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Lorenz K, Machens A, Dralle H. [Individualization of treatment in sporadic and hereditary medullary thyroid cancer]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:186-191. [PMID: 38214736 DOI: 10.1007/s00104-023-02015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Routine preoperative assessment of the tumor marker calcitonin for medullary thyroid cancer (MTC) and the generally improved diagnostics with high-resolution ultrasound, elastography and Doppler function as well as functional imaging, enable the earlier detection of organ-limited, non-metastasized MTC. Thereby, a new treatment option arises for surgical de-escalation in sporadic MTC, moving from routine thyroidectomy with bilateral central lymph node dissection towards unilateral thyroidectomy with ipsilateral central lymph node dissection. MATERIAL AND METHODS A search was carried out in PubMed for surgical approaches and selection of publications with results from limited resection in sporadic MTC. RESULTS In selected patient cohorts limited resection surgery can achieve adequate oncological results but requires long-term follow-up. DISCUSSION When sporadic unifocal primary tumors are identified and intraoperative frozen section pathological investigation is consistently employed for assessing the grade of desmoplasia and breach of the tumor capsule, the extent of resection can be intraoperatively adapted. Pivotal prerequisites for this personalized concept include consideration of preoperative clinical criteria and intraoperative surgical assessment in conjunction with the intraoperative frozen section examination in order to achieve an adequate oncological tumor resection and a biochemical cure.
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Affiliation(s)
- Kerstin Lorenz
- Klinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland.
| | - Andreas Machens
- Klinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsmedizin Halle, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland
| | - Henning Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion für Endokrine Chirurgie, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Brandenburg T, Machlah YM, Führer D. [Precision medicine in endocrinology exemplified by medullary thyroid cancer]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:202-210. [PMID: 38231404 DOI: 10.1007/s00108-023-01635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
Medullary thyroid cancer (MTC) is a prime example for precision medicine in endocrinology and underlines the immediate benefits of basic, translational and healthcare research for patients with a rare disease in clinical . A mutation in the rearranged during transfection (RET) proto-oncogene that codes for a transmembrane receptor protein tyrosine kinase, leads to constitutive activation of the kinase, which is the decisive pathomechanism for the disease. The MTC occurs in a sporadic (somatic RET mutation) or hereditary form (RET germline mutation, multiple endocrine neoplasia types 2 and 3). For germline mutation carriers the timing of preventive thyroidectomy depends on the RET genotype. For advanced metastasized RET-mutant MTC, selective RET kinase inhibitors are available, which are currently considered to be game changers in the treatment. Based on the specific tumor marker calcitonin, MTC can be identified at an early stage during the differential diagnosis of thyroid nodules. The preoperative calcitonin level even enables statements on the degree of dissemination of the disease and on the probability of a cure through surgery. A new development is the consideration of desmoplasia as a histopathological biomarker for the metastatic potential of a MTC, which could possibly modify the operative approach as well as the future MTC nomenclature. Furthermore, the postoperative calcitonin level and the calcitonin doubling time are highly valid prognostic markers for tumor burden and biological aggressiveness of MTC and therefore decisive for patient follow-up. Biochemical, molecular and histological markers enable a risk-adapted surgical treatment and together with new targeted systemic treatments have contributed to a paradigm shift in the diagnostics, prognosis and treatment of MTC in recent years. Endocrine precision medicine for MTC therefore enabled a change from the previous purely symptom-oriented to a modern preventive and individualized treatment.
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Affiliation(s)
- Tim Brandenburg
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Essen, Deutschland
- Endokrines Tumorzentrum am Westdeutschen Tumorzentrum (WTZ), Universitätsklinikum Essen, Universität Duisburg-Essen, Member of Endo-ERN und EURACAN, Essen, Deutschland
| | - Yara Maria Machlah
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Essen, Deutschland
- Endokrines Tumorzentrum am Westdeutschen Tumorzentrum (WTZ), Universitätsklinikum Essen, Universität Duisburg-Essen, Member of Endo-ERN und EURACAN, Essen, Deutschland
| | - Dagmar Führer
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Essen, Deutschland.
- Endokrines Tumorzentrum am Westdeutschen Tumorzentrum (WTZ), Universitätsklinikum Essen, Universität Duisburg-Essen, Member of Endo-ERN und EURACAN, Essen, Deutschland.
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Zentrallabor - Bereich Forschung und Lehre, Universitätsklinikum Essen, Hufelandstr. 55, 45177, Essen, Deutschland.
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3
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Machens A, Lorenz K, Brandenburg T, Führer D, Weber F, Dralle H. Latest Progress in Risk-Adapted Surgery for Medullary Thyroid Cancer. Cancers (Basel) 2024; 16:917. [PMID: 38473279 DOI: 10.3390/cancers16050917] [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: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: The wider adoption of a preoperative ultrasound and calcitonin screening complemented by an intraoperative frozen section has increased the number of patients with occult sporadic medullary thyroid cancer (MTC). These advances offer new opportunities to reduce the extent of the initial operations, minimizing operative morbidity and the risk of postoperative thyroxin supplementation without compromising the cure. (2) Methods: This systematic review of the international literature published in the English language provides a comprehensive update on the latest progress made in the risk-adapted surgery for sporadic and hereditary MTC guided by an intraoperative frozen section. (3) Results: The current evidence confirms the viability of a hemithyroidectomy for desmoplasia-negative sporadic MTC. To add an extra safety margin, the hemithyroidectomy may be complemented by a diagnostic ipsilateral central node dissection. Despite the limited extent of the surgery, all the patients with desmoplasia-negative sporadic tumors achieved a biochemical cure with excellent clinical outcomes. A hemithyroidectomy decreases the need for postoperative thyroxine substitution, but a total thyroidectomy may be required for bilateral nodular thyroid disease. Hereditary MTC is a different issue. Because each residual thyroid C cell carries its own risk of malignant progression, a total thyroidectomy remains mandatory for hereditary MTC. (4) Conclusion: In experienced hands, a hemithyroidectomy, which minimizes morbidity without compromising the cure, is an adequate therapy for desmoplasia-negative sporadic MTC.
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Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany
| | - Tim Brandenburg
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Hufelandstraße 55, D-45147 Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Hufelandstraße 55, D-45147 Essen, Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Hufelandstraße 55, D-45147 Essen, Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Hufelandstraße 55, D-45147 Essen, Germany
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4
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Dralle H, Brandenburg T, Weber F, Führer-Sakel D, Theurer S, Baba HA, Schmid KW, Machens A. Sporadic noninvasive medullary thyroid neoplasm: A desmoplasia-negative unifocal nonmetastatic tumor cured by hemithyroidectomy. Surgery 2023; 174:1356-1362. [PMID: 37821265 DOI: 10.1016/j.surg.2023.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/14/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The absence of primary tumor desmoplasia, a marker of node metastases, on frozen section may help reduce the extent of surgery without compromising the biochemical cure. We aimed to clarify whether hemithyroidectomy with diagnostic ipsilateral central neck dissection can replace total thyroidectomy with routine central neck dissection in patients with sporadic medullary thyroid cancer. METHODS We retrospectively evaluated data collected from patients who had undergone primary neck surgery for hypercalcitoninemic sporadic medullary thyroid cancer between January 2017 and December 2022 at one institution. RESULTS Of the 25 patients we examined, 19 had desmoplasia-negative and 6 desmoplasia-positive primary thyroid tumors on frozen section. The desmoplasia-negative patients had undergone less surgery with fewer nodes removed than the desmoplasia-positive patients (medians of 6 vs 31 nodes, P < .001). The desmoplasia-negative patients had predominantly undergone hemithyroidectomy with ipsilateral central neck dissection. None of the desmoplasia-negative tumors was multifocal (0 of 19 desmoplasia-negative vs 2 of 6 desmoplasia-positive or 0% vs 33%, P = .050) or node-positive (0 of 19 vs 6 of 6 patients or 0% vs 100%; medians of 0 vs 3.5 node metastases; both P < .001). Despite limited surgery, all desmoplasia-negative patients attained and maintained biochemical cure. CONCLUSION Hemithyroidectomy combined with diagnostic ipsilateral central neck dissection is a viable risk-reducing and curative strategy for desmoplasia-negative and node-negative, nonmetastatic unifocal tumors, for which we propose the term sporadic noninvasive medullary thyroid neoplasm (SNMTP).
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Tim Brandenburg
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Sarah Theurer
- Department of Pathology, University of Duisburg-Essen, Essen, Germany
| | - Hideo A Baba
- Department of Pathology, University of Duisburg-Essen, Essen, Germany
| | | | - Andreas Machens
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Borchert S, Mathilakathu A, Nath A, Wessolly M, Mairinger E, Kreidt D, Steinborn J, Walter RFH, Christoph DC, Kollmeier J, Wohlschlaeger J, Mairinger T, Brcic L, Mairinger FD. Cancer-Associated Fibroblasts Influence Survival in Pleural Mesothelioma: Digital Gene Expression Analysis and Supervised Machine Learning Model. Int J Mol Sci 2023; 24:12426. [PMID: 37569808 PMCID: PMC10419996 DOI: 10.3390/ijms241512426] [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: 06/21/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
The exact mechanism of desmoplastic stromal reaction (DSR) formation is still unclear. The interaction between cancer cells and cancer-associated fibroblasts (CAFs) has an important role in tumor progression, while stromal changes are a poor prognostic factor in pleural mesothelioma (PM). We aimed to assess the impact of CAFs paracrine signaling within the tumor microenvironment and the DSR presence on survival, in a cohort of 77 PM patients. DSR formation was evaluated morphologically and by immunohistochemistry for Fibroblast activation protein alpha (FAP). Digital gene expression was analyzed using a custom-designed CodeSet (NanoString). Decision-tree-based analysis using the "conditional inference tree" (CIT) machine learning algorithm was performed on the obtained results. A significant association between FAP gene expression levels and the appearance of DSR was found (p = 0.025). DSR-high samples demonstrated a statistically significant prolonged median survival time. The elevated expression of MYT1, KDR, PIK3R1, PIK3R4, and SOS1 was associated with shortened OS, whereas the upregulation of VEGFC, FAP, and CDK4 was associated with prolonged OS. CIT revealed a three-tier system based on FAP, NF1, and RPTOR expressions. We could outline the prognostic value of CAFs-induced PI3K signaling pathway activation together with FAP-dependent CDK4 mediated cell cycle progression in PM, where prognostic and predictive biomarkers are urgently needed to introduce new therapeutic strategies.
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Affiliation(s)
- Sabrina Borchert
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | - Alexander Mathilakathu
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | - Alina Nath
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | - Michael Wessolly
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | - Elena Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | - Daniel Kreidt
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | | | - Robert F. H. Walter
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
| | - Daniel C. Christoph
- Department of Medical Oncology, Evangelische Kliniken Essen-Mitte, 45131 Essen, Germany;
| | - Jens Kollmeier
- Department of Pneumology, Helios Klinikum Emil von Behring, 14165 Berlin, Germany;
| | | | - Thomas Mairinger
- Department of Tissue Diagnostics, Helios Klinikum Emil von Behring, 14165 Berlin, Germany;
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8036 Graz, Austria;
| | - Fabian D. Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg Essen, 45147 Essen, Germany; (S.B.); (A.M.); (A.N.); (M.W.); (E.M.); (D.K.); (R.F.H.W.)
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Contarino A, Dolci A, Maggioni M, Porta FM, Lopez G, Verga U, Elli FM, Iofrida EF, Cantoni G, Mantovani G, Arosio M. Is Encapsulated Medullary Thyroid Carcinoma Associated With a Better Prognosis? A Case Series and a Review of the Literature. Front Endocrinol (Lausanne) 2022; 13:866572. [PMID: 35574005 PMCID: PMC9094444 DOI: 10.3389/fendo.2022.866572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Context Medullary thyroid carcinoma (MTC) is a malignant neuroendocrine neoplasm that may spread to lymph nodes before the primary tumor is diagnosed; moreover, distant metastases are already present in about 10% of patients at diagnosis. Serum calcitonin (Ctn) usually reflects the spread of disease, thus orienting the extent of surgery and predicting the possibility of biochemical remission. Tumor size and vascular invasion are important prognostic factors, but little is known on the relationship between other histopathological features, such as the presence of a tumor capsule, and long term outcome of MTC. Purpose To evaluate the prevalence of encapsulated tumors among MTCs and the association of tumor capsule with a favorable outcome after surgery. Methods A retrospective observational single-center study was conducted together with a narrative review of the available literature. Results Among 44 patients (27 female, 17 male; median age: 56 years) with MTC (6 hereditary, 37 sporadic) followed up at our center in the last four years (median follow-up: 29.2 months), seven (15.9%) showed an encapsulated tumor at histology and a clinical remission after surgery. None of them had nodal metastases and median preoperative Ctn (398 pg/mL, IQR 126.5-7336) did not differ significantly from that of the 14 patients (31.8%) with persistent disease after surgery (787 pg/mL, IQR 340.5-2905.5; p=0.633), although their tumor size was significantly higher (median 33 mm versus 16 mm respectively, p=0.036). Among patients with preoperative Ctn levels above 500 pg/mL (n=11), only two (18.2%) showed undetectable Ctn levels during follow-up, both having an encapsulated MTC (OR 0.000, p=0.02). Notably, they were two similar cases of large MTC (> 3 cm) with extensive hyalinization and calcification, associated with very high Ctn levels (> 13'500 and 1'100 pg/mL, respectively) but no nodal nor distant metastases, in complete remission after surgery although one of them carried the aggressive M918T somatic RET mutation. Conclusion MTC rarely shows a tumor capsule, which seems to correlate with a better prognosis and absence of nodal metastases, regardless of RET or RAS mutational status. Among encapsulated MTCs (E-MTC), Ctn levels and tumor size are not predictive of persistence of disease after surgery.
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Affiliation(s)
- Andrea Contarino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessia Dolci
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Maggioni
- Pathology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Maria Porta
- Pathology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Lopez
- Pathology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Uberta Verga
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Marta Elli
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Francesca Iofrida
- Otolaryngology and Head and Neck Surgery Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianmaria Cantoni
- Endocrine Surgery Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Zhang D, Colombo C, Sun H, Kim HY, Pino A, De Leo S, Gazzano G, Persani L, Dionigi G, Fugazzola L. Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines. Front Endocrinol (Lausanne) 2022; 13:875875. [PMID: 35898450 PMCID: PMC9309363 DOI: 10.3389/fendo.2022.875875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Optimized preoperative diagnostic tools with calcitonin tests, ultrasound features, functional imaging modalities, and genetic testing to detect hereditary forms have led to an increased rate of earlier diagnosis and surgery for medullary thyroid cancer (MTC). This helps to adapt the primary surgery to the tumor stage and avoid surgical overtreatment for localized tumor growth, i.e., deviating from the regularly recommended thyroidectomy with bilateral central lymph node dissection in favor of a limited unilateral approach. To limit primary surgical therapy, it is crucial that the MTC is clinically unifocal, sporadic, and confined to the thyroid, and that calcitonin levels indicate biochemical recovery after surgery. The main requirement for such a limited approach is the availability of frozen section studies that reliably indicate (i) R0 resection of the MTC, (ii) absence of infiltration of the organ capsule, (iii) lack of desmoplasia (i.e., evidence of the metastatic potential of the MTC), (iiii) absence of contralateral disease or precancerous lesions. Informed consent is mandatory from the patient, who has been fully informed of the advantages, disadvantages, and potential risks of not undergoing the "classic" surgical procedure. The aim of this article is to review the guidelines for the management of early-stage MTC.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun City, China
| | - Carla Colombo
- Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- *Correspondence: Carla Colombo, ; Hui Sun,
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun City, China
- *Correspondence: Carla Colombo, ; Hui Sun,
| | - Hoon Yub Kim
- Korea University College of Medicine (KUMC) Thyroid Center, Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Antonella Pino
- Division of Surgery, Istituto Auxologico Italiano INstituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Simone De Leo
- Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
| | - Giacomo Gazzano
- Pathology Unit, Istituto Auxologico Italiano INstituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Luca Persani
- Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Gianlorenzo Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano INstituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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8
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Herring B, Jang S, Whitt J, Goliwas K, Aburjania Z, Dudeja V, Ren B, Berry J, Bibb J, Frost A, Chen H, Rose JB, Jaskula-Sztul R. Ex Vivo Modeling of Human Neuroendocrine Tumors in Tissue Surrogates. Front Endocrinol (Lausanne) 2021; 12:710009. [PMID: 35002949 PMCID: PMC8734644 DOI: 10.3389/fendo.2021.710009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022] Open
Abstract
Few models exist for studying neuroendocrine tumors (NETs), and there are mounting concerns that the currently available array of cell lines is not representative of NET biology. The lack of stable patient-derived NET xenograft models further limits the scientific community's ability to make conclusions about NETs and their response to therapy in patients. To address these limitations, we propose the use of an ex vivo 3D flow-perfusion bioreactor system for culturing and studying patient-derived NET surrogates. Herein, we demonstrate the utility of the bioreactor system for culturing NET surrogates and provide methods for evaluating the efficacy of therapeutic agents on human NET cell line xenograft constructs and patient-derived NET surrogates. We also demonstrate that patient-derived NET tissues can be propagated using the bioreactor system and investigate the near-infrared (NIR) dye IR-783 for its use in monitoring their status within the bioreactor. The results indicate that the bioreactor system and similar 3D culture models may be valuable tools for culturing patient-derived NETs and monitoring their response to therapy ex vivo.
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Affiliation(s)
- Brendon Herring
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samuel Jang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jason Whitt
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kayla Goliwas
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Zviadi Aburjania
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vikas Dudeja
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Bin Ren
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joel Berry
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Bibb
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andra Frost
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Bart Rose
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Renata Jaskula-Sztul
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
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9
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Machens A, Kaatzsch P, Lorenz K, Horn LC, Wickenhauser C, Schmid KW, Dralle H, Siebolts U. Abandoning node dissection for desmoplasia-negative encapsulated unifocal sporadic medullary thyroid cancer. Surgery 2021; 171:360-367. [PMID: 34602296 DOI: 10.1016/j.surg.2021.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Predictive criteria to determine the absence of node metastases from thyroid specimens are scarce for sporadic medullary thyroid cancer. METHODS Histopathologic stratification of patients with unifocal sporadic medullary thyroid cancer ≤25 mm with ≥10 neck nodes at thyroidectomy to evaluate the suitability of desmoplasia (7 increments) and tumor capsule integrity (5 decrements) for intraoperative prediction of node metastasis in unifocal sporadic medullary thyroid cancer. RESULTS Paraffin-embedded thyroid specimens were available for 139 eligible patients. Significant (P < .001) associations were found between increasing desmoplasia and decreasing tumor capsule integrity and nodal disease (from 0 to 79% and 0 to 62%); the number of node metastases (medians, from 0 to 3 and 0 to 2 nodes); and biochemical cure (from 100 to 36% and 100 to 58%). Desmoplasia (low-moderate to high, with fibrosis >10%) and breach of the tumor capsule (>3 extensions; 1 extension >3 mm in width; or diffuse growth without tumor capsule) yielded excellent sensitivity and negative predictive value (100%), with moderate specificity (57 and 48%) and positive predictive value (50 and 46%). In retrospect, node dissection proved unnecessary in 55 (57%) and 47 (48%) patients who harbored desmoplasia-negative and encapsulated tumors. When available frozen sections were histopathologically compared with matching paraffin-embedded thyroid tumor specimens, concordance was 98% (53 of 54 pairs): 1 of 7 upgrades changed the diagnosis to desmoplasia, whereas 1 of 3 downgrades shifted the diagnosis of tumor capsule breach from "present" to "absent." CONCLUSIONS Patients with desmoplasia-negative encapsulated sporadic medullary thyroid cancer may forgo node dissection at specialist centers.
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Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Peter Kaatzsch
- Department of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Claudia Wickenhauser
- Department of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Henning Dralle
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; Department of General, Visceral, and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Udo Siebolts
- Department of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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10
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Moura MM, Cabrera RA, Esteves S, Cavaco BM, Soares P, Leite V. Correlation of molecular data with histopathological and clinical features in a series of 66 patients with medullary thyroid carcinoma. J Endocrinol Invest 2021; 44:1837-1846. [PMID: 33575974 DOI: 10.1007/s40618-020-01456-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/18/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Medullary thyroid carcinoma (MTC) displays a wide variety of histopathological features, and several histological variants have been described. In follicular cell-derived thyroid carcinomas, there is a good correlation between genotype and phenotype. In this study, we investigated whether such a correlation is also present in MTC. METHODS The histopathological features were evaluated in a series of 66 molecularly characterised tumours and correlated with the clinical characteristics. RESULTS Most MTC exhibited the classical variant (83.3%). Other variants included spindle cell (6.1%), pseudopapillary (4.5%), paraganglioma-like (3.0%), angiosarcoma-like (1.5%), and oncocytic follicular (1.5%). Tumours were classified into four groups: group 1, with somatic p.Met918Thr and p.Ala883Phe RET mutations; group 2, with other RET mutations; group 3, with RAS mutations; and group 4, without RET or RAS mutations. Tumours from groups 1 and 4 were typically associated with the classical variant, with abundant fibrosis, lymphovascular invasion, extrathyroidal extension, and more advanced stages of disease, whereas group 2 included histological variants other than the classical variant (namely, pseudopapillary and paraganglioma-like), with tumours that were highly cellular, less invasive, and with a better overall prognosis. In tumours from group 4, amyloid deposition was characteristically absent or low. The spindle cell variant appeared only in tumours from group 3, which had high cellularity and a degree of invasion and prognosis intermediate between groups 1 and 2, but better than group 4. The grade of fibrosis correlated directly with the clinical outcome. CONCLUSION Our results support the idea that a genotype-phenotype correlation does, indeed, exist in MTC. However, further studies are warranted to confirm these findings in a larger sample size.
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Affiliation(s)
- M M Moura
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal.
| | - R A Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 , Lisboa, Portugal
| | - S Esteves
- Unidade de Investigação Clínica (UIC), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 , Lisboa, Portugal
| | - B M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - P Soares
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia, Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135, Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-135, Porto, Portugal
| | - V Leite
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 , Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal
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11
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Kasperska A, Borowczak J, Szczerbowski K, Stec E, Ahmadi N, Szylber Ł. Current challenges in targeting tumor desmoplasia to improve the efficacy of immunotherapy. Curr Cancer Drug Targets 2021; 21:919-931. [PMID: 34525931 DOI: 10.2174/1568009621666210825101456] [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: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
Desmoplasia is crucial for the development, progression and treatment of immune-resistant malignancies. and treatment of immune-resistant malignancies. Targeting desmoplasia-related metabolic pathways appears to be an interesting approach to expand our stock of disposable anti-tumor agents.CXCL12/CXCR4 axis inhibition reduces fibrosis, alleviates immunosuppression and significantly enhances the efficacy of PD-1 immunotherapy. CD40L substitute therapy may increase the activity of T-cells, downregulate CD40+, prolong patients' survival and prevent cancer progression. Although FAPα antagonists used in preclinical models did not lead to permanent cure, an alleviation of immune-resistance, modification of desmoplasia and a decrease in angiogenesis were observed. Targeting DDR2 may enhance the effect of anti-PD-1 treatment in multiple neoplasm cell lines and has the ability to overcome the adaptation to BRAF-targeted therapy in melanoma. Reprogramming desmoplasia could potentially cooperate not only with present treatment, but also other potential therapeutic targets. We present the most promising metabolic pathways related to desmoplasia and discuss the emerging strategies to improve the efficacy of immunotherapy.
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Affiliation(s)
- Anna Kasperska
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Poland
| | - Jędrzej Borowczak
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Poland
| | - Krzysztof Szczerbowski
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Poland
| | - Ewa Stec
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Poland
| | - Navid Ahmadi
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge. United Kingdom
| | - Łukasz Szylber
- Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Poland
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12
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Niederle MB, Riss P, Selberherr A, Koperek O, Kaserer K, Niederle B, Scheuba C. Omission of lateral lymph node dissection in medullary thyroid cancer without a desmoplastic stromal reaction. Br J Surg 2021; 108:174-181. [PMID: 33704404 DOI: 10.1093/bjs/znaa047] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/16/2020] [Accepted: 09/20/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Medullary thyroid cancer can be subdivided during surgery into tumours with or without a desmoplastic stromal reaction (DSR). DSR positivity is regarded as a sign of disposition to metastasize. The aim of this study was to analyse whether lateral lymph node dissection can be omitted in patients with DSR-negative tumours. METHODS This was a retrospective cohort study of a prospectively maintained database of patients with medullary thyroid cancer treated using a standardized protocol, and subdivided into DSR-negative and -positive groups based on the results of intraoperative frozen-section analysis. Patients in the DSR-negative group did not undergo lateral lymph node dissection. Long-term clinical and biochemical follow-up data were collected, and baseline parameters and histopathological characteristics were compared between groups. RESULTS The study included 360 patients. In the DSR-negative group (17.8 per cent of all tumours) no patient had lateral lymph node or distant metastases at diagnosis or during follow-up, and all patients were biochemically cured. In the DSR-positive group (82.2 per cent of all tumours), lymph node and distant metastases were present in 31.4 and 6.4 per cent of patients respectively. DSR-negative tumours were more often stage pT1a and were significantly smaller. The median levels of basal calcitonin and carcinoembryonic antigen were significantly lower in the DSR-negative group, although when adjusted for T category both showed widely overlapping ranges. CONCLUSION Lymph node surgery may be individualized in medullary thyroid cancer based on intraoperative analysis of the DSR. Patients with DSR-negative tumours do not require lateral lymph node dissection.
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Affiliation(s)
- M B Niederle
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of General Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - P Riss
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - A Selberherr
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - O Koperek
- Labor Kaserer, Koperek & Beer, Pathology, Medical University of Vienna, Vienna, Austria.,Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - K Kaserer
- Labor Kaserer, Koperek & Beer, Pathology, Medical University of Vienna, Vienna, Austria.,Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - B Niederle
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Former Head of Endocrine Surgery Section, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - C Scheuba
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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13
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Ingenwerth M, Brandenburg T, Führer-Sakel D, Goetz M, Weber F, Dralle H, Schildhaus HU, Schmid KW, Theurer S. DLL3 (delta-like protein 3) expression correlates with stromal desmoplasia and lymph node metastases in medullary thyroid carcinomas. Endocr Connect 2021; 10:283-289. [PMID: 33617464 PMCID: PMC8052580 DOI: 10.1530/ec-20-0611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
Medullary thyroid carcinomas (MTC) are rare and aggressive neuroendocrine tumors of the thyroid. About 70% of MTC are sporadic; approximately 50% of those harbor somatic RET mutation. DLL3 is widely expressed in many neuroendocrine tumors and has been evaluated as a potential therapeutic target. Since stromal desmoplasia in sporadic MTC has been identified as a reliable predictor of aggressive behavior and development of lymph node metastases, a possible correlation of DLL3 expression with the presence of stromal desmoplasia was of particular interest. 59 paraffin-embedded samples of sporadic MTC with (44 cases) and without (15 cases) stromal desmoplasia and known lymph node status were included. DLL3 expression was determined by immunohistochemistry; no expression (0%), low expression (1-49%) and high expression (≥50%) were correlated with clinicopathological data. The proportion of DLL3 positivity was significantly correlated with both stromal desmoplasia (P < 0.0001) and lymph node metastases (P < 0.0001). MTC without stromal desmoplasia consistently lack DLL3 expression. This is the first study to focus on MTC regarding DLL3 expression and the relationship to various factors. Our results demonstrate that expression of DLL3 in MTC represents a reliable surrogate marker for stromal desmoplasia and lymph node metastases and might be an indicator for aggressive clinical behavior. DLL3 expression in ≥50% of tumor cells virtually excludes MTC without stromal desmoplasia. DLL3 was discussed as a potential therapeutic target in malignant tumors of other locations with positive immunohistochemical reaction and might therefore be a new therapeutic option in MTC, as well.
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Affiliation(s)
- M Ingenwerth
- Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany
| | - T Brandenburg
- Division of Laboratory Research, Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, University Hospital Essen, University of Duisburg-Essen, Germany
| | - D Führer-Sakel
- Division of Laboratory Research, Department of Endocrinology, Diabetes and Metabolism and Clinical Chemistry, University Hospital Essen, University of Duisburg-Essen, Germany
| | - M Goetz
- Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany
| | - F Weber
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - H Dralle
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - H-U Schildhaus
- Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany
| | - K W Schmid
- Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany
| | - S Theurer
- Institute of Pathology, University Hospital of Essen, University of Duisburg–Essen, Essen, Germany
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14
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A Proposed Grading Scheme for Medullary Thyroid Carcinoma Based on Proliferative Activity (Ki-67 and Mitotic Count) and Coagulative Necrosis. Am J Surg Pathol 2020; 44:1419-1428. [PMID: 32452872 PMCID: PMC7641183 DOI: 10.1097/pas.0000000000001505] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We investigated the prognostic value of a range of histologic parameters in medullary thyroid carcinoma (MTC) to design a grading system to predict overall survival. We assessed 76 patients with MTCs undergoing primary tumor resection for age, sex, tumor size, vascular space invasion, lymph node metastasis, multiple endocrine neoplasia type 2 (MEN2) status, mitotic count, Ki-67 proliferative index, spindled morphology, sheet-like growth pattern, coagulative necrosis, incipient necrosis, nuclear grade, multinucleation, prominent nucleoli, fibrosis, and amyloid deposition. In addition to the clinical features of age and the diagnosis of MEN2, the only histologic features that significantly predicted reduced overall survival were Ki-67 proliferative index, mitotic count, and the presence of coagulative necrosis. Using a combination of these 3 variables, we propose a 3-tiered grading system based solely on proliferative activity (Ki-67 proliferative index and mitotic count) and necrosis. There were 62 (82%) low-grade MTCs (low proliferative activity, no necrosis), 9 (12%) intermediate grade (low proliferative activity and necrosis present, or intermediate proliferative activity and no necrosis), and 5 (7%) high grade (intermediate proliferative activity and necrosis present, or high proliferative activity with or without necrosis). The mean overall survival was 193, 146, and 45 months, respectively (P=0.0001) for the 3 grades. The grading system remained prognostic when controlled for other factors associated with survival including age and known MEN2 syndrome. We conclude that this proposed grading system, which uses only a combination of proliferative activity (Ki-67 index, mitotic count) and coagulative necrosis, is a strong predictor of overall survival in MTC.
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15
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Abstract
Improvements in preoperative diagnostic modalities in conjunction with highly sensitive calcitonin assays, ultrasound and functional imaging modalities and differentiated genetic testing for detection of hereditary forms, have enabled detection and resection of medullary thyroid carcinoma at an increasingly earlier stage. These developments open up possibilities to deescalate primary surgery adapted to these stages and avoid surgical overtreatment in locally limited tumor growth: thus, promoting a shift from routinely recommended total thyroidectomy with bilateral central lymph node dissection in favor of limited unilateral thyroid resection. Prerequisites for limited thyroid resection include clinical evidence that the tumor is sporadic, unifocal and confined to the thyroid. Corresponding calcitonin levels should also indicate that a biochemical cure will be achieved after unilateral resection. A decisive structural prerequisite for such a limited concept is the low threshold availability of intraoperative frozen section analysis that reliably detects and evaluates a medullary thyroid carcinoma and can assess a breach of the thyroid capsule and desmoplasia with certainty.
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16
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Alzumaili B, Xu B, Spanheimer PM, Tuttle RM, Sherman E, Katabi N, Dogan S, Ganly I, Untch BR, Ghossein RA. Grading of medullary thyroid carcinoma on the basis of tumor necrosis and high mitotic rate is an independent predictor of poor outcome. Mod Pathol 2020; 33:1690-1701. [PMID: 32313184 PMCID: PMC7483270 DOI: 10.1038/s41379-020-0532-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a rare nonfollicular cell-derived tumor. A robust grading system may help better stratify patients at risk for recurrence and death from disease. In total, 144 MTC between 1988 and 2018 were subjected to a detailed histopathologic evaluation. Clinical and pathologic data were correlated with disease specific survival (DSS), local recurrence free survival (LRFS) and distant metastasis free survival (DMFS). Median age was 53 years (range: 3-88). Median tumor size was 1.8 cm (range: 0.2-11). Lymph node metastases were present in 84 (58%) cases while distant metastases at presentation were found in 9 (6%) patients. Seven (5%) had ≥5 mitoses/10 HPFs. Tumor necrosis was present in 30 cases (20%) while lymphovascular invasion occurred in 41 (28%) of tumors. Extra-thyroidal extension was found in 44 (31%) and positive margins were seen in 19 (14%). There was a strong correlation between increasing tumor size and tumor necrosis (p < 0.001). Median follow up was 39 months. In univariate analysis, male gender, higher American Joint Committee on Cancer (AJCC) stage group, larger tumor size, tumor necrosis, high mitotic index (≥5/10 HPF), nodal status, size of largest nodal metastasis, and elevated postoperative serum calcitonin predicted worse DSS, LRFS, and DMFS (p < 0.05). Extra-thyroidal extension correlated with DSS and DMFS while positive margins and distant metastasis at presentation imparted worse DSS (p < 0.05). In multivariate analysis, tumor necrosis and mitotic activity (5 mitosis/10 HPFs as the cutoff) were the only independent predictors for DSS (p = 0.008 and 0.026, respectively). Tumor necrosis was the sole independent prognostic factor for LRFS and DMFS (p = 0.001 and 0.003, respectively). The presence of tumor necrosis and high mitotic rate are powerful independent prognostic factors in MTC and outperform serum calcitonin and stage. We propose a grading system based on tumor necrosis and mitotic activity to better stratify MTC patients for counseling, post-resection surveillance, and therapy.
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Affiliation(s)
- Bayan Alzumaili
- Department of Pathology, Mount Sinai Hospital, New York, NY, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip M Spanheimer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Sherman
- Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian R Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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17
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Hermann M, Gschwandtner E, Schneider M, Handgriff L, Prommegger R. [Modern thyroid surgery - the surgeon's endocrine-surgical understanding and his responsibility for the extent of surgery and complication rate]. Wien Med Wochenschr 2020; 170:379-391. [PMID: 32342248 PMCID: PMC7653805 DOI: 10.1007/s10354-020-00750-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/08/2020] [Indexed: 01/26/2023]
Abstract
Die hohe Qualität der Schilddrüsenchirurgie impliziert ein endokrin-chirurgisches Verständnis des Operateurs mit dem Ziel einer bestmöglichen Ergebnisqualität. Das beinhaltet ein befundadäquates Resektionsausmaß und eine möglichst niedrige Komplikationsrate. Der Chirurg sollte frühzeitig in die Operationsindikation eingebunden sein und auch selbst die Diagnostik, speziell den Schilddrüsen- und Halslymphknotenultraschall, sowie die Interpretation der Schnittbild- und nuklearmedizinischen Verfahren beherrschen. Im Besonderen sollte er über zeitgemäße Radikalitätsprinzipien in der Chirurgie Bescheid wissen. Bei der gutartigen Struma ist eine individualisierte Operationsstrategie anzuwenden: Solitärknoten können auch einer gewebeschonenden Knotenresektion unterzogen werden. Bei multinodulärer Knotenstruma ist nicht zwingend eine totale Thyreoidektomie notwendig, die Vermeidung eines permanenten Hypoparathyreoidismus hat Priorität. Bei Rezidivstrumen ist oft die einseitige Operation des dominanten Befundes zu bevorzugen. Auch besteht zunehmend der Trend, die Indikation zur Entfernung der Schilddrüsenlappen seitengetrennt zu stellen. Die Basedow Struma erfordert eine Thyreoidektomie. Auch die hypertrophe Thyreoiditis Hashimoto kann eine Operationsindikation darstellen. Die Radikalitätsprinzipien bei maligner Struma haben sich ebenfalls deutlich gewandelt als auch die strenge Indikation zur Radiojodtherapie. Das gilt speziell für papilläre Mikrokarzinome und minimal invasive follikuläre Tumortypen. Selbst bei medullären Schilddrüsenkarzinom stehen die Radikalitätsprinzipien im Hinblick auf synchrone oder metachrone laterale Halsdissektion in Diskussion. Der Hypoparathyreoidismus stellt derzeit das Hauptproblem in der radikalen Schilddrüsenchirurgie dar. Recurrensparese und Nachblutung sind durch die subtile Operationstechnik selten geworden. Spezielle extrazervikale Operationszugänge sind nach wie vor in der Erprobungsphase und unter strengen Studienbestimmungen nur Zentren vorbehalten. Die Radiofrequenzablation stellt für gewisse Läsionen wie Zysten und autonome Adenome bei chirurgischer Kontraindikation ein alternatives Ablationsverfahren dar.
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Affiliation(s)
- Michael Hermann
- Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich
| | - Elisabeth Gschwandtner
- Klinische Abteilung für Thoraxchirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Max Schneider
- Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich
| | - Laura Handgriff
- Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich
| | - Rupert Prommegger
- Chirurgie, Sanatorium Kettenbrücke der Barmherzigen Schwestern, Sennstraße 1, 6020, Innsbruck, Österreich
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18
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Ingenwerth M, Goetz M, Schmid KW, Theurer S. The mismatch repair system is not affected in medullary thyroid carcinoma independent of stromal desmoplasia or ret proto-oncogene mutation. Ann Diagn Pathol 2019; 44:151445. [PMID: 31862521 DOI: 10.1016/j.anndiagpath.2019.151445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/07/2019] [Accepted: 12/02/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) is an aggressive neuroendocrine neoplasia of the thyroid with 10 year overall survival of 50% and limited therapeutic options. High tumor mutational burden because of microsatellite instability (MSI) seems to be a predictor of response to immune checkpoint inhibitor therapy in different tumors. Therefor in 2017 the U.S. Food and Drug Administration (FDA) permitted the therapy of solid tumors with proven Microsatellite instability (MSI) with PD1 antibody Pembrolizumab independently of their origin. As little is known about MSI in MTC and new therapeutic strategies would be eligible we tried to find out, if therapy with PD1-inhibitors could be promising. MATERIAL AND METHODS We performed MSI-analyses of 38 cases of MTC. Included were MTCs with and without stromal desmoplasia and with/without lymph node metastases. We also checked the immunhistochemical expression of PD-L-1 and performed next generation sequencing for genetic alterations. RESULTS All cases revealed stable conditions of the microsatellites and showed immunohistochemically positive staining of the four mismatch repair proteins. PD-L-1- Immunostaining was negative in all cases. DISCUSSION Our data show there is no MSI in MTCs, irrespectively of their status of desmoplasia, metastases and/or ret-mutation. Therefore a positive effect of PD1 inhibitors, because of MSI-associated high tumor mutational burden, seems to be unlikely.
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Affiliation(s)
- Marc Ingenwerth
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Moritz Goetz
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Kurt W Schmid
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Sarah Theurer
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany.
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19
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Schmid KW. Warum muss ein Schilddrüsentumor als Karzinom klassifiziert werden, wenn er sich biologisch nicht wie Krebs verhält? ONKOLOGE 2019. [DOI: 10.1007/s00761-019-0548-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Medullary thyroid carcinoma (MTC) represents a distinct form of thyroid cancer with a potentially aggressive behavior, early lymph node metastases, and sporadic as well as hereditary forms. Only surgery with total thyroidectomy and lymph node dissection is able to achieve biochemical cure. Due to the uncommon nature of MTC, a specialization in endocrine surgery for diagnosis as well as therapy of MTC seem to be mandatory for a successful treatment. Knowledge of genotype-phenotype correlations for hereditary forms or routine calcitonin screening for sporadic forms is important to analyze preoperative findings and plan surgical procedures. Postoperative follow-up depends on biochemical cure or monitoring for patients with elevated calcitonin levels.
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Affiliation(s)
- Theresia Weber
- Department of Endocrine Surgery, Katholisches Klinikum, Mainz, Germany
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21
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Pezzani R, Bertazza L, Cavedon E, Censi S, Manso J, Watutantrige-Fernando S, Pennelli G, Galuppini F, Barollo S, Mian C. Novel Prognostic Factors Associated with Cell Cycle Control in Sporadic Medullary Thyroid Cancer Patients. Int J Endocrinol 2019; 2019:9421079. [PMID: 30911297 PMCID: PMC6398011 DOI: 10.1155/2019/9421079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/10/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is a rare neuroendocrine-derived malignancy. It is represented by sporadic and familiar forms, and both can have RET oncogene mutations. Numerous markers can be used to define MTC; however, none is generally approved for predicting the outcome of sporadic MTC. AIM The aim of this work was to analyze PTTG1/securin and Aurora kinase A expressions in MTC patients, both at the gene and protein levels, and to define their prognostic role in MTC assessing their association with lab and clinical parameters. PATIENTS AND METHODS Seventy-one sporadic MTC human samples were analyzed for RET mutations and by qPCR for PTTG1 and AURKA (Aurora kinase A) expression. Ki-67 levels and western blot reactivity for PTTG1 and Aurora kinase A were also determined in a selected cohort of patients. RESULTS RET somatic mutations were found in 48% of the patients (34/71). PTTG1 expression was statistically different among the groups with or without regional lymph node metastasis (p < 0.0001) and advanced stage disease (p < 0.01). PTTG1 and AURKA expressions were statistically higher than those of controls (p = 0.01 and p < 0.002, respectively). PTTG1 expression and Ki-67 levels were statistically different among the groups with remitted or persistent disease (p < 0.05 and p < 0.01, respectively). We found a significant correlation between the expressions of AURKA and PTTG1 (p < 0.0002, r = 0.5298) and between the expressions of PTTG1 and Ki-67 (p = 0.01). Ki-67 levels were statistically different among the groups with or without metastatic lymph nodes (p = 0.01) or distant metastases (p = 0.003). CONCLUSION The presence of an altered expression of PTTG1 and AURKA is a negative prognostic factor associated with a more aggressive course of disease, such as an advanced stage or disease persistence. It emerges as a cell cycle process mediated by the 2 factors, in addition to the RET pathway, which can be altered in MTC patients.
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Affiliation(s)
- Raffaele Pezzani
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
- Associazione Italiana per la Ricerca Oncologica di Base (AIROB), Padova, Italy
| | - Loris Bertazza
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Elisabetta Cavedon
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Sara Watutantrige-Fernando
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Gianmaria Pennelli
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padova, Via Gabelli 61, 35121 Padova, Italy
| | - Francesca Galuppini
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padova, Via Gabelli 61, 35121 Padova, Italy
| | - Susi Barollo
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale 105, Padova 35128, Italy
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Chmielik E, Rusinek D, Oczko-Wojciechowska M, Jarzab M, Krajewska J, Czarniecka A, Jarzab B. Heterogeneity of Thyroid Cancer. Pathobiology 2018; 85:117-129. [PMID: 29408820 DOI: 10.1159/000486422] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022] Open
Abstract
There are 5 main histological types of thyroid cancers (TCs): papillary, follicular (also known as differentiated), poorly differentiated, anaplastic (the most aggressive form), and medullary TC, and only the latter arises from thyroid C cells. These different forms of TCs show significant variability, both among and within tumours. This great variation is particularly notable among the first 4 types, which all originate from thyroid follicular cells. Importantly, this heterogeneity is not limited to histopathological diversity only but is also manifested as variation in several genetic and/or epigenetic alterations, the numbers of interactions between the tumour and surrounding microenvironment, and interpatient differences, for example. All these factors contribute to the great complexity in the development of a tumour from cancer cells. In the present review, we summarise the knowledge accumulated about the heterogeneity of TCs. Further research in this direction should help to gain a better understanding of the underlying mechanisms contributing to the development and diversity of TCs, paving the way toward more effective treatment strategies.
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Affiliation(s)
- Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Malgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Michal Jarzab
- 3rd Department of Radiotherapy and Chemotherapy, Breast Unit, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
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Aubert S, Berdelou A, Gnemmi V, Behal H, Caiazzo R, D'herbomez M, Pigny P, Wemeau JL, Carnaille B, Renaud F, Bouchindhomme B, Leteurtre E, Perrais M, Pattou F, Do Cao C. Large sporadic thyroid medullary carcinomas: predictive factors for lymph node involvement. Virchows Arch 2018; 472:461-468. [PMID: 29388012 DOI: 10.1007/s00428-018-2303-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/01/2018] [Accepted: 01/18/2018] [Indexed: 12/27/2022]
Abstract
Lymph node involvement (LNI) is one of the most important prognostic factors for poor survival in medullary thyroid carcinoma (MTC). At diagnosis, LNI is found in over 50% of sporadic MTCs, and especially in large tumours. Cervical lymph node dissection is therefore mandatory during MTC surgery. However, some large tumours (responsible for high preoperative basal calcitonin levels) are found to lack LNI, and can be cured definitely. Preoperative detection of these particular tumours might spare patients from undergoing extensive cervical dissection. The objective of the present retrospective study of a series of large sporadic MTCs was to identify clinical, biological and pathological factors that were predictive of LNI. Consecutive cases of large, sporadic MTCs (measuring at least 1 cm in diameter) were retrieved and reviewed. The levels of several mature microRNAs (miRs) in paraffin-embedded samples were assessed using qPCR. Of the 54 MTCs, 26 had LNI and 28 were pN0. Relative to pN0 patients, patients with LNI had a significant higher preoperative basal calcitonin level (p = 0.0074) and a greater prevalence of infiltrative margins (p < 0.0001), lymphovascular invasion (p = 0.0004), extrathyroidal extension (p < 0.0001), a higher pT stage (p = 0.0003) and more abundant desmoplastic stroma (p = 0.0006). Tumour expression levels of miR-21 (p = 0.0008) and miR-183 (p = 0.0096) were higher in the LNI group. The abundance of desmoplastic stroma (p = 0.007) and the miR-21 expression level (p = 0.0026) were independent prognostic factors for LNI. The abundance of desmoplastic stroma and high levels of miR-21 expression were strong indicators of LNI, and may thus help the surgeon to choose the extent of cervical lymph node dissection for large, sporadic MTCs with no preoperatively obvious LNI.
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Affiliation(s)
- Sébastien Aubert
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France.
- Faculté de Médecine, Université de Lille, 59045, Lille, France.
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France.
| | - Amandine Berdelou
- Service de Cancérologie endocrinienne, IGR, 94805, Villejuif, Paris, France
| | - Viviane Gnemmi
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - Hélène Behal
- Unité de Biostatistiques - Pôle de Santé Publique, CHRU de Lille, 59037, Lille, France
| | - Robert Caiazzo
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service de Chirurgie Endocrine, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Michèle D'herbomez
- Institut de Biochimie, Centre de Biologie Pathologie Génétique, CHRU de Lille, 59037, Lille, France
| | - Pascal Pigny
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
- Institut de Biochimie, Centre de Biologie Pathologie Génétique, CHRU de Lille, 59037, Lille, France
| | - Jean Louis Wemeau
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service d'Endocrinologie, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Bruno Carnaille
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service de Chirurgie Endocrine, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Florence Renaud
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - Brigitte Bouchindhomme
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
| | - Emmanuelle Leteurtre
- Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - Michael Perrais
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- UMR 1172, INSERM Bâtiment Biserte, JPArc, 59045, Lille, France
| | - François Pattou
- Faculté de Médecine, Université de Lille, 59045, Lille, France
- Service de Chirurgie Endocrine, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
| | - Christine Do Cao
- Service d'Endocrinologie, Hôpital Huriez, CHRU de Lille, 59037, Lille, France
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Cappagli V, Potes CS, Ferreira LB, Tavares C, Eloy C, Elisei R, Sobrinho-Simões M, Wookey PJ, Soares P. Calcitonin receptor expression in medullary thyroid carcinoma. PeerJ 2017; 5:e3778. [PMID: 28929017 PMCID: PMC5600720 DOI: 10.7717/peerj.3778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022] Open
Abstract
Background Calcitonin expression is a well-established marker for medullary thyroid carcinoma (MTC); yet the role of calcitonin receptor (CTR), its seven-transmembrane G-protein coupled receptor, remains to be established in C-cells derived thyroid tumors. The aim of this work was to investigate CTR expression in MTC and to correlate such expression with clinicopathological features in order to evaluate its possible role as a prognostic indicator of disease aggressiveness and outcome. Methods Calcitonin receptor expression was analyzed in a series of 75 MTCs by immunohistochemistry, and by qPCR mRNA quantification in specimens from four patients. Statistical tests were used to evaluate the correlation between CTR expression and the clinicopathological and molecular characteristics of patients and tumors. Results Calcitonin receptor expression was detected in 62 out of 75 samples (82.7%), whereas 13 of the 75 samples (17.3%) were completely negative. CTR expression was significantly associated with expression of cytoplasmatic phosphatase and tensin homologue deleted on chromosome 10 and osteopontin, as well as with wild type RET/RAS genes and absence of tumor stroma, suggesting that CTR expression do not associate with clinicopathological signs of worse prognosis. Discussion Calcitonin receptor expression appears to be associated in MTC with more differentiated status of the neoplastic cells.
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Affiliation(s)
- Virginia Cappagli
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy
| | - Catarina Soares Potes
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal.,Department of Biomedicine - Experimental Biology Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luciana Bueno Ferreira
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal
| | - Catarina Tavares
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal
| | - Catarina Eloy
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Endocrine Unit, University of Pisa, Pisa, Italy
| | - Manuel Sobrinho-Simões
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Department of Pathology, Hospital de S. João, Porto, Portugal.,Department of Pathology, Medical Faculty, University of Porto, Porto, Portugal
| | - Peter J Wookey
- Department of Medicine at Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Paula Soares
- Cancer Signaling and Metabolism Group, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Medical Faculty, University of Porto, Porto, Portugal
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25
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Herac M, Niederle B, Raderer M, Krebs M, Kaserer K, Koperek O. Expression of somatostatin receptor 2A in medullary thyroid carcinoma is associated with lymph node metastasis. APMIS 2016; 124:839-45. [DOI: 10.1111/apm.12584] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/20/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Merima Herac
- Clinical Institute of Pathology; Medical University of Vienna; Vienna Austria
| | - Bruno Niederle
- Section of Endocrine Surgery; Division of General Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Markus Raderer
- Department of Internal Medicine I; Division of Oncology; Medical University of Vienna; Vienna Austria
| | - Michael Krebs
- Department of Internal Medicine I; Division of Endocrinology and Metabolism; Medical University of Vienna; Vienna Austria
| | | | - Oskar Koperek
- Clinical Institute of Pathology; Medical University of Vienna; Vienna Austria
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26
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[Thyroid C cells and their pathology: Part 2: Medullary thyroid carcinoma]. DER PATHOLOGE 2016; 36:254-60. [PMID: 25917773 DOI: 10.1007/s00292-015-0017-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
All tumours with C cell differentiation are designated as medullary carcinomas (MTC). MTC occur sporadically (75-80%) or hereditary (20-25%), the latter being part of the multiple endocrine neoplasia type 2. Familial MTC, which is commonly preceded by "neoplastic" C cell hyperplasia, is caused by autosomal-dominant inherited germ line mutation of the RET-protooncogene; dependent on the codon affected by the mutation, patients show substantially different clinical courses. Due to its morphological heterogeneity, the immunohistochemical demonstration of calcitonin is mandatory for the diagnosis of MTC. For early diagnosis of MTC calcitonin screening has been introduced in Germany and Austria approx. 10 years ago in patients with thyroid nodules; however, an increased calcitonin serum level may also be caused by "non-MEN2-associated" C cell, which is not regarded as a precursor of sporadic MTC. Very rarely tumours may show a mixed C cell-follicular cell differentiation.
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Ting S, Synoracki S, Schmid KW. [Thyroid C cells and their pathology: Part 1: normal C cells, - C cell hyperplasia, - precursor of familial medullary thyroid carcinoma]. DER PATHOLOGE 2016; 36:246-53. [PMID: 25898937 DOI: 10.1007/s00292-015-0019-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The C cells (parafollicular) of the human thyroid gland are predominantly located within the thyroid follicles, are of neuroendocrine origin and produce and secrete the peptide hormone calcitonin. Calcitonin is clinically utilized as a screening marker to detect occult medullary thyroid carcinoma (MTC) as well as in the follow-up of patients with MTC. An increase in the number of C cells is designated as C cell hyperplasia (CCH). Neoplastic CCH is caused by an autosomal dominant inherited mutation of the RET protooncogene, which develops into invasive familial MTC in the setting of multiple endocrine neoplasia (MEN) type 2 depending on the location of the mutation in the RET gene with a high variation in latency. According to the current state of knowledge CCH without a germline mutation in the RET protooncogene, designated as non-MEN2-associated CCH, seems to be unrelated to the development of sporadic MTC.
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Affiliation(s)
- S Ting
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland
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Synoracki S, Ting S, Siebolts U, Dralle H, Koperek O, Schmid KW. Intraoperativer Gefrierschnitt der Schilddrüse. DER PATHOLOGE 2015; 36:362-71. [DOI: 10.1007/s00292-015-0038-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The human thyroid gland contains less than 0.01-0.1% calcitonin producing and secreting C cells, which in men are almost exclusively situated in an intrafollicular location; the vast majority of C cells are embryologically derived of remnants of the ultimobranchial body and ultimately of the neural crest, a small subset, however, is presumed to originate from endodermal stem cells. Thyroid tumours with C cell differentiation have been named medullary thyroid carcinoma (MTC); calcitonin is also produced and secreted by MTC which makes this peptide hormone a very useful serum marker both for early detection and clinical follow-up of patients with MTC. About 70-80% of MTC are sporadic tumours, whereas 20-30% are familial MTC which are autosomal-dominant inherited and caused by germline mutations of the RET proto-oncogene located on chromosome 10. This article summarizes the histological, immunhistochemical and molecular genetic features of C cells, C-cell hyperplasia (CCH) and MTC, emphasizing the role of diagnostic pathology.
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Affiliation(s)
- Kurt Werner Schmid
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
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31
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Koperek O, Akin E, Asari R, Niederle B, Neuhold N. Expression of hypoxia-inducible factor 1 alpha in papillary thyroid carcinoma is associated with desmoplastic stromal reaction and lymph node metastasis. Virchows Arch 2013; 463:795-802. [DOI: 10.1007/s00428-013-1484-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/22/2013] [Accepted: 09/17/2013] [Indexed: 12/24/2022]
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32
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Harry BL, Smith ML, Burton JR, Dasari A, Eckhardt SG, Diamond JR. Medullary thyroid cancer and pseudocirrhosis: case report and literature review. ACTA ACUST UNITED AC 2013; 19:e36-41. [PMID: 22328846 DOI: 10.3747/co.19.840] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pseudocirrhosis is a rare form of liver disease that can cause clinical symptoms and radiographic signs of cirrhosis; however, its histologic features suggest a distinct pathologic process. In the setting of cancer, hepatic metastases and systemic chemotherapy are suspected causes of pseudocirrhosis. Here, we present a patient with medullary thyroid carcinoma metastatic to the liver who developed pseudocirrhosis while on maintenance sunitinib after receiving 5-fluorouracil, leucovorin, and oxaliplatin (folfox) in combination with sunitinib. Cirrhotic change in liver morphology was accompanied by diffusely infiltrative carcinomatous disease resembling the primary tumor. We discuss the diagnosis of pseudocirrhosis in this case and review the literature regarding pseudocirrhosis in cancer.
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Affiliation(s)
- B L Harry
- Medical Scientist Training Program, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, U.S.A
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Abstract
PURPOSE OF REVIEW The lateral neck compartment is the second most frequent target region for metastatic papillary thyroid cancer (PTC) and medullary thyroid cancer (MTC). Lateral lymph node metastases are associated with locoregional recurrence and, when they involve either side of the neck, with mediastinal and distant metastases. RECENT FINDINGS For tumors originating from the upper thyroid pole, the first nodal basin is not invariably the central compartment (as for primaries arising from the inferior thyroid pole) but often the upper part of the ipsilateral lateral compartment. Lymph node dissection of the first basin may differ depending on the location of the primary tumor. Involvement of the contralateral lateral compartment is seen in PTC with extensive central compartment involvement, and in MTC with preoperative basal calcitonin levels more than 200 pg/ml (normal limit <10 pg/ml). SUMMARY After lateral lymph node dissection for metastatic thyroid cancer, dysfunction of lateral neck nerves is fairly common. This observation underpins the importance of striking a balance between oncological benefit and surgical risk. Lateral lymph node dissection may be warranted for an upper thyroid pole primary, for a tumor with extensive involvement of the central compartment, and for an MTC with increased basal calcitonin level of 20-200 pg/ml (ipsilateral dissection) or more than 200 pg/ml (bilateral dissection).
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El Khoury J, Khalifeh I, Kibbi AG, Abbas O. Cutaneous metastasis: clinicopathological study of 72 patients from a tertiary care center in Lebanon. Int J Dermatol 2013; 53:147-58. [PMID: 23557182 DOI: 10.1111/j.1365-4632.2012.05650.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. OBJECTIVE To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut - Medical Center (AUB-MC) and to compare our findings with those published in the literature. METHODS Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB-MC between 1992 and 2010. RESULTS A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). CONCLUSION This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences.
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Affiliation(s)
- Jinane El Khoury
- Departments of DermatologyPathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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35
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Gimm O. Extent of surgery in clinically evident but operable MTC - when is central and/or lateral lympadenectomy indicated? Thyroid Res 2013; 6 Suppl 1:S3. [PMID: 23514526 PMCID: PMC3599729 DOI: 10.1186/1756-6614-6-s1-s3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) metastasizes very early lymphogeneously. It has been shown that the presence of lymph node metastases is associated with a worse outcome. Postoperative biochemical cure, i.e. normalization of posttherapeutical calcitonin levels, has been shown to correlate with a better outcome. The rate of biochemical cure decreases dramatically in the presence of lymph node metastases but can still be achieved in about 30-40% of patients despite the presence of lymph node metastases.In 2009, the American Thyroid Association (ATA) published guidelines on the management of MTC. Various recommendations in the guidelines are dealing with the extent of lymph node dissection in different clinical settings. This article summarizes and comments on these recommendations.
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Affiliation(s)
- Oliver Gimm
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-58185 Linköping, Sweden.
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Immunohistochemical Detection of the BRAF V600E-mutated Protein in Papillary Thyroid Carcinoma. Am J Surg Pathol 2012; 36:844-50. [DOI: 10.1097/pas.0b013e318246b527] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koperek O, Bergner O, Pichlhöfer B, Oberndorfer F, Hainfellner JA, Kaserer K, Horvat R, Harris AL, Niederle B, Birner P. Expression of hypoxia-associated proteins in sporadic medullary thyroid cancer is associated with desmoplastic stroma reaction and lymph node metastasis and may indicate somatic mutations in the VHL gene. J Pathol 2011; 225:63-72. [DOI: 10.1002/path.2926] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/05/2011] [Accepted: 04/13/2011] [Indexed: 11/09/2022]
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Koperek O, Asari R, Niederle B, Kaserer K. Desmoplastic stromal reaction in papillary thyroid microcarcinoma. Histopathology 2011; 58:919-24. [DOI: 10.1111/j.1365-2559.2011.03791.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Molecular genetic analysis is gaining in significance for the differential diagnosis of thyroid tumours. Identifying specific mutations and/or rearrangements offers not only the possibility to distinguish benign from malignant tumours, but also to classify thyroid malignancies more precisely, which can have a substantial influence on the clinical management of patients. In recent years expression analysis of micro-RNA (miRNA) has become an additional tool to improve diagnostic accuracy in thyroid tumours. In addition to its diagnostic contribution, molecular genetic evaluation of thyroid tumours has significantly deepened our understanding of the development, progression and therapy of these tumours.
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Affiliation(s)
- K W Schmid
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147 Essen.
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Abstract
Thyroid nodular disease is highly frequent and affects 20-23% of the adult population in Germany. Differential diagnosis of thyroid nodules is directed at exclusion of thyroid autonomy and thyroid cancer. In addition, large nodules/nodular goiters may cause oesophageal and/or tracheal compression. Besides the patient's history and clinical examination, laboratory investigations (TSH-level, calcitonin screening), functional (scintiscan) and morphological imaging (ultrasound, in rare cases also CT without contrast media and MRI), as well as fine needle aspiration biopsy are useful tools in the differential diagnosis. In the past years, major advances have been made in the understanding of the molecular pathogenesis of thyroid tumors. This has led to the possibility of a molecular classification of thyroid tumors and may have prognostic as well as therapeutic impact.
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Affiliation(s)
- D Führer
- Klinik für Endokrinologie und Nephrologie,Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Liebigstrasse 18, 04103, Leipzig, Deutschland.
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Taïeb D, Giusiano S, Sebag F, Marcy M, de Micco C, Palazzo FF, Dusetti NJ, Iovanna JL, Henry JF, Garcia S, Taranger-Charpin C. Tumor protein p53-induced nuclear protein (TP53INP1) expression in medullary thyroid carcinoma: a molecular guide to the optimal extent of surgery? World J Surg 2010; 34:830-5. [PMID: 20145930 DOI: 10.1007/s00268-010-0395-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is characterized by early regional lymph node metastasis, the presence of which represents a critical obstacle to cure. At present no molecular markers have been successfully integrated into the clinical care of sporadic MTC. The present study was designed to evaluate TP53INP1 expression in MTC and to assess its ability to guide the surgeon to the optimal extent of surgery performed with curative intent. METHODS Thirty-eight patients with sporadic MTC were evaluated. TP53INP1 immunoexpression was studied on embedded paraffin material and on cytological smears. RESULTS TP53INP1 was expressed in normal C cells, in C-cell hyperplasia, and in 57.9% of MTC. It was possible to identify two groups of MTC according to the proportion of TP53INP1 expressing tumor cells: group 1 from 0% to <50% and group 2 from 50% to 100% of positive cells. Patients with a decreased expression of TP53INP1 (group 1) had a lower rate of nodal metastasis (18.8% versus 63.4% in group 2; P = 0.009), with only minimal lymph node involvement per N1 patient (2.7% of positive lymph nodes versus 22.9%; P < 0.001) and better outcomes (100% of biochemical cure versus 55.5%; P < 0.001). Patients with distant metastases were only observed in group 2. Cytological samples exhibit similar results to their embedded counterparts. CONCLUSIONS TP53INP1 immunoexpression appears to be a clinical predictor of lymph node metastasis in MTC. The evaluation of TP53INP1 expression may guide the extent of lymph node dissection in the clinically node-negative neck. These findings require prospective validation.
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Affiliation(s)
- D Taïeb
- INSERM U624 Stress Cellulaire, Parc Scientifique et Technologique de Luminy, Case 915, 13288, Marseille, France.
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Caporale A, Bonapasta SA, Scarpini M, Ciardi A, Vestri A, Ruperto M, Giuliani A. Quantitative Investigation of Desmoplasia as a Prognostic Indicator in Colorectal Cancer. J INVEST SURG 2010; 23:105-9. [DOI: 10.3109/08941930903469417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Multiple endocrine neoplasia type 2 (MEN 2) is an autosomal dominantly inherited tumor syndrome subclassified into three distinct syndromes: MEN 2A, MEN 2B and familial medullary thyroid carcinoma. In MEN 2 families, medullary thyroid carcinoma, pheochromocytomas and parathyroid adenomas occur with a variable frequency, also depending on the specific genetic defect involved. In 1993, the responsible MEN2 gene was identified. The genetic defect in these disorders involves the RET proto-oncogene on chromosome 10. The germline RET mutations result in a gain-of-function of the RET protein. Extensive studies on large families revealed that there is a strong genotype-phenotype correlation. In this review, guidelines for early diagnosis, including MEN2 gene mutation analysis, and treatment, including preventive surgery, periodic and clinical monitoring, have been formulated, enabling improvement of life expectancy and quality of life. Identification of the RET protein has also provided new insights into its function, and the specific pathways it effects involved in cell proliferation, migration, differentiation and survival. In the near future, identification of biological tumor markers will enable target-directed intervention and may prevent and/or delay progression of both primary and residual tumor growth.
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Affiliation(s)
- Cornelis Jm Lips
- a University Medical Center Utrecht, Department of Internal Medicine, Wassenaarseweg 109, 2596 CN The Hague, The Netherlands.
| | - Wendy van Veelen
- b Erasmus Medical Center Department of Gastroenterology and Hepatology PO Box 2040, 3000 CA Rotterdam The Netherlands.
| | - Thera P Links
- c University Medical Center Groningen, Department of Internal Medicine, PO Box 30001, 9700 RB Groningen, The Netherlands.
| | - Jo Wm Höppener
- d University Medical Center Utrecht Department of Metabolic and Endocrine Diseases & Netherlands Metabolomics Centre, Utrecht KC-02.069.1, PO Box 85090, 3508 AB Utrecht, The Netherlands.
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Pillarisetty VG, Katz SC, Ghossein RA, Tuttle RM, Shaha AR. Micromedullary Thyroid Cancer: How Micro Is Truly Micro? Ann Surg Oncol 2009; 16:2875-81. [DOI: 10.1245/s10434-009-0595-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 06/10/2009] [Accepted: 06/11/2009] [Indexed: 11/18/2022]
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van Veelen W, de Groot JWB, Acton DS, Hofstra RMW, Höppener JWM, Links TP, Lips CJM. Medullary thyroid carcinoma and biomarkers: past, present and future. J Intern Med 2009; 266:126-40. [PMID: 19522831 DOI: 10.1111/j.1365-2796.2009.02106.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The clinical management of patients with persistent or recurrent medullary thyroid carcinoma (MTC) is still under debate, because these patients either have a long-term survival, due to an indolent course of the disease, or develop rapidly progressing disease leading to death from distant metastases. At this moment, it cannot be predicted what will happen within most individual cases. Biomarkers, indicators which can be measured objectively, can be helpful in MTC diagnosis, molecular imaging and treatment, and/or identification of MTC progression. Several MTC biomarkers are already implemented in the daily management of MTC patients. More research is being aimed at the improvement of molecular imaging techniques and the development of molecular systemic therapies. Recent discoveries, like the prognostic value of plasma calcitonin and carcino-embryonic antigen doubling-time and the presence of somatic RET mutations in MTC tissue, may be useful tools in clinical decision making in the future. In this review, we provide an overview of different MTC biomarkers and their applications in the clinical management of MTC patients.
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Affiliation(s)
- W van Veelen
- The Division of Biomedical Genetics, Department of Metabolic and Endocrine Diseases, University Medical Centre Utrecht, Utrecht.
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Koperek O, Prinz A, Scheuba C, Niederle B, Kaserer K. Tenascin C in medullary thyroid microcarcinoma and C-cell hyperplasia. Virchows Arch 2009; 455:43-8. [PMID: 19484261 DOI: 10.1007/s00428-009-0786-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 04/24/2009] [Accepted: 04/27/2009] [Indexed: 12/12/2022]
Abstract
Tenascin C (Tn-C) is an extracellular matrix glycoprotein that is expressed early in carcinogenesis including intraepithelial neoplastic lesions of different organs. In this study, we analyze whether stroma reaction seen by Tn-C expression is detected early in tumorigenesis of medullary thyroid carcinoma (MTC) including medullary microcarcinoma and C-cell hyperplasia (CCH), which is accepted to be a precursor lesion of MTC in the setting of RET oncogene germ-line mutation. Tn-C was expressed in the stroma of all medullary microcarcinoma and in the stroma next to CCH. Stromal Tn-C expression was significantly more often seen in CCH with concomitant MTC than in isolated CCH of hereditary as well as nonhereditary cases (p = 0.001 and p = 0.016, respectively). We conclude that Tn-C expression and thus early stroma remodeling is seen in medullary microcarcinoma and CCH. Stromal Tn-C expression seems to be an indicator of a further step in carcinogenesis of MTC irrespective of a RET oncogene germ-line mutation.
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Affiliation(s)
- Oskar Koperek
- Department of Clinical Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Koperek O, Scheuba C, Cherenko M, Neuhold N, De Micco C, Schmid KW, Niederle B, Kaserer K. Clinical relevance of desmoplasia in medullary thyroid carcinoma. Histopathology 2008. [DOI: 10.1111/j.1365-2559.2008.03133.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Machens A, Dralle H. Clinical relevance of desmoplasia in medullary thyroid carcinoma. Histopathology 2008; 53:481; author reply 482-3. [DOI: 10.1111/j.1365-2559.2008.03122.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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