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Li Z, Su J, Wang J, Yan L, Zhang H, Li X, Tai Y, Fang Y, Yan T. Ultrasound-guided core needle biopsy combined with immunohistochemistry and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, two case reports and analyses. Clin Case Rep 2024; 12:e8959. [PMID: 38817707 PMCID: PMC11136645 DOI: 10.1002/ccr3.8959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Key Clinical Message Ultrasound-guided core needle biopsy combined with immunohistochemistry and molecular testing could improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, help to predict distant metastasis and prognosis. Abstract Metastatic thyroid follicular carcinoma presenting initially with bone lesion is uncommon, its prime symptom is gradual onset, localized pain. Patient with bone metastasis who were diagnosed before thyroidectomy had a higher rate of mortality, clinician should be cautious in eliciting the clinical history and this insidious symptom in middle age group, carry out further examination. We are presenting two case reports of a follicular thyroid carcinoma with bone metastasis, ultrasound-guided core needle biopsy combined with immunohistochemistry (IHC) were carried out by our clinical team to determine the source and nature of the tumor, relevant literature was reviewed, molecular testing was discussed, we believe core needle biopsy combined with IHC and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma.
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Affiliation(s)
- Zhiyuan Li
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jianbin Su
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jinjing Wang
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Li Yan
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Huiqiang Zhang
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xinyu Li
- Center for Disease Control and Prevention of Xicheng DistrictBeijingChina
| | - Yanhong Tai
- Department of PathologyFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yi Fang
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Tao Yan
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
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Verma P, Malhotra G, Rao RD, Sonavane S, Agrawal R. Rare Presentations of Differentiated Thyroid Cancer Exposing Dr Jekyll and Mr Hyde Nature of an Otherwise Indolent Disease: Case Series. Clin Nucl Med 2024; 49:e193-e196. [PMID: 38409755 DOI: 10.1097/rlu.0000000000005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
ABSTRACT Differentiated thyroid carcinoma (DTC) usually manifests as an indolent cancer with good prognosis. However, rarely uncommon sites of metastatic involvement can worsen the prognosis and require aggressive therapeutic approach. Here in, we describe 5 patients (3 women and 2 men) harboring rare sites of metastatic involvement from DTC including the adrenals, colon, kidneys, urinary bladder, brachial plexus, and superior vena cava with contiguous right atrial involvement. The awareness of such rare sites of involvement from DTC is imperative for treating clinicians to plan individualistic approach in management including multiprong therapies for better patient care.
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Affiliation(s)
| | | | | | | | - Ritesh Agrawal
- Department of Endocrine Surgery, Bombay Hospital and Medical Research Centre, Mumbai, India
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3
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Basso C, Colapinto A, Vicennati V, Gambineri A, Pelusi C, Di Dalmazi G, Rizzini EL, Tabacchi E, Golemi A, Calderoni L, Fanti S, Pagotto U, Repaci A. Radioiodine whole body scan pitfalls in differentiated thyroid cancer. Endocrine 2024:10.1007/s12020-024-03754-y. [PMID: 38498129 DOI: 10.1007/s12020-024-03754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE whole body scan (WBS) performed following diagnostic or therapeutic administration of I-131 is useful in patients with differentiated thyroid carcinoma. However, it can be falsely positive in various circumstances. We aimed to report a series of pitfalls in a clinical perspective. METHODS A search in the database PubMed utilizing the following terms: "false radioiodine uptake" and "false positive iodine 131 scan" has been made in January 2023. Among the 346 studies screened, 230 were included in this review, with a total of 370 cases collected. Physiological uptakes were excluded. For each patient, sex, age, dose of I-131 administered, region and specific organ of uptake and cause of false uptake were evaluated. RESULTS 370 cases of false radioiodine uptake were reported, 19.1% in the head-neck region, 34.2% in the chest, 14.8% in the abdomen, 20.8% in the pelvis, and 11.1% in the soft tissues and skeletal system. The origin of false radioiodine uptake was referred to non-tumoral diseases in 205/370 cases (55.1%), benign tumors in 108/370 cases (29.5%), malignant tumors in 25/370 cases (6.7%), and other causes in 32/370 cases (8.7%). CONCLUSIONS WBS is useful in the follow-up of patients with differentiated thyroid carcinoma, however it can be falsely positive in various circumstances. For this reason, it is critically important to correlate the scintigraphic result with patient's medical history, serum thyroglobulin levels, additional imaging studies and cytologic and/or histologic result.
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Affiliation(s)
- Cristina Basso
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Colapinto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Vicennati
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Carla Pelusi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elisa Lodi Rizzini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Tabacchi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arber Golemi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Chwa S, Lee SH, Lee SH. Unusual mesentery metastasis of differentiated thyroid cancer: a case report. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2023; 19:84-87. [PMID: 38229494 DOI: 10.14216/kjco.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/24/2023] [Indexed: 01/18/2024]
Abstract
Distant metastases of well-differentiated thyroid cancers (WDTCs) to bone and lungs are well known, while intra-abdominal, mesenteric metastases are very rare. Herein, we report a case of intra-abdominal, mesenteric metastasis of WDTC. A 62-year-old man underwent thyroid lobectomy for follicular thyroid cancer. One year later, lung metastasis was observed. The patient simultaneously underwent lung wedge resection and complete thyroidectomy. Eleven years later, serum thyroglobulin level was elevated. On the work-up study, a metastatic lesion in the lungs and a mass in the mesentery were identified. Two lesions of the lung and mesentery were surgically resected. The mass in the mesentery was pathologically diagnosed as metastatic WDTC.
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Affiliation(s)
- Sunyoung Chwa
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
| | - Seung Hun Lee
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
| | - Seung Hyun Lee
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
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5
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Ilerhunmwuwa NP, Wasifuddin M, Perry J, Hakobyan N, Inyang L, Zavgorodneva Z, Gasparyan L, Tahir M. Pituitary Metastases From Differentiated Thyroid Cancers: A Systematic Review. World J Oncol 2023; 14:165-173. [PMID: 37350806 PMCID: PMC10284638 DOI: 10.14740/wjon1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/24/2023] Open
Abstract
Background Pituitary metastasis (PM) from differentiated thyroid cancer (DTC) is extremely rare and may adversely affect outcomes. We aimed to assess the characteristics and outcomes of patients with PM from DTC. Methods We systematically reviewed the literature on publications on PM and the different DTC histologic types (papillary, follicular, and Hurthle cell cancers). Three databases (PubMed, Embase, and Scopus) were searched for articles published from 1967 to 2022. Survival time was estimated as the period from the first treatment of PM to the time of death or last follow-up. Results Twenty-five articles comprising 27 cases that met the eligibility criteria were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The median age of the patients was 60 years (23 - 86). A preponderance of females (66.7%) with PM most commonly reported papillary thyroid cancer (55.6%). This was followed by follicular thyroid cancer (37.0%) and Hurthle cell cancer (7.4%). The most common presentations were headache, nausea, and vomiting, with visual symptoms in 44.4%. Diabetes insipidus was an infrequent finding (7.4%). The median time from diagnosis or first treatment of DTC to the diagnosis of PM was 3 years (0 - 25). The most common endocrine abnormality was hyperprolactinemia (63.2%), while the most frequently deficient hormone was luteinizing hormone (50%). The most common treatment modality for PM was a combination of radiotherapy and surgery with or without radio-iodine. At the end of the follow-up, 30% of the patients died. Only 33.3% of the patients achieved complete resolution of symptoms. The overall median survival time was 12 months (3 - 108). There was a moderate inverse correlation between the age of patients and survival, which was, however, not statistically significant (rs = -0.45, P = 0.103). Conclusion PM from DTC is extremely rare, and Hurtle cell cancer appears to be the least associated with PM. Diabetes insipidus is a rare initial manifestation of PM from DTC. Complete resolution of symptoms is less likely to be achieved in PM from DTC. Older age may confer an increased survival tendency, probably due to more intracranial space volume in older people compared to the younger population. Larger studies are needed to examine the relationship between age and survival in PM from DTC. Also, more observational data are required to determine the predictors of survival and compare the efficacy of the different treatment modalities in patients with PM from DTC.
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Affiliation(s)
| | - Mustafa Wasifuddin
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Jamal Perry
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Narek Hakobyan
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Lawrence Inyang
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Zhanna Zavgorodneva
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Lilit Gasparyan
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
| | - Muhammad Tahir
- Internal Medicine Department, Brookdale Hospital Medical Center/One Brooklyn Health, Brooklyn, NY, USA
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Tatar G, Alçın G, Erol Fenercioğlu Ö, Şahin R, Çermik TF. Findings of I-131 SPECT/CT, 18F-FDG, and 68Ga-FAPI-04 PET/CT Imaging in a Patient Treated with Radioiodine Therapy for Metastatic Papillary Thyroid Carcinoma. Mol Imaging Radionucl Ther 2023; 32:57-61. [PMID: 36819619 PMCID: PMC9950682 DOI: 10.4274/mirt.galenos.2022.02438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
A 50-year-old man undergone total thyroidectomy and histopathology revealed papillary thyroid carcinoma with a tumor size of 4.5 cm. The patient was referred to a nuclear medicine clinic for radioiodine therapy. Since the thyroglobulin level before the treatment was 495 ug/L, low-dose (185 MBq) I-131 scan was performed. In addition to multiple liver metastases, bone metastases were detected in the sacrum and right 7th rib in I-131 whole body scanning and single photon emission computed tomography/computed tomography (CT) imaging at the time of initial staging. We present a case of multiple metastatic papillary thyroid carcinoma whose radioiodine treatment response and clinical outcome were evaluated with 18F-fluorodeoxyglucose and Gallium-68 FAPI-04 positron emission tomography/CT.
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Affiliation(s)
- Gamze Tatar
- University of Health Sciences Turkey, İstanbul Bağcılar Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey,* Address for Correspondence: University of Health Sciences Turkey, İstanbul Bağcılar Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey Phone: +90 212 444 40 00 E-mail:
| | - Göksel Alçın
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Özge Erol Fenercioğlu
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Rahime Şahin
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Bashank N, Farghaly H, Hassanein S, Abdel-Tawab M, Wahman M, Mahmoud H. Rare sites of metastases in patients with differentiated thyroid carcinoma and added value of SPECT/CT over planar whole body radioactive iodine scan. Eur J Hybrid Imaging 2022; 6:34. [DOI: 10.1186/s41824-022-00155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Being aware of the unusual or rare location of thyroid metastases helps in early diagnosis and proper patient management. Rare metastases (RM) can be missed resulting in diagnostic pitfalls and delayed treatment. The use of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging in the follow-up of differentiated thyroid cancer (DTC) patients provides precise anatomical localization and characterization of RM that may be missed or misinterpreted in planar whole body iodine-131 (WBI) scan. There is a lack of knowledge about dealing with such patients, the treatment they should receive, and therapy response due to the rarity of such cases. In this work, we reported these rare cases increasing awareness about them and their methods of treatment with response to therapy and evaluated the added value of SPECT/CT imaging in changing patients’ management.
Materials and methods
In this study we reviewed all patients with DTC referred to our unit either for initial radioactive iodine-131 therapy (RAIT) or under follow-up from January 2019 to January 2022. When a suspected lesion was detected in a conventional planar WBI scan whether follow-up scan or post-therapeutic scan, SPECT/CT was acquired immediately in the same session for that region. Additional imaging modalities were performed for confirmation. Response to the given treatment either disease progression (DP) or favorable response which include complete response (CR), partial regression (PR) and stable disease (SD) recorded for each patient.
Results
Two hundred and forty patients with DTC referred to our unit over a three-year period (from January 2019 to January 2022) were reviewed. Forty patients developed lung and bone distant metastases. Twenty-one patients were thought to have metastases at unusual sites. Due to incomplete data (no SPECT/CT pictures or confirmatory imaging), 6/21 patients were eliminated. We studied 15 patients with RM (9 females, 6 males) with a median age of 52 years (range 27–79). All patients received the initial RAIT after thyroidectomy in addition to other therapeutic modalities, e.g., radiotherapy (RTH), chemotherapy (CTH) or surgical tumor excision after detection of RM. Ten out of 15 patients (66.67%) showed favorable response to therapy (2 patients had CR, 6 patients had PR and 2 patients had SD), whereas only 5 patients had DP. Additional SPECT/CT changed management in 10/15 patients (66, 67%) of patients.
Conclusion
RM identification is mandatory to avoid misdiagnosis and delayed therapy. Increasing the awareness about such rare cases allows for better management. SPECT/CT could significantly impact patients' management through its precise anatomic localization and lesion characterization.
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Youssef B, Hanna K, Bowman A, Ardor GD, Alhaj AM, Nassar A. Metastatic Thyroid Carcinoma to the Kidneys Presenting Initially as Bilateral Renal Masses: A Rare Case Report and Literature Review. Int J Surg Pathol 2022:10668969221138860. [PMID: 36437643 DOI: 10.1177/10668969221138860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thyroid cancers exist in multiple forms. Papillary and follicular carcinomas of the thyroid are often referred to as well-differentiated thyroid cancers. Well-differentiated thyroid cancers rarely present as a distant metastatic cancer on initial diagnosis. Papillary thyroid cancer tends to have a good prognosis; however, if distant metastasis of PTC is present, there is usually a poor clinical outcome with a less favorable prognosis. In this study, we report a 90-year-old female who presented with right-sided abdominal discomfort. A renal ultrasound revealed bilateral upper pole renal masses. A percutaneous biopsy was ordered, and the microscopic examination revealed bilateral renal metastasis with a follicular variant of papillary thyroid carcinoma. The patient underwent thyroidectomy and sustained radiation therapy for her bilateral renal metastases. She died 6 years after her initial diagnosis, due to sepsis. This is the second study in literature to report bilateral renal metastasis of follicular variant of papillary thyroid cancer.
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Affiliation(s)
- Bahaaldin Youssef
- Department of Pathology and Laboratory Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Karina Hanna
- Department of Pathology and Laboratory Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
- The Bolles High School, Jacksonville, FL, USA
| | - Andrew Bowman
- Department of Radiology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Gokce Deniz Ardor
- Department of Pathology and Laboratory Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Ahmed M. Alhaj
- Division of Hematology and Oncology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Aziza Nassar
- Department of Pathology and Laboratory Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
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Kihara M, Miyauchi A, Hirokawa M, Fujishima M, Masuoka H, Higashiyama T, Onoda N, Ito Y, Miya A. Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report. Surg Case Rep 2022; 8:45. [PMID: 35292876 PMCID: PMC8924338 DOI: 10.1186/s40792-022-01397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The major sites of distant metastases of papillary thyroid carcinoma (PTC) are the lung and bone; metastasis to the liver is rare. Although the postoperative serum thyroglobulin (Tg) level after total thyroidectomy is a good prognostic indicator for PTC when anti-thyroglobulin antibody (TgAb) is negative, the presence of TgAb interferes with the Tg assay, making serum Tg levels unreliable. Here we report a case of liver metastasis of PTC that presented with elevated serum levels of carbohydrate antigen 19-9 (CA19-9), which is usually a serum marker of pancreatic and gastrointestinal neoplasias. CASE PRESENTATION A 69-year-old man was diagnosed with PTC and underwent total thyroidectomy 16 years ago. The patient's serum Tg levels increased progressively during follow-up and his serum TgAb was negative. Positron emission tomography (PET) and computed tomography (CT) revealed metastases of the lung, cervical spine, mediastinum and liver. The liver lesion was a solitary tumor measuring 4.0 cm in the greatest dimension. His serum CA19-9 level was very high (326 U/mL), and intrahepatic cholangiocarcinoma was suspected from the results of various examinations including gastrointestinal endoscopic imaging and CT. Laparoscopic partial liver resection for segment 4 was performed. The histopathological diagnosis was a metastatic liver tumor from PTC. The immunohistological examination revealed that the liver tumor was positive for CA19-9 and Tg. The primary PTC, recovered from paraffin-embedded specimen, was also positive for CA19-9. After the surgery, his serum CA19-9 level as well as serum Tg level markedly decreased. CONCLUSIONS We presented the first reported case of liver metastasis of a PTC presenting with elevated serum levels of CA19-9 after total thyroidectomy. This case suggests that the serum CA19-9 levels may serve as a surrogate marker for PTC in place of the serum Tg level in patients with positive serum TgAb if the PTC and/or the metastatic lesions are positive for CA19-9 staining.
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Affiliation(s)
- Minoru Kihara
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan.
| | - Akira Miyauchi
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Makoto Fujishima
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Hiroo Masuoka
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Takuya Higashiyama
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Naoyoshi Onoda
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Yasuhiro Ito
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Akihiro Miya
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
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Dhanani R, Faisal M, Akram M, Shakeel O, Zahid MT, Hassan A, Hussain R. Differentiated Thyroid Carcinoma: Distant Metastasis as an Unusual Sole Initial Manifestation. Turk Arch Otorhinolaryngol 2021; 59:188-192. [PMID: 34713003 PMCID: PMC8527540 DOI: 10.4274/tao.2021.2021-2-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/25/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomes Methods: A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected. Results: There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation. Conclusion: Distant metastases without a neck lump as the initial presentation of well-differentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature.
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Affiliation(s)
- Rahim Dhanani
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Mahir Akram
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Osama Shakeel
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Toqeer Zahid
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Aamna Hassan
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
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11
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Clinical Indications for Treatment with Multi-Kinase Inhibitors in Patients with Radioiodine-Refractory Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13092279. [PMID: 34068664 PMCID: PMC8126102 DOI: 10.3390/cancers13092279] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Differentiated thyroid cancer is usually a slow-growing disease, even if the patients develop distant metastasis. For recurrent or metastatic disease, radioactive iodine therapy is a standard treatment. However, the disease gradually progresses in some of the patients and can ultimately develop into life-threatening conditions. For patients with progressive radioactive iodine-refractory differentiated thyroid cancer (RR-DTC), multi-kinase inhibitors (MKIs) including sorafenib and lenvatinib prolonged progression-free survival compared with placebo in pivotal randomized phase 3 trials, although the benefit in overall survival has not been clearly confirmed, possibly because the patients who received placebo were permitted to cross-over to lenvatinib upon disease progression. Moreover, the adverse events related to MKIs were not negligible. Therefore, the optimal timing of MKI initiation has long been controversial, and physicians should consider various patient and disease factors. Herein, we comprehensively review the clinical factors that can be helpful in determining the initiation of MKIs for patients with RR-DTC.
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Butt MI, Khalid Bakhsh AM, Nadri QJ. Lenvatinib-induced multiorgan adverse events in Hurthle cell thyroid cancer: A case report. World J Clin Oncol 2021; 12:272-281. [PMID: 33959480 PMCID: PMC8085512 DOI: 10.5306/wjco.v12.i4.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/30/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of metastatic progressive radioiodine-resistant differentiated thyroid cancer remains challenging for clinicians. The availability of tyrosine kinase inhibitors (TKIs), sorafenib and lenvatinib, within the last decade has expanded treatment options; however, these lead to significant adverse effects, which may curtail their use.
CASE SUMMARY We report the case of a 47-year-old female with Hurthle cell thyroid cancer who underwent total thyroidectomy followed by radioiodine ablation. During follow-up, she developed noniodine-avid renal and pulmonary metastases. With respect to her pre-existing diabetes, hypertension, and polycystic kidney disease, the tumor board decided against performing renal metastasectomy because of the risk of future renal decline requiring dialysis. Metastases were treated using sorafenib, which provided stability followed by progression within a year. We switched to lenvatinib, which led to disease regression. However, the patient experienced severe adverse effects, including cardiomyopathy, bicytopenia, renal impairment, and the rarely reported nephrotic syndrome. Renal metastasis is a rare manifes-tation of Hurthle cell thyroid cancer with only two reported cases in literature. We report the experience of our first case of renal metastasis and its treatment with TKIs. This case serves as a reminder of the adverse drug reactions associated with TKI use.
CONCLUSION We advocate close monitoring of patients’ hematological and renal profiles as well as their cardiac status using an echocardiogram.
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Affiliation(s)
- Muhammad Imran Butt
- Department of Medicine, King Faisal Specialist Hospital, Research Centre, Al Faisal University, Riyadh 12713, Saudi Arabia
| | | | - Quaid Johar Nadri
- Department of Medicine, King Faisal Specialist Hospital, Research Centre, Al Faisal University, Riyadh 12713, Saudi Arabia
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13
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Li L, Li H, Zhang J, Gao X, Jin H, Liu R, Zhang Z, Zhang X, Wang X, Qu P, Zhao Y, Lu X. Bisphenol A at a human exposed level can promote epithelial-mesenchymal transition in papillary thyroid carcinoma harbouring BRAF V600E mutation. J Cell Mol Med 2021; 25:1739-1749. [PMID: 33469997 PMCID: PMC7875916 DOI: 10.1111/jcmm.16279] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Bisphenol A (BPA), a ubiquitous endocrine-disrupting chemical, alters the function of endocrine system and enhances the susceptibility to tumorigenesis in several hormone-dependent tumours as thyroid carcinoma. About 50% of papillary thyroid cancers (PTC), the most common type of thyroid malignancy, harbours the BRAFV600E mutation. This study aimed to investigate a potential combined effect of BPA exposure and BRAFV600E mutation on epithelial-mesenchymal transition (EMT) in PTC. Firstly, the level of BPA in plasma, the evaluation of BRAFV600E mutation and the level of EMT-related proteins in PTC samples were individually determined. Additionally, the migration, invasion, colony formation capacity and the expression of EMT-related proteins after exposure to BPA were precisely analysed in vitro thyroid cells genetically modified by the introduction of BRAFV600E mutation. Moreover, ERK-Cox2 signalling pathway was also introduced to explore the possible mechanism in PTC development. As expected, whether the clinical investigation or cultured thyroid cells demonstrated that BPA at a concentration compatible with human exposed levels (10-7 M) synergized with the BRAFV600E mutation promoted EMT via the activation of ERK-Cox2 signalling pathway. Our findings offer some evidence that BPA as an environmental risk factor can facilitate the progression of PTC harbouring BRAFV600E mutation.
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Affiliation(s)
- Liuli Li
- Department of Toxicology, School of Public health, China Medical University, Shenyang, China
| | - Hao Li
- Department of Toxicology, School of Public health, China Medical University, Shenyang, China
| | - Jun Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, China
| | - Xin Gao
- Department of head and Neck Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hao Jin
- Jin Zhou Center for Disease Control and Prevention, Jinzhou, China
| | - Renqi Liu
- Jin Zhou Center for Disease Control and Prevention, Jinzhou, China
| | - Zhen Zhang
- Jin Zhou Center for Disease Control and Prevention, Jinzhou, China
| | - Xuan Zhang
- Department of Toxicology, School of Public health, China Medical University, Shenyang, China
| | - Xichang Wang
- Department of Toxicology, School of Public health, China Medical University, Shenyang, China
| | - Peng Qu
- Department of Toxicology, School of Public health, China Medical University, Shenyang, China
| | - Yuejiao Zhao
- Department of head and Neck Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xiaobo Lu
- Department of Toxicology, School of Public health, China Medical University, Shenyang, China
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14
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Follicular Thyroid Neoplasms: Comparison of Clinicopathologic and Molecular Features of Atypical Adenomas and Follicular Thyroid Carcinomas. Am J Surg Pathol 2020; 44:881-892. [PMID: 32282345 DOI: 10.1097/pas.0000000000001489] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In follicular thyroid neoplasms without invasion, a diagnosis of atypical adenoma (AA) (follicular tumor of uncertain malignant potential) may be rendered if atypical features (indefinite capsular/vascular invasion, necrosis, solid growth, increased mitoses) are present. This study compares clinical, histologic, and molecular features of patients with AAs (n=31), nonmetastatic follicular thyroid carcinoma (nmFTC) (n=18), and metastatic follicular thyroid carcinoma (mFTC) (n=38). Patients with mFTC were older. Mitotic activity in areas of solid growth was greatest in mFTC (P=0.05). Oncocytic tumors tended to show solid growth (P=0.04). The presence or frequency of capsular and/or vascular invasion was not different between nmFTC and mFTC. TERT promoter mutations were higher in patients with mFTC (50%) than nmFTC (25%) and AA (10%) (P=0.02). TERT promoter mutation was associated with necrosis (P=0.01) and solid growth plus increased mitoses (P=0.03). Necrosis and TERT promoter mutations were identified in all groups, most frequently in mFTC. The combination of solid growth with increased mitoses, necrosis, and TERT promoter mutation was only seen in follicular carcinomas. Poorly differentiated features, vascular invasion, and TERT promoter mutation correlated with metastasis in FTC. Given the low frequency of necrosis and TERT promoter mutation in AAs, close clinical follow-up is recommended in patients with these findings, especially if additional atypical features (such as solid growth plus mitoses) are present.
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15
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Sánchez-Garavito JE, Sanchez-Garcia J, Olsen D, Shorti RM, Lopez-Verdugo F, Rodriguez-Davalos MI. Liver resection for metastatic thyroid carcinoma. Case report and literature review. J Surg Case Rep 2020; 2020:rjaa370. [PMID: 33005326 PMCID: PMC7517888 DOI: 10.1093/jscr/rjaa370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
Liver resection for metastatic cancer has become the standard of care for specific groups of patients, including noncolorectal non-neuroendocrine liver metastases (NCNNELM). Liver metastasis from differentiated thyroid carcinoma is considered rare, with an approximated frequency of 0.5%. We present a case of metastatic papillary thyroid carcinoma (PTC) to the liver and literature review. Herein, we report a 72-year-old male that underwent formal left hepatectomy for 4.4 cm metastatic PTC generating left bile duct obstruction. Two months after, presented with multiple small lesions within the hepatic parenchyma and diffuse ductal dilatation of the right biliary system. Therefore, treated with a percutaneous biliary drain placement without complications. In a patient diagnosed with initial Stage II PTC, undergoing total thyroidectomy 10 years before presenting to the clinic. Bearing over a decade of treatments for local and distal recurrences. We believe approaching strategies for this specific disease should be developed to establish standard management.
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Affiliation(s)
| | - Jorge Sanchez-Garcia
- Hepatobiliary and Liver Transplant Service, Intermountain Medical Center, Murray, UT, USA
| | - Daniel Olsen
- Pathology Service, Intermountain Medical Center, Murray, UT, USA
| | - Rami M Shorti
- Emerging Technologies, Intermountain Medical Center, Murray, UT, USA
| | - Fidel Lopez-Verdugo
- Hepatobiliary and Liver Transplant Service, Intermountain Medical Center, Murray, UT, USA
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16
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Yoon JH, Jeon MJ, Kim M, Hong AR, Kim HK, Shin DY, Kim BH, Kim WB, Shong YK, Kang HC. Unusual metastases from differentiated thyroid cancers: A multicenter study in Korea. PLoS One 2020; 15:e0238207. [PMID: 32841270 PMCID: PMC7447021 DOI: 10.1371/journal.pone.0238207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Although infrequent, distant metastasis from differentiated thyroid cancer is the main cause of mortality in patients and mostly involves the lung, bone, and brain. Distant metastases to other sites in differentiated thyroid cancer patients are rare, thus, the clinical course of unusual metastases has not been adequately researched. In the present study, the clinico-pathological findings and treatment outcomes of unusual metastases in differentiated thyroid cancer patients in Korea were evaluated. Patients and methods We retrospectively reviewed the medical records of differentiated thyroid cancer patients with unusual metastases in four Korean tertiary hospitals (Chonnam National University Hwasun Hospital, Asan Medical Center, Busan National University Hospital, Severance Hospital). Unusual metastases were diagnosed using (1) cytology or histology and/or (2) imaging studies including fluorodeoxyglucose F 18 positron emission tomography/computed tomography and/or iodine 131 whole body scans with simultaneously elevated serum levels of thyroglobulin. The pathological findings of primary thyroid cancer, diagnostic method for unusual metastases, and treatment responses of unusual metastases were examined. Results In all, 25 unusual metastatic foci of 19 patients were analyzed; 13 patients (68.4%) had papillary thyroid carcinoma including 4 follicular variant papillary thyroid carcinomas. The median time interval between the first diagnosis of primary thyroid cancer and unusual metastases diagnosis was 110 months (11.0–138.0 months). Only 4 patients (21.1%) had synchronous unusual metastases and 6 patients (31.6%) were symptomatic. Unusual metastases included 19 metastases to solid organs (6 to kidney, 5 to liver, 4 to pancreas, 3 to adrenal gland, and 1 to ovary) and 6 to the skin and muscles. Unusual metastases were pathologically proven in 10 patients (52.6%) and 11 of 16 patients (68.8%) who received iodine 131 whole body scans had radioiodine-refractory differentiated thyroid cancer. Among 5 patients treated with tyrosine kinase inhibitors, 4 treated with lenvatinib showed stable disease or a partial response at the first treatment response. Six patients (31.6%) died due to disease progression during the median 20.0-month follow-up period (11.0–55.0 months). Conclusion Unusual metastases from differentiated thyroid cancer are thought to be underestimated due to disease rarity and their metachronous nature with other distant metastases. The most of unusual metastases in differentiated thyroid cancer patients are existed with usual distant metastasis and clinical outcomes of those could not be significantly different from the prognosis of usual distant metastasis.
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Affiliation(s)
- Jee Hee Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - A. Ram Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho-Cheol Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
- * E-mail:
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Ostrovsky V, Bar-Zakai B, Miller R, Schiller T, Kirzhner A, Knobler H, Zornitzki T. Single liver metastasis of a follicular variant of papillary thyroid carcinoma: a rare pattern of organ spread. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200074. [PMID: 32820131 PMCID: PMC7487177 DOI: 10.1530/edm-20-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
SUMMARY Well-differentiated thyroid cancer (WDTC), including papillary, follicular, and Hurthle-cell types, is characterized by a slow course and usually remain localized to the thyroid. However, a minority of these cases develop distant metastases with the most common sites being lungs, bones, and lymph nodes. Liver metastases of WDTC are rare and are usually found along with other distant metastases sites and in a multiple or diffuse pattern of spread. The recognition of distant metastasis in WDTC has a significant impact on the treatment and prognosis. However, because of their low incidence and awareness, distant metastases are often diagnosed late. Herein, we describe a case of a 71 years old woman who during routine surveillance of a follicular variant of papillary thyroid cancer (FV-PTC), 5 years after being treated for her primary thyroid tumor, was found to have a single liver metastasis and underwent liver segmental resection. This case highlights the importance of maintaining vigilant surveillance of patients with WDTC, and illustrates the possibility of unique metastasis at unexpected sites. Further studies are needed to understand the organ tropism of some WDTC leading to distant metastases development and to better prediction of an aggressive course. LEARNING POINTS WDTC patients with distant metastases have a poor prognosis with a 10-year survival of about 50%. The most common sites of distant metastases are lung, bone and lymph nodes. Liver metastases are rare in WDTC, are usually multiple or diffuse and are found along with other distant metastases sites. Single liver metastasis of WDTC is an unexpected pattern of spread, and very few cases are reported in the literature. Rare sites of distant metastases in WDTC can manifest many years after the primary tumor, stressing the importance of maintaining vigilant surveillance. More studies are needed to predict which WDTC tumors may develop a more aggressive course, allowing clinicians to individualize patient management.
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Affiliation(s)
- Viviana Ostrovsky
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
| | - Barak Bar-Zakai
- Surgery A Department, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
| | - Rafael Miller
- Surgery A Department, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
| | - Tal Schiller
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
| | - Alena Kirzhner
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
| | - Hilla Knobler
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Rehovot, Israel
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18
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Iñiguez-Ariza NM, Lee RA, Brewer JD, Hay ID. Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery. J Endocr Soc 2020; 4:bvaa095. [PMID: 32803095 PMCID: PMC7417876 DOI: 10.1210/jendso/bvaa095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/04/2020] [Indexed: 12/19/2022] Open
Abstract
Ultrasound-guided percutaneous ethanol ablation procedures for locoregional recurrences in papillary thyroid carcinoma (PTC) can be repeatedly performed over years. Skin metastases (SM) from PTC generally portend a lethal prognosis. Our patient case report demonstrates the innovative use in low-risk PTC (LRPTC) of treatment modalities designed to prevent neck re-explorations and capable of eliminating both locoregional recurrences and SM. In 2004, a 48-year-old man presented with neck nodal metastases due to PTC. He underwent a near-total thyroidectomy and nodal dissection, confirming an 8-mm PTC involving 2 ipsilateral node metastases. Postoperatively, he received 2 doses of radioactive iodine (RAI) for remnant uptake (cumulative dose 338 mCi); posttherapy scanning was unrevealing. In 2007, he underwent right neck dissection for further node metastases. In 2008, a guided biopsy confirmed a level IV node metastasis. He was referred to our institution for ethanol ablation. Two node metastases were ablated and subsequently disappeared. During 2010-2016, he developed an additional 6 node metastases, which were treated with ethanol ablation; all disappeared on high-resolution sonography. FDG-PET-CT scans in 2009 and 2016 were negative for distant spread. In 2016, a SM in his right neck was removed by dermatologic surgery. In 2017-2018, 2 further SM were excised with negative margins, one after Mohs surgery. He has now been disease-free for 20 months. In conclusion, despite 3 neck surgeries and 2 RAI therapies, our patient repeatedly developed both locoregional recurrences and SM. All 11 disease foci were eliminated with minimally invasive procedures which should more often be considered as effective treatment options in LRPTC.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Robert A Lee
- Department of Radiology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Ian D Hay
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
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19
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Tsukagoshi M, Harimoto N, Araki K, Kubo N, Watanabe A, Igarashi T, Ishii N, Yajima T, Sano T, Shirabe K. Liver metastasis from papillary thyroid carcinoma treated by laparoscopic hepatectomy 43 years after resection of the primary tumor: a case report. Surg Case Rep 2020; 6:142. [PMID: 32556940 PMCID: PMC7303250 DOI: 10.1186/s40792-020-00906-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) generally has a good prognosis, while liver metastasis from PTC is rare and difficult to diagnose. Case presentation A 67-year-old woman was diagnosed with PTC and underwent a left hemithyroidectomy 43 years ago. Two years ago, thoracoscopic right middle lobectomy was performed for a lung tumor, and pathology reports confirmed a metastatic lung tumor of PTC. The patient was followed up regularly with computed tomography, and a liver tumor measuring 16 mm was found in the lateral segment of the liver. Fluorodeoxyglucose positron emission tomography (FDG-PET) was negative for liver tumor. However, FDG uptake was observed at the nodule outside the right lobe of the thyroid gland, suggesting metastasis to the right supraclavicular lymph node. Laparoscopic partial S2 hepatectomy was performed without complications. The final diagnosis was metastatic liver tumor from PTC, and the surgical margins were free of tumor. Postoperatively, the patient underwent complementary thyroidectomy and right supraclavicular lymph node dissection, followed by I-131 ablation. The final diagnosis was PTC of 7 mm and 4 mm and lymph node metastasis of 9 mm. The patient is currently doing well and has had no recurrence 1 year after surgery. Conclusions This case demonstrates that liver metastases from PTC may be found after long-term follow-up, and liver resection might be the most appropriate treatment.
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Affiliation(s)
- Mariko Tsukagoshi
- Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takamichi Igarashi
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Toshiki Yajima
- Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takaaki Sano
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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20
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Splenectomy for Solitary Splenic Metastasis in Recurrent Papillary Thyroid Cancer. A Case Report and Literature Review. Case Rep Oncol Med 2020; 2020:2084847. [PMID: 32455035 PMCID: PMC7232720 DOI: 10.1155/2020/2084847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/17/2022] Open
Abstract
Thyroid cancer is the most common endocrine malignancy, presenting with 23 500 new cases per year in the United States. About 7-23% of the patients will present recurrent metastases disease during follow-up. The classic variant of papillary carcinoma is less aggressive compared to its other variants like diffuse sclerosing, tall cell or columnar cell, and insular variants, and the sites to which this metastasizes is already well identified. Metastasis to the spleen is an extremely rare manifestation of papillary thyroid cancer. To date, only 3 cases have been reported in the literature. Herein, we present a 52-year-old male, who developed spleen metastases, 2.4 years after total thyroidectomy and central neck dissection followed by radioactive iodine ablation and seven months after treatment with sorafenib for lung metastases. The splenic lesion was detected in surveillance studies. This case highlights that splenic metastasis, although rare, may occur even in a patient with a locoregional and systemic controlled thyroid cancer and that it can be treated safely with surgical resection.
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21
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Wang Y, Nie F, Fang Q. Multidisciplinary Diagnosis of Subcutaneous Soft Tissue Metastasis of Follicular Thyroid Carcinoma: A Case Report. Front Endocrinol (Lausanne) 2020; 11:235. [PMID: 32390944 PMCID: PMC7188785 DOI: 10.3389/fendo.2020.00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Subcutaneous soft tissue metastasis of follicular thyroid carcinoma (FTC) is rarely diagnosed before surgery for clinicians. Case Report: We present a case of a 67-year-old man with a history of FTC and papillary thyroid microcarcinoma for 5 years. Multiple protruding subcutaneous nodules of the neck were found and removed from the surface of the sternocleidomastoid muscle. Ultrasound, computed tomography and technetium-99 m pertechnetate single-photon emission computed tomography of the neck were performed before the operation, which unfortunately indicated suspicious malignant lesions. Serum Tg was > 300 ng/ml (0.83-68.0 ng/ml), TSH was 36.580 uIU/ml (0.380-4.340 uIU/ml) and AbTg was negative. The pathologic diagnosis was metastatic FTC, invading the surrounding striated muscle, adipose tissue and vessels. Immunohistochemical staining revealed the tumor cells to be positive for thyroglobulin and TTF-1. The specimens of these nodules were further investigated for TERT promoter mutation and the result revealed mutated type (position g 1,295, 228 C>T). Conclusion: Preoperative diagnosis and prognostic prediction of metastatic FTC may be available through a combination of clinical, multimodal imaging and molecular genetic test (viz. multidisciplinary diagnosis). A long-term standardized follow-up is required for patients with a previous diagnosis of FTC.
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Affiliation(s)
- Yanfang Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- *Correspondence: Fang Nie
| | - Qingqing Fang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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22
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Li T, Ma Z, Lu C, Zhou Q, Feng Z, Wu X, Luo Y, Li D, Cheng X, Liu X. Chest wall lymph node metastasis from follicular thyroid carcinoma: a rare case report. Diagn Pathol 2019; 14:130. [PMID: 31747942 PMCID: PMC6864998 DOI: 10.1186/s13000-019-0907-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Distant metastases from follicular thyroid carcinoma are mainly hematogenous and are commonly observed in the lungs and bones. Other rare sites are the parotid gland, skin, brain, ovary, adrenal gland, kidney, pancreas and breast, with chest wall lymph node metastasis being even more rare. Case presentation Over the past 10 years, three surgeries were performed on a 69-year-old women with a history of follicular thyroid cancer and its metastatic lesions. The patient presented with a 3-month history of masses in the left chest. She underwent detailed examination of the chest wall tumors, and surgery was then performed to resect all of the tumors. Based on the histopathology, these lymph nodes were confirmed to harbor metastatic follicular thyroid carcinoma. Conclusion This study reports the first case of follicular thyroid carcinoma metastasis to the chest wall lymph node.
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Affiliation(s)
- Taolang Li
- Thyroid and Breast Surgery Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhiyuan Ma
- Thyroid and Breast Surgery Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chengli Lu
- Thyroid and Breast Surgery Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Quanzhong Zhou
- Imaging Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zelong Feng
- Nuclear Medicine Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xinglong Wu
- Pathology Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Luo
- Thyroid and Breast Surgery Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dan Li
- Thyroid and Breast Surgery Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaoming Cheng
- Thyroid and Breast Surgery Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China.
| | - Xuemei Liu
- Gastroenterology Department, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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23
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Jain PV, Sharan R, Manikantan K, Biswas G, Ray S, Arun P. Unusual loco-regional presentation in papillary carcinoma of thyroid: A case series. Indian J Cancer 2019; 56:325-329. [PMID: 31607701 DOI: 10.4103/ijc.ijc_368_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites. MATERIALS AND METHODS Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series. RESULTS AND CONCLUSION Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases.
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Affiliation(s)
- Prateek V Jain
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Rajeev Sharan
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Kapila Manikantan
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Gautam Biswas
- Department of Plastic and Reconstructive Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Soumendranath Ray
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Pattatheyil Arun
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
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24
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Zunino A, Pitoia F, Faure E, Reyes A, Sala M, Sklate R, Ilera V, Califano I. Unusual metastases from differentiated thyroid carcinoma: analysis of 36 cases. Endocrine 2019; 65:630-636. [PMID: 31327159 DOI: 10.1007/s12020-019-01991-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/22/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Metastases of differentiated thyroid cancer (DTC) in sites different from lungs and bone are unusual (UM); their impact in management and prognosis remains unknown. Our aim was to evaluate the prevalence of UM, to describe their characteristics and to analyze their impact in disease outcome and mortality. METHODS We retrospectively reviewed the file records from 8 different centers. Those patients with DTC and UM were included. UM were diagnosed by: (i) biopsy/cytology and/or (ii) radioiodine (RAI) uptake associated to elevated thyroglobulin (Tg) levels and/or c) presence of one or more structural lesion/s with 18-FDG uptake in the PET/CT scan and elevated Tg levels. RESULTS Thirty-six (0.9%) out of a total of 3982 DTC patients were diagnosed with UM; 75% had papillary histology. The most frequent localization was central nervous system (CNS, 31%). UM were metachronous in 75%, symptomatic in 55.6% and fulfilled RAI-refractoriness criteria in 77.8% of cases. Metastatic lesions in lung/bone and/or locoregional disease were present in 34 cases (94.4%). Diagnosis of UM changed the therapeutic approach in 72.2% of patients. After a median follow up of 13 months, 21 (58.3%) patients died from DTC related causes. In 8 of them CNS progression was the immediate cause of death. CONCLUSIONS Prevalence of UM was low; they were frequently metachronic and RAI-refractory. Although UM were found in patients with widespread disease, their diagnosis usually led to changes in therapy. UM were associated with poor prognosis and high frequency of disease-specific mortality.
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Affiliation(s)
- Anabela Zunino
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Fabián Pitoia
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Faure
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Adriana Reyes
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Sala
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Rosana Sklate
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Verónica Ilera
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Inés Califano
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
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25
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Clinicopathologic and Molecular Features of Metastatic Follicular Thyroid Carcinoma in Patients Presenting With a Thyroid Nodule Versus a Distant Metastasis. Am J Surg Pathol 2019; 43:514-522. [DOI: 10.1097/pas.0000000000001208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Saito Y, Sugino K, Takami H, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Kawakubo H, Ito K, Kitagawa Y. Clinical Status and Treatment of Liver Metastasis of Differentiated Thyroid Cancer Using Tyrosine Kinase Inhibitors. World J Surg 2018; 42:3632-3637. [PMID: 29766229 DOI: 10.1007/s00268-018-4676-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of patients with liver metastasis of differentiated thyroid carcinoma (DTC) has not been sufficiently defined, because liver metastasis of DTC has been described mostly as case reports. Additionally, such patients are considered end-of-treatment responders. A relatively new approach using tyrosine kinase inhibitors (TKIs) may provide opportunities to manage systemic metastasis. This study aims to define the clinical features of DTC patients with liver metastasis and evaluate the benefits of TKIs. METHODS We retrospectively analyzed clinical features of 29 patients (mean age 67.8 years) diagnosed with liver metastasis of DTC at our institution between January 1981 and May 2017. RESULTS All patients had distant metastasis at other organ sites upon diagnosis of liver metastasis; 41% of them developed new metastasis afterward. Management after diagnosis of liver metastasis comprised palliative care (48%), radioactive iodine therapy (28%), and TKI therapy (24%). The median survival after diagnosis of liver metastasis was only 4.8 months. Survival rates were significantly better in patients with performance statuses between 0 and 2 on the Eastern Cooperative Oncology Group scale at diagnosis of liver metastasis (n = 22, 76%) treated with TKI compared to those who were not (P = 0.017; log-rank test; hazard ratio 0.19). One-year survival rates were 71.4 and 26.7% for patients treated with or without TKI, respectively. CONCLUSIONS Patients with liver metastasis had poor clinical prognosis. When other distant metastases existed at diagnosis of liver metastasis, TKI therapy was considered an effective therapeutic option for patients with liver metastasis of DTC.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Papillary, Follicular/drug therapy
- Carcinoma, Papillary, Follicular/mortality
- Carcinoma, Papillary, Follicular/pathology
- Female
- Humans
- Liver Neoplasms/drug therapy
- Liver Neoplasms/mortality
- Liver Neoplasms/secondary
- Male
- Middle Aged
- Phenylurea Compounds/therapeutic use
- Protein-Tyrosine Kinases/therapeutic use
- Quinolines/therapeutic use
- Retrospective Studies
- Thyroid Cancer, Papillary/drug therapy
- Thyroid Cancer, Papillary/mortality
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Yoshiyuki Saito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Hiroshi Takami
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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27
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Abstract
Introduction Hypoxic stress is a feature of rapidly growing thyroid tumours. Cancer progression is thought to be driven by a small population of tumour cells possessing stem cell properties. Hypoxia-inducible factors (HIFs) are important mediators of hypoxia. Both HIF-1alpha and HIF-2alpha have been reported to be expressed in thyroid cancers. There is growing evidence that the HIF pathway plays a significant role in the maintenance of thyroid cancer stem cells (CSC). Methodology We have isolated thyroid CSC from a papillary thyroid cancer-derived cell line (BCPAP) and an anaplastic thyroid cancer-derived cell line (SW1736) as side population (SP) cells (a putative stem cell population) and treated them with cobalt chloride (II) to induce hypoxia. Results and discussion We observed an increase in the SP of cells within the thyroid cancer cell lines following induction of hypoxia.
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Affiliation(s)
- K Mahkamova
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE1 3BZ, UK
| | - N Latar
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE1 3BZ, UK
| | - S Aspinall
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - A Meeson
- Institute of Genetic Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE1 3BZ, UK.
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28
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Blažeković I, Jukić T, Granić R, Punda M, Franceschi M. An Unusual Case of Papillary Thyroid Carcinoma Iodine-131 Avid Metastasis to the Adrenal Gland. Acta Clin Croat 2018; 57:372-376. [PMID: 30431733 PMCID: PMC6532007 DOI: 10.20471/acc.2018.57.02.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SUMMARY – Papillary thyroid carcinoma (PTC) is considered one of the most favorable tumors, indolent, with rare distant dissemination. Lungs and bones are the most common metastatic sites. Unusual sites of PTC distant metastases are extremely rare. Brain, liver, skin, kidney, pancreas, and adrenal gland PTC metastases have been sporadically reported in the literature. An 86-year-old female patient underwent total thyroidectomy and neck dissection due to PTC. Postoperative whole body iodine-131 scintigraphy with I-131 SPECT/CT of the abdomen revealed radioiodne avid left adrenal gland metastasis together with high postoperative serum thyroglobulin (Tg) value of more than 5000 µg/L and high serum Tg antibodies. Considering the above-mentioned findings, patient‘s age and multiple comorbidities, radioiodine therapy was applied. PTC metastases to the adrenal gland are extremely rare, and to our knowledge, only nine cases have been reported in the literature. This case report complements rare examples of unusual PTC metastases.
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Affiliation(s)
| | - Tomislav Jukić
- Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Roko Granić
- Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marija Punda
- Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Maja Franceschi
- Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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29
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Cracolici V, Mujacic I, Kadri S, Alikhan M, Niu N, Segal JP, Rosen LE, Sarne DH, Morgan A, Desouky S, Cipriani NA. Synchronous and Metastatic Papillary and Follicular Thyroid Carcinomas with Unique Molecular Signatures. Endocr Pathol 2018; 29:9-14. [PMID: 28710706 DOI: 10.1007/s12022-017-9491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Despite the relatively high prevalence of thyroid cancer, the occurrence of multiple synchronous, distinct subtypes of primary thyroid carcinoma is uncommon. The incidental finding of papillary thyroid microcarcinoma in a gland with a biologically relevant follicular or medullary carcinoma is more frequent than the synchronous occurrence of multiple clinically significant carcinomas. We report a case of synchronous papillary and follicular thyroid carcinomas metastatic to lymph node and bone, respectively. Next generation sequencing showed BRAF V600E mutation in the primary papillary carcinoma and NRAS Q61R mutation in the primary follicular carcinoma and bony metastasis. To our knowledge, this is the first reported case of synchronous and metastatic primary papillary and follicular carcinomas, and the first report of synchronous BRAF V600E mutated papillary and NRAS mutated follicular carcinoma.
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Affiliation(s)
- Vincent Cracolici
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA.
| | - Ibro Mujacic
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Sabah Kadri
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Mir Alikhan
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Nifang Niu
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Jeremy P Segal
- Division of Molecular Pathology, Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Lauren E Rosen
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - David H Sarne
- Section of Endocrinology, Department of Medicine, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
| | - Adam Morgan
- Department of Pathology, St. Mary's Hospital, 700 South Park St, Madison, WI, 53715, USA
| | - Samy Desouky
- Department of Pathology, St. Mary's Hospital, 700 South Park St, Madison, WI, 53715, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL, 60637, USA
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30
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Iftikhar H, Ikram M, Muhammad AY, Nathani KR. Unusual Presentation of Differentiated Thyroid Cancer Metastasis. Int Arch Otorhinolaryngol 2017; 22:167-170. [PMID: 29619107 PMCID: PMC5882378 DOI: 10.1055/s-0037-1604038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction
The rates of thyroid cancers are on a rise, especially well-differentiated thyroid cancers. This could be partly due to newer diagnostic modalities, like high-resolution ultrasound, that can pick up smaller lesions. Differentiated thyroid cancers with distant metastases are not common, and even rarer is the initial presentation with complaints not related to the neck.
Objectives
The objective of this series was to study and report the unusual cases of patients with differentiated thyroid cancer with distant metastasis. There is a lack of data in the literature on these cases, and due to the rarity of such metastases, no definite treatment protocol has been defined.
Methods
A retrospective chart review of 1,200 cases of thyroid surgeries was performed. A total of 10 cases of well-differentiated thyroid cancer on the final histopathology exam that had initially presented with usual complaints to departments other than the Otolaryngology Department were identified.
Results
A total of 6 patients had papillary carcinoma, whereas 4 patients had follicular carcinoma on final the histopathology exam. Two patients presented with iliac crest lesions, 2 with vertebral lesions one each with parapharyngeal mass, supraclavicular mass, labia majora swelling and bleeding, lung, rib and neck of femur lesion.
Conclusion
There are still no specific guidelines on how to address these patients with differentiated thyroid cancer with distant metastasis (except for the cases of bone and lung lesions) and on which treatment should be offered in case of recurrence. More studies on the subject are required.
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Affiliation(s)
- Haissan Iftikhar
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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31
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Metástasis a distancia en cáncer diferenciado de tiroides: diagnóstico y tratamiento. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.raem.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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32
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Yoshihiro T, Tsuchihashi K, Kusaba H, Nakashima T, Obara T, Nio K, Takayoshi K, Kodama H, Tsuruta N, Kiyohara H, Asai K, Harada E, Kamezaki K, Arita T, Sato M, Yamamoto H, Arita S, Ariyama H, Odashiro K, Oda Y, Akashi K, Baba E. Cardiac metastasis of squamous cell carcinoma of the thyroid gland with severe disseminated intravascular coagulation: A case report. Mol Clin Oncol 2017; 6:91-95. [PMID: 28123737 DOI: 10.3892/mco.2016.1091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/21/2016] [Indexed: 01/11/2023] Open
Abstract
Distant metastasis of primary squamous cell carcinoma (SCC) of the thyroid gland is rare and, to the best of our knowledge, cardiac metastasis has not been reported to date. A 57-year-old man underwent surgery and adjuvant chemoradiotherapy for stage IVA SCC of the thyroid gland. After 3 months, the patient was admitted to the Kyushu University Hospital (Fukuoka, Japan) with subcutaneous hematomas of the left thigh and lower leg, and he was diagnosed with cardiac and mediastinal lymph node metastases of SCC of the thyroid gland with severe disseminated intravascular coagulation (DIC). Echocardiography revealed a mass, 52 mm in greatest diameter, protruding from the interventricular septum towards the right ventricle. Weekly administration of paclitaxel and concurrent irradiation of the cardiac and lymph node metastases were performed. Eighteen days after the initiation of chemoradiotherapy, the DIC and hematomas had significantly improved, and the cardiac metastasis was stable. However, 2 months after admission, the patient developed dyspnea and multiple nodular shadows appeared to be spreading in the subpleura of the lungs bilaterally, which were initially suspected to be pulmonary tumor embolisms. Prednisolone and subsequent administration of lenvatinib were not effective and the patient succumbed to respiratory failure. Severe DIC caused by extremely rare cardiac metastasis of SCC of the thyroid gland was effectively controlled by chemoradiotherapy. However, intensive local control appears to be required for this condition.
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Affiliation(s)
- Tomoyasu Yoshihiro
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kenji Tsuchihashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hitoshi Kusaba
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Torahiko Nakashima
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Teppei Obara
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kenta Nio
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kotoe Takayoshi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroyuki Kodama
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Nobuhiro Tsuruta
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hideyuki Kiyohara
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kaori Asai
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Eiji Harada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Kenjiro Kamezaki
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takeshi Arita
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masanobu Sato
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shuji Arita
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hiroshi Ariyama
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Keita Odashiro
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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33
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Claimon A, Suh M, Cheon GJ, Lee DS, Kim EE, Chung JK. Bilateral Renal Metastasis of Hürthle Cell Thyroid Cancer with Discordant Uptake Between I-131 Sodium Iodide and F-18 FDG. Nucl Med Mol Imaging 2016; 51:256-260. [PMID: 28878853 DOI: 10.1007/s13139-016-0462-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/06/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Renal metastasis of thyroid cancer is extremely rare. We report the case of a 62-year-old woman with Hürthle cell thyroid cancer (HCTC) with lungs, bones, and bilateral kidneys metastases. The renal metastatic lesions were clearly demonstrated by 131I whole body scan (WBS) with SPECT/CT. However, they exhibited false-negative results in 18F-FDG PET/CT, kidney ultrasonography, and contrast-enhanced CT scan. The findings imply that tumors have low glucose metabolism and are able to accumulate radioiodine, which is not commonly found in the relatively aggressive nature of HCTC. The patient received two sessions of 200 mCi 131I therapy within 6 months duration. There was complete treatment response as evaluated by the second post-therapeutic 131I SPECT/CT and serum thyroglobulin. To our knowledge, renal metastasis from HCTC with positive 131I but negative 18F-FDG uptake has not been reported in the literature. This case suggests that 131I SPECT/CT is useful for lesion localization and prediction of 131I therapy response.
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Affiliation(s)
- Apichaya Claimon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 Korea.,Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Minseok Suh
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 Korea
| | - E Edmund Kim
- Department of Radiological Sciences, University of California, Irvine, CA USA.,Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744 Korea
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34
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Simões-Pereira J, Macedo D, Bugalho MJ. Clinical outcomes of a cohort of patients with central nervous system metastases from thyroid cancer. Endocr Connect 2016; 5:82-88. [PMID: 27856495 PMCID: PMC5148797 DOI: 10.1530/ec-16-0049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Metastases to central nervous system (M1-CNS) are rarely reported in thyroid cancer (TC) patients. We aimed to characterize patients with M1-CNS from TC followed in our department. METHODS Review of the medical records of 27 patients with TC-related M1-CNS. RESULTS Mean age at TC diagnosis was 56.9 ± 19.1 years. Papillary TC (55.6%) was the commonest histological type, followed by poorly differentiated (18.5%), medullary (11.1%), follicular (7.4%) and Hürthle cell (7.4%) carcinomas. Angioinvasion and extrathyroidal extension were observed in a high number of patients. At M1-CNS diagnosis, other distant metastases were already present in 77.8% of the patients. Treatment directed to M1-CNS was offered to 20 (74%) patients: 1 was submitted to surgery, 18 to radiotherapy (either whole-brain radiotherapy or stereotaxic radiosurgery or both) and 4 to surgery and radiotherapy. Four patients received cytotoxic chemotherapy and one was submitted to 131I. Median survival since M1-CNS detection was 5.0 months. The only factor associated with better survival was surgery to brain metastases (P = 0.012). CONCLUSIONS The management of these patients is very challenging given the inexistence of effective treatments, except for brain surgery in selected cases.
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Affiliation(s)
- Joana Simões-Pereira
- Endocrinology DepartmentInstituto Português de Oncologia de Lisboa, Francisco Gentil, Lisboa, Portugal
| | - Daniel Macedo
- Endocrinology DepartmentInstituto Português de Oncologia de Lisboa, Francisco Gentil, Lisboa, Portugal
| | - Maria João Bugalho
- Endocrinology DepartmentInstituto Português de Oncologia de Lisboa, Francisco Gentil, Lisboa, Portugal
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Abstract
OBJECTIVES To study the various local treatments available for thyroid cancer metastases, investigate techniques and assess their advantages and limitations and roles in the overall treatment strategy for metastatic disease. RESULTS We investigated metastases surgery, external radiation therapy, embolization, chemoembolization, cementoplasty, radiofrequency ablation and cryotherapy, describing techniques, advantages and drawbacks and possible complications. Indications were reviewed according to metastases location, and the roles of the various techniques are discussed in the overall treatment strategy for thyroid cancer metastases. Despite the advent of new targeted therapies, local treatment still has an important role to play: either palliative or, in oligometastatic involvement, curative. Even in extensive disease, it may allow postponement of tyrosine kinase inhibitor therapy, which, once initiated, has to be continued life-long, is expensive and is not free of side-effects.
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Vyas M, Harigopal M. Metastatic thyroid carcinoma presenting as malignant pleural effusion: A cytologic review of 5 cases. Diagn Cytopathol 2016; 44:1085-1089. [PMID: 27456348 DOI: 10.1002/dc.23547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 01/18/2023]
Abstract
Malignant pleural effusion can be a manifestation of many malignancies. Involvement of pleural fluid by metatstatic thyroid carcinoma, though reported, is relatively rare. We present 5 cases of metastatic thyroid carcinoma involving the pleural fluid. The diagnosis of thyroid carcinoma in pleural fluid can be particularly challenging as thyroid transcription factor -1 (TTF-1) which is a marker for carcinoma of thyroid origin is also positive in lung adenocarcinomas (which are more frequently associated with pleural effusions) and thyroglobulin (TG) can often be negative in poorly differentiated/analplastic thyroid carcinomas. In our experience, PAX8 is a particularly useful marker in making the distinction. The diagnosis of metastatic thyroid carcinoma in pleural fluid can be challenging and knowledge of the clinical context and supporting immunohistochemical stains is essential for making the right diagnosis. Diagn. Cytopathol. 2016;44:1085-1089. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Monika Vyas
- Department of Pathology, Yale New Haven Hospital, New Haven, Connecticut
| | - Malini Harigopal
- Department of Pathology, Yale New Haven Hospital, New Haven, Connecticut
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Katsenos S, Archondakis S. The value of radial probe endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymph node metastasis from primary papillary thyroid cancer. Diagn Cytopathol 2016; 44:748-52. [PMID: 27393724 DOI: 10.1002/dc.23534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 06/20/2016] [Accepted: 06/24/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Stamatis Katsenos
- Department of Pneumonology, Army General Hospital of Athens, Athens, Greece
| | - Stavros Archondakis
- Department of Cytopathology, Army General Hospital of Athens, Athens, Greece
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Farina E, Monari F, Tallini G, Repaci A, Mazzarotto R, Giunchi F, Panzacchi R, Cammelli S, Padula GDA, Deodato F, Pasquali R, Fanti S, Fiorentino M, Morganti AG. Unusual Thyroid Carcinoma Metastases: a Case Series and Literature Review. Endocr Pathol 2016; 27:55-64. [PMID: 26662609 DOI: 10.1007/s12022-015-9410-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission.
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Affiliation(s)
- Eleonora Farina
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Fabio Monari
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy.
| | - Giovanni Tallini
- Anatomic Pathology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Bellaria Hospital, University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Renzo Mazzarotto
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Integrata, Ospedale Civile Maggiore, Piazzale Aristide Stefani 1, Verona, Italy
| | - Francesca Giunchi
- Pathology Unit of the "F. Addarii" Institute of Oncology, Department of Oncology and Hematology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Riccardo Panzacchi
- Department of Pathology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Gilbert D A Padula
- Radiation Oncology Department, The Lacks Cancer Center, Saint Mary's Health Care, 250 Cherry St SE, Grand Rapids, MI, 49503, USA
| | - Francesco Deodato
- Radiation Oncology Unit, Fondazione "Giovanni Paolo II", Catholic University of Sacred Heart, Largo Agostino Gemelli, 1, 86100, Campobasso, Italy
| | - Renato Pasquali
- Division of Endocrinology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Michelangelo Fiorentino
- Pathology Unit of the "F. Addarii" Institute of Oncology, Department of Oncology and Hematology, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40135, Bologna, Italy
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Chen-Ku CH, Roldán B. Unusual Papillary Thyroid Cancer Metastases to Kidney and Pharynx: A Case Report. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15683.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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A Clear Cell Variant of Papillary Thyroid Microcarcinoma With Lung, Bone, and Soft Tissue Metastases. Clin Nucl Med 2015; 40:885-7. [PMID: 26018685 DOI: 10.1097/rlu.0000000000000832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 56-year-old woman presented with a mass lesion on the right occipital bone underwent total resection of the tumor. An adenocarcinoma with immunostaining positive for thyroid transcription factor-1 and thyroglobulin was found. An ultrasound/thyroid scan detected a hot nodule of 9 mm in the right lobe. Fine needle biopsy revealed the similar histological findings with the previous bone resection material. Then, a total thyroidectomy was performed. Histopathologic examination revealed clear cell variant of papillary thyroid microcarcinoma. She received 7.4 GBq of I. On posttherapy scan, metastatic focuses were seen in the left lung and soft tissue between the left paravertebral muscles.
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Han B, Cui H, Kang L, Zhang X, Jin Z, Lu L, Fan Z. Metformin inhibits thyroid cancer cell growth, migration, and EMT through the mTOR pathway. Tumour Biol 2015; 36:6295-304. [PMID: 25854169 DOI: 10.1007/s13277-015-3315-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/05/2015] [Indexed: 12/17/2022] Open
Abstract
Mammalian target of rapamycin (mTOR) signaling pathways have been shown to be activated in thyroid cancer. Recent evidences have demonstrated that the antidiabetic agent metformin, an activator of 5'-AMP-activated protein kinase, can impair the proliferation and migration of cancer cells via inhibition of mTOR. However, the underlying mechanisms remain unclear. In this study, we show that metformin can inhibit mTOR pathway to impair growth and migration of the thyroid cancer cell lines. Cyclin D1 and c-Myc are important regulators of cancer cell growth, and we observed that treatment of thyroid cancer cells with metformin reduced c-Myc and cyclin D1 expression through suppression of mTOR and subsequent inhibition of P70S6K1 and 4E-BP1 phosphorylation. Metformin reduced epithelial to mesenchymal transition (EMT) in thyroid carcinoma cells. Moreover, metformin regulated expression of the EMT-related markers E-cadherin, N-cadherin, and Snail. Additionally, knockdown of TSC2, the upstream regulatory molecule of mTOR pathway, or treatment of rapamycin, the mTOR inhibitor, could abolish the effects of metformin to regulate thyroid cancer cell proliferation, migration, EMT, and mTOR pathway molecules. These results indicate that metformin can suppress the proliferation, migration, and EMT of thyroid cancer cell lines by inhibiting mTOR signaling. These findings suggest that metformin and its molecular targets may be useful in thyroid carcinoma therapy.
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Affiliation(s)
- Baiyu Han
- Department of Endocrinology and Metabolism, The 264 Hospital of PLA, 30 Qiao-Dong Street, Taiyuan, 030000, Shanxi, China
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