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1.
Adv Exp Med Biol ; 1287: 155-168, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33034031

RESUMO

Thyroid cancer is the most common malignancy of the endocrine system with a steadily rising incidence. The term "thyroid cancer" encompasses a spectrum of subtypes, namely papillary thyroid cancer, follicular thyroid cancer, anaplastic thyroid cancer, and medullary thyroid cancer. Each subtype differs histopathologically and in degrees of cellular differentiation, which may be in part due to signaling of the Notch pathway. The Notch pathway is an evolutionarily conserved signal transduction mechanism that regulates cell proliferation, differentiation, survival, stem cell maintenance, embryonic and adult development, epithelial-mesenchymal transition, and angiogenesis. Its role in cancer biology is controversial, as it has been shown to play both an oncogenic and tumor-suppressive role in many different types of cancers. This discordance holds true for each subtype of thyroid cancer, indicating that Notch signaling is likely cell type and context dependent. Whether oncogenic or not, Notch signaling has proven to be significantly involved in the tumorigenesis of thyroid cancer and has thus earned interest as a therapeutic target. Advancement in the understanding of Notch signaling in thyroid cancer holds great promise for the development of novel treatment strategies to benefit patients.


Assuntos
Receptores Notch/metabolismo , Transdução de Sinais , Neoplasias da Glândula Tireoide/metabolismo , Humanos , Oncogenes , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia
2.
Medicine (Baltimore) ; 99(40): e22350, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019411

RESUMO

BACKGROUND: Ultrasonography is the first choice for clinical diagnosis and differentiation of thyroid cancer Currently. However, due to the complexity and overlapping nature of the thyroid nodule sonograms, it remains difficult to accurately identify nodules with atypical ultrasound characteristics. Previous studies showed that superb microvascular imaging (SMI) can detect tumor neovascularization to differentiate benign from malignant thyroid nodules. However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant thyroid nodules. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the August 20, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software ((Stata Corp, College Station, TX) will be used for data analysis. RESULTS: This systematic review will determine the accuracy of SMI in distinguishing thyroid nodules. CONCLUSION: Its findings will provide helpful evidence for the accuracy of SMI in in distinguishing thyroid nodules.Systematic review registration: INPLASY202080084.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos , Diagnóstico Diferencial , Neovascularização Patológica/patologia , Projetos de Pesquisa , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem
3.
Medicine (Baltimore) ; 99(33): e21599, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872013

RESUMO

INTRODUCTION: Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is a rare neoplasm characterized by morphological analogy to papillary thyroid carcinoma and the abnormal expression of thyroid transcription factor-1 (TTF-1). We herein report a rare case of TL-LGNPPA with a review of its clinical and morphological characteristics and the treatment provided. PATIENT CONCERNS AND DIAGNOSIS: The patient was a 50-year-old Chinese woman with the complaint of a three-year history of phlegm with blood with pharyngeal discomfort. There were no remarkable physical findings, and the laboratory tests were normal. Laryngoscopy and nasal computed tomography identified a mass at the posterior end of the nasal septum. Histologically, the tumor exhibited an oval papillary growth. Immunohistochemically, the neoplastic cells were positive for TTF-1, vimentin, cytokeratin 7, and cytokeratin 19. Pathological examination indicated a thyroid-like low-grade nasopharyngeal papillary adenocarcinoma. INTERVENTION: The neoplasm was completely resected without any complication. OUTCOMES: The patient had neither local recurrence nor distant metastasis 1 year after the removal of the tumor. CONCLUSION: Although TL-LGNPPA is a malignant tumor, complete surgical resection is an effective treatment.


Assuntos
Adenocarcinoma Papilar/patologia , Carcinoma Nasofaríngeo/patologia , Adenocarcinoma Papilar/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/cirurgia , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/patologia
4.
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
5.
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
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.
Tokai J Exp Clin Med ; 45(3): 144-147, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901904

RESUMO

A 14 year-old girl with a previous medical history of cholecystic polyps was referred to our department with throat discomfort during swallowing. The cervical ultrasound and magnetic resonance imaging revealed a massive polycystic formation with a diameter of 45 × 24 × 31 mm consistent with a right lobe goiter. However, there were no findings for suspected malignancy. Hemithyroidectomy was performed and the specimen was sent for histopathological assessment. Hematoxylin-eosin staining of the right lower nodule showed variably-sized follicles consistent with adenomatous goiter. The right upper nodule showed a growth of relatively compact sized follicles with a thick fibrous capsule. A satellite nodule lying outside of the tumor capsule was consistent with minimally invasive follicular thyroid microcarcinoma. We observed her without any additional treatment and no recurrence is seen at present.


Assuntos
Carcinoma/patologia , Bócio/patologia , Bócio/cirurgia , Achados Incidentais , Neoplasias da Glândula Tireoide/patologia , Adolescente , Feminino , Bócio/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Microscopia Acústica , Tireoidectomia/métodos
8.
Medicine (Baltimore) ; 99(36): e21802, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899008

RESUMO

Bone is a frequent site for the occurrence of metastasis of thyroid cancer (TC). TC with bone metastasis (TCBM) is associated with skeletal-related events (SREs), with poor prognosis and low overall survival (OS). Therefore, it is necessary to develop a predictive nomogram for prognostic evaluation. This study aimed to construct an effective nomogram for predicting the OS and cancer-specific survival (CSS) of TC patients with BM. Those TC patients with newly diagnosed BM were retrospectively examined over a period of 6 years from 2010 to 2016 using data from the Surveillance, Epidemiology and End Results (SEER) database. Demographics and clinicopathological data were collected for further analysis. Patients were randomly allocated into training and validation cohorts with a ratio of ∼7:3. OS and CSS were retrieved as research endpoints. Univariate and multivariate Cox regression analyses were performed for identifying independent predictors. Overall, 242 patients were enrolled in this study. Age, histologic grade, histological subtype, tumor size, radiotherapy, liver metastatic status, and lung metastatic status were determined as the independent prognostic factors for predicting the OS and CSS in TCBM patients. Based on the results, visual nomograms were separately developed and validated for predicting 1-, 2-, and 3-year OS and CSS in TCBM patients on the ground of above results. The calibration, receiver operating characteristic (ROC) curve and decision curve analysis (DCA) also demonstrated the reliability and accuracy of the clinical prediction model. Our predictive model is expected to be a personalized and easily applicable tool for evaluating the prognosis of TCBM patients, and may contribute toward making an accurate judgment in clinical practice.


Assuntos
Neoplasias Ósseas/secundário , Nomogramas , Neoplasias da Glândula Tireoide/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Estudos Retrospectivos , Programa de SEER/estatística & dados numéricos , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
9.
Medicine (Baltimore) ; 99(38): e22338, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957404

RESUMO

The ability to identify patients with aggressive papillary thyroid microcarcinoma (PTMC) from the low-risk patients is critical to planning proper management of PTMC. Lymph node metastases showed association with recurrence and low survival rate, especially in patients with >5 or ≥2 mm metastatic lymph nodes. Therefore, this study aimed to investigate the preoperatively predictive factors of non-small-volume (metastatic lymph nodes >5 or ≥2 mm in size) central lymph node metastases (NSVCLNM) in PTMC patients. A total of 420 patients with clinically node-negative (cN0) PTMC without extrathyroidal extension underwent thyroidectomy plus central neck dissection (CND) between January 2013 and December 2015, were retrospectively analyzed. Of the 420 patients, 33 (7.9%) had NSVCLNM. The 5-year recurrence-free survival was significantly less in cN0 PTMC patients with NSVCLNM, when compared with patients without NSVCLNM (80.8% vs 100%, P < .001). Multivariate logistic regression revealed age ≤36 years (P < .001), male sex (P = .002), ultrasonic tumor sizes of >0.65 cm (P < .001), and ultrasonic multifocality (P = .039) were independent predictive factors of NSVCLNM. A prediction equation (Y = 1.714 × age + 1.361 × sex + 1.639 × tumor size + 0.842 × multifocality -5.196) was developed, with a sensitivity (69.7%) and a specificity (84.0%), respectively, at an optimal cutoff point of -2.418. In conclusion, if the predictive value was >-2.418 according to the equation, immediate surgery including CND rather than active surveillance might be considered for cN0 PTMC patients.


Assuntos
Carcinoma Papilar/patologia , Metástase Linfática/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Carcinoma Papilar/mortalidade , Carcinoma Papilar/cirurgia , Feminino , Humanos , Metástase Linfática/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Melhoria de Qualidade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto Jovem
10.
Medicine (Baltimore) ; 99(34): e21882, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846846

RESUMO

Thyroid cancer (TC) is the most well-known endocrine neoplasia as well as a common malignant tumor in the head and neck. Our study was designed to assess the prognostic meaningful of TNFRSF12A expression in TC dependent on data acquired from TCGA and so as to increase further knowledge into the biological pathways involved in TC pathogenesis related TNFRSF12A.Information on gene expression and comparing clinical data were identified and downloaded from TCGA. Gene set enrichment analysis (GSEA) created an arranged list of all genes indicated by their connection with TNFRSF12A expression.Our study cohort included 370 (73.1%) female and 136 (26.9%) male patients. The scatter plot and paired plot showed the difference of TNFRSF12A expression between normal and tumor samples (P < .01). The univariate analysis suggested that TNFRSF12A-low associated essentially with age (HR: 1.15; 95%CI: 1.08-1.22; P < .01), stage (HR: 2.79; 95%CI: 1.43-5.46; I vs IV; P = .003) and tumor stage (HR: 2.39; 95%CI: 1.08-5.30; P = .031). The GSEA results show that type II diabetes mellitus, pantothenate and CoA biosynthesis, adipocytokine signaling pathway, PPAR signaling pathway, mTOR signaling pathway, insulin signaling pathway, are enriched in TNFRSF12A low expression phenotype.TNFRSF12A expression may be a potential useful prognostic molecular biomarker of bad survival in thyroid cancer, in addition, PPAR signaling pathway, insulin signaling pathway, mTOR signaling pathway may be the key pathway controlled by TNFRSF12A in thyroid cancer. Further experimental ought to be performed to demonstrate the biologic effect of TNFRSF12A.


Assuntos
Transdução de Sinais , Receptor de TWEAK/genética , Neoplasias da Glândula Tireoide/genética , Adipocinas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Receptores Ativados por Proliferador de Peroxissomo/genética , Valor Preditivo dos Testes , Prognóstico , Serina-Treonina Quinases TOR/genética , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia
11.
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
12.
APMIS ; 128(11): 563-572, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32794589

RESUMO

Neuroendocrine tumors (NETs) are often diagnosed from the metastases of an unknown primary tumor. Specific immunohistochemical (IHC) markers indicating the location of a primary tumor are needed. The proprotein convertase subtilisin/kexin type 2 (PCSK2) is found in normal neural and neuroendocrine cells, and known to express in NETs. We investigated the tissue microarray (TMA) of 86 primary tumors from 13 different organs and 9 metastatic NETs, including primary tumor-metastasis pairs, for PCSK2 expression with polymer-based IHC. PCSK2 was strongly positive in all small intestine and appendiceal NETs, the so-called midgut NETs, in most pheochromocytomas and paragangliomas, and in some of the typical and atypical pulmonary carcinoid tumors. NETs showing strong positivity were re-evaluated in larger tumor cohorts confirming the primary observation. In the metastases, the expression of PCSK2 mirrored that of the corresponding primary tumors. We found negative or weak staining in NETs from the thymus, gastric mucosa, pancreas, rectum, thyroid, and parathyroid. PCSK2 expression did not correlate with Ki-67 in well-differentiated NETs. Our data suggest that PCSK2 positivity can indicate the location of the primary tumor. Thus, PCSK2 could function in the IHC panel determined from screening metastatic NET biopsies of unknown primary origins.


Assuntos
Neoplasias das Glândulas Suprarrenais/genética , Carcinoma Neuroendócrino/genética , Neoplasias Gastrointestinais/genética , Neoplasias Pulmonares/genética , Tumores Neuroendócrinos/genética , Paraganglioma/genética , Feocromocitoma/genética , Pró-Proteína Convertase 2/genética , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Biomarcadores Tumorais/genética , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/cirurgia , Cromogranina A/genética , Feminino , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Expressão Gênica , Humanos , Imuno-Histoquímica , Antígeno Ki-67/genética , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/patologia , Paraganglioma/cirurgia , Feocromocitoma/diagnóstico , Feocromocitoma/patologia , Feocromocitoma/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
13.
Eur J Endocrinol ; 183(5): 521-528, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32841935

RESUMO

Objective: The ultrasonographic scores EU TI-RADS and ACR TI-RADS were introduced to give the clinicians indications for fine needle aspiration cytology (FNAC). The predictive role of these scores was never evaluated and compared in a surgical series of patients. The aim of this study was to evaluate the ex post diagnostic accuracy of EU TI-RADS and ACR TI-RADS in a real-life series of thyroidectomized patients and to evaluate the 'missing' thyroid cancer following the operational indications of these scores. Design: Retrospective monocentric cohort study. Methods: In total, 255 patients (harboring 304 nodules) undergoing thyroidectomy for benign and malignant thyroid conditions were enrolled. The prevalence of thyroid malignancy for each class of ACR TI-RADS and EU TI-RADS, their diagnostic accuracy, the number of 'unnecessary' FNAC and the number of 'missed' cancers were evaluated. Results: ACR TI-RADS and EU TI-RADS score had similar and satisfactory accuracy values for predicting thyroid malignancy (AUC: 0.835 for ACR TI-RADS vs 0.827 for EU TI-RADS). The ACR TI-RADS and EU TI-RADS categories (suspicious vs non-suspicious), age, sex and presence of a single nodule significantly and independently predicted the presence of malignancy in a logistic regression model. An ex post analysis according to the indications for FNAC for each score indicated that 31 and 16 cases of cancer would have been missed by ACR TI-RADS and EU TI-RADS scores, respectively. Conclusions: ACR TI-RADS and EU TI-RADS display a good performance in predicting thyroid cancer when histology is taken as reference standard, but additional clinical judgement is required to decide the indication for FNAC.


Assuntos
Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Tireoidectomia , Ultrassonografia , Adulto Jovem
14.
Am J Surg Pathol ; 44(9): 1161-1172, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32804453

RESUMO

Given the high incidence and excellent prognosis of many papillary thyroid microcarcinomas, the Porto proposal uses the designation papillary microtumor (PMT) for papillary microcarcinomas (PMCs) without risk factors to minimize overtreatment and patients' stress. To validate Porto proposal criteria, we examined a series of 190 PMC series, also studying sex hormone receptors and BRAF mutation. Our updated Porto proposal (uPp) reclassifies as PMT incidental PMCs found at thyroidectomy lacking the following criteria: (a) detected under the age of 19 years; (b) with multiple tumors measuring >1 cm adding up all diameters; and (c) with aggressive morphologic features (extrathyroidal extension, angioinvasion, tall, and/or hobnail cells). PMCs not fulfilling uPp criteria were considered "true" PMCs. A total of 102 PMCs were subclassified as PMT, 88 as PMC, with no age or sex differences between subgroups. Total thyroidectomy and iodine-131 therapy were significantly more common in PMC. After a median follow-up of 9.6 years, lymph node metastases, distant metastases, and mortality were only found in the PMC subgroup. No subgroup differences were found in calcifications or desmoplasia. Expression of estrogen receptor-α and estrogen receptor-ß, progesterone receptor, and androgen receptor was higher in PMC than in nontumorous thyroid tissue. BRAF mutations were detected in 44.7% of PMC, with no differences between subgroups. In surgical specimens, the uPp is a safe pathology tool to identify those PMC with extremely low malignant potential. This terminology could reduce psychological stress associated with cancer diagnosis, avoid overtreatment, and be incorporated into daily pathologic practice.


Assuntos
Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Carcinoma Papilar/química , Carcinoma Papilar/genética , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Receptores de Esteroides/análise , Neoplasias da Glândula Tireoide/química , Neoplasias da Glândula Tireoide/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/patologia , Carcinoma Papilar/terapia , Análise Mutacional de DNA , Receptor alfa de Estrogênio/análise , Receptor beta de Estrogênio/análise , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radioterapia Adjuvante , Receptores Androgênicos/análise , Receptores de Progesterona/análise , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Resultado do Tratamento , Adulto Jovem
15.
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
16.
Medicine (Baltimore) ; 99(31): e21398, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756134

RESUMO

Pediatric patients with differentiated thyroid cancer (DTC) tend to have more advanced disease at presentation, for which more aggressive radioiodine (RAI) treatment would be commonly recommended. Several previous studies recommended dosimetry to calculate the optimal activity of RAI in pre-pubertal children and in children with a significant distant metastasis. This study aimed to evaluate the effect of empirical RAI treatment for DTC on bone marrow function in pre-pubertal children and adolescents.DTC patients aged ≤ 18 years receiving empirical RAI treatment with complete blood count data before and after treatment were included and divided into pre-pubertal and pubertal groups. Blood count values at baseline and 1.5-3 months, 3-6 months, and 6-12 months after RAI treatment were compared. The effect of demographic, clinical, and laboratory variables on bone marrow function were assessed.We included 83 patients (113 treatments). At diagnosis, pre-pubertal children had more aggressive tumor features, including tumor size (P = .045) and distant metastases (P = .037). Approximately 51% to 96% of hypocellular bone marrow, and 11% to 14% of anemia were observed in the pre-pubertal and pubertal groups, with a majority of mild (Grade 1-2) and minority of moderate (Grade 3) bone marrow suppression. No significant differences in bone marrow function or Common Terminology Criteria for Adverse Events (CTCAE) grades were found between the pre-pubertal and pubertal groups after RAI treatment. None of the clinical factors tested were found to be significant predictors for bone marrow suppression after RAI treatment.Empirical RAI treatment for DTC in pre-pubertal children and adolescents causes mild to moderate bone marrow suppression with limited clinical significance. With adequate preparations for RAI treatment, empirical high activities (150-200 mCi) could be safe and well tolerated by both pre-pubertal and pubertal patients with DTC.


Assuntos
Radioisótopos do Iodo/uso terapêutico , Neoplasias da Glândula Tireoide/radioterapia , Adolescente , Contagem de Células Sanguíneas , Medula Óssea/efeitos dos fármacos , Criança , Feminino , Humanos , Radioisótopos do Iodo/farmacologia , Leucopenia/induzido quimicamente , Masculino , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento
17.
An. Fac. Cienc. Méd. (Asunción) ; 53(2): 67-72, 20200800.
Artigo em Espanhol | LILACS | ID: biblio-1119431

RESUMO

Introducción: El Cáncer de tiroides es la neoplasia maligna más frecuente del sistema endócrino. Durante las últimas décadas se ha observado un aumento de su incidencia de forma progresiva en numerosos países y regiones del mundo. Objetivos: Determinar la prevalencia de Cáncer de tiroides y, los tipos histológicos, en 3 hospitales de referencia en Paraguay. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se incluyó a todos los pacientes sometidos a tiroidectomía parcial o total en el Hospital de Clínicas, Instituto de Previsión Social e Instituto Nacional del Cáncer, entre los años 2011 y 2015. Resultados: La prevalencia de cáncer de tiroides fue de 23,7% de 1913 pacientes sometidos a tiroidectomía. El 85,7% fueron del sexo femenino. La edad media fue de 43±14 años. El 85,4 % de los pacientes presentó Carcinoma Papilar; el 9,5% Carcinoma Folicular; el 3,1% Carcinoma Medular; el 1,6% Carcinoma Anaplásico y el 0,4% Carcinoma Papilar + Carcinoma Folicular en el mismo paciente. El sexo femenino fue más frecuente en todos los tipos histológicos y, el Carcinoma Medular resultó igual en ambos sexos. La edad media de los pacientes con Carcinoma Papilar fue de 42±13 años, Carcinoma Medular 49±15 años, del Carcinoma Folicular 50±18 años y Carcinoma Anaplásico 69±11 años. El tamaño promedio del Carcinoma Papilar fue de 19±17 mm, del Carcinoma Folicular 53±24 mm, del Carcinoma Medular 40±22 mm, y el Carcinoma Anaplásico 50±35 mm. Conclusión: Aproximadamente 1 de cada 4 pacientes sometidos a tiroidectomía presentó cáncer de tiroides, siendo más frecuente en el sexo femenino y, el Carcinoma Papilar es el tipo histológico más frecuente.


Introduction: Thyroid cancer is the most frequent malignant neoplasm of the endocrine system. During the last decades, an increase in its incidence has been observed progressively in many countries and regions of the world. Objectives: To determine the prevalence of thyroid cancer and its histological types in thyroidectomies carried out in reference hospitals in Paraguay. Materials and methods: Observational, descriptive, retrospective, cross-sectional study. All patients undergoing partial or total thyroidectomy at the Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: The prevalence of thyroid cancer was 23.7% of 1913 patients undergoing thyroidectomy. 85.7% were female. The mean age was 43 ± 14 years. 85.4% of the patients presented Papillary Carcinoma; 9.5% Follicular Carcinoma; 3.1% Medullary Carcinoma; 1.6% Anaplastic Carcinoma and 0.4% Papillary Carcinoma + Follicular Carcinoma in the same patient. The mean age of the patients with Papillary Carcinoma was 42 ± 13 years, Medullary Carcinoma 49 ± 15 years, Follicular Carcinoma 50 ± 18 years, and Anaplastic Carcinoma 69 ± 11 years. The average size of Papillary Carcinoma was 19 ± 17 mm, Medullary Carcinoma 40 ± 22 mm, Anaplastic Carcinoma 50 ± 35 mm, and Follicular Carcinoma 53 ± 24 mm. Conclusion: About 1 in 4 patients undergoing thyroidectomy has thyroid cancer, it is more frequent in women, and the most frequent histological type is Papillary Carcinoma.


Assuntos
Neoplasias da Glândula Tireoide , Neoplasias da Glândula Tireoide/patologia , Paraguai , Prevalência
18.
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
19.
Acta Med Indones ; 52(2): 163-171, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32778631

RESUMO

Global widespread of current coronavirus disease 2019 (COVID-19) pandemic has emerged huge predicament to healthcare systems globally. This disease caused by a new beta-type coronavirus, known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), may lead to systemic multiorgan dysfunction syndrome and subsequently cause death due to abundant angiotensin converting enzyme 2 as its functional receptors throughout body. Oncology patients even have a worse prognosis with greater infection susceptibility because they are in a state of suppression of the systemic immune system due to malignancy and anticancer therapy. This problem makes adequate and appropriate treatment urgently needed. Through randomized clinical trials, various drugs were known to have good responses in COVID-19 patients. Here, we reported a-49-year-old-woman that was confirmed for COVID-19 by clinical manifestation, radiology profile, high procalcitonin concentration, and positive polymerase chain reaction (PCR) test. The patient also had breast and thyroid cancers history and had undergone various therapeutic modalities such as chemotherapy, thyroid surgery, and breast surgery. She was undergoing hormone therapy but experiencing disease progression after achieving complete remission based on PET-CT scan 4 months before. The patient was treated with various antibiotics but showed a significant clinical improvement by administering moxifloxacin.


Assuntos
Antineoplásicos/uso terapêutico , Betacoronavirus/isolamento & purificação , Neoplasias da Mama , Infecções por Coronavirus , Moxifloxacina/administração & dosagem , Pandemias , Pneumonia Viral , Pró-Calcitonina/sangue , Neoplasias da Glândula Tireoide , Anti-Infecciosos/administração & dosagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Radiografia Torácica/métodos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia/métodos , Resultado do Tratamento
20.
Eur J Endocrinol ; 183(4): 411-417, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688334

RESUMO

Objective: At present, recombinant TSH cannot be used for the treatment of metastatic differentiated thyroid cancer patients. The aim of this study was to evaluate if the type of TSH stimulation, recombinant or endogenous, had an impact on the outcome of these patients. Design and methods: We compared the outcome of two propensity score-matched groups of metastatic patients, stimulated by either only recombinant TSH (n = 43) or only endogenous TSH (n = 34). Results: As expected from the matching procedure, the clinical-pathological features and the cumulative 131-I activities administered to the two groups were very similar. After 4 years of follow-up, 4% of patients were cured, 3% had biochemical disease and 93% had structural disease. However, 91% of patients obtained a clinical benefit from this therapy in terms of stabilization of the disease or complete remission or partial response. When considering the two groups separately, we did not find any difference in their outcome. When considering the response to 131-I therapy of the single type of metastases, 8% of lymph node metastases and 8% of lung metastases disappeared but none of the bone metastases. The response to 131-I therapy of the single type of metastases was similar when we looked at the two groups separately. Conclusions: This study shows (i) an overall clinical benefit of the 131-I therapy, since the majority of patients remained affected but with a stable disease, and (ii) that the preparation with either recombinant or endogenous TSH has no impact on the 131-I therapy efficacy and the outcome of our two groups of patients.


Assuntos
Adenocarcinoma/tratamento farmacológico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tireotropina/uso terapêutico , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Quimioterapia Adjuvante , Criança , Terapia Combinada , Feminino , Seguimentos , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Pontuação de Propensão , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Resultado do Tratamento , Adulto Jovem
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