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Castroneves LA, Mangone FRR, Lerario AM, da Cunha Mercante AM, Batista RL, Barros LRC, Ferreira CV, Farias EC, Vanderlei FAB, Maia AL, Nagai MA, Jorge AAL, Hoff AO. Not Only RET but NF1 and Chromosomal Instability Are Seen in Young Patients with Sporadic Medullary Thyroid Carcinoma. J Endocr Soc 2024; 8:bvae059. [PMID: 38655100 PMCID: PMC11036102 DOI: 10.1210/jendso/bvae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 04/26/2024] Open
Abstract
Context Genetic analysis of sporadic medullary thyroid carcinoma (MTC) has revealed somatic variants in RET, RAS, and occasionally other genes. However, around 20% of patients with sporadic MTC lack a known genetic driver. Objective To uncover potential new somatic or germline drivers, we analyze a distinct cohort of patients with sporadic, very early-onset, and aggressive MTC. Methods Germline and somatic DNA exome sequencing was performed in 19 patients, previously tested negative for germline RET variants. Results Exome sequencing of 19 germline samples confirmed the absence of RET and identified an NF1 pathogenic variant in 1 patient. Somatic sequencing was successful in 15 tumors revealing RET variants in 80%, predominantly p.Met918Thr, which was associated with disease aggressiveness. In RET-negative tumors, pathogenic variants were found in HRAS and NF1. The NF1 germline and somatic variants were observed in a patient without a prior clinical diagnosis of neurofibromatosis type 1, demonstrating that the loss of heterozygosity of NF1 functions as a potential MTC driver. Somatic copy number alterations analysis revealed chromosomal alterations in 53.3% of tumors, predominantly in RET-positive cases, with losses in chromosomes 9 and 22 being the most prevalent. Conclusion This study reveals that within a cohort of early-onset nonhereditary MTC, RET remains the major driver gene. In RET-negative tumors, NF1 and RAS are drivers of sporadic MTC. In addition, in young patients without a RET germline mutation, a careful clinical evaluation with a consideration of germline NF1 gene analysis is ideal to exclude Neurofibromatosis type 1 (NF1).
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Affiliation(s)
| | - Flavia Regina Rotea Mangone
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology (LIM-24), Instituto do Câncer do Estado de São Paulo, São Paulo 01252-000, Brazil
| | | | | | - Rafael Loch Batista
- Endocrinology, Instituto do Câncer do Estado de São Paulo, São Paulo 01252-000, Brazil
| | - Luciana Rodrigues Carvalho Barros
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology (LIM-24), Instituto do Câncer do Estado de São Paulo, São Paulo 01252-000, Brazil
| | - Carla Vaz Ferreira
- Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
| | | | | | - Ana Luiza Maia
- Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
| | - Maria Aparecida Nagai
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology (LIM-24), Instituto do Câncer do Estado de São Paulo, São Paulo 01252-000, Brazil
| | - Alexander Augusto Lima Jorge
- Genetic Endocrinology Unit, Cellular and Molecular Endocrinology Laboratory (LIM-25) Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Ana Oliveira Hoff
- Endocrinology, Instituto do Câncer do Estado de São Paulo, São Paulo 01252-000, Brazil
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Cabral Miranda LJ, Danilovic DLS, Vanderlei FAB, Tavares MR, Neto NL, Asato de Camargo RY, Marui S. Prevalence of DICER1 variants in large multinodular goiter: thyroid function, clinical and imaging characteristics. Arch Endocrinol Metab 2024; 68:e230030. [PMID: 38330293 PMCID: PMC10948041 DOI: 10.20945/2359-4292-2023-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/14/2023] [Indexed: 02/10/2024]
Abstract
Objective Mutations in DICER1 are found in differentiated thyroid carcinoma (DTC) and in multinodular goiter (MNG) at a younger age with other tumors, which characterizes DICER1 syndrome. DICER1 is one driver to DTC; however, it is also found in benign nodules. We speculated that patients with mutations in DICER1 may present long-lasting MNG. Our aim was to investigate the frequency of DICER1 variants in patients with MNG. Subjects and methods Patients who submitted to total thyroidectomy due to large MNG with symptoms were evaluated. DICER1 hotspots were sequenced from thyroid nodule samples. To confirm somatic mutation, DNA from peripheral blood was also analyzed. Results Among 715 patients, 154 were evaluated with 56.2 ± 12.3 years old (28-79) and the thyroid volume was 115.7 ± 108 mL (16.2-730). We found 11% with six DICER1 variations in a homo or heterozygous state. Only rs12018992 was a somatic DICER1 variant. All remaining variants were synonymous and likely benign, according to the ClinVar database. The rs12018992 was previously described in an adolescent with DTC, measuring 13 mm. There were no significant differences according to gender, familial history of goiter, age, thyroid volume, TSH and TI-RADS classification between DICER1 carriers. Free T4 were lower in patients with DICER1 polymorphisms (13.77 ± 1.8 vs. 15.44 ± 2.4 pmol/L, p = 0.008), regardless of TSH levels. Conclusion We conclude that germline DICER1 variants can be found in 11% of large goiters but no second-hit somatic mutation was found. DICER1 is one driver to thyroid lesion and a second-hit event seems unnecessary in the MNG development.
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Affiliation(s)
- Lara Judith Cabral Miranda
- Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Débora L S Danilovic
- Unidade de Tireoide, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Felipe Augusto Brasileiro Vanderlei
- Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcos Roberto Tavares
- Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nicolau Lima Neto
- Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rosalinda Yossie Asato de Camargo
- Unidade de Tireoide, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Suemi Marui
- Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil,
- Unidade de Tireoide, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Freitas RMCD, Vanderlei FAB, Rosenfeld MG, Borges ADPP, Kowalski LP, Chammas MC. Cryoablation of Benign Thyroid Nodules: Preliminary Experience in 3 Cases. J Vasc Interv Radiol 2023; 34:2259-2262.e1. [PMID: 37640103 DOI: 10.1016/j.jvir.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Ricardo Miguel Costa de Freitas
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Endereço: Av. Dr. Eneas de Carvalho Aguiar, 255-3° andar, CEP: 05403-001, Cerqueira César-São Paulo, São Paulo, Brazil.
| | | | - Matheus Gerhard Rosenfeld
- Department of Head and Neck Surgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra de Pinho Pimenta Borges
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Endereço: Av. Dr. Eneas de Carvalho Aguiar, 255-3° andar, CEP: 05403-001, Cerqueira César-São Paulo, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Cristina Chammas
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Endereço: Av. Dr. Eneas de Carvalho Aguiar, 255-3° andar, CEP: 05403-001, Cerqueira César-São Paulo, São Paulo, Brazil
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Santana NO, Freitas RMC, Marcos VN, Chammas MC, Camargo RYA, Schmerling CK, Vanderlei FAB, Hoff AO, Marui S, Danilovic DLS. Diagnostic performance of thyroid ultrasound in Hürthle cell carcinomas. Arch Endocrinol Metab 2019; 63:300-305. [PMID: 31038598 PMCID: PMC10522209 DOI: 10.20945/2359-3997000000131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/27/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Hürthle cell carcinomas (HCCs) of the thyroid have been recently reclassified as a separate entity due to their distinct clinical and molecular profiles. Few studies have assessed the ability of preoperative characteristics in differentiating HCCs from Hürthle cell adenomas (HCAs) due to the low prevalence of both lesions. This study aimed to compare the preoperative features of HCCs and HCAs and evaluate the diagnostic performance of ultrasound in distinguishing between both. SUBJETCS AND METHODS Retrospective study including 101 patients (52 HCCs and 49 HCAs) who underwent thyroid surgery from 2000 to 2016. Clinical, ultrasonographic, and histological data were reviewed. Diagnostic performance of suspicious sonographic features was analyzed in 51 cases (24 HCCs and 27 HCAs). RESULTS Hürthle cell neoplasms were predominant in females. Subjects ≥ 55 years represented 58% of the cases of HCCs and 53% of those of HCAs. Carcinomas were significantly larger (p < 0.001), and a tumor size ≥ 4 cm significantly increased the risk of malignancy (odds ratio 3.67). Other clinical, cytologic, and sonographic data were similar between HCCs and HCAs. Among the HCCs, the lesions were purely solid in 54.2%, hypoechoic in 37.5%, and had coarse calcifications in 12.5%, microcalcifications in 8.3%, irregular contours in 4.2%, and a taller-than-wide shape in 16.7%. Predominantly/exclusive intranodular vascularization was observed in 52.6%. Overall, 58% of the HCCs were classified as TI-RADS 4 or 5 compared with 48% of the HCAs. TI-RADS 4 or 5 had a specificity of only 51.8% and a positive likelihood ratio of 1.21. CONCLUSIONS Apart from the lesion size, no other preoperative feature adequately distinguished HCCs from HCAs. Sonographic characteristics raising suspicion for malignancy, which are mostly present in papillary carcinomas, were infrequent in HCCs. New tools must be developed to improve preoperative diagnosis and deferral of surgery in cases of adenomas.
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Affiliation(s)
- Nathalie Oliveira Santana
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Miguel Costa Freitas
- Universidade de São PauloInstituto do Câncer do Estado de São PauloFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Radiologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Vinicius Neves Marcos
- Universidade de São PauloInstituto do Câncer do Estado de São PauloFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Radiologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Cristina Chammas
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Radiologia, Instituto de Radiologia (InRad), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rosalinda Yossie Asato Camargo
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Cláudia Kliemann Schmerling
- Universidade de São PauloInstituto do Câncer do Estado de São PauloFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Patologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Felipe Augusto Brasileiro Vanderlei
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ana Oliveira Hoff
- Universidade de São PauloInstituto do Câncer do Estado de São PauloFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Endocrinologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Suemi Marui
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Debora Lucia Seguro Danilovic
- Universidade de São PauloHospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Laboratório de Endocrinologia Celular e Molecular (LIM25), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Universidade de São PauloInstituto do Câncer do Estado de São PauloFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Endocrinologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Maeda SS, Moreira CA, Borba VZC, Bandeira F, Farias MLFD, Borges JLC, Paula FJAD, Vanderlei FAB, Montenegro FLDM, Santos RO, Ferraz-de-Souza B, Lazaretti-Castro M. Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism. Archives of Endocrinology and Metabolism 2018; 62:106-124. [PMID: 29694629 PMCID: PMC10118685 DOI: 10.20945/2359-3997000000015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
Objective To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Sociedade Brasileira de Endocrinologia e Metabologia (SBEM; Brazilian Society of Endocrinology and Metabolism) was invited to prepare a document following the rules set by the Guidelines Program of the Associação Médica Brasileira (AMB; Brazilian Medical Association). Relevant papers were retrieved from the databases MEDLINE/PubMed, LILACS, and SciELO, and the evidence derived from each article was classified into recommendation levels according to scientific strength and study type. Conclusion An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil.
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Vanderlei FAB, Vieira JGH, Hojaij FC, Cervantes O, Kunii IS, Ohe MN, Santos RO, Abrahão M. Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy. ACTA ACUST UNITED AC 2012; 56:168-72. [DOI: 10.1590/s0004-27302012000300003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 03/23/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.
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