Insular carcinoma arising on a background of follicular carcinoma, thyrolipomatosis and amyloid goitre.

A 67-year-old man was referred with a history of a right-sided neck lump and dysphonia, secondary to a lesion in the thyroid gland. After undergoing a total thyroidectomy, he was found to have an exceedingly rare combination of follicular carcinoma, insular carcinoma, thyrolipomatosis and an amyloid goitre in his thyroid gland. He subsequently underwent further radioactive iodine ablation and has been in remission. He was also later incidentally diagnosed with systemic amyloidosis, which explained the amyloid deposition in his thyroid gland.

Notable decrease of malignant pleural effusion after treatment with sorafenib in radioiodine-refractory follicular thyroid carcinoma.

BACKGROUND: Malignant pleural effusion (MPE) caused by metastatic differentiated thyroid carcinoma (DTC) is usually associated with a rapid fatal outcome and should be recognized as a grim prognostic indicator. A standard therapeutic strategy has not been established for this situation. Here, we report a radioiodine-refractory follicular thyroid carcinoma (FTC) patient in whom a notable decrease of MPE was achieved after treatment with sorafenib. PATIENT FINDINGS: A 50-year-old patient underwent a total thyroidectomy and resection of recurrence for poorly differentiated FTC followed by radioiodine therapy with a negative whole body scan. One year later, dissection of the inferior lobe of the left lung was performed because two fluorodeoxyglucose-avid nodules were identified; pathological examination revealed a metastatic poorly differentiated FTC. Half a year later, he was referred to our clinic because of cough, thoracic pain, nausea, and loss of appetite. Chest computed tomography showed right lung multiple nodules, left pleural effusion, and left lung collapse with left-sided pleural thickening. We treated him with sorafenib. Clinical and radiographic assessments were performed periodically. SUMMARY: Symptoms and signs improved dramatically and continuously after initiation of sorafenib treatment. A duration of more than 12 weeks of apparent reduction of pleural effusion was achieved, which was confirmed by consecutive computed tomography examinations. Despite grade 1 alopecia, no other obvious treatment-related adverse events occurred. CONCLUSIONS: As a grim prognostic indicator for patients with DTC, no standard treatment recommendation for pleural effusion exists. Targeted therapy using sorafenib may be an effective therapeutic strategy in the treatment of MPE caused by FTC.

A low-grade follicular thyroid carcinoma in a woman with Down syndrome.

AIMS: Analysis of a thyroid neoplasm in a person with Down syndrome. METHOD: Report of a case and review of the literature. RESULTS: A 34-year-old woman with Down syndrome developed a right thyroid low-grade follicular carcinoma. She is alive 20 years after the discovery of the initial tumor. A review of the literature including epidemiological studies revealed only one unspecified cancer, one papillary carcinoma and one lymphoma. Persons with Down syndrome present an excess of goiter and thyroiditis and often are overweight and have low serum selenium, all these conditions being risk factors for thyroid carcinomas. CONCLUSION: Thyroid malignant neoplasms are very rare in persons with Down syndrome. We suspect that some constitutional, hormonal and genetic factors could protect these subjects against thyroid carcinoma.

Differentiated thyroid cancer and outcome in iodine deficiency.

AIMS: Factors influencing prognosis and long-term outcome of thyroid cancer have been described by several groups. We wished to asses the previously described prognostic factors in a moderately iodine deficient region in Hungary. METHODS: Four hundred and fifty-four out of 492 patients who had surgery for papillary thyroid cancer (PTC, 386 cases) and follicular thyroid cancer (FTC, 106 cases) between 1971 and 1998 were analyzed. Survival curves were compared using the Kaplan-Meier method and Cox regression analysis. RESULTS: The 10 and 20-year survival rates were 87.9 and 84% for PTC, and 78.2 and 78.2% for FTC. In PTC, extrathyroidal invasion (p<0.0001), lymph node metastasis (p<0.0001), distant metastasis (p<0.0001), and age over 40 years (p=0.002) were significant adverse predictors. In FTC, extrathyroidal invasion (p=0.003) distant metastases (p<0.0001), and age over 40 years (p=0.011) were significant adverse predictors. CONCLUSION: Iodine intake did not appear to influence survival. The incidence of follicular cancer, which has less favourable prognosis, was higher in iodine deficient regions. This supports the importance of iodine supplementation in these areas.

[Superior vena cava syndrome and insular thyroid carcinoma: the stent as a palliative therapeutic alternative]. / Síndrome de vena cava superior y carcinoma insular de tiroides: el stent como alternativa terapéutica paliativa.

The superior vena cava syndrome (SVCS) is a uncommon complication of thyroid cancers. It is produced as consequence of the mediastinal spread of the tumor or by intravascular invasion with thrombosis. We describe a case of insular thyroid carcinoma with an SVCS solved by putting an intravenous stent. The patient was a 73 year old male that consulted for aphonia and presence of a tumor in the right side of the neck of two months of evolution. The PAAF of thyroid suggested the diagnosis of "follicular tumor". A total thyroidectomy was performed on the patient and the sample histological study revealed the existence of a insular carcinoma. An ablative dosis of 131I was administered to him. One year after the patient developed the SVCS. A TAC detected a tumoral relapse consistent with clinical syntoms, and was confirmed by a high level of Tg (with TgAntibodies -). As the patient showed a slight response to radiotherapy (52Gy), a thoracic phlebography was realized demostrating an extense upper vena cava obstruction. After having accomplished an angioplasty, a long stent (20 mm wide) was put into the upper vena cava that was followed by a fast clinical and radiological improvement. A new phlebography practiced three month later showed a rapid venous flux through the stent, and near total disapperance of collateral circulation on thorax wall and mediastinum.

"Hot" carcinoma of the thyroid. Case reports and comments on the literature.

It seems somewhat difficult to exactly define the real number of case reports concerning the association of hyperfunctioning thyroid node and carcinoma; the overall incidence of this condition seems, however, to be very rare. Different inclusion criteria are probably a fairly relevant cause of variability in the number of cases reported during the years. A basic classification scheme, as the one here reported, may be of help in characterizing the different possible conditions: 1. the coexistence of carcinoma and focally hyperfunctioning tissue in the same gland but at different locations (not uncommon); 2. the presence of such a large tumour mass that it can compete with normal tissue for tracer uptake, despite being hormonogenetically uneffective in itself; 3. the carcinoma located in the hyperfunctioning adenoma; 4. the real hyperfunctioning carcinoma, where coincidence between hyperfunctioning tissue and malignancy is complete (very rare). Two cases are reported here, respectively belonging to the third and fourth of these categories (the most challenging from a diagnostic point of view). The matter is intrinsically poor from a statistical standpoint: it is therefore difficult to draw definitive conclusions on the subject in operative terms. It is however felt that the systematic evaluation of oncological risk in thyroid nodes, occasionally recommended in the literature, may be cumbersome and not necessarily cost-effective.

Differentiated thyroid cancer: surgical treatments of 190 patients.

Between 1968 and 1991, 190 patients (51 men, 139 women) with a mean age of 46.3 years underwent surgery for differentiated thyroid cancer (148 papillary and 42 follicular carcinomas). In 29.5% of the cases a concomitant goitre was histologically demonstrated. These patients were significantly older (mean: 54.7 years) (P<0.01). The patients who had previously received cervical radiotherapy were significantly younger (mean: 29.7 years) (P<0.01). The analysis of historical and clinical findings failed to identify predictive factors of biological aggressiveness. Hyperthyroidism occurred in 5.7% of patients: this subgroup did not show any difference in clinical behaviour. Occult carcinoma (14.7%) and multifocality (9.4%) were found more frequently in the glands with a pre-existent goitre (P<0.05), but the clinical significance of these aspects is uncertain. The surgical treatment of choice was total thyroidectomy (135 patients); more conservative procedures were performed only in younger patients with small lesions, without a difference in survival. Post-operatively a permanent recurrent laryngeal nerve injury occurred in four patients (2.1%) and nine patients (4.7%) required a permanent calcium supplementation. Among patients in follow-up (91.6%), those who underwent a total thyroidectomy were studied using a total body scinti scan. A poor prognosis was associated with age (>40 years), pT, stage, pM and symptomatic metastases.