The value of diagnostic nomogram based on CT radiomics for the preoperative differentiation between benign and malignant thyroid follicular neoplasms / 中华放射学杂志

Objective:To investigate the value of nomogram constructed by CT-based radiomics for differentiating benign and malignant thyroid follicular neoplasms.Methods:Totally 200 post-surgery patients with pathologically confirmed thyroid follicular neoplasms in Fudan University Shanghai Cancer Center from January 2016 to December 2018 were retrospectively analyzed. Among the patients, 46 were follicular thyroid carcinoma (FTC) and 154 patients were follicular thyroid adenoma (FTA). The patients were randomly divided into a training set ( n=140) and validation set ( n=60) using a random number table. CT signs and radiomics features of each patient were analyzed within the LIFEx package. A predictive model was developed by the least absolute shrinkage and selection operator regression to build a nomogram based on selected parameters. The predictive effectiveness of differentiating benign and malignant thyroid follicular neoplasms was evaluated by the area under receiver operating characteristic curve (AUC). Calibration plots were formulated to evaluate the reliability and accuracy of the nomogram based on internal (training set) and external (validation set) validity. The clinical value of the nomogram was estimated through the decision curve analysis. Results:The prediction nomogram was built with 4 selected parameters, including grey level zone length matrix (GLZLM)-gray-level zone length matrix_zone length non-uniformity, GLZLM-gray-level zone length matrix_low gray-level zone emphasis, CONVENTIONAL_HUQ3, CONVENTIONAL_HUmean. In training and validation sets, the AUCs for differentiating FTC and FTA were 0.863 (95%CI 0.746-0.932), 0.792 (95%CI 0.658-0.917), accuracy were 87.9% and 75.0%, sensitivity were 67.9% and 66.7%, specificity were 91.1% and 90.5%, respectively. The calibration curves indicated good consistency between actual observation and prediction for differentiating the malignancy. Decision curve analysis demonstrated the nomogram was clinically useful.Conclusions:The CT radiomics mode shows the certain value and great potential to identify benign or malignant thyroid follicular neoplasms and the nomogram can accurately and intuitively predict the malignancy potential in patients with thyroid follicular neoplasms.

Características clínicas asociadas al hallazgo de cáncer de tiroides originado a partir de nódulos calientes en pacientes con hipertiroidismo: reporte de un caso y revisión sistemática de la literatura / Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature

La coexistencia entre cáncer de tiroides e hipertiroidismo es infrecuente, y la mayoría de las lesiones nodulares a partir de las cuales se documenta un tumor maligno en este grupo de pacientes corresponden a nódulos fríos. Justificado en el creciente número de reportes en la literatura acerca de tumores malignos diagnosticados a partir de nódulos calientes, se realizó una revisión sistemática que tuvo como objetivo determinar los posibles factores asociados con el diagnóstico de cáncer de tiroides a partir de nódulos calientes en pacientes con hipertiroidismo. Los resultados sugieren que el diagnóstico clínico de bocio nodular tóxico, lesiones nodulares de diámetro mayor de 10 mm y tipo histológico compatible con carcinoma folicular, son factores que aumentan por sí solos el riesgo de realizar el diagnóstico de cáncer a partir de un nódulo caliente

Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in pa-tients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule

Características clínicas asociadas al hallazgo de cáncer de tiroides originado a partir de nódulos calientes en pacientes con hipertiroidismo: reporte de un caso y revisión sistemática de la literatura / Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature

Abstract Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in patients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule.

Resumen La coexistencia entre cáncer de tiroides e hipertiroidismo es infrecuente, y la mayoría de las lesiones nodulares a partir de las cuales se documenta un tumor maligno en este grupo de pacientes corresponden a nódulos fríos. Justificado en el creciente número de reportes en la literatura acerca de tumores malignos diagnosticados a partir de nódulos calientes, se realizó una revisión sistemática que tuvo como objetivo determinar los posibles factores asociados con el diagnóstico de cáncer de tiroides a partir de nódulos calientes en pacientes con hipertiroidismo. Los resultados sugieren que el diagnóstico clínico de bocio nodular tóxico, lesiones nodulares de diámetro mayor de 10 mm y tipo histológico compatible con carcinoma folicular, son factores que aumentan por sí solos el riesgo de realizar el diagnóstico de cáncer a partir de un nódulo caliente.

Relationship of HRAS gene mutation with cervical lymph node metastasis and ultrasonographic characteristics in differentiated thyroid carcinoma / 中华全科医师杂志

Objective:To investigate the relationship of HRAS gene mutation and lymph node metastasis and ultrasonographic characteristics in differentiated thyroid carcinoma (DTC).Methods:The clinical data of 162 patients with DTCs who underwent thyroidectomy and confirmed by postoperative pathological examination in Beijing Friendship Hospital from January 2014 to February 2019 were retrospectively analyzed. There were 139 patients with papillary thyroid carcinoma (PTC group) and 23 patients with follicular thyroid carcinoma (FTC group); the PTC were further classified as classic variant of papillary thyroid carcinoma (CVPTC, n=34), follicular variant of papillary thyroid carcinoma (FVPTC, n=36) and tall cell variant (TCV, n=69). Tissue HRAS mutation frequency was detected in 162 DTC patients and 19 patients with follicular adenoma (FA); blood HRAS mutation frequency was detected in 195 healthy subjects. The correlation between HRAS mutation (IVS1-82del gctgggcctggg) and cervical lymph node metastasis was analyzed, and the ultrasonographic characteristics of DTC patients were also analyzed. Results:The frequency of HRAS mutation in DTC patients was higher than that in healthy controls[37.0%(60/162) vs. 26.2%(51/195), χ2=4.538, P=0.03], while there was no significant difference between FTC and FA [39.1%(9/23) vs. 5/19, χ2=0.769, P=0.38]. In DTC patients there was no significant difference in cervical lymph node metastasis between HRAS mutation group and wild type group [57.3% (43/75) vs. 42.6% (32/75), χ2=1.898, P=0.16]. Among CVPTC, FVPTC and TCV patients, the rates of cervical lymph node metastasis were 7/12, 8/14 and 48.0% (12/25) in HRAS mutation group, while those were 50.0% (11/22), 40.9% (9/22) and 43.1% (19/44) in wild-type group, respectively (χ2=1.009, P=0.98).There were 9 patients with HRAS mutation in FTC group, and the cervical lymph node metastasis in mutation group and wild-type group was 5/9 and 4/14, respectively ( P=0.38). The ultrasonographic characteristics of PTC patients with HRAS mutation were more likely to have clear boundaries [66.7%(34/51) vs. 42.0%(37/88); χ 2=7.833, P<0.01] and not close to the membrane[84.3%(43/51) vs. 65.9%(58/88);χ2=5.506, P=0.02]. Conclusion:DTC patients are more likely to have HRAS (IVS1-82del gctgggcctggg) mutation, and the ultrasonic characteristics of DTC patients with HRAS mutation are likely to have clear boundaries and be not close to the membrane.

Expressions of glutathione S-transferases M1 and glutathione S-transferases M2 in follicular thyroid carcinoma and their significances / 肿瘤研究与临床

Objective:To investigate the expressions of glutathione S-transferases M1 (GSTM1) and glutathione S-transferases M2 (GSTM2) in follicular thyroid carcinoma (FTC) and their clinical significances.Methods:Gene expression profile of GSE82208 generated from 52 human thyroid samples, including 27 cases of FTC and 25 cases of follicular adenoma (FA) were collected from Gene Expression Omnibus (GEO) database. The gene matrix data were extracted and analyzed, and then differentially expressed genes (DEG) between FTC and FA were identified by using Limma package. Immunohistochemical SABC method was used to detect the expression levels of GSTM1 and GSTM2 proteins in FTC tissues and FA tissues collected from 56 FTC samples and 56 FA samples in Dandong First Hospital of Liaoning Province from January 2000 to December 2020. The relationship between GSTM1 and GSTM2 was analyzed; the association of expression levels of GSTM1 and GSTM2 with the clinicopathological factors of FTC patients was also analyzed.Results:Based on the GEO database, a total of 40 DEG were identified, including 9 up-regulated DEG (GSTM1, GSTM2, COL6A2, CUX2, CLUH, TSC2, OGDHL, ACADVL, SDHA) and 31 down-regulated DEG in FTC. The immunohistochemistry results of samples resected showed that the positive rates of GSTM1 and GSTM2 proteins in FTC tissues were higher than those in FA tissues [71.4% (40/56) vs. 23.2% (13/56), 80.4% (45/56) vs. 14.3% (8/56)], and differences were statistically significant ( χ2 values were 26.11 and 49.03, both P < 0.01). The expressions of GSTM1 and GSTM2 in FTC tissues were correlated with clinical staging, invasion degree and distant metastasis (all P < 0.05), but not with gender, age and tumor diameter (all P>0.05). There was a positive correlation between GSTM1 and GSTM2 proteins expressions in FTC ( r = 0.384, P = 0.004). Conclusions:The expression levels of GSTM1 and GSTM2 in FTC are increased. The interaction between GSTM1 and GSTM2 proteins can be involved in the development and progression of FTC.

Clinical Implication of World Health Organization Classification in Patients with Follicular Thyroid Carcinoma in South Korea: A Multicenter Cohort Study.

BACKGROUND: The study aimed to compare the prognostic value of the 4th edition of World Health Organization classification (WHO-2017) with the previous WHO classification (WHO-2004) for follicular thyroid carcinoma (FTC). METHODS: This multicenter retrospective cohort study included 318 patients with FTC from five tertiary centers who underwent thyroid surgery between 1996 and 2009. We evaluated the prognosis of patients with minimally invasive (MI), encapsulated angioinvasive (EA), and widely invasive (WI) FTC according to WHO-2017. Further, we evaluated the proportion of variation explained (PVE) and Harrell's C-index to compare the predictability of disease-free survival (DFS) and disease-specific survival (DSS). RESULTS: In total, 227, 58, and 33 patients had MI-, EA-, and WI-FTC, respectively. During a median follow-up of 10.6 years, 46 (14.5%) patients had disease recurrence and 20 (6.3%) patients died from FTC. The 10-year DFS rates of patients with MI-, EA-, and WI-FTC were 91.1%, 78.2%, and 54.9%, respectively (P<0.001, PVE=7.1%, C-index=0.649). The corresponding 10-year DSS rates were 95.9%, 93.5%, and 73.5%, respectively (P<0.001, PVE=2.6%, C-index=0.624). The PVE and C-index values were higher using WHO-2017 than using WHO-2004 for the prediction of DFS, but not for DSS. In multivariate analysis, older age (P=0.02), gross extrathyroidal extension (ETE) (P=0.003), and distant metastasis (P<0.001) were independent risk factors for DSS. CONCLUSION: WHO-2017 improves the predictability of DFS, but not DSS, in patients with FTC. Distant metastasis, gross ETE and older age (≥55 years) were independent risk factors for DSS.

Malignancy risk with atypia of undetermined significance finding on thyroid nodule FNA: clinical experience from a tertiary institution.

The Bethesda System for Reporting Thyroid Cytopathology from 2009 introduced a new category in thyroid nodule fine-needle aspiration (FNA) findings named atypia of undetermined significance (AUS), which usually appears in around 5% of FNA findings. Our study aimed to assess the utility of AUS finding in determining the risk of malignancy in thyroid nodules. In our study, 160 patients with AUS finding on initial FNA were regularly followed-up. Total and specific malignancy rates were calculated after receiving histopathologic confirmation or histopathologic/cytologic exclusion of malignancy. Eventually 80 (50%) patients were referred to surgery, with malignancy rate of 37.5% on histopathology. Another 52 (32.5%) patients were confirmed to have benign nodules on repeat FNA. After combining results obtained from histopathologic reports with those obtained from cytologic follow-up, total malignancy rate was 22.72%. However, malignancy was confirmed in only one (5.26%) of 19 patients with AUS finding on repeat FNA with surgical and histopathologic follow-up. In conclusion, FNA is an extremely useful tool for clinicians to discriminate patients to be referred to surgery and those that can be followed-up safely without the need for further invasive procedures.

DIFFERENTIATED THYROID CANCER IN PEDIATRIC POPULATION (≤18 YEARS): POSTOPERATIVE TREATMENT WITH RADIOACTIVE IODINE (I-131).

The aim is to present data on the treatment and follow-up in a cohort of patients with pediatric thyroid cancer who underwent total thyroidectomy and received postoperative radioactive iodine (I-131) therapy. The study was conducted in a tertiary high-volume thyroid center, in pediatric patients with differentiated thyroid cancer who were consecutively treated during the 1965-2015 period. A total of 45 patients aged ≤18 years having undergone total thyroidectomy with or without selective neck dissection were included in the study. Decision on postoperative I-131 ablation was based on tumor characteristics, postoperative thyroglobulin level, preablative whole body scintigraphy, and/or neck ultrasound. Median age at diagnosis was 15 years. The presence of cervical lymph node metastases was significantly associated with papillary thyroid cancer, larger tumor size, involvement of two thyroid lobes, and multifocal disease. The presence of distant metastases was significantly associated with larger tumor size. None of the patients died during follow-up period, and the 5-year and 10-year overall survival rates were 100%. The 5-year and 10-year progression-free survival (PFS) rates were 87% and 73%, respectively. Male gender (p=0.046), age ≤15 years (p=0.029) and tumor size >15 mm (p=0.042) were significantly associated with inferior PFS. A significant positive trend of increase in the number of newly diagnosed patients was observed over time (p=0.011). Clinical management of pediatric thyroid cancer is challenging, especially in the light of increasing incidence in this population. Male patients younger than 15 years and with tumors of more than 15 mm in size require additional caution due to lower PFS observed.

Molecular markers in well-differentiated thyroid cancer.

PURPOSE: Thyroid nodules are of common occurrence in the general population. About a fourth of these nodules are indeterminate on aspiration cytology placing many a patient at risk of unwanted surgery. The purpose of this review is to discuss various molecular markers described to date and place their role in proper perspective. This review covers the fundamental role of the signaling pathways and genetic changes involved in thyroid carcinogenesis. The current literature on the prognostic significance of these markers is also described. METHODS: PubMed was used to search relevant articles. The key terms "thyroid nodules", "thyroid cancer papillary", "carcinoma papillary follicular", "carcinoma papillary", "adenocarcinoma follicular" were searched in MeSH, and "molecular markers", "molecular testing", mutation, BRAF, RAS, RET/PTC, PAX 8, miRNA, NIFTP in title and abstract fields. Multiple combinations were done and a group of experts in the subject from the International Head and Neck Scientific Group extracted the relevant articles and formulated the review. RESULTS: There has been considerable progress in the understanding of thyroid carcinogenesis and the emergence of numerous molecular markers in the recent years with potential to be used in the diagnostic algorithm of these nodules. However, their precise role in routine clinical practice continues to be a contentious issue. Majority of the studies in this context are retrospective and impact of these mutations is not independent of other prognostic factors making the interpretation difficult. CONCLUSION: The prevalence of these mutations in thyroid nodule is high and it is a continuously evolving field. Clinicians should stay informed as recommendation on the use of these markers is expected to evolve.

The diagnosis value of TI-RADS and sonographic characteristics for papillary thyroid carcinoma and follicular thyroid carcinoma / 中华普通外科杂志

Objective To investigate the value of TI-RADS for sonographic diagnosis of papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) and to evaluate the sonographic findings of FTC compared to PTC.Methods The clinical and sonographic data of 363 cases of pathology confirmed thyroid nodules were retrospectively analyzed.The thyroid nodules were classified by TI-RADS grading criteria,the accuracy of TI-RADS and sonographic findings between FTC and PTC was analyzed.Results In 363 thyroid nodules,114 cases were confirmed as benign lesions;249 cases were confirmed as carcinomas,including 50 FTC cases and 199 PTC cases.The sensitivity,specificity,PPV,NPV,and accuracy of PTC were 97.0％ (193/199),85.1％ (97/114),91.9％ (193/210),85.8％ (97/113),95.7％ (290/303) respectively.The sensitivity,specificity,PPV,NPV,and accuracy of FTC were 97.0％(193/199),85.1％ (97/114),91.9％ (193/210),85.8％ (97/113),95.7％ (290/303) respectively.There were significant differences of nodule size,shape,margin,echogenecity,calcification,halo and flow between FTC group and PTC group (P ＜ 0.05).Conclusion TI-RADS has higher value in the sonographic diagnosis of PTC than that of FTC.FTC are greatly different from PTC in many sonographic findings making it less valuable for the diagnosis of FTC.

Follicular proliferative lesion arising in struma ovarii.

Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

The Diagnostic Usefulness of HMGA2, Survivin, CEACAM6, and SFN/14-3-3 δ in Follicular Thyroid Carcinoma.

BACKGROUND: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy and its differential diagnosis includes follicular adenoma (FA) and adenomatous goiter (AG). Several ancillary markers have been suggested to aid in the diagnosis of FTC, but the successful use of these methods still needs to be validated. METHODS: In the present study, we verified the immunoexpression of HMGA2, CEACAM6, survivin, and SFN/14-3-3 δ in lesions including 41 AGs, 72 FAs, and 79 FTCs. We evaluated their diagnostic usefulness, combined with galectin 3, Hector Battifora mesothelial 1 (HBME1), cytokeratin 19, and cyclin D1, in diagnosing FTC. RESULTS: The expressions of HBME1 (65.8%) and HMGA2 (55.7%) were significantly higher in FTCs than in FAs and AGs (p<.001 and p=.005, respectively). HBME1 was the only marker that was more frequently expressed in FTCs than in FAs (p=.021) and it was more frequently expressed in follicular neoplasms than in AGs (p<.001). Among the novel markers, the combination of HMGA2 and HBME1 showed the highest sensitivity (72.2%) and specificity (76.1%) for diagnosing FTC. CEACAM6, survivin, and SFN/14-3-3 δ were barely expressed in most cases. CONCLUSIONS: Our present results show that only HMGA2 can be beneficial in differentiating FTC using the novel markers.

The Diagnostic Usefulness of HMGA2, Survivin, CEACAM6, and SFN/14-3-3 delta in Follicular Thyroid Carcinoma

BACKGROUND: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy and its differential diagnosis includes follicular adenoma (FA) and adenomatous goiter (AG). Several ancillary markers have been suggested to aid in the diagnosis of FTC, but the successful use of these methods still needs to be validated. METHODS: In the present study, we verified the immunoexpression of HMGA2, CEACAM6, survivin, and SFN/14-3-3 delta in lesions including 41 AGs, 72 FAs, and 79 FTCs. We evaluated their diagnostic usefulness, combined with galectin 3, Hector Battifora mesothelial 1 (HBME1), cytokeratin 19, and cyclin D1, in diagnosing FTC. RESULTS: The expressions of HBME1 (65.8%) and HMGA2 (55.7%) were significantly higher in FTCs than in FAs and AGs (p<.001 and p=.005, respectively). HBME1 was the only marker that was more frequently expressed in FTCs than in FAs (p=.021) and it was more frequently expressed in follicular neoplasms than in AGs (p<.001). Among the novel markers, the combination of HMGA2 and HBME1 showed the highest sensitivity (72.2%) and specificity (76.1%) for diagnosing FTC. CEACAM6, survivin, and SFN/14-3-3 delta were barely expressed in most cases. CONCLUSIONS: Our present results show that only HMGA2 can be beneficial in differentiating FTC using the novel markers.

Follicular Proliferative Lesion Arising in Struma Ovarii

Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.

The clinical value of color doppler diagnosis for thyroid cancer / 中国基层医药

Objective To compare color doppler ultrasound examination for the different pathological types of thyroid cancer.Methods 62 cases of thyroid cancer in patients with color doppler ultrasound examination,then compared with pathological examination and compared the different pathological types of thyroid cancer with ultrasound image map features.Results Ultrasound examination showed papillary adenocarcinoma in 31 cases within the hypoechoic,ill-defined in 28 cases,there was calcification in 31 cases,follicular carcinoma in 6 cases、6 cases and 12 cases,there were significant differences between the two groups ( x2 =27.884,20.545,13.964,P =0.000 ),There was no significant difference both in the form of regularity,the nature of the back echo,Vmax and RI.( P =0.427,0.338,0.110,0.872 ).Pathology consistent with papillary carcinoma was 80.0％,follicular carcinoma pathology found was 70.4％.Conclusion Color doppler ultrasound examination of the different pathological types of thyroid cancer had a certain differential diagnosis and it had higher rate of pathological diagnosis.

Expression of chemokine receptor CCR5 in human follicular thyroid carcinoma / 第二军医大学学报

Objective: To study the expression of chemokine receptor CCR5 in follicular thyroid carcinoma and the serum level of CCR5 ligand, so as to assess the role of CCR5 in progression and metastasis of follicular thyroid carcinoma. Methods: Fifteen samples of follicular thyroid carcinoma, 17 samples of follicular thyroid adenoma and 12 adjacent normal samples were analyzed immunohistochemically for CCR5 expression. The sera concentrations of CCL3, CCL4 and CCL5 were measured by ELISA in all patients. Results: CCR5 was positive in follicular thyroid carcinoma samples, with the positive rate being 73.33%, and was not detected in the follicular thyroid adenoma and the normal samples (P<0.01). The concentrations of CCL3 and CCL5 in the sera of follicular thyroid carcinoma patients were significantly higher than those of the other 2 groups (P<0.05). Conclusion: CCR5 is highly expressed in follicular thyroid carcinoma tissues and the concentrations of CCL3 and CCL5 are obviously increased in the sera of patients, indicating that CCR5 may play an important role in the pathogenesis of follicular thyroid carcinoma.

Carcinoma do ducto tireoglosso / Thyroglossal duct carcinoma

O carcinoma do ducto tireoglosso (DTG) é incomum, ocorrendo em aproximadamente 1% dos cistos do DTG, sendo em 80% dos casos do tipo papilífero. O carcinoma folicular é ainda mais raro, correspondendo a menos de 6% dos carcinomas do DTG. Relatamos um caso de carcinoma folicular de cisto do DTG em uma mulher de 70 anos. A citologia da punção aspirativa por agulha fina pré-operatória da lesão não foi capaz de estabelecer o diagnóstico de malignidade, sendo este revelado somente através do exame anátomo-patológico do espécime cirúrgico.

The thyroglossal duct cist (TGD) carcinoma is uncommon, occurring in approximately 1% of all TGD cysts. Follicular carcinoma is even rarer, corresponding to less than 6% of all TGD carcinomas. We report a case of TGD cyst follicular carcinoma in a 70-year-old woman. Preoperative fine needle aspiration biopsy could not establish the diagnosis of malignancy. This was only possible with the postoperative histology of the excised lesion.

Expressions of Id-1 and Id-2 in Hyperplastic Thyroid Tissue and Thyroid Carcinoma

BACKGROUND: Id proteins are a family of helix-loop-helix proteins and are regarded to be negative regulators of cell differentiation. In general, Id-1 and Id-2 expressions are upregulated during tumor development and progression in a variety of neoplasms, and these expressions may be associated with aggressive tumor behavior. However, little is known about the roles of Id-1 and Id-2 in thyroid neoplasms. METHODS: The expressions of Id-1 and Id-2 were assessed immunohistochemically in 310 normal, hyperplastic, and neoplastic thyroid tissues using tissue microarrays. RESULTS: Normal thyroid tissues rarely expressed Id-1 or Id-2. Moreover, whilst Id-1 expression was more elevated in malignant thyroid tissue than in hyperplastic thyroid tissue, Id-2 expression was more variable. No significant differences were observed between histologic subtypes of thyroid carcinomas with respect to Id-1 or Id-2 expression. Follicular adenomas showed higher expressions of Id-1 and Id-2 than thyroid carcinomas. No significant association was found between clinicopathological parameters and Id-1 expression, though Id-2 expression was significantly reduced in metastatic, stage IV tumors. CONCLUSION: The expressions of Id-1 and Id-2 were elevated in hyperplastic and neoplastic thyroid tissues. However, neither appears suitable as a marker of malignancy or an aggressive phenotype, although Id-2 expression in advanced thyroid carcinomas may reflect a favorable prognosis.

Synchronous Bony and Soft Tissue Metastases from Follicular Carcinoma of the Thyroid

Follicular carcinoma of the thyroid rarely manifests itself as a distant metastatic lesion, and, when present, is usually found in flat bones. A soft tissue metastasis is extremely rare, and synchronous metastases to the bone and soft tissue is not reported in the literature so far. We report such a case of a 42-yr-old male, who presented with a goiter, scalp and forearm soft tissue swellings, and, fine needle aspiration cytology of all these swellings revealed a follicular neoplasm. A wide excision of the forearm swelling was carried out and the histopathology was consistent with features of metastatic follicular carcinoma of the thyroid. The main stay of treatment is surgical resection of the primary tumor. The various modalities of treatment of metastasis is discussed with a review of literature.

A Case of Coexistent Angiosarcoma and Follicular Carcinoma of the Thyroid

Angiosarcoma of the thyroid has long been a controversial entity, and it is histologically defined as cleft-like anastosmosing spaces lined by large, atypical cells of endothelial lineage. However, clear-cut separation between the angiosarcoma and anaplastic carcinoma of the thyroid is difficult because they yield nearly the same clinical prognosis and overlapping histologic findings. We report a case of thyroid neoplasm composed of minimally invasive well differentiated follicular carcinoma and angiosarcoma with intervening transitional area. Immunohistochemically, the angiosarcomatous portion showed focal immunoreactivity for endothelial markers such as CD31, CD34, Ulex europaeus 1 lectin, factor VIII-related antigen, and immunonegativity for epithelial markers including pancytokeratin, epithelial membrane antigen and thyroglobulin, whereas the reverse was demonstrated in the minimally invasive follicular carcinomatous portion. The follicular carcinoma portion was positive for thyroid transcription factor-1 (TTF-1). Each component showed ultrastructural findings of epithelial and endothelial differentiation, respectively. The present case was unique in that angiosarcoma of the thyroid was confirmed by immunohistochemistry and electron microscopy, as well as light microscopy, and also coexisted with a minimally invasive well differentiated follicular carcinoma in the same mass. This combination has never been described in the literature. Although restricted to a single case, the present case further supports that angiosarcoma is a true existent entity rather than a variant of anaplastic carcinoma.