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Canberk S, Thodou E, Bongiovanni M. Small-Cell Malignancies of Thyroid: Challenge Solved? Acta Cytol 2022; 66:307-318. [PMID: 35016187 DOI: 10.1159/000520876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
"Small-cell malignancies of thyroid" is an unsolved dilemma. This term represents an umbrella terminology in thyroid, encompassing for a small group of tumors in which some of them are well-recognized tumors like medullary thyroid carcinoma, poorly differentiated thyroid carcinoma, and primary thyroid lymphomas and teratoma, whereas the remaining are less known as primary neuroendocrine carcinoma of thyroid, primary extraskeletal Ewing family tumors, and adamantinoma-like Ewing sarcoma. When the issue comes to evaluate a cytological sample predominantly composed of small-cell morphology, metastatic small-cell carcinomas to thyroid also should be excluded. In this review, our group focused on the main cytomorphological and clinical clues of each entity that help to set up a correct differential diagnosis. The literature discussions were also included for the entities that are not yet recognized by the mother publication WHO. A key point of the issue's simple algorithm based on FNAC with small-cell morphology of thyroid was suggested by the authors.
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Affiliation(s)
- Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Eleni Thodou
- Department of Pathology, Faculty of Medicine, University of Thessaly, Larisa, Greece
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Nastos C, Paspala A, Stamelos M, Mavroeidi I, Proikas K, Thomopoulou G, Psyrri A, Pikoulis E. Primary thyroid teratoma in adults: A case report and systematic review of the literature. Mol Clin Oncol 2021; 15:169. [PMID: 34295469 DOI: 10.3892/mco.2021.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/08/2021] [Indexed: 11/05/2022] Open
Abstract
Extragonadal germ cell tumors are uncommon in adults and only 2-5% of teratomas develop in extragonadal sites. Primary thyroid teratomas represent <0.1% of all primary thyroid gland neoplasms. In the present report, a case of primary thyroid teratoma in a 65-year-old female is described. Furthermore, the current literature regarding patients who were diagnosed with primary thyroid teratoma and underwent surgical resection was systematically reviewed. A total of 15 studies of 27 patients (age range, 17-65 years). Growing mass or neck swelling were the primary symptoms in 14 patients (51.8%). Only one (5.5%) patient was preoperatively diagnosed with malignant thyroid teratoma. All patients underwent thyroidectomy, but 6 cases had more advanced surgery, including lymph node dissection. A total of 12 patients received a combination of adjuvant chemoradiation postoperatively, 10 (45.4%) patients reported recurrence of disease and 8 (29.6%) were postoperatively diagnosed with distant metastases. A total of 9 (39.1%) patients died due to progression of the disease. In conclusion, primary thyroid teratomas are rare and difficult to diagnose preoperatively. In particular, malignant cases are very aggressive tumors with a considerably poor prognosis, even after surgical resection combined with adjuvant chemoradiation.
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Affiliation(s)
- Constantinos Nastos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anna Paspala
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Mathew Stamelos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine and Research Institute, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Proikas
- ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Thomopoulou
- Department of Cytopathology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Emmanuil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Miller DL, Thompson LDR, Bishop JA, Rooper LM, Ali SZ. Malignant teratomas of the thyroid gland: clinico-radiologic and cytomorphologic features of a rare entity. J Am Soc Cytopathol 2020; 9:221-231. [PMID: 32448730 DOI: 10.1016/j.jasc.2020.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary thyroid gland malignant teratomas are extremely rare and can pose diagnostic challenges on fine needle aspiration (FNA) due to their cytomorphologic heterogeneity. Recent next generation sequencing studies have identified recurrent DICER1 hotspot mutations in these tumors, suggesting that malignant teratomas of the thyroid should be considered a distinct pathological entity. Herein, we review the clinico-radiologic and FNA findings in a series of DICER1 mutated malignant teratomas. METHODS We performed a retrospective case review of 9 FNAs from 5 patients with a histologically confirmed malignant teratoma of the thyroid gland from 2 large tertiary care pathology practices. RESULTS The patients included 4 females and 1 male, with an average age of 43 years (22-65 years). The nodules were centered within the thyroid gland and ranged from 1.7 to 10 cm in diameter. FNAs of primary thyroid teratomas demonstrate marked cellularity, epithelial proliferations, an absence of colloid, and a predominance of immature spindled cells, representing the mesenchymal and neural ectodermal components of these tumors. The FNA interpretations ranged from atypia of undetermined significance to overtly malignant. Three patients died of their disease and 2 are alive with no evidence of disease. CONCLUSIONS Malignant thyroid teratoma is a rare entity with cytomorphologic overlap with other high-grade neoplasms of the thyroid. Recent molecular studies have defined recurrent DICER1 mutations in malignant thyroid teratomas and propose these as a distinct clinicopathological entity. The features described here may be helpful in providing a correct prospective interpretation.
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Affiliation(s)
- Daniel L Miller
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, California
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa M Rooper
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
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Starling CE, Sabra J, Brady B, Horton M, Traweek ST. Malignant teratoma of the thyroid: A difficult diagnosis by fine-needle aspiration. Diagn Cytopathol 2019; 47:930-934. [PMID: 31120625 DOI: 10.1002/dc.24216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/03/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
Primary thyroid teratomas are rare, usually benign, and typically occur in children. We report the unusual occurrence of a malignant thyroid teratoma in a young man. Initial ultrasound and CT studies revealed an 8.5 heterogeneous mass involving the entire right thyroid lobe causing tracheal compression and deviation. Fine-needle aspiration (FNA) revealed malignant cells with possible neuroendocrine features. Similar findings have been previously reported, with an occasional interpretation as possible medullary thyroid carcinoma. In no report, as with our case, has the correct diagnosis been suggested with FNA. The surgical specimen contained abundant primitive neuroepithelium with a very minor component of mature ectodermal tissue in one area. Like this case, an abundance of immature neuroepithelium has been reported in essentially all previous reports of primary malignant thyroid teratoma, sometimes creating a challenge to find another type of germ cell tissue. Array comparative genomic hybridization studies in this case revealed a markedly complex karyotype including gain of chromosome 12 and loss of 17p. Amplification of MYCN, EWSR1 rearrangement and isochromosome 12p were not identified, providing no evidence for neuroblastoma or Ewing sarcoma/peripheral neuroectodermal tumor, both of which have also rarely been reported as primary thyroid tumors. With the use of cisplatinum-based chemotherapy combined with radiation, survival times have increased dramatically. Our patient is now disease free and back to his normal activities after relatively short follow-up. Although rare, it is important to be aware that teratomas may present as a thyroid nodule. Recognition by FNA is challenging, and requires multiple modalities for full identification.
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Michalski W, Jonska-Gmyrek J, Poniatowska G, Kucharz J, Stelmasiak P, Nietupski K, Sadowska M, Demkow T, Wiechno P. Testicular teratomas: a growing problem? Med Oncol 2018; 35:153. [PMID: 30367327 DOI: 10.1007/s12032-018-1215-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/24/2018] [Indexed: 01/05/2023]
Abstract
Testicular teratomas represent a specific entity within the group of germ-cell tumours. They may comprise elements of all three germ layers. In contrast to prepubertal benign teratomas observed in infants and adolescents, postpubertal teratomas originate from the malignant germ-cell precursor. Given the good prognosis and curability of most patients with germ-cell tumour, medical oncologists and urological surgeons must be well acquainted with the principles of teratomas management. Surgery plays the decisive part in teratomas treatment, as these tumours are resistant to radio- and, to some extent, chemotherapy. In this article we concentrate on the management of post-chemotherapy resection of teratomatous masses, with special attention to the phenomenon of 'growing teratoma syndrome' and somatic-type transformation of teratomas. To understand the nature of teratomas better, we begin with a glimpse of their biological, molecular and immunohistochemical features. Managing germ-cell tumours, teratomas in particular, in high-volume reference centres is of utmost importance to maintain and increase the survivorship rate in these patients.
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Affiliation(s)
- Wojciech Michalski
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Grazyna Poniatowska
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Jakub Kucharz
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland.
| | - Pawel Stelmasiak
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Karol Nietupski
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Malgorzata Sadowska
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Tomasz Demkow
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
| | - Pawel Wiechno
- Department of Uro-oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, 5, Roentgen Street, 02-781, Warsaw, Poland
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