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2.
Rev. esp. patol ; 53(3): 149-157, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194268

RESUMO

INTRODUCTION: The hypothesis of an association between papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) continues to generate debate. Retrospective studies suggest that there is a greater probability of diagnosing a PTC in surgical specimens with CLT; however, prospective studies suggest that there is no true increase in risk. METHODS: An analytical, cross-section measurement and retrospective study was carried out considering gender, age and diagnosis of CLT and PTC in surgical specimens. A binary logistic regression model was proposed to predict the probability of carrying out the diagnosis of PTC based on the diagnosis of CLT, gender and age. RESULTS: The study population consisted of 1136 patients, 1047 (92.2%) women and 89 (7.8%) men, with an average age of 47.5±14.3 years. The prevalence of CLT and PTC was 14.9% and 16.1% respectively. Coexistence between PTC and CLT was found in 44 patients, corresponding to 3.9% of the population. Our logistic regression model suggests that the probability of diagnosing PTC in surgical specimens of male patients under 40 years old and with CLT is 53.8%. CONCLUSIONS: We suggest that there is a greater probability of diagnosing PTC in surgical specimens with confirmatory histological data for CLT; in addition, in males under 40 years old this probability increases


INTRODUCCIÓN: La hipótesis que sugiere una asociación entre el cáncer papilar de tiroides (PTC, por sus siglas en inglés) y la tiroiditis linfocítica crónica (CLT, por sus siglas en inglés) sigue generando debate. Los estudios retrospectivos sugieren que existe una mayor probabilidad de realizar un diagnóstico de PTC en las muestras quirúrgicas de CLT. Los estudios prospectivos sugieren que no existe un incremento real del riesgo. MÉTODOS: Se realizó un estudio analítico de medición transversal y temporalidad retrospectiva en cuanto a sexo, edad, diagnóstico de CLT y espécimen quirúrgico de PTC. Se propuso un modelo de regresión logística binaria para predecir la probabilidad de realizarse un diagnóstico de PTC basado en el diagnóstico de CLT, sexo y edad. RESULTADOS: La población de estudio consistió en 1.136 pacientes, 1.047 mujeres (92,2%) y 89 varones (7,8%), con una edad media de 47,5 ± 14,3 años. La prevalencia de CLT y PTC fue del 14,9% y 16,1%, respectivamente. La coexistencia de PTC y CLT fue encontrada en 44 pacientes, correspondiente al 3,9% de la población. Nuestro modelo de regresión logística sugiere que la probabilidad de realizar el diagnóstico de PTC en muestras quirúrgicas de pacientes varones con edades inferiores a 40 años y con CLT es del 53,8%. CONCLUSIONES: Sugerimos que existe una mayor probabilidad de diagnosticar PTC en muestras quirúrgicas con datos histológicos confirmatorios de CLT; además, esta probabilidad puede modificarse sobre la base de sexo masculino y edad superior a 40 años


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/complicações , Tireoidite Autoimune/patologia , Tireoidite Autoimune/complicações , Câncer Papilífero da Tireoide/cirurgia , Tireoidite Autoimune/cirurgia , Estudos Retrospectivos , Doença Crônica , Fatores de Risco
3.
Medicine (Baltimore) ; 99(35): e21996, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871952

RESUMO

It is of significance to evaluate central lymph node status in patients with papillary thyroid carcinoma (PTC), because it can decrease postoperative complications resulting from unnecessary prophylactic central lymph node dissection (CLND). Due to the low sensitivity and specificity of neck ultrasonography in the evaluation of central lymph node metastasis (CLNM), it is urgently required to find alternative biomarkers to predict CLNM in PTC patients, which is the main purpose of this study.RNA-sequencing datasets and clinical data of 506 patients with thyroid carcinoma from the Cancer Genome Atlas (TCGA) database were downloaded and analyzed to identify differentially expressed miRNAs (DEMs), which can independently predict CLNM in PTC. A nomogram predictive of CLNM was developed based on clinical characteristics and the identified miRNAs. Receiver operating characteristics curves were drawn to evaluate the predictive performance of the nomogram. Bioinformatics analyses, including target genes identification, functional enrichment analysis, and protein-protein interaction network, were performed to explore the potential roles of the identified DEMs related to CLNM in PTC.A total of 316 PTC patients were included to identify DEMs. Two hundred thirty-seven (75%) PTC patients were randomly selected from the 316 patients as a training set, while the remaining 79 (25%) patients were regarded as a testing set for validation. Two DEMs, miRNA-146b-3p (HR: 1.327, 95% CI = 1.135-1.551, P = .000) and miRNA-363-3p (HR: 0.714, 95% CI = 0.528-0.966, P = .029), were significantly associated with CLNM. A risk score based on these 2 DEMs and calculating from multivariate logistic regression analysis, was significantly lower in N0 group over N1a group in both training (N0 vs N1a: 2.04 ±â€Š1.01 vs 2.73 ±â€Š0.61, P = .000) and testing (N0 vs N1a: 2.20 ±â€Š0.93 vs 2.79 ±â€Š0.68, P = .003) sets. The nomogram including risk score, age, and extrathyroidal extension (ETE) was constructed in the training set and was then validated in the testing set, which showed better prediction value than the other three predictors (risk score, age, and ETE) in terms of CLNM identification. Bioinformatics analyses revealed that 5 hub genes, SLC6A1, SYT1, COL19A1, RIMS2, and COL1A2, might involve in pathways including extracellular matrix organization, ion transmembrane transporter activity, axon guidance, and ABC transporters.On the basis of this study, the nomogram including risk score, age, and ETE showed good prediction of CLNM in PTC, which has a potential to facilitate individualized decision for surgical plans.


Assuntos
Metástase Linfática , MicroRNAs/metabolismo , Nomogramas , Câncer Papilífero da Tireoide/metabolismo , Mineração de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mapas de Interação de Proteínas , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/patologia
4.
Medicine (Baltimore) ; 99(38): e22200, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957351

RESUMO

The central lymph nodes of the neck are the most common sites of papillary thyroid carcinoma (PTC) but cannot be easily diagnosed preoperatively. Prophylactic central lymph node dissection (CLND), especially contralateral CLND, is not recommended in various guidelines due to its high risk. The aim of our study was to establish an objective point score based on preoperative and intraoperative data to guide the selection of patients for contralateral CLND.We retrospectively evaluated 1085 consecutive patients with PTC treated by thyroidectomy for inclusion in this study (the training cohort). Variables of contralateral central lymph node macro-metastasis (CLNMM) were investigated using univariate and multivariate analyses; subsequently, nomograms were developed and then validated in an independent cohort of patients (n = 326, the validation cohort).Univariate and multivariate analyses indicated that preoperative fine needle aspiration-proven ipsilateral lateral lymph node metastasis (LNM) (odds ratio [OR] 4.888, 95% confidence interval [CI] 1.587-41.280, P < .001) and cases with frozen-section pretracheal LNM (OR 19.015, 95% CI 2.949-186.040, P < .001) or Delphian LNM (OR 4.494, 95% CI 1.503-54.128, P < .001) were the 3 risk factors for contralateral CLNMM. A receiver operating characteristic curve indicated a cutoff value of 1 for the frozen-section pretracheal LNM number or the Delphian LNM number as a predictor of contralateral central lymph node metastasis (CLNM). The nomogram was then generated according to the 3 risk factors and well validated in the external cohorts, and the intraoperative frozen-section results were highly consistent with the postoperative pathological results.The proposed nomogram based on the 3 factors showed a good prediction of contralateral CLNMM in PTC.


Assuntos
Excisão de Linfonodo , Linfonodos/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Curva ROC , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
5.
Nat Commun ; 11(1): 4807, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968067

RESUMO

Non-invasive assessment of the risk of lymph node metastasis (LNM) in patients with papillary thyroid carcinoma (PTC) is of great value for the treatment option selection. The purpose of this paper is to develop a transfer learning radiomics (TLR) model for preoperative prediction of LNM in PTC patients in a multicenter, cross-machine, multi-operator scenario. Here we report the TLR model produces a stable LNM prediction. In the experiments of cross-validation and independent testing of the main cohort according to diagnostic time, machine, and operator, the TLR achieves an average area under the curve (AUC) of 0.90. In the other two independent cohorts, TLR also achieves 0.93 AUC, and this performance is statistically better than the other three methods according to Delong test. Decision curve analysis also proves that the TLR model brings more benefit to PTC patients than other methods.


Assuntos
Metástase Linfática/diagnóstico , Aprendizado de Máquina , Câncer Papilífero da Tireoide/complicações , Adulto , Estudos de Coortes , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
6.
Life Sci ; 259: 118374, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32891613

RESUMO

OBJECTIVE: Dipeptidyl peptidase IV (DPP4) has been indicated as a possible prognostic biomarker in papillary thyroid cancer (PTC). However, the mechanism of DPP4 during metastasis of PTC remains unclear. In this study, we investigated whether lysine acetyltransferase 5 (KAT5) and FBJ murine osteosarcoma viral oncogene homolog B (FosB) synergistically regulate high DPP4 expression in PTC. METHODS: PTC tissues and matched paracancerous tissues were harvested, followed by the establishment of IHH-4 and TPC-1 cells with downregulation of DPP4. The relevance of DPP4 on the metastasis of PTC cells was assessed. Subsequently, the effect of KAT5 on the transcription of DPP4 was verified. The binding relationship between FosB and DPP4 was predicted by a bioinformatics website. Functional rescue experiments were performed to evaluate cell activities after overexpression of KAT5 or FosB in cells with DPP4 knockdown. RESULTS: DPP4 was overexpressed in PTC tissues and cell lines, which was correlated with higher risks for metastases and poorer survival. DPP4 downregulation curtailed cell growth and metastasis. Moreover, KAT5 acetylated DPP4 promoter histone, which promoted transcription activation of DPP4. Subsequently, FosB recruited KAT5 at the DPP4 promoter, thereby enhancing DPP4 transcriptional activation. Further overexpression of KAT5 or FosB in cells with low expression of DPP4 promoted cell activity. Finally, DPP4 expedited p62 nuclear translocation to elevate Keap1/Nrf2 expression, thus facilitating the growth and metastasis of PTC cells. CONCLUSION: FosB enhanced the growth and metastasis of PTC cells by recruiting histone acetyltransferases KAT5 to increase DPP4 transcription and activate the p62/Keap1/Nrf2 signaling.


Assuntos
Dipeptidil Peptidase 4/metabolismo , Lisina Acetiltransferase 5/metabolismo , Proteínas Proto-Oncogênicas c-fos/metabolismo , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Animais , Western Blotting , Linhagem Celular Tumoral , Feminino , Imunofluorescência , Humanos , Masculino , Camundongos Endogâmicos BALB C , Camundongos Nus , Pessoa de Meia-Idade , Transplante de Neoplasias , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Câncer Papilífero da Tireoide/metabolismo , Neoplasias da Glândula Tireoide/metabolismo
7.
Medicine (Baltimore) ; 99(30): e21346, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791734

RESUMO

RATIONALE: Papillary thyroid carcinoma (PTC) is the most common type of primary thyroid cancer with a low incidence of distant metastases. PTC represents more than 70% to -90% of thyroid malignancies. Distant metastases have only been observed in only 1% to 15% of patients with PTC. In this article, we reported the case of a patient with PTC and hyperthyroidism as well as simultaneous multiple metastases. PATIENT CONCERNS: A 47-year-old man was admitted to our hospital on February 22, 2019, with several neck masses that had been present for 12 months, low back pain for 9 months, and lower limb paraplegia for 3 months. DIAGNOSES: According to the patient physical examination, adjuvant examination (e.g., ultrasound, computed tomography, magnetic resonance imaging, blood test, and biopsy) and medical history, the clinical diagnosis was as follows: thyroid papillary carcinoma; cervical lymph node metastasis; multisite bone metastasis (6th and 7th cervical vertebrae, left clavicle proximal, right scapula bone, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, bilateral ilium, and left pubic bone); muscular metastasis (the right medial femoral muscle, the vastus lateralis muscle, left thigh muscle, and the flexor superficialis of the left forearm); possible mediastinal lymph node metastasis; and paraplegia due to the soft-tissue metastasis around the 9th thoracic vertebral spine; and hyperthyroidism (free thyroxine: 36.59 pmol/L, free triiodothyronine: 9.58 pmol/L, thyroid-stimulating hormone: 0.005 µIU/mL, thyroid autoantibody: 2.53 IU/L). INTERVENTIONS AND OUTCOMES: The patient refused to undergo further intervention or follow-up. LESSONS: In summary, this is the 1st case of in which a patient with PTC and hyperthyroidism, as well as simultaneous multiple skeletal muscles and bone metastases, lymph node metastasis, and paraplegia was observed. In practice, in cases where patients have PTC and hyperthyroidism, practitioners should perform further examinations to rule out the presence of distant metastases. We believe that the use of ultrasound has a unique advantage in the diagnosis of PTC and skeletal muscle metastasis.


Assuntos
Carcinoma Papilar/patologia , Hipertireoidismo/diagnóstico , Paraplegia/etiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Recusa do Paciente ao Tratamento , Ultrassonografia/métodos
10.
Rev Col Bras Cir ; 47: e20202545, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844910

RESUMO

INTRODUCTION: papillary thyroid carcinoma is a tumor with good prognosis. However, some patients treated present neck recurrence. OBJECTIVE: to evaluate the risk factors for neck recurrence. METHODS: a retrospective study enrolled 89 patients (68 women and 21 men) diagnosed with papillary carcinoma who underwent total thyroidectomy. In 21 patients, neck dissection was performed and 62 patients underwent radioiodinetherapy. Twelve patients relapsed with metastasis in this period with an average of 3.6 years. RESULTS: out of 89 patients, 76.4% were female. Relapse occurred in nine (13.23%) women and three (14.28%) men. The average age of the patients was 44 years in the control group and in patients with relapsed. Eighteen patients (23.37%) in the control group and eight (64.28%) who relapsed had positive lymph nodes at initial diagnosis. The tumor size was significantly larger in the group of patients with cervical recurrence (3.3cm vs. 1.6cm - p=0.008, Student t test), whereas the presence of metastatic lymph nodes at the moment of the first operation was also significant (p=0.004 -Fisher exact test). The tumor size was an independent risk factor for recurrence at the multivariate anaylsis (OR=2.4, IC95%:1.3-4.6 - p=0,007, logistic regression). CONCLUSION: there is an increase in the risk of lymph node recurrence during the follow up of 2.4 folds for each increase of 1cm in the longer nodule diameter.


Assuntos
Carcinoma Papilar/cirurgia , Esvaziamento Cervical , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
11.
PLoS One ; 15(8): e0238207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841270

RESUMO

BACKGROUND: Although infrequent, distant metastasis from differentiated thyroid cancer is the main cause of mortality in patients and mostly involves the lung, bone, and brain. Distant metastases to other sites in differentiated thyroid cancer patients are rare, thus, the clinical course of unusual metastases has not been adequately researched. In the present study, the clinico-pathological findings and treatment outcomes of unusual metastases in differentiated thyroid cancer patients in Korea were evaluated. PATIENTS AND METHODS: We retrospectively reviewed the medical records of differentiated thyroid cancer patients with unusual metastases in four Korean tertiary hospitals (Chonnam National University Hwasun Hospital, Asan Medical Center, Busan National University Hospital, Severance Hospital). Unusual metastases were diagnosed using (1) cytology or histology and/or (2) imaging studies including fluorodeoxyglucose F 18 positron emission tomography/computed tomography and/or iodine 131 whole body scans with simultaneously elevated serum levels of thyroglobulin. The pathological findings of primary thyroid cancer, diagnostic method for unusual metastases, and treatment responses of unusual metastases were examined. RESULTS: In all, 25 unusual metastatic foci of 19 patients were analyzed; 13 patients (68.4%) had papillary thyroid carcinoma including 4 follicular variant papillary thyroid carcinomas. The median time interval between the first diagnosis of primary thyroid cancer and unusual metastases diagnosis was 110 months (11.0-138.0 months). Only 4 patients (21.1%) had synchronous unusual metastases and 6 patients (31.6%) were symptomatic. Unusual metastases included 19 metastases to solid organs (6 to kidney, 5 to liver, 4 to pancreas, 3 to adrenal gland, and 1 to ovary) and 6 to the skin and muscles. Unusual metastases were pathologically proven in 10 patients (52.6%) and 11 of 16 patients (68.8%) who received iodine 131 whole body scans had radioiodine-refractory differentiated thyroid cancer. Among 5 patients treated with tyrosine kinase inhibitors, 4 treated with lenvatinib showed stable disease or a partial response at the first treatment response. Six patients (31.6%) died due to disease progression during the median 20.0-month follow-up period (11.0-55.0 months). CONCLUSION: Unusual metastases from differentiated thyroid cancer are thought to be underestimated due to disease rarity and their metachronous nature with other distant metastases. The most of unusual metastases in differentiated thyroid cancer patients are existed with usual distant metastasis and clinical outcomes of those could not be significantly different from the prognosis of usual distant metastasis.


Assuntos
Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/secundário , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico por imagem , Metástase Neoplásica/patologia , Metástase Neoplásica/terapia , Especificidade de Órgãos , Compostos de Fenilureia/uso terapêutico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Inibidores de Proteínas Quinases/uso terapêutico , Quinolinas/uso terapêutico , República da Coreia , Estudos Retrospectivos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/terapia , Fatores de Tempo , Imagem Corporal Total
12.
Anticancer Res ; 40(7): 3801-3809, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620619

RESUMO

AIM: Cancer stem-like cell (CSC) markers and the role of CSCs derived from papillary thyroid carcinoma (PTC) in pathogenesis are unclear. This study aimed to investigate CSC properties using tumor spheres from passaged PTC cells but without sorting CSCs. MATERIALS AND METHODS: To identify the properties of CSCs derived from PTC, the expression of SRY-box transcription factor 2(SOX2), octamer-binding transcription factor 4 (OCT4), Nanog homeobox (NANOG), thyroglobulin (TG), thyroid-stimulating hormone receptor (TSHR), E-cadherin, YES-associated protein 1 (YAP1), and signal transducer and activator of transcription 3 (STAT3) was investigated in tumor spheres serially passaged without sorting CSCs. RESULTS: The cultured tumor spheres had cancer stemness; high expression of OCT4, SOX2, NANOG, and YAP1; low expression of E-cadherin; and varied expression of TG, TSHR, and STAT3. PTC tumor spheres transfected with small interfering RNA targeting YAP1 had fewer CSC properties than the non-transfected tumor spheres did. CONCLUSION: Tumor spheres derived from PTC cells by passaging without sorting CSCs have more stem-like cell properties, and less differentiation potential. Thus, this simple and cost-effective method can be used for the enrichment of PTC stemness for employment in cell-based models, reducing the need for use of animal models.


Assuntos
Células-Tronco Neoplásicas/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Proteínas Adaptadoras de Transdução de Sinal/biossíntese , Proteínas Adaptadoras de Transdução de Sinal/genética , Antígenos CD/biossíntese , Antígenos CD/genética , Biomarcadores Tumorais/biossíntese , Biomarcadores Tumorais/genética , Caderinas/biossíntese , Caderinas/genética , Linhagem Celular Tumoral , Proliferação de Células/fisiologia , Humanos , Células-Tronco Neoplásicas/metabolismo , Fator 3 de Transcrição de Octâmero/biossíntese , Fator 3 de Transcrição de Octâmero/genética , Fator de Transcrição STAT3/biossíntese , Fator de Transcrição STAT3/genética , Esferoides Celulares , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/metabolismo , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/metabolismo , Fatores de Transcrição/biossíntese , Fatores de Transcrição/genética
13.
PLoS One ; 15(7): e0236257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32692768

RESUMO

BACKGROUND: It is estimated that one of the potential cause of the increasing prevalence of thyroid cancer (TC) is the easier and widespread access to diagnostic tools. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA). AIM OF THE STUDY: We 1) estimated what types of TC were diagnosed due to CSA, 2) analyzed what clinicopathological features were characteristic of TCs diagnosed by CSA, 3) determined if these features were characteristic of indolent cases, and finally we 4) assessed whether CSA could have resulted in the increasing incidence of potentially indolent papillary thyroid cancer (PTC). MATERIALS AND METHODS: A retrospective review of 4,701 medical records of patients admitted and surgically treated at one surgical center between 2008 and 2017 was performed. Among the enrolled patients, 569 (12.1%) had thyroid malignancy, and 514 (10.9%) were diagnosed with PTC. We divided these patients into two groups: 1) patients in whom TC diagnostics were performed without considering any TC risk factors or symptoms (CSA-yes) and 2) those in whom TC was diagnosed due to TC risk factors or symptoms (CSA-no). We then compared the clinicopathological features of these two groups. RESULTS: The most common type of TC diagnosed in the CSA-group was PTC (p = 0.024). CSA-yes patients showed a significantly lower degree of Tumor-Node-Metastasis (TNM) staging and demonstrated a significantly lower rate of multifocality, but not of bilaterality (p<0.0001 and p = 0.198, respectively). In the CSA-yes group, the number of TC foci was significantly lower than that in the CSA-no group (p<0.0001). All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p<0.0001), while all features observed in CSA-yes patients were characteristic of indolent cases (p<0.0001). CONCLUSIONS: The use of CSA results in the diagnosis of indolent cases of PTC and may be one of the potential causes of overdiagnosis and overtreatment of this malignancy.


Assuntos
Detecção Precoce de Câncer , Sobremedicalização , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia
14.
Am J Otolaryngol ; 41(4): 102543, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474327

RESUMO

PURPOSE: The purpose of this study is to assess the efficacy of ultrasonography in the differentiation of a bilateral and a unilateral WDTC to help physicians decide on performing a total or a partial thyroidectomy. MATERIALS AND METHODS: Retrospective chart review of all patients diagnosed with papillary thyroid carcinoma following a total thyroidectomy or a complete thyroidectomy between January 2013 and December 2015 at the Department of Otorhinolaryngology and Head and Neck Surgery in Soroka University Medical Center in southern Israel. The preoperative ultrasound images of the thyroid were compared to the final pathology in the contralateral lobe. RESULTS: Seventy seven patients (77) were included in this study, There was no correlation between the sonography in the contralateral lobe and the malignancy on that side (p = 0.479). US had a 39% false negative rate and 69% false positive rate. CONCLUSION: The patients with a well-differentiated carcinoma of the thyroid, a benign nodule detected sonographically in the contralateral lobe should not bear a high weight in decision making regarding the extent of surgery.


Assuntos
Tomada de Decisão Clínica/métodos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Ultrassonografia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
15.
Medicine (Baltimore) ; 99(26): e20644, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590739

RESUMO

The present study aimed to investigate the correlation between ultrasonographic features, basic fibroblast growth factor (bFGF), and the local invasiveness of papillary thyroid carcinoma (PTC).A total of 350 samples of thyroid nodules were collected. Routine ultrasonography was performed before the operation and routine pathological diagnosis and bFGF detection were performed after the operation.'These 350 samples of thyroid nodules included 90 samples of nodular goiter, 36 samples of focal thyroiditis, and 224 samples of PTC. A total of 326 thyroid nodules were examined for bFGF. The results revealed that the difference in the expression of bFGF between the benign and malignant groups was statistically significant (P < .05) and the difference in the positive expression of bFGF between the invasive and non-invasive PTC groups was statistically significant (P < .05).Whether the shape of PTC is regular or not and whether there is micro-calcification in PTC and other ultrasonographic features, the size and location of the lesions and the age of the patient help make a preliminary prediction of local invasiveness before the operation. Postoperative detection of bFGF is helpful for further risk assessments of PTC.


Assuntos
Fator 2 de Crescimento de Fibroblastos/metabolismo , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/metabolismo , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/metabolismo , Adulto , Fatores Etários , Idoso , Biomarcadores Tumorais/metabolismo , Feminino , Bócio/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Prospectivos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/metabolismo , Tireoidite/metabolismo , Ultrassonografia , Adulto Jovem
16.
Eur J Endocrinol ; 183(1): 83-93, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487777

RESUMO

Objective: The characteristics of metastatic lymph nodes (MLNs) have been investigated as important predictors of recurrence and progression in papillary thyroid cancer (PTC). However, clinically applicable risk stratification systems are limited to the assessment of size and number of MLNs. This study investigated the predictive value of detailed characteristics of MLNs in combination with currently used risk stratification systems. Design and methods: We retrospectively characterized 2811 MLNs from 9014 harvested LNs of 286 patients with N1 PTC according to the maximum diameter of MLN (MDLN), maximum diameter of metastatic focus (MDMF), ratio of both diameters (MDMFR), lymph node ratio (LNR, number of MLNs/number of total harvested LNs), presence of extranodal extension (ENE), desmoplastic reaction (DR), cystic component, and psammoma body. Results: Factors related to the size and number of MLNs were associated with increased risk of recurrence and progression. Extensive presence of ENE (>40%) and DR (≥50%) increased the risk of recurrence/progression. The combination of MDLN, LNR, ENE, and DR had the highest predictive value among MLN characteristics. Combination of these parameters with ATA risk stratification or 1-year response to therapy improved the predictive power for recurrence/progression from a Harrell's C-index of 0.781 to 0.936 and 0.867 to 0.960, respectively. Conclusions: The combination of currently used risk stratification systems with detailed characterization of MLNs may improve the predictive accuracy for recurrence/progression in N1 PTC patients.


Assuntos
Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Adulto , Feminino , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
17.
Zhonghua Zhong Liu Za Zhi ; 42(6): 463-468, 2020 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-32575941

RESUMO

Objective: To explore the differential protein expressions in papillary thyroid carcinoma (PTC) with or without Hashimoto's thyroiditis (HT). Methods: Tissue microarray was prepared and the protein expression levels of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF), vascular endothelial growth factor (VEGF), cyclinD1, mesothelial cell (MC) , CD56 and Galectin3 in the PTC tissues with or without HT were detected by immunohistochemical staining. Results: The positive expression rates of BRAF protein in the PTC tissues with or without HT groups were 55.4% (36/65) and 63.6% (42/66), respectively, without significant difference (P=0.336). The positive expression rates of VEGF protein in the PTC tissues with or without HT groups were 25.7% (19/74) and 25.8%(17/66), respectively, without significant difference (P=0.991). The positive expression rates of cyclin D1 protein in the PTC tissues with or without HT groups were 93.4% (71/76) and 97.6% (80/82), without significant difference (P=0.206). The positive expression rates of MC protein in the PTC tissues with or without HT groups were 86.1% (62/72) and 83.5%(71/85), without significant difference (P=0.654). The positive expression rates of Galectin3 protein in the PTC tissues with or without HT groups were 98.7% (76/77) and 97.5% (78/80), without significant difference (P=0.583). The positive expression rates of CD56 in the PTC tissues and adjacent thyroid follicular epithelial cells were 27.4% (32/117) and 65.0% (76/117), respectively, and the difference was statistically significant (P=0.001). The positive expression rates of CD56 in PTC tissues with or without HT were 35.5% (24/68) and 16.5% (13/79), respectively, and the difference was statistically significant (P=0.009). Conclusions: There are no significant differences in the expressions of BRAF, VEGF, CyclinD1, MC and Galectin3 between the PTC tissues with or without HT. However, the significantly differential expression of CD56 between the two group suggests that CD56 may be related to the pathogenesis of PTC with HT. CD56 may be used as a potential molecular marker in PTC diagnosis.


Assuntos
Adenocarcinoma Papilar/genética , Antígeno CD56/metabolismo , Carcinoma Papilar/patologia , Doença de Hashimoto/genética , Proteínas Proto-Oncogênicas B-raf/genética , Câncer Papilífero da Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adenocarcinoma Papilar/metabolismo , Adenocarcinoma Papilar/patologia , Animais , Biomarcadores/análise , Carcinoma Papilar/metabolismo , Ciclina D1/genética , Galectinas , Doença de Hashimoto/metabolismo , Doença de Hashimoto/patologia , Humanos , Camundongos , Valor Preditivo dos Testes , Proteínas Proto-Oncogênicas B-raf/metabolismo , Câncer Papilífero da Tireoide/metabolismo , Câncer Papilífero da Tireoide/patologia , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/metabolismo , Análise Serial de Tecidos , Fator A de Crescimento do Endotélio Vascular/genética
18.
BMC Infect Dis ; 20(1): 440, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571242

RESUMO

BACKGROUND: Infection with the Cryptococcus neoformans yeast fungus is largely restricted to patients with HIV, sarcoidosis or immunosuppressive therapies. In sarcoidosis, there is intense local immune response in granuloma lesions, coupled with a paradoxical systemic anergy. An analysis of cryptococcal infection in sarcoidosis may therefore shed light on whether opportunistic pathogens preferentially engage immune-privileged tissues. CASE PRESENTATION: A 54-year-old man was admitted to our hospital after 2 months with palpitations and activity-related presyncope. A chest X-ray was normal, electrocardiography showed type-II atrioventricular-block, and there was a tentative diagnosis of myocarditis. Computed tomography reported minor hilar lymph glands and multiple nodular lesions in the lungs. Magnetic resonance imaging showed oedema and nodular structures in the heart, and fibrosis and granulomas were found in endomyocardial biopsies. The diagnosis was revised to cardiac sarcoidosis, and prednisone was initiated. In parallel, positron-emission tomography had revealed a marked uptake in the right thyroid lobe, a thyroid lobectomy was then performed, and the pathology showed a BRAF-positive papillary thyroid carcinoma. Four days postoperatively the patient developed symptoms suggestive of meningoencephalitis. Cerebrospinal fluid and blood cultures yielded growth of C. neoformans. Fungal staining of the thyroid specimen revealed cryptococcal elements in the carcinoma and in granulomas close to the tumour. Notably, there was no evidence of cryptococci in the heart sarcoid sections or in the normal thyroid parenchyma. The patient was successfully treated with antifungal agents and at the 2-year follow-up there was no evidence of thyroid cancer relapse. CONCLUSION: This sarcoidosis patient had a remarkable clinic with evidence of cryptococcal infection only in body compartments commonly regarded to be immune-privileged. The findings suggest that an opportunistic and environmentally abundant pathogen, when infecting an immunocompromised host, primarily engages immunodeficient locations such as the brain, a tumour microenvironment and some forms of granuloma.


Assuntos
Criptococose/imunologia , Sarcoidose/etiologia , Antifúngicos/uso terapêutico , Cardiomiopatias/etiologia , Líquido Cefalorraquidiano/microbiologia , Criptococose/tratamento farmacológico , Cryptococcus neoformans/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Masculino , Meningoencefalite/microbiologia , Pessoa de Meia-Idade , Miocárdio/patologia , Sarcoidose/microbiologia , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/microbiologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
19.
Arch Endocrinol Metab ; 64(3): 251-256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555991

RESUMO

OBJECTIVE: We aimed to evaluate the impact of minimal extrathyroidal extension (mETE) alone on the risk of recurrence of papillary thyroid carcinoma (PTC). The impact of other factors, including multifocality, age, tumor size, and stimulated thyroglobulin (sTg) values was also assessed. SUBJECTS AND METHODS: We retrospectively analyzed 1,108 PTC patients from a medical institution, who presented tumors ≤ 4 cm without any adverse characteristics other than mETE. Patients were classified according to their response to initial treatment 12 to 24 months after surgery as proposed by the 2015 American Thyroid Association (ATA) guideline. Statistical analysis was performed using multivariate logistic regression and receiver operating characteristic (ROC) curve. RESULTS: In the multivariate logistic regression analysis, mETE did not have an impact on the response to initial treatment (p = 0.44), similar to multifocality, age, and tumor size. Initial Tg value was the only variable associated with a poor response (p < 0.01, odds ratio = 1.303, 95% confidence interval 1.25-1.36). The ROC analysis revealed that Tg was significant (area under curve = 0.8750); the cutoff value of sTg as a predictor of poor response was 10 ng/mL (sensitivity = 72.2%, specificity = 98.5%). CONCLUSION: For low-risk PTC presenting mETE as the only aggressive feature, the initial sTg value is essential to identify patients who may have a poor response after initial treatment and benefit from further treatment. Arch Endocrinol Metab. 2020;64(3):251-6.


Assuntos
Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Distribuição Aleatória , Estudos Retrospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Carga Tumoral , Adulto Jovem
20.
Clin Nucl Med ; 45(9): 687-688, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32453076

RESUMO

Breast metastasis from thyroid papillary carcinoma is an exceptional situation. Here, we present the diagnostic approach and the management of a 19-year-old woman with single breast metastasis from thyroid carcinoma. There was no extra thyroidal extension, neoplastic emboli, or lymph node invasion. The metastasis was revealed by whole-body radioactive I scan, explored by a fine-needle aspiration, and confirmed by elevated thyroglobulin in situ.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/secundário , Radioisótopos do Iodo , Câncer Papilífero da Tireoide/patologia , Imagem Corporal Total , Biópsia por Agulha Fina , Neoplasias da Mama/patologia , Feminino , Humanos , Metástase Linfática , Adulto Jovem
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