1
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Bischoff LA, Ganly I, Fugazzola L, Buczek E, Faquin WC, Haugen BR, McIver B, McMullen CP, Newbold K, Rocke DJ, Russell MD, Ryder M, Sadow PM, Sherman E, Shindo M, Shonka DC, Singer MC, Stack BC, Wirth LJ, Wong RJ, Randolph GW. Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma: A Review and Multidisciplinary 2023 Update. JAMA Otolaryngol Head Neck Surg 2024; 150:265-272. [PMID: 38206595 DOI: 10.1001/jamaoto.2023.4323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Importance Oncocytic (Hürthle cell) thyroid carcinoma is a follicular cell-derived neoplasm that accounts for approximately 5% of all thyroid cancers. Until recently, it was categorized as a follicular thyroid carcinoma, and its management was standardized with that of other differentiated thyroid carcinomas. In 2022, given an improved understanding of the unique molecular profile and clinical behavior of oncocytic thyroid carcinoma, the World Health Organization reclassified oncocytic thyroid carcinoma as distinct from follicular thyroid carcinoma. The International Thyroid Oncology Group and the American Head and Neck Society then collaborated to review the existing evidence on oncocytic thyroid carcinoma, from diagnosis through clinical management and follow-up surveillance. Observations Given that oncocytic thyroid carcinoma was previously classified as a subtype of follicular thyroid carcinoma, it was clinically studied in that context. However, due to its low prevalence and previous classification schema, there are few studies that have specifically evaluated oncocytic thyroid carcinoma. Recent data indicate that oncocytic thyroid carcinoma is a distinct class of malignant thyroid tumor with a group of distinct genetic alterations and clinicopathologic features. Oncocytic thyroid carcinoma displays higher rates of somatic gene variants and genomic chromosomal loss of heterozygosity than do other thyroid cancers, and it harbors unique mitochondrial DNA variations. Clinically, oncocytic thyroid carcinoma is more likely to have locoregional (lymph node) metastases than is follicular thyroid carcinoma-with which it was formerly classified-and it develops distant metastases more frequently than papillary thyroid carcinoma. In addition, oncocytic thyroid carcinoma rarely absorbs radioiodine. Conclusions and Relevance The findings of this review suggest that the distinct clinical presentation of oncocytic thyroid carcinoma, including its metastatic behavior and its reduced avidity to radioiodine therapy, warrants a tailored disease management approach. The reclassification of oncocytic thyroid carcinoma by the World Health Organization is an important milestone toward developing a specific and comprehensive clinical management for oncocytic thyroid carcinoma that considers its distinct characteristics.
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Affiliation(s)
- Lindsay A Bischoff
- Department of Medicine, Division of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Fugazzola
- Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, The University of Kansas, Kansas City
| | - William C Faquin
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan R Haugen
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Caitlin P McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Kate Newbold
- Thyroid Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniel J Rocke
- Department of Otolaryngology Head and Neck Surgery, Weill Medical College, Cornell University, New York, New York
| | - Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Mabel Ryder
- Division of Endocrinology and Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
| | - Michael C Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Lori J Wirth
- Departments of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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2
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Oszwald A, Wasinger G, Zisser L, Compérat E. Update on classification of oncocytic neoplasms of the kidney. Curr Opin Urol 2023; 33:239-244. [PMID: 36660966 DOI: 10.1097/mou.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW This review provides a summary of recent developments in classification of renal oncocytic neoplasms that were incorporated in the fifth edition WHO classification of renal tumors, released in 2022. RECENT FINDINGS Besides the distinct entities of renal oncocytoma and chromophobe renal cell carcinoma, the WHO now acknowledges a heterogeneous group of oncocytic tumors of the kidney that can be reported as 'oncocytic renal neoplasms of low malignant potential'. Case series by multiple institutions have revealed recurrent patterns of morphological features, protein marker expression, and genetic alterations within these neoplasms that may permit further subclassification in the future. SUMMARY The new classification system provides pathologists with the opportunity to simplify the diagnostic workup and reporting of morphologically equivocal oncocytic neoplasms.
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Affiliation(s)
| | | | - Lucia Zisser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna
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3
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Abstract
Background: Thyroid cancer is a common malignancy whose detection has increased significantly in past decades. Most of the increased incidence is due to detection of early well-differentiated thyroid cancer, but the incidence of more advanced thyroid cancers has increased as well. Recent methodological advancements have allowed for a deep understanding of the molecular underpinnings of the various types of thyroid cancer. Summary: Thyroid cancers harbor a high frequency of potential druggable molecular alterations, including the highest frequency of oncogenic driver kinase fusions seen across all solid tumors. Analyses of poorly differentiated and anaplastic thyroid carcinoma confirmed that these tumors develop from more well-differentiated follicular-derived thyroid cancers through acquired additional mutations. The recognition of driver genomic alterations in thyroid cancers not only predicts tumor phenotype but also now can inform treatment approaches. Conclusions: Major progress in understanding the oncogenic molecular underpinnings across the array of thyroid cancers has led to considerable gains in gene-specific systemic therapies for many cancers. This article focuses on the molecular characteristics of aggressive follicular-derived thyroid cancers and medullary thyroid cancer and highlights advancements in treating thyroid cancer in the era of targeted therapy.
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MESH Headings
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Carcinoma, Neuroendocrine/genetics
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Humans
- Immunotherapy/methods
- Immunotherapy/trends
- Molecular Targeted Therapy/methods
- Molecular Targeted Therapy/trends
- Mutation
- Oncogene Fusion
- Phosphotransferases/genetics
- Proto-Oncogene Proteins B-raf
- Thyroid Carcinoma, Anaplastic/genetics
- Thyroid Carcinoma, Anaplastic/pathology
- Thyroid Carcinoma, Anaplastic/therapy
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
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Affiliation(s)
- Carrie C. Lubitz
- Department of Surgery; Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts, USA
| | - Peter M. Sadow
- Department of Pathology; Harvard Medical School, Boston, Massachusetts, USA
| | - Gilbert H. Daniels
- Department of Medicine; Harvard Medical School, Boston, Massachusetts, USA
- Department of Thyroid Unit; Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori J. Wirth
- Department of Medicine; Harvard Medical School, Boston, Massachusetts, USA
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4
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Besic N, Vidergar-Kralj B, Zaletel K, Grasic-Kuhar C. Graves disease and metastatic hormonal-active Hürthle cell thyroid cancer: A case report. Medicine (Baltimore) 2021; 100:e26384. [PMID: 34160415 PMCID: PMC8238273 DOI: 10.1097/md.0000000000026384] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A hormone-active metastatic Hürthle cell thyroid carcinoma (HCTC) and Graves disease (GD) present a therapeutic challenge and is rarely reported. PATIENT CONCERNS We present a 64-year-old male patient, who had dyspnea and left hip pain lasting 4 months. He had clinical signs of hyperthyroidism and a tumor measuring 9 cm in diameter of the left thyroid lobe, metastatic neck lymph node and metastases in the lungs, mediastinum, and bones. DIAGNOSIS Laboratory findings confirmed hyperthyroidism and GD. Fine-needle aspiration biopsy and cytological investigation revealed metastases of HCTC in the skull and in the 8th right rib. A CT examination showed a thyroid tumor, metastatic neck lymph node, metastases in the lungs, mediastinum and in the 8th right rib measuring 20 × 5.6 × 4.5 cm, in the left acetabulum measuring 9 × 9 × 3 cm and parietooccipitally in the skull measuring 5 × 4 × 2 cm. Histology after total thyroidectomy and resection of the 8th right rib confirmed metastatic HCTC. INTERVENTIONS The region of the left hip had been irradiated with concomitant doxorubicin 20 mg once weekly. When hyperthyroidism was controlled with thiamazole, a total thyroidectomy was performed. Persistent T3 hyperthyroidism, most likely caused by TSH-R-stimulated T3 production in large metastasis in the 8th right rib, was eliminated by rib resection. Thereafter, the patient was treated with 3 radioactive iodine-131 (RAI) therapies (cumulative dose of 515 mCi). Unfortunately, the tumor rapidly progressed after treatment with RAI and progressed 10 months after therapy with sorafenib. OUTCOMES Despite treatment, the disease rapidly progressed and patient died due to distant metastases. He survived for 28 months from diagnosis. LESSONS Simultaneous hormone-active HCTC and GD is extremely rare and prognosis is dismal. Concomitant external beam radiotherapy and doxorubicin chemotherapy, followed by RAI therapy, prevented the growth of a large metastasis in the left hip in our patient. However, a large metastasis in the 8th right rib presented an unresolved problem. Treatment with rib resection and RAI did not prevent tumor recurrence. External beam radiotherapy and sorafenib treatment failed to prevent tumor growth.
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Affiliation(s)
- Nikola Besic
- Department of Surgical Oncology, Institute of Oncology Ljubljana
- Faculty of Medicine Ljubljana
| | | | - Katja Zaletel
- Faculty of Medicine Ljubljana
- Department of Nuclear Medicine, University Clinical Center Ljubljana
| | - Cvetka Grasic-Kuhar
- Faculty of Medicine Ljubljana
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, Ljubljana, Slovenia
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5
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Abstract
Hürthle cell lesions have been a diagnostic conundrum in pathology since they were first recognized over a century ago. Controversy as to the name of the cell, the origin of the cell, and even which cells in particular may be designated as such still challenge pathologists and confound those treating patients with a diagnosis of "Hürthle cell" anything within the diagnosis, especially if that anything is a sizable mass lesion. The diagnosis of Hürthle cell adenoma (HCA) or Hürthle cell carcinoma (HCC) has typically relied on a judgement call by pathologists as to the presence or absence of capsular and/or vascular invasion of the adjacent thyroid parenchyma, easy to note in widely invasive disease and a somewhat subjective diagnosis for minimally invasive or borderline invasive disease. Diagnostic specificity, which has incorporated a sharp increase in molecular genetic studies of thyroid tumor subtypes and the integration of molecular testing into preoperative management protocols, continues to be challenged by Hürthle cell neoplasia. Here, we provide the improving yet still murky state of what is known about Hürthle cell tumor genetics, clinical management, and based upon what we are learning about the genetics of other thyroid tumors, how to manage expectations, by pathologists, clinicians, and patients, for more actionable, precise classifications of Hürthle cell tumors of the thyroid.
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Affiliation(s)
- David G. McFadden
- Division of Endocrinology, Department of Internal Medicine, Department of Biochemistry, Program in Molecular Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Peter M. Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Peter M. Sadow,
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6
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An J, Park CK, Kim M, Joo JW, Cho NH. HNF-1β as an immunohistochemical marker for distinguishing chromophobe renal cell carcinoma and hybrid oncocytic tumors from renal oncocytoma. Virchows Arch 2020; 478:459-470. [PMID: 32816058 DOI: 10.1007/s00428-020-02912-7] [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] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022]
Abstract
The histologic features of renal oncocytoma (RO) are similar to those for the more aggressive chromophobe renal cell carcinoma (ChRCC). To assess immunohistochemical markers of the two, the sensitivity and specificity of cytokeratin 7 (CK7) and C-kit, as well as hepatocyte nuclear factor-1β (HNF-1β), were analyzed. Typical cases of ChRCC and RO at Severance Hospital between July 2014 and July 2018 were selected retrospectively. Among 44 cases, 17 were unanimously compatible with ChRCC, 16 were RO, and 11 cases were indeterminate. Samples from all selected cases were used for immunostaining with antibodies against CK7, C-kit, HNF-1β, and CD10. Immunostaining demonstrated complete loss of HNF-1β expression in 11 out of 17 (64.7%) ChRCC cases and a partial, but significant loss in > 50% of tumor cells in the remaining 6 cases (35.3%). In contrast, HNF-1β expression was preserved in tumor cells of RO cases. Fourteen of 17 ChRCC cases (82.4%) were diffusely positive for CK7, whereas cases of RO were focal positive or negative. C-kit staining did not show a significant difference between ChRCC and RO. Two of five ChRCC cases showing diffuse immunoreactivity for CD10 had poor prognoses of local invasion, distant metastasis, or death. Loss of HNF-1β expression is a useful marker with which to diagnose ChRCC, especially in cases with confusing histologic findings or equivocal CK7 staining. Additionally, CD10 staining in high-grade ChRCC aids in diagnosis and prediction of the clinical prognosis.
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MESH Headings
- Adenoma, Oxyphilic/chemistry
- Adenoma, Oxyphilic/mortality
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Carcinoma, Renal Cell/chemistry
- Carcinoma, Renal Cell/mortality
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/therapy
- Diagnosis, Differential
- Down-Regulation
- Female
- Hepatocyte Nuclear Factor 1-beta/analysis
- Humans
- Immunohistochemistry
- Keratin-7/analysis
- Kidney Neoplasms/chemistry
- Kidney Neoplasms/mortality
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Proto-Oncogene Proteins c-kit/analysis
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Affiliation(s)
- Jiyeon An
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Cheol Keun Park
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moonsik Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin Woo Joo
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Nam Hoon Cho
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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7
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San Román Gil M, Pozas J, Molina-Cerrillo J, Gómez J, Pian H, Pozas M, Carrato A, Grande E, Alonso-Gordoa T. Current and Future Role of Tyrosine Kinases Inhibition in Thyroid Cancer: From Biology to Therapy. Int J Mol Sci 2020; 21:E4951. [PMID: 32668761 PMCID: PMC7403957 DOI: 10.3390/ijms21144951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 12/16/2022] Open
Abstract
Thyroid cancer represents a heterogenous disease whose incidence has increased in the last decades. Although three main different subtypes have been described, molecular characterization is progressively being included in the diagnostic and therapeutic algorithm of these patients. In fact, thyroid cancer is a landmark in the oncological approach to solid tumors as it harbors key genetic alterations driving tumor progression that have been demonstrated to be potential actionable targets. Within this promising and rapid changing scenario, current efforts are directed to improve tumor characterization for an accurate guidance in the therapeutic management. In this sense, it is strongly recommended to perform tissue genotyping to patients that are going to be considered for systemic therapy in order to select the adequate treatment, according to recent clinical trials data. Overall, the aim of this article is to provide a comprehensive review on the molecular biology of thyroid cancer focusing on the key role of tyrosine kinases. Additionally, from a clinical point of view, we provide a thorough perspective, current and future, in the treatment landscape of this tumor.
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MESH Headings
- Adenocarcinoma, Follicular/enzymology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/enzymology
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/therapy
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Carcinoma, Medullary/enzymology
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/therapy
- Carcinoma, Papillary/enzymology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/therapy
- Clinical Trials as Topic
- Combined Modality Therapy
- Disease Management
- Forecasting
- Genes, Neoplasm
- Humans
- Immune Checkpoint Inhibitors/therapeutic use
- Immunoconjugates/therapeutic use
- Immunotherapy
- Iodine Radioisotopes/therapeutic use
- Molecular Targeted Therapy
- Multicenter Studies as Topic
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/antagonists & inhibitors
- Oncogene Proteins, Fusion/genetics
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Randomized Controlled Trials as Topic
- Thyroid Neoplasms/enzymology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/therapy
- Tumor Microenvironment/immunology
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Affiliation(s)
- María San Román Gil
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
| | - Javier Pozas
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
| | - Javier Molina-Cerrillo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
- The Ramon y Cajal Health Research Institute (IRYCIS), CIBERONC, 28034 Madrid, Spain
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
| | - Joaquín Gómez
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
- General Surgery Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Héctor Pian
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Miguel Pozas
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
| | - Alfredo Carrato
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
- The Ramon y Cajal Health Research Institute (IRYCIS), CIBERONC, 28034 Madrid, Spain
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
| | - Enrique Grande
- Medical Oncology Department, MD Anderson Cancer Center, 28033 Madrid, Spain;
| | - Teresa Alonso-Gordoa
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (M.S.R.G.); (J.P.); (M.P.); (A.C.); (T.A.-G.)
- The Ramon y Cajal Health Research Institute (IRYCIS), CIBERONC, 28034 Madrid, Spain
- Medicine School, Alcalá University, 28805 Madrid, Spain; (J.G.); (H.P.)
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8
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van Velsen EFS, Stegenga MT, van Kemenade FJ, Kam BLR, van Ginhoven TM, Visser WE, Peeters RP. Evaluating the 2015 American Thyroid Association Risk Stratification System in High-Risk Papillary and Follicular Thyroid Cancer Patients. Thyroid 2019; 29:1073-1079. [PMID: 31140385 DOI: 10.1089/thy.2019.0053] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Indexed: 12/18/2022]
Abstract
Background: The 2015 American Thyroid Association (ATA) Risk Stratification System for differentiated thyroid cancer (DTC) is designed to predict recurring/persisting disease but not survival. Earlier studies evaluating this system evaluated the 2009 edition, comprised a low number of patients with ATA high-risk, had low numbers of patients with follicular thyroid cancer (FTC), or did not distinguish between papillary and FTC. Therefore, we evaluated the prognostic value of the 2015 ATA Risk Stratification System in a large population of high-risk thyroid cancer patients, which included a substantial proportion of FTC patients. Methods: We retrospectively studied adult patients with DTC who were diagnosed and/or treated at a Dutch university hospital between January 2002 and December 2015. All patients fulfilled the 2015 ATA high-risk criteria. Overall survival and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method. Logistic regression and Cox proportional hazards models were used to estimate the effects of DTC subtype and ATA high-risk criteria on response to therapy, recurrence, as well as survival. Results: We included 236 patients with high-risk DTC (32% FTC) with a mean age of 56 years. Median follow-up was 6 years. At final follow-up, 69 patients (29%) had excellent response, while 120 (51%) had structural disease. All high-risk criteria, except large pathologic lymph nodes, were inversely related to excellent response and positively related to structural disease at final follow-up. During follow-up, 14% of the 79 patients who achieved excellent response developed a recurrence. Finally, 10-year DSS was much higher in the initial excellent response than in the initial structural disease group (100% vs. 61%, respectively). Conclusions: In a population of high-risk DTC patients harboring a large subset of FTC patients, the 2015 ATA Risk Stratification System is not only an excellent predictor of persisting disease but also of survival. As much as 14% of the high-risk patients who had an excellent response upon dynamic risk stratification experienced a recurrence during follow-up. Clinicians should thus be aware of the relatively high recurrence risk in these patients, even after an excellent response to therapy.
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MESH Headings
- Adenocarcinoma, Follicular/mortality
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/mortality
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Adult
- Aged
- Bone Neoplasms/secondary
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Kaplan-Meier Estimate
- Logistic Models
- Lung Neoplasms/secondary
- Male
- Middle Aged
- Neck Dissection
- Neoplasm Recurrence, Local
- Netherlands
- Prognosis
- Proportional Hazards Models
- Protein Kinase Inhibitors/therapeutic use
- Radiotherapy
- Retrospective Studies
- Risk Assessment
- Societies, Medical
- Survival Rate
- Thyroid Cancer, Papillary/mortality
- Thyroid Cancer, Papillary/pathology
- Thyroid Cancer, Papillary/therapy
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Treatment Outcome
- Tumor Burden
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Affiliation(s)
- Evert F S van Velsen
- 1Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Merel T Stegenga
- 1Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Folkert J van Kemenade
- 2Academic Center for Thyroid Diseases, Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Boen L R Kam
- 3Academic Center for Thyroid Diseases, Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- 4Academic Center for Thyroid Diseases, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Edward Visser
- 1Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- 1Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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9
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Abstract
Hürthle cell tumors (HCT), including Hürthle cell adenomas (HCA) and Hürthle cell carcinomas (HCCs), arise in the thyroid gland and are defined in part by an accumulation of mitochondria. These neoplasms were long considered a subtype of follicular neoplasm, although HCT is now generally considered a distinct entity. HCTs exhibit overlapping but distinct clinical features compared to follicular tumors, and several studies have demonstrated that HCTs harbor distinct genomic alterations compared to other forms of thyroid cancer. Two studies recently reported the most complete characterization of the HCC genome to date. These studies assessed complementary cohorts of HCC specimens. The study by Ganly et al. consisted of a large panel of primary HCCs, including 32 widely invasive and 24 minimally invasive primary tumors. Exome and RNA sequencing of material isolated from fresh-frozen tumor specimens was performed. The study by Gopal et al. utilized exome and targeted sequencing to characterize the nuclear and mitochondrial genomes of 32 primary tumors and 38 resected regional and distant metastases using DNA isolated from formalin-fixed paraffin-embedded tissues. Here, HCC is briefly reviewed in the context of these studies.
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Affiliation(s)
- Ian Ganly
- 1 Human Oncology and Pathogenesis Program, Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David G McFadden
- 2 Department of Internal Medicine, Division of Endocrinology, Department of Biochemistry, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Dehbi HM, Mallick U, Wadsley J, Newbold K, Harmer C, Hackshaw A. Recurrence after low-dose radioiodine ablation and recombinant human thyroid-stimulating hormone for differentiated thyroid cancer (HiLo): long-term results of an open-label, non-inferiority randomised controlled trial. Lancet Diabetes Endocrinol 2019; 7:44-51. [PMID: 30501974 PMCID: PMC6299255 DOI: 10.1016/s2213-8587(18)30306-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Two large randomised trials of patients with well-differentiated thyroid cancer reported in 2012 (HiLo and ESTIMABL1) found similar post-ablation success rates at 6-9 months between a low administered radioactive iodine (131I) dose (1·1 GBq) and the standard high dose (3·7 GBq). However, recurrence rates following radioactive iodine ablation have previously only been reported in observational studies, and recently in ESTIMABL1. We aimed to compare recurrence rates between radioactive iodine doses in HiLo. METHODS HiLo was a non-inferiority, parallel, open-label, randomised controlled factorial trial done at 29 centres in the UK. Eligible patients were aged 16-80 years with histological confirmation of differentiated thyroid cancer requiring radioactive iodine ablation (performance status 0-2, tumour stage T1-T3 with the possibility of lymph-node involvement but no distant metastasis and no microscopic residual disease, and one-stage or two-stage total thyroidectomy). Patients were randomly assigned (1:1:1:1) to 1·1 GBq or 3·7 GBq ablation, each prepared with either recombinant human thyroid-stimulating hormone (rhTSH) or thyroid hormone withdrawal. Patients were followed up at annual clinic visits. Recurrences were diagnosed at each hospital with a combination of established methods according to national standards. We used Kaplan-Meier curves and hazard ratios (HRs) for time to first recurrence, which was a pre-planned secondary outcome. This trial is registered with ClinicalTrials.gov, number NCT00415233. RESULTS Between Jan 16, 2007, and July 1, 2010, 438 patients were randomly assigned. At the end of the follow-up period in Dec 31, 2017, median follow-up was 6·5 years (IQR 4·5-7·6) in 434 patients (217 in the low-dose group and 217 in the high-dose group). Confirmed recurrences were seen in 21 patients: 11 who had 1·1 GBq ablation and ten who had 3·7 GBq ablation. Four of these (two in each group) were considered to be persistent disease. Cumulative recurrence rates were similar between low-dose and high-dose radioactive iodine groups (3 years, 1·5% vs 2·1%; 5 years, 2·1% vs 2·7%; and 7 years, 5·9% vs 7·3%; HR 1·10 [95% CI 0·47-2·59]; p=0·83). No material difference in risk was seen for T3 or N1 disease. Recurrence rates were also similar among patients who were prepared for ablation with rhTSH and those prepared with thyroid hormone withdrawal (3 years, 1·5% vs 2·1%; 5 years, 2·1% vs 2·7%; and 7 years, 8·3% vs 5·0%; HR 1·62 [95% CI 0·67-3·91]; p=0·28). Data on adverse events were not collected during follow-up. INTERPRETATION The recurrence rate among patients who had 1·1 GBq radioactive iodine ablation was not higher than that for 3·7 GBq, consistent with data from large, recent observational studies. These findings provide further evidence in favour of using low-dose radioactive iodine for treatment of patients with low-risk differentiated thyroid cancer. Our data also indicate that recurrence risk was not affected by use of rhTSH. FUNDING Cancer Research UK.
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Affiliation(s)
- Hakim-Moulay Dehbi
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | | | | | | | | | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK.
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Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2018; 6:500-514. [PMID: 29102432 DOI: 10.1016/s2213-8587(17)30325-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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12
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Christakis I, Dimas S, Kafetzis ID, Roukounakis N. Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment. Ann R Coll Surg Engl 2018; 100:357-365. [PMID: 29484944 PMCID: PMC5956592 DOI: 10.1308/rcsann.2018.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/surgery
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/epidemiology
- Adenoma, Oxyphilic/surgery
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/diagnosis
- Carcinoma/epidemiology
- Carcinoma/surgery
- Carcinoma/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/therapy
- Female
- Humans
- Incidence
- Incidental Findings
- Male
- Middle Aged
- Neoplasm Invasiveness
- Practice Guidelines as Topic
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Young Adult
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Affiliation(s)
- I Christakis
- Department of Endocrine Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Dimas
- Department of Endocrine Surgery, Mediterraneo Hospital, Athens, Greece
| | - ID Kafetzis
- Department of Endocrine Surgery, Errikos Dunant Hospital Center, Athens, Greece
| | - N Roukounakis
- First Department of General Surgery and Transplantation, ‘Evangelismos‘ General Hospital, Athens, Greece
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13
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Stanzel S, Gyürüs P, Kresnik E, Aigner R. A rare case of Marine-Lenhart syndrome with unilateral endocrine orbitopathy and Hürthle cell carcinoma. Nuklearmedizin 2017; 56:N28-N30. [PMID: 28488725 DOI: 10.3413/nukmed-0862-16-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/07/2017] [Indexed: 11/20/2022]
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14
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15
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Qasem E, Murugan AK, Al-Hindi H, Xing M, Almohanna M, Alswailem M, Alzahrani AS. TERT promoter mutations in thyroid cancer: a report from a Middle Eastern population. Endocr Relat Cancer 2015; 22:901-8. [PMID: 26354077 DOI: 10.1530/erc-15-0396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 09/09/2015] [Indexed: 01/03/2023]
Abstract
Telomerase reverse transcriptase (TERT) promoter mutations C228T and C250T have recently been described in follicular cell-derived thyroid cancer (TC) in patients from North America and Europe. In this study, we explored whether these findings could be replicated in patients from a different ethnic group. We screened 17 benign thyroid adenomas and 265 TC samples from patients in the Middle East for these mutations by PCR and direct sequencing using DNA isolated from paraffin-embedded tumor tissues. None of the 17 benign adenomas harbored TERT promoter mutations. Of 265 TC, 34 (12.8%) harbored TERT promoter mutations, including 10/153 (6.5%) conventional papillary TC (CPTC), 8/57 (14.0%) follicular variant PTC, 9/30 (30%) tall cell variant PTC, 1/3 (30%) Hurthle cell thyroid cancer (HTC), 1/5 (20%) follicular TC, and 5/13 (38.5%) poorly differentiated TC. C250T mutation was present in only 6/265 (2.3%) cases, while C228T mutation was present in a total of 28/265 (10.6%) cases. These two mutations were mutually exclusive. TERT promoter mutations were significantly more common in older (≥45 years) than younger patients and were associated with larger tumour size, vascular invasion, higher TNM stage (stage III and IV), BRAF(V600E) mutation and persistent/recurrent disease at 6-12 months after initial treatment and at the last follow up. These associations were stronger in non-CPTC. Thus, this study on a large cohort of TC patients from Middle East demonstrates that TERT promoter mutations are relatively common, especially in the non-CPTC, and are associated with more aggressive histopathological features, BRAF(V600E) mutation, and disease persistence/recurrence than the WT TERT.
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MESH Headings
- Adenocarcinoma, Follicular/ethnology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenoma/ethnology
- Adenoma/genetics
- Adenoma/pathology
- Adenoma, Oxyphilic/ethnology
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Age Factors
- Aged
- Arabs/genetics
- Carcinoma, Papillary/ethnology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Child
- Combined Modality Therapy
- DNA, Neoplasm/genetics
- Ethnicity/genetics
- Female
- Follow-Up Studies
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Mutation, Missense
- Neoplasm Invasiveness
- Neoplasm Proteins/genetics
- Neoplasm Staging
- Point Mutation
- Promoter Regions, Genetic/genetics
- Proto-Oncogene Proteins B-raf/genetics
- Recurrence
- Saudi Arabia/epidemiology
- Telomerase/genetics
- Thyroid Neoplasms/ethnology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Treatment Outcome
- Tumor Burden
- Young Adult
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Affiliation(s)
- Ebtesam Qasem
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avaniyapuram Kannan Murugan
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hindi Al-Hindi
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mingzhao Xing
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mai Almohanna
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meshael Alswailem
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali S Alzahrani
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Shuch B, Amin A, Armstrong AJ, Eble JN, Ficarra V, Lopez-Beltran A, Martignoni G, Rini BI, Kutikov A. Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity. Eur Urol 2014; 67:85-97. [PMID: 24857407 DOI: 10.1016/j.eururo.2014.04.029] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/29/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Once believed to represent a uniform malignant phenotype, renal cell carcinoma (RCC) is now viewed as a diverse group of cancers that arise from the nephron. OBJECTIVE To review the pathologic characteristics, clinical behavior, molecular biology, and systemic therapy options of recognized RCC histologic subtypes. EVIDENCE ACQUISITION A systematic review of English-language articles was performed using the Medline and Web of Science databases. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. EVIDENCE SYNTHESIS The major findings of the evaluated manuscripts are discussed with an emphasis on the description of the pathologic features, clinical behavior, prognosis, and therapeutic strategies. CONCLUSIONS Classification schemes for kidney cancer have undergone dramatic changes over the past two decades. Improvements in these classification schemes are important, as pathologic variants differ not only in disease biology, but also in clinical behavior, prognosis, and response to systemic therapy. In the era of genomic medicine, further refinements in characterization of RCC subtypes will be critical to the progress of this burgeoning clinical space. PATIENT SUMMARY Kidney cancer can be subdivided into related but different cancers that arise from the kidney's tubules. In this article we review current classifications for kidney cancer, discuss their characteristics, and provide an overview of each subtype's clinical behavior and treatment. We stress that each subtype harbors unique biology and thus responds differently to available treatment strategies.
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MESH Headings
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Carcinoma, Renal Cell/classification
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/therapy
- Humans
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Prognosis
- Translocation, Genetic
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Affiliation(s)
- Brian Shuch
- Department of Urology, Yale School of Medicine, New Haven, CT, USA.
| | - Ali Amin
- Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Andrew J Armstrong
- Divisions of Urology and Medical Oncology, Departments of Medicine and Surgery, Duke School of Medicine, Durham, NC, USA
| | - John N Eble
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vincenzo Ficarra
- Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padova, Padova, Italy
| | - Antonio Lopez-Beltran
- Unit of Anatomical Pathology, Department of Surgery and Pathology, University of Cordoba, Faculty of Medicine, Cordoba, Spain
| | - Guido Martignoni
- Department of Pathology and Diagnostic, University of Verona and Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Brian I Rini
- Department of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
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17
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Mori T, Mishima H, Sakai H, Noguchi S, Maruo K. Multimodal therapy for the treatment of an oncocytoma in the nasal cavity of a cat. J Small Anim Pract 2013; 54:390. [PMID: 23718925 DOI: 10.1111/jsap.12094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Cinel M, Aksoy S, Dede DS, Dizdar O, Altundag K. Oncocytic carcinoma of the breast: rare histology. Am Surg 2010; 76:E25. [PMID: 21457641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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19
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Hu YW, Lin CZ, Li WY, Chang CP, Wang LW. Locally advanced oncocytic carcinoma of the nasal cavity treated with surgery and intensity-modulated radiotherapy. J Chin Med Assoc 2010; 73:166-72. [PMID: 20231003 DOI: 10.1016/s1726-4901(10)70033-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 12/11/2009] [Indexed: 11/30/2022] Open
Abstract
Oncocytic carcinomas of the nasal cavity are extremely rare. We report 1 patient whose primary tumor and neck lymphadenopathies were under control nearly 2 years after combined surgery and radiotherapy. An 80-year-old man with a history of nasal oncocytoma had received excision twice previously. Computed tomography demonstrated locally advanced recurrent tumor invading the paranasal sinuses and orbit with lymphadenopathies in the right neck. Skull base surgery was performed. Pathological examination revealed oncocytic carcinoma. Positron emission tomography showed hypermetabolic lesions in the surgical bed and right neck. The patient subsequently received intensity-modulated radiotherapy to the primary site and the whole neck. Follow-up computed tomography 4 months later showed marked shrinkage of the neck lymphadenopathies. There was no progression after nearly 2 years. Although these tumors have historically been regarded as radioresistant, the combined treatment of surgery followed by radiotherapy may offer the best chance for control of locally advanced disease.
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Affiliation(s)
- Yu-Wen Hu
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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20
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Carmichael KA. Hürthle cell carcinoma in a patient with Graves' Disease. Mo Med 2009; 106:366-368. [PMID: 19902719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hürthle cell, a rare form of thyroid carcinoma, has been reported only five times in patients with Grave's Disease. We present a case report and comprehensive review of the literature. Surgery should be considered in patients with both Graves' Disease and an expanding goiter. Initial high-dose radioiodine should be administered post-operatively in patients with Hürthle cell carcinoma. Serum thyroglobulin and 18-FDG total body PET imaging may be valuable in discovering residual or recurrent disease.
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Affiliation(s)
- Kim A Carmichael
- Division of Endocrinology, Metabolism and Lipid Research, Department of Internal Medicine, Washington University School of Medicine, USA.
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21
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Musholt PB, Musholt TJ, Morgenstern SC, Worm K, Sheu SY, Schmid KW. Follicular histotypes of oncocytic thyroid carcinomas do not carry mutations of the BRAF hot-spot. World J Surg 2008; 32:722-8. [PMID: 18235983 DOI: 10.1007/s00268-007-9431-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The BRAF V600E mutation is the most prevalent genetic aberration in papillary thyroid carcinomas (PTCs), and it is found exclusively in RET/PTC-negative tumors. In oncocytic (Hürthle cell, oxyphilic) thyroid tumors, the presence of RET/PTC rearrangements is associated with either the conventional papillary histotype or the "solid" Hürthle cell tumors, whereas all predominantly follicular oncocytic carcinomas do not harbor RET/PTC chimeras. Although 12% of tumors of the follicular variant of PTC carry BRAF mutations, none of the few oncocytic follicular thyroid adenomas (oncoAd) or carcinomas (oncoFTC) published worldwide tested positive. An aspired molecular-based classification of oncocytic thyroid tumors is in need of additional evidence on BRAF mutations in the follicular histotype. METHODS A series of 44 oncocytic thyroid tumors with well-documented clinicopathological data was subjected to BRAF mutation analysis (complete exon 15) by automated sequencing. RESULTS The series of oncocytic thyroid tumors consisted of 21 adenomas (oncoAds: 17 females, 4 males; mean age, 54.5 years; range, 27-80 years), 20 follicular carcinomas (oncoFTCs: 14 females, 6 males; mean age, 61.4 years; range, 39-80 years), and 3 "classic" papillary carcinomas (oncoPTCs: 3 females; mean age, 58.1 years; range, 46-70 years; 3x T2 tumors). The follicular variants of oncocytic cancers are divided into 11x T2, 5x T3, and 4x T4 tumor stages (International Union Against Cancer [UICC] TNM 5th edition). None of the 44 neoplasms of the presented series demonstrated genetic alterations in the BRAF hot-spot region (exon 15, codons 599-601). Congruently, 0/10 oncoAd and 0/20 oncoFTC described in the literature so far carried BRAF V600E mutations. CONCLUSIONS Our results add to the evidence that, in contrast to follicular variants of oncoPTCs, predominantly follicular oncocytic thyroid tumors harbor neither RET/PTC rearrangements nor BRAF mutations. Furthermore, the findings support the concept that oncocytic neoplasms of the thyroid gland are oncocytic counterparts of the respective histotype (adenoma, FTC, PTC, or poorly differentiated thyroid carcinoma) rather than a separate tumor entity. Molecular characterization of oncocytic thyroid malignancies for RET/PTC or BRAF genetic alterations may help with (preoperative) classification and prognostic evaluation of these tumors.
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MESH Headings
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Cohort Studies
- DNA Mutational Analysis
- Female
- Humans
- Male
- Middle Aged
- Mutation
- Polymerase Chain Reaction
- Proto-Oncogene Proteins B-raf/genetics
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
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Affiliation(s)
- Petra B Musholt
- Department of Endocrine Surgery, Gutenberg University Medical School, Johannes Gutenberg University, Langenbeckstr. 1, 55101 Mainz, Germany.
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Abstract
BACKGROUND Renal oncocytoma has been reported mostly in the Western literature, and only a few cases have been reported in Eastern populations. In the present study, we review the clinical course of renal oncocytoma in our institution. METHODS We obtained the files of 13 cases of renal oncocytoma between 1988 and 2006 from the pathological archives of Taipei Veterans General Hospital. We retrospectively analyzed the patients' characteristics, clinical manifestations, surgical technique and clinical outcome. RESULTS The study population comprised 10 men and 3 women, and the mean age at diagnosis was 59.6 years (range, 37-75 years). Twelve patients (92%) were asymptomatic at presentation and were incidentally diagnosed to have renal tumor by sonography (9 patients), computed tomography (1 patient) or magnetic resonance imaging (2 patients), and 1 presented with hematuria. The clinical impression of oncocytoma was made preoperatively in only 3 patients by imaging studies, and most of the patients (76.9%) were diagnosed with renal cell carcinoma before surgery. Ten were treated with radical nephrectomy, 2 with partial nephrectomy, and 1 received excisional biopsy. All patients had unilateral solitary renal tumor; the right kidney was involved in 7 cases (54%) and the left in 6 (46%). Mean tumor size was 5.3 cm (range, 2.7-8.5 cm). Three patients were lost to follow-up in our series, and there was no recurrence or death (100% disease-specific survival) in the remaining 10 patients (77%) who were followed-up for a mean duration of 53.2 months (range, 10-117 months). CONCLUSION Renal oncocytoma has a benign clinical course with excellent long-term outcomes. Currently, nephron-sparing surgery is the mainstay of treatment, especially in patients with small tumors. However, accurate preoperative diagnosis based only on imaging studies is difficult, and radical nephrectomy was performed for most of the patients in our series.
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Affiliation(s)
- Yu-Hua Fan
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lin CC, Tsai MH, Huang CC, Hua CH, Tseng HC, Huang ST. Parotid tumors: a 10-year experience. Am J Otolaryngol 2008; 29:94-100. [PMID: 18314019 DOI: 10.1016/j.amjoto.2007.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 02/27/2007] [Accepted: 03/02/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the present study was to analyze the clinical presentation, histopathology, and complications of parotid tumors, as well as the management of malignant parotid tumors. METHODS We retrospectively reviewed the medical records of 271 patients who underwent parotidectomy from August 1996 to July 2006. Data including age, sex, clinical signs and symptoms, histologic findings, complications, malignant tumor stage, and prognosis were collected from medical charts. RESULTS Of the 271 patients who underwent parotidectomy, 229 (85%) had benign tumors, 33 (12%) had malignant tumors, and 9 had chronic inflammatory disease (3%). The most common benign tumor was pleomorphic adenoma (51%), and the most common malignant tumor was mucoepidermoid carcinoma (3%). The 5-year overall survival rate was 42%, and the disease-specific survival rate for malignant tumor was 72%. Only disease stage was the statistically significant prognostic factor of malignancy. The most common complication of parotidectomy was transient facial palsy (18%). CONCLUSIONS Standardized superficial and total parotidectomy are safe procedures for treating parotid tumors. Management of malignant tumors depends on tumor stage and histologic grade. Advanced tumor stage is a predictor of poor outcome.
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Affiliation(s)
- Ching-Chia Lin
- Department of Otolaryngology, China Medical University Hospital, Taichung, Taiwan
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24
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Marglani O, Alherabi A, Corsten M. Malignant oncocytoma of the lacrimal sac with cervical metastasis: case report and literature review. J Otolaryngol Head Neck Surg 2008; 37:E8-E10. [PMID: 18479617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Osama Marglani
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario
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25
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Hölz S, Verse T. [Dysphagia and cervical space-occupying lesion]. HNO 2007; 55:804-6. [PMID: 17786396 DOI: 10.1007/s00106-007-1599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S Hölz
- HNO-Abteilung, Asklepios-Klinik Harburg, Hamburg.
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26
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Abe T, Murakami A, Nakajima N, Inoue T, Ohde S, Miwa M, Ueda Y, Kawabata K, Watanabe K. Oncocytic carcinoma of the nasal cavity with widespread lymph node metastases. Auris Nasus Larynx 2007; 34:393-6. [PMID: 17459629 DOI: 10.1016/j.anl.2007.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 11/11/2006] [Accepted: 01/19/2007] [Indexed: 01/12/2023]
Abstract
The first case of oncocytic carcinoma which arose from the inferior turbinate of the nasal cavity with orbital invasion through the nasolacrimal canal and widespread lymph node metastases in the neck and face is reported here. The tumor metastasized rapidly, spread widely to the whole neck and face, and produced tumor emboli in the lymphatics and extranodal extension by rupture of the lymph node capsule in the absence of clinically palpable regional lymph node enlargement. We think the oncocytic carcinoma of the nasal cavity may be a high-grade malignancy tumor.
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Affiliation(s)
- Tsugio Abe
- Department of Otorhinolaryngology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama 343-8555, Japan.
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27
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Fotiadis NI, Sabharwal T, Morales JP, Hodgson DJ, O'Brien TS, Adam A. Combined Percutaneous Radiofrequency Ablation and Ethanol Injection of Renal Tumours: Midterm Results. Eur Urol 2007; 52:777-84. [PMID: 17400364 DOI: 10.1016/j.eururo.2007.03.063] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 03/19/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of combined percutaneous, image-guided, radiofrequency (RF) ablation and ethanol injection of renal tumours, and to present our midterm results. METHODS Since February 2002, 27 consecutive patients (22 men, 5 women; age range: 39-84 yr; mean: 69) with 28 renal tumours (mean diameter: 2.87cm) were treated with combined percutaneous RF and ethanol ablation, and were prospectively evaluated. Twenty-five patients were considered nonsurgical candidates because of comorbid conditions (16 patients) or had previous nephrectomy (9 patients), and 2 had refused surgery. Thirty-three ablation sessions were performed, with computed tomography (26 sessions), ultrasound (6), or combined magnetic resonance imaging/fluoroscopic guidance in 1. Absolute ethanol (0.5-3ml; mean: 1.7) was injected into the tumour immediately before treatment with radiofrequency. Mean follow-up period was 18.6 mo (range: 3-56). RESULTS Twenty-seven of the 28 tumours were completely ablated with either one (21 tumours) or two treatment sessions (6 tumours). One patient with residual disease refused further treatment. Only three minor complications, including a subcapsular haematoma and two patients with loin pain, occurred; all three patients were treated conservatively. None of the complications was related to the ethanol injection. During the follow-up period, no evidence of local recurrence or metastatic disease was seen. Creatinine levels have not changed significantly in any of the patients following ablation. CONCLUSIONS Combined use of percutaneous RF and ethanol ablation is a safe and effective alternative treatment for selective patients with renal tumours.
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Affiliation(s)
- Nicos I Fotiadis
- Department of Interventional Radiology, Guy's and St Thomas' Hospital, London, UK.
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28
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Abstract
A 72-year-old man presented with a 2-year history of epiphora. CT revealed an extensive inferomedial orbital tumor connected to the lacrimal sac and duct. Incisional biopsy revealed malignant oncocytoma of the lacrimal sac. The patient was treated with exenteration and maxillectomy followed by a course of postoperative radiotherapy. Patients with malignant oncocytoma may present with simple epiphora in absence of other signs and symptoms such as blood stained tearing or purulent rhinorrhea.
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Affiliation(s)
- Hunter K L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong, SAR, China.
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29
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Abstract
BACKGROUND Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy. CASE REPORT A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months. CONCLUSION For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.
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Affiliation(s)
- Murat Caloglu
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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30
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Caplan RH. Radioactive iodine scanning and treatment in management of Hürthle cell thyroid carcinoma. Endocr Pract 2006; 12:342; author reply 342. [PMID: 16772210 DOI: 10.4158/ep.12.3.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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Ghossein RA, Hiltzik DH, Carlson DL, Patel S, Shaha A, Shah JP, Tuttle RM, Singh B. Prognostic factors of recurrence in encapsulated Hurthle cell carcinoma of the thyroid gland: a clinicopathologic study of 50 cases. Cancer 2006; 106:1669-76. [PMID: 16534796 DOI: 10.1002/cncr.21825] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Follicular carcinomas of the thyroid gland, including its oncocytic variant (so-called Hurthle cell carcinoma), are subdivided into the indolent encapsulated ("minimally invasive") and the clinically aggressive widely invasive tumors. There are, however, cases of encapsulated follicular carcinoma that recur and metastasize. Identifying these cases at the time of diagnosis is crucial for prognostic and therapeutic considerations. Because to the authors' knowledge most studies do not focus exclusively on the encapsulated Hurthle cell carcinoma (EHC), the current study attempted to identify predictors of recurrence in EHC. METHODS A tumor was defined as EHC if it was encapsulated, macroscopically well defined with microscopic but no macroscopic evidence of vascular or capsular invasion, and composed of > 75% follicular oncocytic cells. Retrospective chart review and microscopic examination identified 50 primary tumors meeting the above criteria at the Memorial Sloan-Kettering Cancer Center between 1967 and 2005. The cases were analyzed for various histologic and clinical parameters. Each parameter was correlated with recurrence-free survival (RFS). RESULTS Seven of 50 (14%) patients developed disease recurrence. All patients who developed recurrence were found to have a high number of foci of vascular invasion (> or = 4). In univariate analysis, > or = 4 foci of vascular invasion (P <.0001), tumor size > 4 cm (P = .049), the presence of mitosis (P = .018), and a solid/trabecular growth pattern (P = .009) were found to be correlated with a decreased RFS. Extensive capsular invasion, gender, and age did not confer a statistically higher recurrence rate. The finding of a solid/trabecular growth and mitosis correlated with the presence of numerous foci (> or = 4) of vascular invasion (P = .01 and P = .005, respectively). CONCLUSIONS A diligent search for vascular invasion is recommended in EHC that display mitosis or a solid/trabecular growth pattern. The presence of > or = 4 foci of vascular invasion should alert the pathologist and the clinician to a significantly higher risk of recurrence in EHC.
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Affiliation(s)
- Ronald A Ghossein
- Department of Pathology Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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32
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Neuzillet Y, Lechevallier E. [Renal oncocytoma]. Prog Urol 2006; 16:105-11. [PMID: 16734229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Due to its nonspecific clinical and radiological features, renal oncocytoma is usually diagnosed on the operative specimen. Histological confirmation of the diagnosis is based on the distinction between oncocytoma and renal cell carcinoma (RCC), which can be difficult. Description of cases in which RCC and oncocytoma are present in the same tumour and the hypothesis of a link between oncocytoma and RCC further complicate the diagnosis of this tumour by the urologist. The authors reviewed the management of tumours suspected to be oncocytoma based on a review of the international literature concerning the diagnosis, natural history and treatment of renal oncocytoma.
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Affiliation(s)
- Yann Neuzillet
- Service d'Urologie, Hôpital Salvator, Marseille, France.
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33
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Abstract
Hürthle cell papillary thyroid carcinoma (HCPTC) has been studied separately from other types of thyroid carcinoma in relatively few studies. The aim of our study was to determine the factors associated with the survival of patients with HCPTC in Slovenia, an iodine-deficient region. A total of 1552 patients with thyroid carcinoma were seen at our institute during the period of 1976-2003; of them, 42 patients (33 females, 9 males; age 10-85 years, median 56.5 years) had histopathologically verified HCPTC. The data on the patients' gender, age, disease history, extent of disease, morphologic characteristics, therapy, locoregional control, disease-free interval, and survival were collected. The statistical correlation between possible prognostic factors and the disease-free interval and survival was analyzed by chi2 test and log rank analysis. The tumor diameter ranged from 1 to 9 cm (median, 3 cm). Extrathyroid tumor growth was found in 19 patients, lymph node metastases in 13 patients, and distant metastases in 2 patients. Primary treatment consisted of total or near-total thyroidectomy (39 patients), lobectomy (2 patients), radioiodine ablation of the thyroid remnant (37 patients), external irradiation (14 patients), and chemotherapy (3 patients). Locoregional recurrence was diagnosed in four patients, and dissemination in 1 patient during the follow-up period of 0.75-20 years (median, 5.5 years). Three patients died of thyroid carcinoma during the follow-up period. The 5-year and 10-year survivals were 94% and 87%, respectively. The 5-year and 10-year disease-free intervals were 93% and 81%, respectively. The factors correlated with the survival were: age, extrathyroid tumor growth, primary tumor stage, and regional and distant metastases. Although extrathyroidal tumor growth was found in 45% of the patients with HCPTC, our patients had a favorable prognosis. Long-term survival and locoregional control of disease are likely after the radical tumor resection, radioiodine ablation of the thyroid remnant, and external irradiation.
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Affiliation(s)
- N Besic
- Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia.
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34
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Haigh PI, Urbach DR. The treatment and prognosis of Hürthle cell follicular thyroid carcinoma compared with its non-Hürthle cell counterpart. Surgery 2005; 138:1152-7; discussion 1157-8. [PMID: 16360403 DOI: 10.1016/j.surg.2005.08.034] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 08/16/2005] [Accepted: 08/19/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND This population study compared the treatment and prognosis of Hürthle cell follicular thyroid carcinoma (HCFC) and non-HCFC. METHODS The Surveillance, Epidemiology and End Results database identified patients with HCFC and non-HCFC from 1988 to 1993 who were followed to 2001. Treatment of each carcinoma was compared, and the effect of prognostic factors on survival was analyzed. RESULTS Eight hundred forty-five patients were identified; 172 patients (20%) had HCFC and 673 patients (80%) had non-HCFC. Total thyroidectomy was performed in 80% of patients with HCFC compared with 69% with non-HCFC (P = .005). Radioactive iodine was used in 33% with HCFC and 45% with non-HCFC (P = .003). The crude 10-year survival was 73% in HCFC and 83% in non-HCFC patients. Older age (> or =50 vs <50 years; hazard ratio, 6.35; 95% CI, 4.07-9.93), men (hazard ratio, 2.07; 95% CI, 1.52-2.81), larger tumor size (>5 vs < or =5 cm; hazard ratio, 2.20; 95% CI, 1.55-3.13; >10 cm vs < or =5 cm; hazard ratio, 3.28; 95% CI, 1.12-9.61), nodal metastases (hazard ratio, 3.11; 95% CI, 1.80-5.37), and distant metastases (hazard ratio, 3.91; 95% CI, 1.94-7.90) were associated with a higher mortality rate. Histologic type (non-HCFC vs HCFC; hazard ratio, 0.85; 95% CI, 0.60-1.19; P = .34), local extension, extent of thyroidectomy, and radioactive iodine use had no effect on the mortality rate. CONCLUSIONS Histologic distinction between HCFC and non-HCFC is not as prognostically important as age, gender, and tumor stage. This study suggests that patients with HCFC should be treated the same as patients with equivalent stage non-HCFC.
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Affiliation(s)
- Philip I Haigh
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, CA 90027, USA.
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35
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Neuzillet Y, Lechevallier E, Andre M, Daniel L, Nahon O, Coulange C. Follow-up of renal oncocytoma diagnosed by percutaneous tumor biopsy. Urology 2005; 66:1181-5. [PMID: 16360437 DOI: 10.1016/j.urology.2005.06.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 04/30/2005] [Accepted: 06/01/2005] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To evaluate the outcome of patients with oncocytoma of the kidney diagnosed in our center by percutaneous biopsy and treated with watchful waiting. METHODS From January 1998 to April 2004, of 148 solid renal tumors biopsied in our center, 15 were renal oncocytomas. The mean (+/- standard deviation) follow-up was 30 +/- 19.8 months. We report on the outcome of these patients. RESULTS The mean age at diagnosis was 57.6 +/- 14.4 years, and mean tumor size was 3.49 +/- 2.43 cm, corresponding to a mean tumor volume of 62.3 +/- 135.4 cm3. During follow-up, 6 of 15 patients needed surgery: two partial and four total nephrectomies. Indications for surgery were initial tumor burden, greater than 0.5 cm/yr tumor growth, and patient's preference in 1 case, 4 cases, and 1 case, respectively. The patients who received surgical treatment were significantly younger (45.5 +/- 11.1 years versus 65.6 +/- 10.3 years) and had more bulky tumors at diagnosis (50 +/- 30.1 mm versus 27.3 +/- 10.5 mm). In 1 patient, a chromophobic renal cell carcinoma was associated with the oncocytoma. All 9 patients who did not receive surgical treatment remained asymptomatic. CONCLUSIONS The evolution of renal oncocytoma seems to be increase of tumor size with variable velocity. Treatment must be conservative. Initial management might be nonsurgical with close follow-up. Monitoring should not miss the time of conservative surgery. Initial tumor volume or fast tumor growth are indications for surgery. Partial nephrectomy, if the tumor size and localization are reasonable, is currently the technique of choice.
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Affiliation(s)
- Yann Neuzillet
- Department of Urology, Hospital Salvator, Marseille, France.
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36
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Abstract
Thyroid cancer is a relatively common and frequently curable malignant neoplasm, accounting for nearly 2% of all new cancers diagnosed annually in the United States. The diagnostic and management options have evolved considerably in the past decade, and a current understanding of these trends in the standard of care have assumed an important consideration in the practices of head and neck surgeons and endocrinologists alike. We sought to review the epidemiology and pathology of the several types of thyroid cancer and to present our evidence-based management algorithm. Every effort was made to offer alternative treatment strategies and supporting data where available. In addition to reviewing well-established approaches to diagnosis and management, emphasis is placed on newer techniques, including minimally invasive thyroidectomy, molecular detection of disease propensity, and the use of recombinant thyrotropin prior to radioiodine ablation.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/therapy
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Biopsy, Fine-Needle
- Carcinoma/diagnosis
- Carcinoma/pathology
- Carcinoma/therapy
- Carcinoma, Medullary/diagnosis
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Evidence-Based Medicine
- Humans
- Lymphoma/diagnosis
- Lymphoma/pathology
- Lymphoma/therapy
- Radionuclide Imaging
- Thyroid Gland/anatomy & histology
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/embryology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- D Russell Blankenship
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta 30912-4060, USA
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37
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Arroyo C, Uribe-Uribe N, Borgen J, Gabilondo F. [Kidney oncocytoma: diagnostic and therapeutic approach in the INCMNSZ]. Rev Invest Clin 2004; 56:297-303. [PMID: 15612510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Renal oncocytoma is a benign tumor that in some series represents up to 18% of all solid neoplasms measuring 4 cm or less. Since radiologic distinction between a renal cell carcinoma and oncocitoma is practically impossible, the histologic examination represents the cornerstone of diagnosis. Follow up will be greatly modified by the diagnosis of oncocytoma since it displays a benign course. Eight cases are presented here that were treated at our institution with special mention to diagnosis and therapy. MATERIAL AND METHOD A retrospective review was performed using records of 288 patients with kidney tumors from 1971 to 2002. Cases had to have several tissue staining including E&O, Schiff's peryodic acid, coloidal Iron, Alcian blue and mucicarmin. RESULTS A total of 8 cases (4 men and 4 women) of oncocitoma were detected (2.7%). Patients had a mean age of 50 years (36-69), none had familial history of renal tumors and hipertension was detected in 6. Patients were diagnosed after surgery since radiologic studies suspected renal carcinoma in all patients. The neoplasms measuring more than 8 cm and association with renal cancer in a patient. Follow up was course benign in all patients without recurrence. DISCUSSION Renal oncocytoma represent a small proportion of renal tumors seen in our institution. It must be suspected in solid renal neoplasms measuring less than 4 cm more so if a centrally located scar is seen on CT scan creating a wagon wheel appearance. Definitive diagnosis is made by histologic examination after a chromophobe tumor is ruled out. Since it has a benign course, minimal radiologic follow up is warrented.
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Affiliation(s)
- Carlos Arroyo
- Dirección General, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF
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Shoup M, Stojadinovic A, Nissan A, Ghossein RA, Freedman S, Brennan MF, Shah JP, Shaha AR. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. J Am Coll Surg 2003; 197:191-7. [PMID: 12892796 DOI: 10.1016/s1072-7515(03)00332-6] [Citation(s) in RCA: 198] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Distant metastasis is uncommon in differentiated thyroid cancer and the prognosis is unclear. This study aims to evaluate outcomes and to define independent variables that are associated with tumor-related mortality in patients with distant metastasis from thyroid carcinoma. STUDY DESIGN A retrospective review of the thyroid cancer research database identified 336 patients with distant metastasis from differentiated thyroid carcinoma treated at a single institution between 1941 and 2000. After excluding patients with local or regional recurrence, distant disease was either the first site of recurrence or was detected at the time of diagnosis of the primary tumor in 242 patients (72%). Patient, tumor, and treatment-related factors were analyzed for their relation to disease-specific survival (DSS) using multivariate Cox regression and the log-rank test. RESULTS Median survival was 4.1 years and 10-year DSS was 26%. Distant disease was synchronous with the primary diagnosis in 97 of 242 (40%) patients. The site of metastasis was lung only in 103 (43%) patients, bone only in 80 (33%), other sites in 14 (6%), and more than one organ system in 45 (19%). Multivariate analysis identified age 45 years or more, symptoms, site other than lung only or bone only, and no radioactive iodine treatment for the metastasis as predictors of poor outcome with 13%, 11%, 16%, and 12% 10-year DSS, respectively. This compares with age less than 45 years, asymptomatic presentation, metastasis only in the lung or bone, and radioactive iodine treatment with 10-year DSS rates of 58%, 45%, 32%, and 33%, respectively (all p < 0.0001). Radioactive iodine treatment was more often given in patients who were less than 45 years of age, asymptomatic, and with metastasis only in the lung or bone only (p = 0.03, 0.11, 0.01). CONCLUSIONS Longterm survival is possible in patients with distant metastasis from differentiated thyroid cancer. This retrospective study found that age of 45 years or more, site other than lung only or bone only, and symptoms at the time of diagnosis are associated with poorer outcomes.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/secondary
- Adenocarcinoma, Follicular/therapy
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/secondary
- Adenocarcinoma, Papillary/therapy
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/secondary
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Female
- Humans
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Survival Analysis
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Treatment Outcome
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Affiliation(s)
- Margo Shoup
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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39
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Abstract
The large numbers of studies on the postoperative management of differentiated thyroid carcinoma allows us to use adjuvant treatment and follow-up studies more selectively based on patient risk for recurrence and mortality. Recurrent differentiated thyroid carcinoma is more easily and more effectively treated with early diagnosis. With this in mind, patients who are at high risk for life-threatening recurrent disease should be treated aggressively and followed up expectantly. In these patients, adjuvant treatment with 131I ablation and thyroid hormone suppression is appropriate. External irradiation may be considered, especially for patients with postoperative residual disease. Close follow-up with stimulated thyroglobulin and 131I whole body scans should be performed to facilitate early detection of recurrent disease. Low-risk patients may be effectively treated with more conservative management. 131I ablation has not resulted in improved survival in these patients. Follow-up with serum thyroglobulin after initial negative 131I whole body scan may be appropriate in these patients. Management of patients at intermediate risk remains controversial. Recombinant human thyrotropin allows us to obtain stimulated serum thyroglobulin and promises the ability to perform 131I ablation and whole body scan without the need for thyroid hormone withdrawal. Functional radionuclide imaging, such as FDG PET, now allows us to localize recurrent disease in patients with elevated serum thyroglobulin but negative 131I scan.
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Affiliation(s)
- Erik G Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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40
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Abstract
Thyroid cancer will be diagnosed in more than 20,000 individuals in the United States in 2002. Approximately 16,000 of these patients will be women. During the same year, an estimated 1300 deaths from thyroid cancer are expected. The various types of thyroid cancer include papillary carcinoma, follicular carcinoma, Hurthle cell carcinoma, medullary carcinoma, anaplastic carcinoma, and thyroid lymphoma. Papillary, follicular, and Hurthle cell carcinoma are considered well-differentiated thyroid cancers and constitute the focus of this article.
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Affiliation(s)
- Ryan T Boone
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot 543, Little Rock, AR 72205-7199, USA
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41
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Abstract
Oncocytoma is the most common benign solid renal tumor, comprising roughly 5% of resected renal masses. Typically discovered incidentally, oncocytoma is generally asymptomatic and very rarely metastasizes; however, multifocal disease and coexistence with renal cell carcinoma can occur. No currently used imaging techniques can reliably distinguish between oncocytoma and malignant lesions; therefore, patients must undergo resection, or in certain circumstances, biopsy, to definitively establish diagnosis. Careful attention to pathologic features and the adjunctive use of immunostains can aid in discriminating oncocytoma from other renal tumors characterized by granular, eosinophilic cytoplasm, especially chromophobe renal cell carcinoma. Nephron-sparing and laparoscopic surgical approaches can be used to treat appropriately selected patients.
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Affiliation(s)
- Stephen M Schatz
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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42
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Ogan K, Cadeddu JA, Sagalowsky AI. Radio frequency ablation induced acute renal failure. J Urol 2002; 168:186. [PMID: 12050520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Kenneth Ogan
- Clinical Center for Minimally Invasive Urologic Cancer Treatment, Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9110, USA
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43
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MESH Headings
- Adenoma, Oxyphilic/complications
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Humans
- Kidney/diagnostic imaging
- Kidney/pathology
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/pathology
- Kidney Failure, Chronic/therapy
- Kidney Neoplasms/complications
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Male
- Middle Aged
- Neoplasms, Multiple Primary/complications
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Tomography, X-Ray Computed
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44
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MESH Headings
- Adenoma, Oxyphilic/diagnostic imaging
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Carcinoma, Renal Cell/diagnostic imaging
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/therapy
- Diagnosis, Differential
- Humans
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/therapy
- Microscopy, Electron
- Radiography
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Affiliation(s)
- Debby H Chao
- Division of Urologic Oncology, Department of Urology, University of California, Los Angeles, School of Medicine, Los Angeles, California 90095-1738 , USA
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45
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Abstract
We evaluated the effectiveness of a replication-defective adenovirus-transducing thymidine kinase (TK) gene under the control of the rat Tg (rTg) promoter (AdrTgtk) in therapy of a human Hurthle cancer (XTC-1 cell) in vitro and in vivo. The ganciclovir (GCV) sensitivity of infected XTC-1 cells was assessed in vitro by H(3)-thymidine incorporation assay and Trypan-blue exclusion, and by an in vivo tumor development assay. Proliferation was strongly inhibited by adding GCV into the culture medium of infected cells, but not uninfected cells, proving cell infection and expression of TK in the XTC-1 cells. AdrTgtk, and also viruses that have the noncell-specific cytomegalovirus (CMV) promoter-directing expression of TK (AdCMVtk), or luciferase (AdCMVLuc), were used to transduce XTC-1 cells to evaluate killing effects. After infection with AdCMVtk or AdrTgtk, followed by GCV treatment, 70% of infected cells were killed in the presence of GCV, compared with less than 20% of cells infected by AdCMVLuc and treated with GCV. In vivo toxicity was studied in BALB/c mice. When adenovirus is given iv, liver is the major organ infected. No significant changes of the serum transaminase levels and no histological abnormalities were found in animals treated with AdrTgtk/GCV given iv, compared with control animals. High levels of serum transaminases, lymphocyte infiltration, some Kupffer's cell prominence, and extensive single-cell hepatocyte death were found in AdCMVtk/GCV-treated animals, indicating severe liver damage induced, as expected, by the noncell-specific CMV promoter. XTL-1 cells (2 x 10(6)) were injected sc into BALB/c-severe combined immunodeficient mice (BALB/c-SCID), and the mice developed tumors after 3 wk. After intratumoral injection of AdrTgtk and treatment with GCV, tumors stabilized in 15 of 17 mice within 3 wk, 9 tumors remained stabilized after 5 wk of treatment, and 2 disappeared during observation. In AdCMVLuc/GCV-treated control mice, almost all tumors grew continuously. The average tumor size in AdrTgtk-treated mice was significantly smaller than that of control animals after 2 wk of treatment. Our data confirm the effectiveness and specificity of an adenovirus using rTg promoter to express TK, and support its future application to thyroid cancer gene therapy in humans.
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Affiliation(s)
- Rusheng Zhang
- Thyroid Study Unit, Department of Medicine, The University of Chicago, Chicago, Illinois 60637, USA
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46
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Angelos P. Current approaches to the treatment of well-differentiated thyroid cancer. Oncology (Williston Park) 2002; 16:309-15; discussion 315, 318, 323-4. [PMID: 15046390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The management of well-differentiated thyroid cancer requires a multidisciplinary approach. The majority of patients are diagnosed only after a nodule is palpable. A cytologic evaluation can readily diagnose a papillary thyroid carcinoma but a follicular carcinoma requires determination of capsular or vascular invasion. Surgical considerations in well-differentiated thyroid cancer are frequently complicated by the need to operate on patients with indeterminate nodules. Also, the extent of surgery remains controversial. A total or near-total thyroidectomy has several advantages: (1) radioactive iodine can be used to ablate any residual thyroid tissue or cancer cells; (2) thyroglobulin levels can be used to follow a patient for recurrence; (3) the risk of leaving a focus of carcinoma in the remaining lobe is eliminated.
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Affiliation(s)
- Peter Angelos
- Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60611, USA
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47
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Stojadinovic A, Hoos A, Ghossein RA, Urist MJ, Leung DHY, Spiro RH, Shah JP, Brennan MF, Singh B, Shaha AR. Hürthle cell carcinoma: a 60-year experience. Ann Surg Oncol 2002; 9:197-203. [PMID: 11888879 DOI: 10.1007/bf02557374] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to define the clinical behavior and prognostic indicators of outcome in Hürthle cell cancer (HCC). METHODS Diagnosis was confirmed for 56 patients with HCC treated between 1940 and 2000, who form the basis of this study. Primary end points were relapse-free survival (RFS) and disease-specific survival (DSS). Data were analyzed with the Kaplan-Meier method and by log-rank test. RESULTS The extent of thyroid resection did not predict outcome. Recurrence was a significant predictor of tumor-related mortality. Significant adverse predictors of RFS and DSS were degree of invasion, size >4 cm, extrathyroidal extension, and initial nodal or distant metastases. The most significant predictor of outcome was extent of invasion. Eight-year RFS values for low- and high-risk groups were 100% and 24%. Corresponding rates of 8-year DSS were 100% and 58%. CONCLUSIONS Widely invasive HCC is an aggressive malignancy that identifies patients who are at high risk for recurrence and tumor-related death. Patients with HCC have a prognosis that is reliably predicted by degree of invasion, tumor size, extrathyroidal disease extension, and initial nodal or distant metastasis. Recurrence portends a poor outcome. High-risk patients and those with recurrence should be considered for adjuvant therapy.
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48
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Lima N, Cavaliere H, Tomimori E, Knobel M, Medeiros-Neto G. Prognostic value of serial serum thyroglobulin determinations after total thyroidectomy for differentiated thyroid cancer. J Endocrinol Invest 2002; 25:110-5. [PMID: 11929080 DOI: 10.1007/bf03343973] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Serial weekly serum samples (for 3 weeks) were obtained from 42 patients with differentiated thyroid cancer (DTC, papillary no.=35, follicular no.=6, Hurthle cell no.=1) for serum thyroid hormone, TSH and TG before and after total thyroidectomy. Serum specimens were also obtained one month after radioiodine (131I) therapy followed by suppressive dose of L-thyroxine (L-T4, 2.5 microg/kg). The patients were subdivided into four groups: group I: the DTC was confined to a single solid nodule (no.=1 2); group II: thyroid malignancy invaded local cervical structures but there were no lymph node metastases (no.=8); group III: DTC with lymph node metastases (no.=6); and group IV: DTC with distant metastases (no.=16). In all group I patients serum TG remained undetectable in spite of elevated serum TSH levels at the 3rd week post-surgery (PS). Only one of group II patients had a detectable serum TG value of 5.2 ng/ml (3rd week PS). By contrast, 37.5% of group III patients had detectable serum TG levels, ranging from 3.4 to 16.8 ng/ml (3rd week PS). Lymph node metastases were detected in 5 of these patients by whole body scan (WBS) and removed surgically in 3. As expected, group IV patients had elevated serum TG values ranging 33.0-958.0 ng/ml and distant metastases were confirmed in all of them by WBS. From the calculations through univariate logistic regression comparing TG concentrations at the 3rd week PS from groups I and II vs groups III and IV, we obtained a cut-off value of 2.3 ng/ml with the following efficacy features: sensitivity=74.5%; specificity=95%; positive predictive value=92.3%; negative predictive value=65.5%; and accuracy=73.8%. After 131I and L-T4 suppressive therapy, only 5 out of 36 patients of groups I, II and III had detectable serum TG levels (3.1-7.0 ng/ml) whereas serum TG was detectable in all group IV patients (ranging 2.5-8.6 ng/ml). We concluded that serum TG concentrations above 2.3 ng/ml at the 3rd week PS could be suggestive of lymph node or distant metastases in patients with DTC. Patients with serum TG above this limit could be considered at risk for metastatic disease and higher doses of diagnostic iodine-131 (131I) may be indicated for actinic ablation.
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MESH Headings
- Adenocarcinoma, Follicular/blood
- Adenocarcinoma, Follicular/surgery
- Adenocarcinoma, Follicular/therapy
- Adenoma, Oxyphilic/blood
- Adenoma, Oxyphilic/surgery
- Adenoma, Oxyphilic/therapy
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary/therapy
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Logistic Models
- Lymphatic Metastasis/diagnosis
- Male
- Middle Aged
- Neoplasm Metastasis/diagnosis
- Prognosis
- Thyroglobulin/blood
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Thyrotropin/blood
- Thyroxine/therapeutic use
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Affiliation(s)
- N Lima
- Endocrine Division, University of Sao Paulo Medical School, SP, Brazil
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49
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Abstract
Renal cell carcinomas account for 80-85% of all primary renal neoplasms. Recent identification of VHL, c-met and TSC as candidate genes mutated in various types of renal carcinomas has greatly enhanced our understanding of the pathogenesis of renal carcinomas and has provided novel therapeutic options for patients with renal cancer. Furthermore, developments in angiogenesis and in tumor immunology have given us additional treatment modalities for cancer patients, especially those with renal cancer. This review highlights the genetic abnormalities seen in renal cell carcinomas and reviews current and future therapeutic options.
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Affiliation(s)
- S Ananth Karumanchi
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
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50
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Marciano S, Petit P, Lechevallier E, De Fromont M, André M, Coulange C, Bartoli J. [Renal onococytic adenoma]. J Radiol 2001; 82:455-61. [PMID: 11353900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Renal oncocytic adenoma. Renal oncocytic adenoma is a rare neoplasm now considered as a benign tumour. The purpose of this paper is to describe the radiological features of this tumour and to assess the value of imaging work-up in the diagnosis and management of patients with renal oncocytic adenomas.
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Affiliation(s)
- S Marciano
- Service de Radiologie Adultes, Pr M Kasbarian, CHU Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
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