followed by adjuvant RT should be considered in cases with extrathyroidal extension and nodal metastases. With RT, shrinkage of the tumour and reduction of local recurrence rate is possible. With that in mind, we present a case of CASTLE who presented with airway compression symptoms three years after thyroid surgery. He subsequently underwent tumour debulking surgery and a tracheostomy. The patient refused adjuvant chemoradiotherapy, and during our serial follow-up, he is well and symptom-free. Thyroid carcinoma showing thymic-like differentiation (CASTLE) is a rare malignancy of the thyroid gland. Diagnosis of CASTLE can be difficult as it resembles other aggressive and advanced thyroid carcinomas. Immunohistochemical staining with CD5 can help to differentiate thyroid CASTLE from other aggressive thyroid neoplasms. Complete surgical resection is vital to reduce local recurrence rates and to improve the chance of long-term survival. Adjuvant radiotherapy should be considered in cases with extrathyroidal extension and nodal metastases.
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Affiliation(s)
- Diana Mellisa Dualim
- The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
| | - Guo Hou Loo
- The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
| | | | - Nani Harlina Md Latar
- The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
| | - Rohaizak Muhammad
- The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
| | - Nordashima Abd Shukor
- The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, Postcode 56000, Selangor, Malaysia
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Wettasinghe MC, Rosairo S, Ratnatunga N, Wickramasinghe ND. Diagnostic accuracy of ultrasound characteristics in the identification of malignant thyroid nodules. BMC Res Notes 2019; 12:193. [PMID: 30940214 PMCID: PMC6444851 DOI: 10.1186/s13104-019-4235-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/28/2019] [Indexed: 01/15/2023] Open
Abstract
Objective This study was aimed at determining the diagnostic accuracy of the ultrasound characteristics in the identification of malignant thyroid nodules in patients attending the surgical clinic at a tertiary care hospital in Sri Lanka. Results This prospective validation study was conducted among 263 patients attending the surgical clinic at a tertiary care hospital, Sri Lanka. The ultrasound characteristics having statistically significant associations with thyroid malignancies were identified by employing a multivariable analysis. These ultrasound characteristics were compared with Fine Needle Aspiration Cytology results and indicators of diagnostic accuracy were computed. The study sample consisted of 33 malignant and 230 benign nodules. Internal vascularity, hypoechogenicity and microcalcification showed statistically significant positive associations with thyroid malignancy (p < 0.05). The highest positive likelihood ratio was observed for the presence of microcalcifications (10.4, 95% CI 4.6–23.7) with a specificity of 96.5% (95% CI 93.3–98.5%). Hypoechogenicity had a sensitivity of 66.7% (95% CI 48.2–82.0%) and a specificity of 74.8% (95% CI 68.6–80.3%). The presence of at least one positive ultrasound characteristic yielded the highest sensitivity (87.9%, 95% CI 71.8–96.6%), whereas, the presence of all three characteristics yielded a near perfect specificity (99.6%, 95% CI 97.6–99.9%). Hence, the presence of microcalcifications was found to be the single most useful criterion in predicting thyroid malignancy.
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Affiliation(s)
| | - Shanthini Rosairo
- Department of Radiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka.
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Sakat MS, Sade R, Kilic K, Gözeler MS, Pala O, Polat G, Kantarcı M. The Use of Dynamic Contrast-Enhanced Perfusion MRI in Differentiating Benign and Malignant Thyroid Nodules. Indian J Otolaryngol Head Neck Surg 2019; 71:706-11. [PMID: 31742047 DOI: 10.1007/s12070-018-1512-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022] Open
Abstract
To investigate the efficacy of perfusion magnetic resonance imaging (MRI) in benign-malignant differentiation of thyroid nodules. Images from 24 patients with thyroid masses were obtained using dynamic contrast enhanced MRI (DCE-MRI) at 3-T MR. DCE-MRI images were evaluated by post-processing of selected regions of interest (ROIs) on software, thus eliciting quantitative data for each voxel within the ROI. Ktrans, Ve, Kep, iAUC and chi2 were calculated automatically. The DCE-MRI values of benign and malignant lesions were then compared. Mean Ktrans and iAUC values in malignant lesions were significantly lower than those in benign lesions (p = 0.028 and 0.049). Ktrans, Kep, and iAUC values in malignant lesions were statistically significantly lower than normal parenchyma values. In contrast to other tissues, the perfusion MRI findings of thyroid masses exhibit a decrease in Ktrans and iAUC values as malignancy increases. Perfusion MRI may be useful in differentiating benign and malignant thyroid nodules once a cut-off value has been determined by other studies.
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Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, Al-Quaryshi Z, Angelos P, Brauckhoff K, Brooks JA, Cernea CR, Chaplin J, Chen AY, Davies L, Diercks GR, Duh QY, Fundakowski C, Goretzki PE, Hales NW, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Miyauchi A, Orloff L, Rastatter JC, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Stack BC, Tolley NS, Slycke SV, Snyder SK, Urken ML, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Randolph GW. International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope 2018; 128 Suppl 3:S18-S27. [PMID: 30291765 DOI: 10.1002/lary.27360] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/22/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022]
Abstract
The purpose of this publication was to inform surgeons as to the modern state-of-the-art evidence-based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real-time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision-making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18-S27, 2018.
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Affiliation(s)
- Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University, Third Chair of General Surgery, Krakow, Poland
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Henning Dralle
- Department of General Surgery, University Hospital Halle, Halle/Saale, Germany
| | - Rick Schneider
- Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Zaid Al-Quaryshi
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Peter Angelos
- Division of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jennifer A Brooks
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudio R Cernea
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - John Chaplin
- Department of Otolaryngology-Head and Neck Surgery, Gillies Hospital and Clinics, Epsom, New Zealand
| | - Amy Y Chen
- VA Endocrine Surgery, Department of Otolaryngology Emory University School of Medicine, Atlanta, GA, USA
| | - Louise Davies
- Outcomes Group, Veterans Affairs Medical Center, Norwich, Vermont, U.S.A
| | - Gill R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Quan Yang Duh
- Department of Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Christopher Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Peter E Goretzki
- P.G. Stadtische Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Nordrhein-Westfalen, DE
| | - Nathan W Hales
- Department of Otolaryngology, Uniformed Services of the Health Sciences, San Antonio, Texas, U.S.A.,San Antonio Head and Neck, San Antonio, Texas, U.S.A
| | - Dana Hartl
- Department of Otolaryngology Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Dipti Kamani
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Natalia Kyriazidis
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York, U.S.A
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | | | - Lisa Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jeff C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Jonathan Serpell
- Breast, Endocrine and General Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University School of Languages, Literatures, Cultures, and Linguistics, Clayton, Victoria, Australia
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Brendan C Stack
- Department of Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A
| | - Neil S Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College Hospitals NHS Trust, St. Mary's Hospital, London, United Kingdom
| | | | - Samuel K Snyder
- Department of General Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, U.S.A
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine, New York, New York, U.S.A
| | - Erivelto Volpi
- Clinics Hospital, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ian Witterick
- Department of Otolaryngology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Richard J Wong
- Department of Surgery-Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A
| | | | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Gregory W Randolph
- Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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22
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Arczewska KD, Stachurska A, Wojewódzka M, Karpińska K, Kruszewski M, Nilsen H, Czarnocka B. hMTH1 is required for maintaining migration and invasion potential of human thyroid cancer cells. DNA Repair (Amst) 2018; 69:53-62. [PMID: 30055508 DOI: 10.1016/j.dnarep.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/16/2022]
Abstract
Cancer cells, including thyroid cancer cells, suffer from oxidative stress damaging multiple cellular targets, such as DNA and the nucleotide pool. The human MutT homologue 1 (hMTH1) controls the oxidative DNA damage load by sanitizing the nucleotide pool from the oxidized DNA precursor, 8-oxodGTP. It has previously been shown that hMTH1 is essential for cancer cell proliferation and survival, therefore hMTH1 inhibition has been proposed as a novel anticancer therapeutic strategy. Here we show that thyroid cancer cells respond to siRNA mediated hMTH1 depletion with increased DNA damage load and moderately reduced proliferation rates, but without detectable apoptosis, cell-cycle arrest or senescence. Importantly, however, hMTH1 depletion significantly reduced migration and invasion potential of the thyroid cancer cells. Accordingly, our results allow us to propose that hMTH1 may be a therapeutic target in thyroid malignancy, especially for controlling metastasis.
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Affiliation(s)
- Katarzyna D Arczewska
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland.
| | - Anna Stachurska
- Department of Immunohematology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland.
| | - Maria Wojewódzka
- Centre for Radiobiology and Biological Dosimetry, Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195 Warsaw, Poland.
| | - Kamila Karpińska
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland.
| | - Marcin Kruszewski
- Centre for Radiobiology and Biological Dosimetry, Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195 Warsaw, Poland; Department of Molecular Biology and Translational Research, Institute of Rural Health, Jaczewskiego 2, 20-090, Lublin, Poland.
| | - Hilde Nilsen
- Department of Clinical Molecular Biology, Institute of Clinical Medicine, University of Oslo and Akershus University Hospital, Sykehusveien 25, Lørenskog, Norway.
| | - Barbara Czarnocka
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland.
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23
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Hong MJ, Na DG, Baek JH, Sung JY, Kim JH. Impact of Nodule Size on Malignancy Risk Differs according to the Ultrasonography Pattern of Thyroid Nodules. Korean J Radiol 2018; 19:534-541. [PMID: 29713232 PMCID: PMC5904481 DOI: 10.3348/kjr.2018.19.3.534] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/06/2017] [Indexed: 01/02/2023] Open
Abstract
Objective To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. Materials and Methods This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). Results Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). Conclusion The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
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Affiliation(s)
- Min Ji Hong
- Department of Radiology, Gachon University Gil Medical Center, Incheon 21565, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
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24
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Lakshman A, V Nampoothiri R, Suri V, Varma S. Cannon Ball Lung Metastases from a Previously Unreported Primary. J Clin Diagn Res 2017; 11:OJ01. [PMID: 28511442 DOI: 10.7860/jcdr/2017/23181.9504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Arjun Lakshman
- Senior Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram V Nampoothiri
- Senior Resident, Department Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Associate Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Professor and Head, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Sasson M, Kay-Rivest E, Shoukrun R, Florea A, Hier M, Forest VI, Tamilia M, Payne RJ. The T4/T3 quotient as a risk factor for differentiated thyroid cancer: a case control study. J Otolaryngol Head Neck Surg 2017; 46:28. [PMID: 28376913 PMCID: PMC5379683 DOI: 10.1186/s40463-017-0208-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 03/29/2017] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of thyroid nodules is increasing among patients in North America. Few of these nodules harbour malignancy, thus further research is required to identify predictive markers of malignant thyroid disease. This study set out to understand the relationship between the levels of fT4 and fT3 and differentiated thyroid cancer. Methods A case-control study was conducted with 142 cases and 86 controls from the McGill University Teaching Hospitals. All patients underwent thyroid surgery. Cases were defined as patients with malignant nodules confirmed on final pathology and controls were defined as patients with benign nodules. The serological levels of TSH, fT4 and fT3 were measured preoperatively. Odds ratios were determined for each parameter and logistic regressions were calculated between markers and probability of malignancy. Additionally, fT4 values were divided by fT3 values (fT4/fT3 quotient) for each patient and an odds ratio was calculated. Results Amongst cases, the mean TSH was 2.25 ± 0.360U/mL, fT4 was 14.8 ± 0.689pmol/L, and fT3 was 4.65 ± 0.463pmol/L. Amongst controls, the mean TSH was 2.36 ± 1.68U/mL, fT4 was 14.3 ± 1.71pmol/L, and fT3 was 5.27 ± 0.957pmol/L. Patients in the control group were more likely to have low TSH, while patients in the case group would have high fT4 and patients in the control group were more likely to have a low fT4. The OR for patients with TSH >4.4U/mL was 2.13 (0.97, 4.65), and for patients with TSH <0.4U/mL was 0.46 (0.22, 0.95). The OR for patients with fT4 > 16pmol/L was 2.10 (1.09, 4.06), and for patients with fT4 < 10pmol/L was 0.45 (0.20, 0.98). The OR for patients with fT3 > 5.5pmol/L was 0.39 (0.14, 1.28). The OR for patients with fT3 < 3pmol/L was 1.83 (0.25, 13.69). The average fT4/fT3 was 3.39 ± 0.206 for cases and 2.93 ± 0.467 for controls. The fT4/fT3 quotient was considered high if it was >3.3 (OR =6.00 (2.94, 12.25)). Conclusion In this study, a direct relationship between high levels of fT4 and malignancy was uncovered. Furthermore, low levels of TSH and fT4 increased the likelihood that a nodule was benign. In this study a fT4/fT3 ratio >3.3 increased the risk of malignancy by 3.6 times (p-value =0.0013).
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Affiliation(s)
- Mark Sasson
- McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada
| | - Emily Kay-Rivest
- McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada
| | - Rami Shoukrun
- McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada
| | - Anca Florea
- Department of Pathology, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology and Metabolism, Jewish General Hospital, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montreal, H3T 1E2, QC, Canada.
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26
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Terlemez R, Akgün K, Palamar D, Boz S, Sarı H. The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis. Clin Rheumatol 2017; 36:1071-6. [PMID: 28357602 DOI: 10.1007/s10067-017-3607-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/28/2017] [Accepted: 03/14/2017] [Indexed: 12/17/2022]
Abstract
The clinical importance of the thyroid nodules in patients with axial spondyloarthritis (ax-SpA) rests with the need to exclude thyroid malignancy. The aim of this study is to assess the risk of thyroid malignancy in ax-SpA patients receiving anti-TNF therapy. From September 2015 until December 2015, 70 patients diagnosed with ax-SpA were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. All cases were screened for the presence of nodules in the thyroid gland with ultrasound. Of the patients that received anti-TNF therapy, 15 (37.5%); and of the anti-TNF naive patients, 11 (36.7%) had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy of the nodules, and two of them were diagnosed with papillary thyroid carcinoma. None of the nodules in anti-TNF naive patients required biopsy. When compared to the normal population, the standardized incidence ratio (SIR) was found to be increased in both male (SIR 2.03, 95% CI 1.9 to 18) and female (SIR 2.7, 95% CI 2.6 to 24) cases. It is not yet established whether the development of cancer during the treatment process is the effect of the treatment or if it is a part of the natural course of the disease or if it is coincidental. We saw a mild increase in thyroid malignancies in ax-SpA patients who received anti-TNF therapy. Therefore, we believe that the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.
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27
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Özemir İA, Bayraktar B, Anılır E, Orhun K, Eren T, Sağıroğlu J, Ceyran AB, Yiğitbaşı R, Alimoğlu O. The association of papillary thyroid cancer with microcalcification in thyroidnodules with indeterminate cytology based on fine-needle aspiration biopsy. Turk J Med Sci 2016; 46:1719-1723. [PMID: 28081315 DOI: 10.3906/sag-1509-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/04/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Microcalcifications are generally accepted as highly specific for thyroid malignancy, especially for papillary thyroid carcinoma (PTC). The aim of this study was to determine the significance of microcalcification within nodules that were classified as being of “indeterminate cytology” (IC) according to fine-needle aspiration biopsy. MATERIALS AND METHODS Patients who underwent thyroidectomy between January 2010 and 2013 were included in the study. Nodules identified as “atypia/follicular lesion of undetermined significance", "follicular neoplasm/suspicious for follicular neoplasm", or "suspicious for malignancy" were categorized as IC. Patients were subcategorized depending on the presence of microcalcification (Group 1) or its absence (Group 2). The relationship between microcalcification and PTC was evaluated in the IC group retrospectively. RESULTS Indeterminate cytology was detected in 135 (28.5%) of 473 patients. Microcalcification was detected in 27 (20%) of 135 nodules and classified as Group 1, while the remaining 108 (80%) patients were classified as Group 2. According to the final pathology results, PTC was diagnosed in 13 of 27 (48.1%) patients in Group 1 and 29 of 108 (26.8%) patients in Group 2. A statistically significant relation between microcalcification and malignancy was determined in the IC group (P < 0.05). CONCLUSION Surgery might be considered primarily for patients harboring nodule(s) with IC accompanied by microcalcification due to increased risk of PTC.
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Affiliation(s)
- İbrahim Ali Özemir
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Barış Bayraktar
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Ender Anılır
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Kıvılcım Orhun
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Tunç Eren
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Jülide Sağıroğlu
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Ayşe Bahar Ceyran
- Department of Pathology, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Rafet Yiğitbaşı
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
| | - Orhan Alimoğlu
- Department of General Surgery, Faculty of Medicine, İstanbul Medeniyet University Göztepe Education and Research Hospital, İstanbul, Turkey
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Affiliation(s)
- Divya Akshintala
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Ill.
| | - Bhanu T Paturi
- Department of Endocrinology, OSF Healthcare, Peoria, Ill
| | - Jijun Liu
- Department of Hematology/Oncology, Illinois Cancer Care, Peoria
| | - Vamsi K Emani
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Ill
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29
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Baser H, Topaloglu O, Tam AA, Evranos B, Alkan A, Sungu N, Dumlu EG, Ersoy R, Cakir B. Higher TSH can be used as an additional risk factor in prediction of malignancy in euthyroid thyroid nodules evaluated by cytology based on Bethesda system. Endocrine 2016; 53:520-9. [PMID: 26972701 DOI: 10.1007/s12020-016-0919-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
Recently, it has been suggested that thyrotropin (TSH) concentration can be used as a marker for prediction of thyroid malignancy. In this study, we aimed to investigate the association between TSH levels and prediction of malignancy in euthyroid patients with different Bethesda categories. The data of 1433 euthyroid patients with 3206 thyroid nodules who underwent thyroidectomy were screened retrospectively. The preoperative cytology results, thyroid function tests, thyroid autoantibodies, and presence of histopathological Hashimoto's thyroiditis (HT) were recorded. Of the 1433 patients, 585 (40.8 %) had malignant and 848 (59.2 %) had benign histopathology. Malignant group had smaller nodule size, elevated TSH levels, and higher rate of presence of HT compared to benign group (p < 0.001, all). Cytology results of 3206 nodules were as follows: 832 nondiagnostic (ND), 1666 benign, 392 atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 68 follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 133 suspicious for malignancy (SM), and 115 malignant. Both SM and malignant cytology groups had higher TSH levels than other 4 Bethesda categories (p < 0.05, all). Benign cytology group had significantly lower TSH levels compared to other cytology groups (p < 0.05, all). Patients with malignant final histopathology in ND and AUS/FLUS cytology groups had significantly higher TSH levels compared to patients with benign final histopathology (p < 0.05, all). Moreover, TSH levels showed to increase from Bethesda categories II to VI. In addition to cytology, higher TSH levels can be used as a supplementary marker in prediction of malignancy in certain Bethesda categories.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Berna Evranos
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Nuran Sungu
- Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Ersin Gurkan Dumlu
- Department of General Surgery, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Aldrink JH, Adler B, Haines J, Watkins D, Matthews M, Lubeley L, Wang W, King DR. Patients exposed to diagnostic head and neck radiation for the management of shunted hydrocephalus have a significant risk of developing thyroid nodules. Pediatr Surg Int 2016; 32:565-9. [PMID: 27083898 DOI: 10.1007/s00383-016-3894-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE External radiation to the head and neck can lead to an increased incidence of thyroid nodules. We investigated whether patients requiring repeated head and neck imaging for the management of shunted hydrocephalus had a higher incidence of ultrasound-detected thyroid nodules compared to reports of comparable age. METHODS Patients treated at our institution for shunted hydrocephalus from 1990 to 2003 were contacted. Enroled patients underwent a thyroid ultrasound. Demographic data and radiation exposure history were obtained retrospectively. RESULTS Thyroid nodules were identified sonographically in 15/112 patients (13.6 %). Patients with thyroid nodules were older (mean 24.3 ± 7.6 years) than those without (mean 18.4 ± 8.0 years) (p = 0.005). Those with a detectable thyroid nodule had a longer follow up time compared to those who did not (mean 21.9 ± 5.5 vs. 15.1 ± 7 years, respectively) (p = 0.018). CONCLUSION Patients with shunted hydrocephalus are exposed to substantial head and neck radiation from diagnostic imaging and have a higher incidence of thyroid nodules detected by ultrasonography. These patients should be provided ongoing surveillance for detection of thyroid nodules and the possibility of malignancy.
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Affiliation(s)
- Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA.
| | - Brent Adler
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jesse Haines
- The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel Watkins
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA
| | - Mika Matthews
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA
| | - Lacey Lubeley
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Wei Wang
- Department of Biostatistics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Denis R King
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, ED320, Columbus, OH, 43205, USA
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Unsal O, Akpinar M, Turk B, Ucak I, Ozel A, Kayaoglu S, Uslu Coskun B. Sonographic scoring of solid thyroid nodules: effects of nodule size and suspicious cervical lymph node. Braz J Otorhinolaryngol 2016; 83:73-79. [PMID: 27161187 PMCID: PMC9444728 DOI: 10.1016/j.bjorl.2016.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/21/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Ultrasound is the most frequently used imaging method to evaluate thyroid nodules. Sonographic characteristics of thyroid nodules which are concerning for malignancy are important to define the need for fine needle aspiration biopsy or open surgery. Objective To evaluate malignancy risk of solid thyroid nodules through sonographic scoring. The effects of nodule size ≥2 cm and associated pathologic cervical lymph node in scoring were examined in addition to generally excepted suspicious features. Methods Medical data of 123 patients underwent thyroid surgery were reviewed, and 89 patients (58 females, 31 males) were included in the study. The presence and absence of each suspicious sonographic feature of thyroid nodules were scored as 1 and 0, respectively. Total ultrasound score was obtained by adding the positive ultrasound findings. Differently from the literature, nodule size ≥2 cm and associated pathologic cervical node were added in scoring criteria. The diagnostic performance of nodule characteristics for malignancy and the effect of total US score to discriminate malignant and benign disease were calculated. Results A significant relationship was found between malignancy and hypoechogenity, border irregularity, intranodular vascularity, and microcalcification (p < 0.05). Pathologic cervical node was observed predominantly in association with malignant nodules. Positive predictive value of suspicious cervical node for malignancy was 67%, similar to microcalcification. Nodule size ≥2 cm was not distinctive for diagnosis of malignancy. The number of suspicious sonographic features obtained with receiver operating characteristic analysis to discriminate between malignant and benign disease was three. Conclusion Sonographic scoring of thyroid nodules is an effective method for predicting malignancy. The authors suggest including associated pathologic node in the scoring criteria. Further studies with larger cohorts will provide more evidence about its importance in sonographic scoring.
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Affiliation(s)
- Ozlem Unsal
- Sisli Etfal Teaching and Research Hospital, Head and Neck Surgery, Clinic of Otolaryngology, Istanbul, Turkey.
| | - Meltem Akpinar
- Sisli Etfal Teaching and Research Hospital, Head and Neck Surgery, Clinic of Otolaryngology, Istanbul, Turkey
| | - Bilge Turk
- Sisli Etfal Teaching and Research Hospital, Head and Neck Surgery, Clinic of Otolaryngology, Istanbul, Turkey
| | - Irmak Ucak
- Sisli Etfal Teaching and Research Hospital, Head and Neck Surgery, Clinic of Otolaryngology, Istanbul, Turkey
| | - Alper Ozel
- Sisli Etfal Teaching and Research Hospital, Clinic of Radiology, Istanbul, Turkey
| | - Semra Kayaoglu
- Nisantasi Family Health Center, Family Medicine, Istanbul, Turkey
| | - Berna Uslu Coskun
- Sisli Etfal Teaching and Research Hospital, Head and Neck Surgery, Clinic of Otolaryngology, Istanbul, Turkey
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Giaginis C, Alexandrou P, Poulaki E, Delladetsima I, Troungos C, Patsouris E, Theocharis S. Clinical Significance of EphB4 and EphB6 Expression in Human Malignant and Benign Thyroid Lesions. Pathol Oncol Res 2016; 22:269-75. [PMID: 26220827 DOI: 10.1007/s12253-014-9879-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ephrin receptors (Ephs) are frequently overexpressed in a wide variety of human malignant tumors, being associated with tumor growth, invasion, angiogenesis and metastasis. The present study aimed to evaluate the clinical significance of EphB4 and EphB6 protein expression in human malignant and benign thyroid lesions. EphB4 and EphB6 protein expression was assessed immunohistochemically on paraffin-embedded thyroid tissues obtained from 127 patients with benign (n = 71) and malignant (n = 56) thyroid lesions. Enhanced EphB4 and EphB6 expression was more frequently observed in malignant compared to benign thyroid lesions (p = 0.0508 and p = 0.0006, respectively). EphB4 and EphB6 expression also provided a distinct discrimination between papillary carcinoma and hyperplastic nodules (p = 0.0302 and p = 0.0013, respectively). In malignant thyroid lesions, enhanced EphB4 expression was significantly associated with larger tumor size (p = 0.0366). Enhanced EphB6 expression was significantly associated with larger tumor size (p = 0.0366), the presence of lymph node metastases (p = 0.0023), the presence of capsular (p = 0.0038), lymphatic (p = 0.0053) and vascular invasion (p = 0.0018) and increased risk of recurrence rate (p = 0.0038). The present study supported evidence that EphB4 and mainly EphB6 may participate in the malignant thyroid transformation, reinforcing their utility as useful biomarkers and possible therapeutic targets in this type of neoplasia.
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Kumar N, Nayak HK, Daga MK, Jain S, Kumar M. Anaplastic Thyroid Carcinoma (ATC) with Superior Vena Cava (SVC) Syndrome, Cardiac Tamponade and Pleural Effusion: An Unusual Clinical Presentation. J Clin Diagn Res 2015; 9:XD01-XD02. [PMID: 25859509 DOI: 10.7860/jcdr/2015/10218.5517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
Superior vena cava (SVC) syndrome and cardiac tamponade are potentially life-threatening conditions that are not uncommon in the oncological setting but their occurrence together in a patient is infrequent. Herein, we present a case of 50-year-old male who presented with SVC syndrome and pleural effusion; developed recurrent cardiac tamponade in the hospital. Fine needle aspiration cytology (FNAC) of left supraclavicular lymph node which appeared during hospital stay revealed high grade carcinoma and diagnosis of anaplastic thyroid carcinoma was established by FNAC of thyroid nodule. Despite rarity, clinicians must be aware of such presentation of thyroid malignancy.
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Affiliation(s)
- Naresh Kumar
- Associate Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| | - Hemant Kumar Nayak
- Resident, Department of Gastroenterology, Sanjay Gandhi Post-Graduate Institute , Lucknow, India
| | - Mradul Kumar Daga
- Director Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| | - Shyama Jain
- Director Professor, Department of Pathology, Maulana Azad Medical College , New Delhi, India
| | - Mukesh Kumar
- Resident, Department of Microbiology, Sardar Patel Medical College , Bikaner, India
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Canete EJ, Sison-Pena CM, Jimeno CA. Clinicopathological, Biochemical, and Sonographic Features of Thyroid Nodule Predictive of Malignancy among Adult Filipino Patients in a Tertiary Hospital in the Philippines. Endocrinol Metab (Seoul) 2014; 29:489-97. [PMID: 25325270 PMCID: PMC4285043 DOI: 10.3803/enm.2014.29.4.489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/17/2014] [Accepted: 05/08/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Thyroid nodules may harbor cancer in 5% to 15% of cases. Specific clinical and sonographic features predictive of malignancy have been investigated in various populations, but due to differences in epidemiology, risk factors and iodine nutrition status, these predictors may not be valid in the Philippines. This study determined the clinicopathological, biochemical, and sonographic features of thyroid nodules predictive of malignancy among adult Filipino patients at the University of the Philippines-Philippine General Hospital (UP-PGH). METHODS We reviewed the medical records of Filipino patients ≥19 years of age who underwent thyroid surgery in UP-PGH from 2008 to 2011. RESULTS A total of 837 of 1,670 patients (50.1%) were enrolled in the study, which included 417 benign and 420 malignant tumors. The mean age at diagnosis was 38±11 years, with female predominance. Multiple logistic regression analysis showed that the presence of a hard or firm nodule (odds ratio [OR], 58.8, P<0.001; OR, 12.8, P<0.001), presence of microcalcifications (OR, 11.1; P<0.001), irregular margins on ultrasound (OR, 4.5; P<0.001), and absence of associated symptoms (OR, 2.3; P<0.002) increased significantly the likelihood of thyroid malignancy. CONCLUSION Similar to international data, the absence of associated symptoms, firm to hard thyroid nodules, and the presence of microcalcifications and irregular margins were significant predictors of thyroid malignancy.
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Affiliation(s)
- Edwin Jadulco Canete
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines.
| | - Cherrie Mae Sison-Pena
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines
| | - Cecilia Alegado Jimeno
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines
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Hebbar K A, K S, Deshmane VL, Kumar V, Arjunan R. Papillary carcinoma in median aberrant thyroid (ectopic) - case report. J Clin Diagn Res 2014; 8:QD01-3. [PMID: 25121039 DOI: 10.7860/jcdr/2014/7626.4463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 05/01/2014] [Indexed: 11/24/2022]
Abstract
Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed.
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Affiliation(s)
- Ashwin Hebbar K
- Assistant Professor, Department of General Surgery, Shimoga Institute of Medical Sciences , Shimoga, Karnataka, India
| | - Shashidhar K
- Associate Professor, Department of ENT, Karnataka Institute of Medical Sciences , Hubli, Karnataka, India
| | - Vijaya Laxmi Deshmane
- Professor and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology , Bangalore, Karnataka, India
| | - Veerendra Kumar
- Professor, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology , Bangalore, Karnataka, India
| | - Ravi Arjunan
- Associate Professor, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology , Bangalore, Karnataka, India
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Al-Jarrah Q, Abou-Foul A, Heis H. Intravascular extension of papillary thyroid carcinoma to the internal jugular vein: A case report. Int J Surg Case Rep 2014; 5:551-3. [PMID: 25044067 PMCID: PMC4147657 DOI: 10.1016/j.ijscr.2014.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 04/30/2014] [Accepted: 06/05/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Papillary thyroid cancer (PTC) is the most common thyroid malignancy and usually spreads via lymphatic system. PTC can sometimes show microscopic vascular invasion, but rarely causes tumour thrombus in the internal jugular vein (IJV) or other great veins of the neck. PRESENTATION OF CASE We report a case of a 62-year-old female presented with symptomatic central neck mass. Clinical examination revealed a hard solitary right-sided thyroid nodule with ipsilateral cervical lymphadenopathy. Ultrasonography (US) confirmed the clinical diagnosis and visualised a dilated ipsilateral IJV. Fine-needle aspiration cytology revealed PTC cells so total thyroidectomy with right neck dissection was done. A tumour thrombus was discovered in the distended right IJV and was cleared successfully. The patient recovered well after the operation with no local or distant metastasis detected. DISCUSSION Tumour vascular spread is observed in tumours with angio-invasive features including follicular carcinoma of the thyroid gland where great cervical veins can be affected. PTC commonly spreads to the lymph nodes and vascular spread via direct intravascular extension is extremely rare. Neck US has an important role in the diagnosis, and operators should attempt to detect signs of tumour thrombi in all patients with thyroid masses. Aggressive surgical treatment with vascular repair is recommended whenever possible to minimise the risk of potentially fatal complications of the intraluminal masses. CONCLUSION Intravascular tumour extension of PTC is rare but with serious consequences. Diagnosis with neck US is possible but some cases are only discovered intraoperatively. Thrombectomy with vascular repair or reconstruction is usually possible.
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Affiliation(s)
- Q Al-Jarrah
- University Hospital of South Manchester NHS turst, Manchester M23 9LT,UK.
| | - Ak Abou-Foul
- Departement of General Surgery, Royal blackburn hospital, East lancashire hospitals NHS Trust, Blackburn BB2 3HH, UK
| | - H Heis
- Department of General Surgery, King Abdullah University Hospital, Irbid, Jordan
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Abstract
Primary thyroid lymphoma is rare, composing approximately 5% of all thyroid malignancies and less than 3% of all extranodal lymphomas. It typically presents as a rapidly enlarging goiter with associated compressive symptoms. Thyroid ultrasound and fine needle aspiration cytology, using flow cytometry and immunohistochemistry, remain the main modalities used to confirm the presence of lymphoma. The increasing use of an ultrasound-guided core biopsy to achieve an accurate diagnosis has further limited the role of surgery. An open surgical biopsy may still be required not only for definitive diagnosis but also to confirm the subtype of lymphoma. There are limited numbers of randomized or prospective trials to guide management, and controversy remains over optimal treatment. Treatment and prognosis of this disease can be dichotomized into two separate groups: pure mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL) or mixed subtypes. Early stage (stage IE) intrathyroidal MALT lymphomas typically have an indolent course and may be treated with single-modality surgery, radiotherapy, or a combination of both. DLBCLs are more aggressive, and survival outcomes are highest with multimodal therapy incorporating monoclonal antibodies, chemotherapy, and radiotherapy. The prognosis is generally excellent but can be varied because of the heterogeneous nature of thyroid lymphomas. The aim of this paper is to discuss the changes in diagnostic modalities and to focus on the recent alterations in the management of this rare disease, including targeted therapies as well as the more limited role of the endocrine surgeon.
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Affiliation(s)
- Siun Walsh
- Department of Endocrine Surgery, St. Vincent's University Hospital, Dublin, Ireland
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Abstract
Thyroid nodules are a common clinical problem with the widespread use of ultrasonography. Fine needle aspiration (FNA) is the mainstay for diagnosing a thyroid malignancy. There have been several guidelines on when to perform FNA in thyroid nodules. This review is based on several published recommendations and helps physicians easily understand the factors favoring FNA.
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Affiliation(s)
- Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Patten DK, Flora R, Tolley N, Palazzo F. Sporadic medullary thyroid carcinoma with a pedunculated intraluminal internal jugular vein recurrence: A case report and literature review. Int J Surg Case Rep 2012; 3:92-6. [PMID: 22288056 DOI: 10.1016/j.ijscr.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is an uncommon usually slowly progressing neuroendocrine tumour that arises from calcitonin (CT) producing parafollicular C cells of the thyroid gland. It accounts for approximately 5% of all thyroid cancers. The majority of MTCs are sporadic (75%) whilst 25% are part of the MEN 2 hereditary syndrome (MEN 2A and MEN 2B and familial MTC). Mutations of the proto-oncogene, RET (Rearranged during Transfection), found on chromosome 10q11, are present in more than 95% of hereditary MTCs and about 25% of sporadic MTCs. MTC metastasizes primarily via lymphatic spread, to central, and lateral nodal neck compartments and the anterior and superior mediastinum. Distant haematogenous spread targets the lungs, liver, bone and brain, and is presumed to be secondary to a lymphatic pathway. There are no previously documented reports of a focal pedunculated metastases located within the jugular vein. We present the first reported case of a metastatic MTC lesion found in the right internal jugular vein in a man with recurrent MTC.
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Affiliation(s)
- Darren K Patten
- Department of Biosurgery and Surgical Oncology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
The hormonal interactions among the systems throughout the body are not fully understood; many vague clinical symptoms may in fact be manifestations of underlying endocrine diseases. The aim of the following review is to discuss gastrointestinal manifestations of surgically correctable endocrine diseases, focusing on abnormalities of thyroid function, cancer and finally autoimmune diseases. We also review manifestations of pancreatic endocrine tumors, and multiple endocrine neoplasia.
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Affiliation(s)
- Christina Maser
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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