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Simões-Pereira J, Saramago A, Rodrigues R, Pojo M, Pires C, Horta M, López-Presa D, Rito M, Cabrera R, Ferreira TC, Leite V, Cavaco BM. Clinical and molecular characterisation of metastatic papillary thyroid cancer according to radioiodine therapy outcomes. Endocrine 2024; 84:625-634. [PMID: 38102497 DOI: 10.1007/s12020-023-03633-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Radioiodine (RAI) therapy remains the gold-standard approach for distant metastatic differentiated thyroid cancer (TC). The main objective of our work was to identify the clinical and molecular markers that may help to predict RAI avidity and RAI therapy response of metastatic lesions in a cohort of papillary thyroid cancer (PTC) patients. METHODS We performed a retrospective analysis of 122 PTC patients submitted to RAI therapy due to distant metastatic disease. We also analysed, through next-generation sequencing, a custom panel of 78 genes and rearrangements, in a smaller cohort of 31 metastatic PTC, with complete follow-up, available RAI therapy data, and existing tumour sample at our centre. RESULTS The most frequent outcome after RAI therapy was progression of disease in 59.0% of cases (n = 71), with median estimate progression-free survival of 30 months. RAI avidity was associated with PTC subtype, age and stimulated thyroglobulin at first RAI therapy for metastatic disease. The most frequently altered genes in the cohort of 31 PTC patients' primary tumours were RAS isoforms (54.8%) and TERT promoter (TERTp) (51.6%). The presence of BRAF p.V600E or RET/PTC alterations was associated with lower avidity (p = 0.012). TERTp mutations were not associated with avidity (p = 1.000) but portended a tendency for a higher rate of progression (p = 0.063); similar results were obtained when RAS and TERTp mutations coexisted (p = 1.000 and p = 0.073, respectively). CONCLUSIONS Early identification of molecular markers in primary tumours may help to predict RAI therapy avidity, the response of metastatic lesions and to select the patients that may benefit the most from other systemic therapies.
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Affiliation(s)
- Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ricardo Rodrigues
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marta Pojo
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Carolina Pires
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Mariana Horta
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Dolores López-Presa
- Serviço de Anatomia Patológica, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, E.P.E., Avenida Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Miguel Rito
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Rafael Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Teresa C Ferreira
- Serviço de Medicina Nuclear, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal.
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Damásio IL, Figueiredo A, Maciel J, Horta M, Silva TN, Simões-Pereira J, Donato S, Leite V. Effectiveness and safety of lenvatinib in a series of advanced well-differentiated thyroid carcinomas from a single tertiary cancer center and literature review. Minerva Endocrinol (Torino) 2024:S2724-6507.23.03982-9. [PMID: 38512702 DOI: 10.23736/s2724-6507.23.03982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Treatment of advanced differentiated thyroid carcinoma (DTC) remains a challenge as 25-50% of patients with locally invasive or distant metastatic disease become refractory to radioiodine (RAI) therapy. Tyrosine kinase inhibitors (TKI) are increasingly used in this setting. The SELECT trial demonstrated that lenvatinib, a multikinase inhibitor, significantly improved progression free survival (PFS) compared to placebo. Our aim was to report the effectiveness and safety of lenvatinib in our series of patients with advanced DTC. METHODS A total of 25 patients with advanced DTC followed at a single tertiary center from January of 2016 to January of 2022 were retrospectively reviewed. RESULTS Patients were treated with a mean daily dose of lenvatinib of 16.9 mg for a mean of 9.1 months. Median estimated PFS was 31.3 months. One patient achieved complete response. The objective response rate (ORR) was 40% and the disease control rate was 84%. The mean change in summed longest diameter of target lesions from baseline to nadir was -36.9%. Lenvatinib prolonged the tumor volume doubling time in 86.7% patients. Interestingly, we found that patients treated with a lower dose of lenvatinib (<16.9 mg daily) had a significantly higher PFS and ORR than patients treated with higher dosages (>16.9 mg). Adverse events were frequently reported. CONCLUSIONS Our results confirm the effectiveness of lenvatinib in the management of patients with advanced DTC and support the need to adjust the dosage of lenvatinib to patient´s performance status and comorbidities.
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Affiliation(s)
- Inês L Damásio
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal -
| | - Ana Figueiredo
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
| | - Joana Maciel
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
| | - Mariana Horta
- Department of Radiology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
| | - Tiago N Silva
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
| | - Joana Simões-Pereira
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
| | - Sara Donato
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology, Lisbon, Portugal
- Nova Medical School, Faculty of Medical Sciences, NOVA University, Lisbon, Portugal
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Pires C, Marques IJ, Valério M, Saramago A, Santo PE, Santos S, Silva M, Moura MM, Matos J, Pereira T, Cabrera R, Lousa D, Leite V, Bandeiras TM, Vicente JB, Cavaco BM. CHEK2 germline variants identified in familial nonmedullary thyroid cancer lead to impaired protein structure and function. J Biol Chem 2024; 300:105767. [PMID: 38367672 PMCID: PMC10956065 DOI: 10.1016/j.jbc.2024.105767] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
Approximately 5 to 15% of nonmedullary thyroid cancers (NMTC) present in a familial form (familial nonmedullary thyroid cancers [FNMTC]). The genetic basis of FNMTC remains largely unknown, representing a limitation for diagnostic and clinical management. Recently, germline mutations in DNA repair-related genes have been described in cases with thyroid cancer (TC), suggesting a role in FNMTC etiology. Here, two FNMTC families were studied, each with two members affected with TC. Ninety-four hereditary cancer predisposition genes were analyzed through next-generation sequencing, revealing two germline CHEK2 missense variants (c.962A > C, p.E321A and c.470T > C, p.I157T), which segregated with TC in each FNMTC family. p.E321A, located in the CHK2 protein kinase domain, is a rare variant, previously unreported in the literature. Conversely, p.I157T, located in CHK2 forkhead-associated domain, has been extensively described, having conflicting interpretations of pathogenicity. CHK2 proteins (WT and variants) were characterized using biophysical methods, molecular dynamics simulations, and immunohistochemistry. Overall, biophysical characterization of these CHK2 variants showed that they have compromised structural and conformational stability and impaired kinase activity, compared to the WT protein. CHK2 appears to aggregate into amyloid-like fibrils in vitro, which opens future perspectives toward positioning CHK2 in cancer pathophysiology. CHK2 variants exhibited higher propensity for this conformational change, also displaying higher expression in thyroid tumors. The present findings support the utility of complementary biophysical and in silico approaches toward understanding the impact of genetic variants in protein structure and function, improving the current knowledge on CHEK2 variants' role in FNMTC genetic basis, with prospective clinical translation.
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Affiliation(s)
- Carolina Pires
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Inês J Marques
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Mariana Valério
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Paulo E Santo
- Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Sandra Santos
- Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Margarida Silva
- Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Margarida M Moura
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - João Matos
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Teresa Pereira
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Rafael Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Diana Lousa
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Valeriano Leite
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - João B Vicente
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal.
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Pires C, Saramago A, Moura MM, Li J, Donato S, Marques IJ, Belo H, Machado AC, Cabrera R, Grünewald TGP, Leite V, Cavaco BM. Identification of Germline FOXE1 and Somatic MAPK Pathway Gene Alterations in Patients with Malignant Struma Ovarii, Cleft Palate and Thyroid Cancer. Int J Mol Sci 2024; 25:1966. [PMID: 38396644 PMCID: PMC10888156 DOI: 10.3390/ijms25041966] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Germline variants in the FOXE1 transcription factor have been associated with thyroid ectopy, cleft palate (CP) and thyroid cancer (TC). Here, we aimed to clarify the role of FOXE1 in Portuguese families (F1 and F2) with members diagnosed with malignant struma ovarii (MSO), an ovarian teratoma with ectopic malignant thyroid tissue, papillary TC (PTC) and CP. Two rare germline heterozygous variants in the FOXE1 promoter were identified: F1) c.-522G>C, in the proband (MSO) and her mother (asymptomatic); F2) c.9C>T, in the proband (PTC), her sister and her mother (CP). Functional studies using rat normal thyroid (PCCL3) and human PTC (TPC-1) cells revealed that c.9C>T decreased FOXE1 promoter transcriptional activity in both cell models, while c.-522G>C led to opposing activities in the two models, when compared to the wild type. Immunohistochemistry and RT-qPCR analyses of patients' thyroid tumours revealed lower FOXE1 expression compared to adjacent normal and hyperplastic thyroid tissues. The patient with MSO also harboured a novel germline AXIN1 variant, presenting a loss of heterozygosity in its benign and malignant teratoma tissues and observable β-catenin cytoplasmic accumulation. The sequencing of the F1 (MSO) and F2 (PTC) probands' tumours unveiled somatic BRAF and HRAS variants, respectively. Germline FOXE1 and AXIN1 variants might have a role in thyroid ectopy and cleft palate, which, together with MAPK pathway activation, may contribute to tumours' malignant transformation.
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Affiliation(s)
- Carolina Pires
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
- NOVA Medical School (NMS)-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
| | - Margarida M. Moura
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
| | - Jing Li
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany; (J.L.); (T.G.P.G.)
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership between DKFZ and Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sara Donato
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal;
| | - Inês J. Marques
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
- NOVA Medical School (NMS)-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - Hélio Belo
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
| | - Ana C. Machado
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (A.C.M.); (R.C.)
| | - Rafael Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (A.C.M.); (R.C.)
| | - Thomas G. P. Grünewald
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany; (J.L.); (T.G.P.G.)
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership between DKFZ and Heidelberg University Hospital, 69120 Heidelberg, Germany
- Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Valeriano Leite
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal;
| | - Branca M. Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (C.P.); (A.S.); (M.M.M.); (I.J.M.); (H.B.); (V.L.)
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Veríssimo D, Regala C, Damásio I, Santos S, Donato S, Leite V. Treatment of metastatic paraganglioma: experience of a single center. Endocrine 2024:10.1007/s12020-024-03700-y. [PMID: 38296912 DOI: 10.1007/s12020-024-03700-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE Data regarding treatment options and their efficacy for metastatic paragangliomas (mPPGL) is limited. This study aims to report a single center experience in treating mPPGL, comparing the efficacy and safety of various treatment approaches. METHODS Retrospective analysis of patients with mPPGL treated at an Endocrinology Department of a cancer institute between January 2000 and October 2022. RESULTS We analyzed 25 patients with mPPGL, 8 pheochromocytomas and 20 paragangliomas (12% multifocal), followed for a median of 9 [4; 14] years. Surgical approach, aimed at the primary tumor or at debulking of metastases, was the only treatment achieving complete response: 87% in primary tumor and 87.5% with debulking of metastases. These were long-lasting results with a duration of 69 (23.8; 136.8) months in primary tumor removal and 35.1 (15.3; 41) months in metastases debulking. As for other therapeutic approaches, such as radioactive isotopes, tyrosine kinase inhibitors, chemotherapy and external beam radiotherapy, the main outcome was stable disease, with few partial responses. At the last follow-up, 66% of the patients were alive, 15.4% were in remission and 84.6% had stable disease. Median overall survival was 14 years. The 5-year and 10-year survival rates from primary tumor diagnosis were 77.9% and 66.9% respectively, and from metastasis diagnosis were 67.4% and 55.6%, respectively. CONCLUSION This is the only European single center analysis addressing outcomes of different therapies in mPGL. The results support surgery as a first-line treatment, being the only approach that may achieve complete response with satisfactory and long-lasting results.
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Affiliation(s)
- David Veríssimo
- Endocrinology Department, Hospital das Forças Armadas - Pólo de Lisboa, Lisbon, Portugal.
| | - Catarina Regala
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Inês Damásio
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Sofia Santos
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
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Pinto AT, Pojo M, Rodrigues R, Sousa DP, Matthiesen R, Carvalho AS, Beck HC, Pires C, Eduardo R, Pereira JS, Leite V, Cavaco BM. SPRY4 as a Potential Mediator of the Anti-Tumoral Role of Macrophages in Anaplastic Thyroid Cancer Cells. Cancers (Basel) 2023; 15:4387. [PMID: 37686663 PMCID: PMC10487195 DOI: 10.3390/cancers15174387] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is the most lethal subtype of thyroid cancer, with high invasive and metastatic potential, not responding to conventional treatments. Its aggressiveness may be influenced by macrophages, which are abundant cells in the tumor microenvironment. To investigate the role of macrophages in ATC aggressiveness, indirect co-cultures were established between ATC cell lines and THP-1-derived macrophages. Macrophages significantly increased both the migration and invasion of T235 cells (p < 0.01; p < 0.01), contrasting with a decrease in C3948 (p < 0.001; p < 0.05), with mild effects in T238 migration (p < 0.01) and C643 invasion (p < 0.05). Flow cytometry showed upregulation of CD80 (pro-inflammatory, anti-tumoral) and downregulation of CD163 (anti-inflammatory, pro-tumoral) in macrophages from co-culture with T235 (p < 0.05) and C3948 (p < 0.05), respectively. Accordingly, we found an upregulation of secreted pro-inflammatory mediators (e.g., GM-CSF, IL-1α; p < 0.05) in C3948-macrophage co-cultures. Proteomic analysis showed the upregulation of SPRY4, an inhibitor of the MAPK pathway, in C3948 cells from co-culture. SPRY4 silencing promoted cancer cell invasion, reverting the reduced invasion of C3948 caused by macrophages. Our findings support that macrophages play a role in ATC cell aggressiveness. SPRY4 is a possible modulator of macrophage-ATC cell communication, with a tumor suppressor role relevant for therapeutic purposes.
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Affiliation(s)
- Ana Teresa Pinto
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
- Instituto de Biomedicina (iBiMED), Universidade de Aveiro, 3810-193 Aveiro, Portugal
| | - Marta Pojo
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
| | - Ricardo Rodrigues
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
| | - Diana Pacheco Sousa
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
| | - Rune Matthiesen
- NMS Research, NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal; (R.M.); (A.S.C.)
| | - Ana Sofia Carvalho
- NMS Research, NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal; (R.M.); (A.S.C.)
| | - Hans C. Beck
- Centre for Clinical Proteomics, Department of Clinical Biochemistry, Odense University Hospital, DK-5000 Odense, Denmark;
| | - Carolina Pires
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
| | - Rodrigo Eduardo
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
| | - Joana Simões Pereira
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
- Serviço de Endocrinologia, IPOLFG, 1099-023 Lisboa, Portugal
| | - Valeriano Leite
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
- Serviço de Endocrinologia, IPOLFG, 1099-023 Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal
| | - Branca Maria Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisboa, Portugal; (M.P.); (R.R.); (D.P.S.); (C.P.); (R.E.); (J.S.P.); (V.L.); (B.M.C.)
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Lomelino Pinheiro S, Saramago A, Cavaco BM, Martins C, Leite V, Nunes da Silva T. Clinical and molecular characterization of parathyroid carcinoma in multiple endocrine neoplasia type 1. Endocr Connect 2023; 12:e220479. [PMID: 37410092 PMCID: PMC10448567 DOI: 10.1530/ec-22-0479] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
Nineteen cases of parathyroid carcinoma in patients with multiple endocrine neoplasia type 1 have been reported in the literature, of which 11 carry an inactivating germline mutation in the MEN1 gene. Somatic genetic abnormalities in these parathyroid carcinomas have never been detected. In this paper, we aimed to describe the clinical and molecular characterization of a parathyroid carcinoma identified in a patient with MEN1. A 60-year-old man was diagnosed with primary hyperparathyroidism during the postoperative period of lung carcinoid surgery. Serum calcium and parathyroid hormone levels were 15.0 mg/dL (8.4-10.2) and 472 pg/mL (12-65), respectively. The patient underwent parathyroid surgery, and histological findings were consistent with parathyroid carcinoma. Analysis of the MEN1 gene by next-generation sequencing (NGS) identified a novel germline heterozygous nonsense pathogenic variant (c.978C>A; p.(Tyr326*)), predicted to encode a truncated protein. Genetic analysis of the parathyroid carcinoma revealed a c.307del, p.(Leu103Cysfs*16) frameshift truncating somatic MEN1 variant in the MEN1 gene, which is consistent with MEN1 tumor-suppressor role, confirming its involvement in parathyroid carcinoma etiology. Genetic analysis of CDC73, GCM2, TP53, RB1, AKT1, MTOR, PIK3CA and CCND1 genes in the parathyroid carcinoma DNA did not detect any somatic mutations. To our knowledge, this is the first report of a PC case presenting both germline (first-hit) and somatic (second-hit) inactivation of the MEN1 gene.
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Affiliation(s)
- Sara Lomelino Pinheiro
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca Maria Cavaco
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Carmo Martins
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia e Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Tiago Nunes da Silva
- Serviço de Endocrinologia e Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Roque J, Nunes Silva T, Regala C, Rodrigues R, Leite V. Outcomes of lenvatinib therapy in poorly differentiated thyroid carcinoma. Eur Thyroid J 2023; 12:e230003. [PMID: 36852694 PMCID: PMC10083649 DOI: 10.1530/etj-23-0003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/01/2023] Open
Abstract
Background and objective Lenvatinib showed promising results in a subgroup of patients with poorly differentiated thyroid carcinoma (PDTC) in the SELECT trial. Our aim was to report the effectiveness and tolerability of lenvatinib in our series of PDTC patients. Methods Medical records of eight consecutive patients with PDTC treated with lenvatinib in a single center between January 2019 and October 2022 were retrospectively reviewed. Inclusion criteria were PDTC diagnosis based on Turin criteria and evidence of disease progression in the previous 6 months. Results Eight PDTC patients received an average dose of lenvatinib of 18.1 mg for a median duration of treatment of 10.3 months. The baseline Eastern Cooperative Oncology Group performance status was ≥2 in 50% of patients. Two patients had unresectable primary tumor. Seven patients showed extrathyroidal disease, particularly mediastinal lymph nodes (85.7%), lung (71.4%), and bone (71.4%). The disease control rate was 100%, with partial response and stable disease in 12.5 and 87.5%, respectively. The median time to best overall response was 3 months, and the median duration of response was 7.5 months. Median progression-free survival was 12 months and median overall survival was not reached. At 6, 12, and 18 months, overall survival was 87.5, 71.4, and 57.1%, respectively. All patients experienced drug-related adverse effects (AEs). Four (50%) had dose reductions and two (25%) had temporary treatment interruptions. Lenvatinib was stopped in two patients due to grade ≥3 AEs. Conclusion Lenvatinib is an effective treatment for real-world PDTC patients. Adequate management of comorbidities and AEs increases treatment tolerability and minimizes dose reductions.
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Affiliation(s)
- João Roque
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Tiago Nunes Silva
- Endocrinology, Diabetes and Metabolism Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas of Universidade NOVA de Lisboa, Lisbon, Portugal
- Unidade Investigação Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Catarina Regala
- Endocrinology, Diabetes and Metabolism Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Ricardo Rodrigues
- Unidade Investigação Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology, Diabetes and Metabolism Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas of Universidade NOVA de Lisboa, Lisbon, Portugal
- Unidade Investigação Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Dias D, Damasio I, Marques P, Simões H, Rodrigues R, Cavaco BM, Leite V. Metastatic follicular thyroid cancer with a longstanding responsiveness to gemcitabine plus oxaliplatin. Eur Thyroid J 2023; 12:ETJ-22-0227. [PMID: 36976625 DOI: 10.1530/etj-22-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Treatment of advanced follicular thyroid carcinoma (FTC) is based primarily on indirect evidence obtained with multikinase inhibitors (MKI) in clinical trials, in which papillary carcinomas represent the vast majority of cases. However, it is should be noted that MKI have a non-negligible toxicity that may decrease the patient's quality of life. Conventional chemotherapy with GEMOX (gemcitabine plus oxaliplatin) is an off-label therapy, which seems to have some effectiveness in advanced differentiated thyroid carcinomas, with a good safety profile, although further studies are needed. CASE REPORT We report a case of a metastatic FTC, resistant to several lines of therapy, however, with a durable response to GEMOX. The overall survival of our patient appears to have been extended significantly due to GEMOX chemotherapy. CONCLUSION GEMOX may have a role in patients with thyroid cancer unresponsive to MKI.
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Affiliation(s)
- Daniela Dias
- D Dias, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Inês Damasio
- I Damasio, Endocrinology, IPOLFG, Lisboa, 1099-023, Portugal
| | - Pedro Marques
- P Marques, Endocrinology, Hospital de Santa Maria, Lisboa, Portugal
| | - Helder Simões
- H Simões, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Ricardo Rodrigues
- R Rodrigues, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE Unidade de Investigação em Patobiologia Molecular, Lisboa, Portugal
| | | | - Valeriano Leite
- V Leite, Endocrinology, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
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Figueiredo AA, Saramago A, Cavaco BM, Simões-Pereira J, Leite V. Familial parathyroid tumours-comparison of clinical profiles between syndromes. J Endocrinol Invest 2023:10.1007/s40618-023-02032-4. [PMID: 36780067 DOI: 10.1007/s40618-023-02032-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) caused by parathyroid tumours is mostly sporadic, with a genetic cause identified in 5-10% of cases. Familial parathyroid tumours can be included in complex syndromes, such as multiple endocrine neoplasia (MEN) type 1, 2A and 4 or hyperparathyroidism-jaw tumour syndrome (HPT-JT). OBJECTIVE Characterisation of the familial parathyroid tumours followed-up at our centre and comparison of the different clinicopathological manifestations between the syndromes. METHODS Retrospective analysis of 48 patients with familial parathyroid tumours harbouring RET (n = 11), CDC73 (n = 20) and MEN1 (n = 17) germline mutations was performed. RESULTS Cases of PHPT in MEN2A syndrome presented with lower serum PTH (sPTH) and serum calcium (sCa) levels at diagnosis (sPTH = 108.0 (IQR 53.3) pg/mL, sCa = 10.6 ± 1.1 mg/dL) than MEN1 (sPTH = 196.9 (IQR 210.5) pg/mL, sCa = 11.7 ± 1.2 mg/dL) (p = 0.01, p = 0.03, respectively) or HPT-JT cases (sPTH = 383.5 (IQR 775.8) pg/mL, sCa = 12.9 ± 1.8 mg/dL) (p = 0.01; p < 0.001, respectively). There was a statistical difference in sCa levels between MEN1 and HPT-JT (p = 0.02), but not between sPTH (p = 0.07). The predominant first manifestation of the syndrome in MEN1 was gastroenteropancreatic neuroendocrine tumour (GEP-NET) in 47.1% of the cases, in MEN2A was medullary thyroid cancer (90.9%) and in HPT-JT was PHPT in 85% patients. In MEN1 syndrome, the number of affected parathyroid glands was significantly higher than in MEN2A (p < 0.001) and HPT-JT (p = 0.01). CONCLUSION The first manifestation of the syndrome in MEN1 cases was GEP-NET and not PHPT. Although presenting at similar ages, patients with MEN2A exhibit less severe biochemical and clinical PHPT at diagnosis than the other familial syndromes.
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Affiliation(s)
- A A Figueiredo
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal.
| | - A Saramago
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - B M Cavaco
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - J Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Nova Medical School | Faculdade de Ciências Médicas, Lisbon, Portugal
| | - V Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Nova Medical School | Faculdade de Ciências Médicas, Lisbon, Portugal
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Pinheiro SL, Miranda Afonso P, Damásio IL, Simões-Pereira J, Nunes da Silva T, Leite V. Clinical significance of papillary thyroid carcinoma with solid/trabecular growth. Clin Endocrinol (Oxf) 2023. [PMID: 36746771 DOI: 10.1111/cen.14886] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The clinical relevance of solid/trabecular (ST) growth in papillary thyroid carcinoma (PTC) is unclear. In this study, we investigated the impact of any amount of ST growth on tumour characteristics and patient outcomes. Furthermore, we evaluated whether ST growth per se affected patients' prognosis in the absence of aggressive features, namely vascular invasion. DESIGN We analysed 222 PTC patients followed up for more than 5 years in the Department of Endocrinology of the Instituto Português de Oncologia de Lisboa Francisco Gentil from 2002 to 2020. All PTC cases with any percentage of ST growth were included and compared with PTC without ST growth (1:2). Carcinomas with high-grade features were excluded. RESULTS There were 74 PTC cases with ST growth and 148 without ST growth (median follow-up of 9.3 years). PTC-ST was associated with larger tumour size (p = 0.001) and increased frequency of vascular invasion (p < 0.001) compared with PTC. However, PTC-ST did not exhibit a higher incidence of extrathyroidal extension (p = 1.000) or lymph node metastasis (p = 0.433). Despite the significantly higher prevalence of distant metastasis in PTC-ST compared with PTC (p = 0.043), the significance is lost when the cases with vascular invasion were excluded (p = 0.347). The total radioiodine activity was higher in PTC-ST than in PTC (p = 0.008). Recurrence rates were similar between groups (p = 0.755). The 10-year overall survival and disease-free survival rates for PTC-ST were 94.6% and 98.6%, respectively, similar to the PCT without ST growth (p = 0.097 and p = 0.333, respectively). There was no evidence of an association between the presence of an ST component (p = 0.201) with the risk of death or recurrence, whereas the presence of distant metastasis significantly increased the risk of these events (hazard ratio 10.14, p < 0.001). CONCLUSIONS The presence of ST growth was associated with several aggressive clinicopathological features. However, the risk of cancer recurrence and death for PTC-ST were similar to PTC. In the absence of vascular invasion, the clinical impact of ST growth alone is negligible.
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Affiliation(s)
- Sara Lomelino Pinheiro
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Pedro Miranda Afonso
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Inês Lemos Damásio
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Joana Simões-Pereira
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Tiago Nunes da Silva
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Endocrinology and Molecular Pathobiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Endocrinology and Molecular Pathobiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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12
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Damásio I, Simões-Pereira J, Donato S, Horta M, Cavaco BM, Rito M, Gomes P, Leite V. Entrectinib in the neoadjuvant setting of anaplastic thyroid cancer: a case report. Eur Thyroid J 2023; 12:e220179. [PMID: 36378538 PMCID: PMC9874958 DOI: 10.1530/etj-22-0179] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors. ATC is frequently diagnosed at advanced stages with unresectable disease and palliative care is often indicated. Recently, several patient-tailored therapies for ATC are emerging due to advances in molecular profiling of these tumors. Entrectinib is a potent oral selective inhibitor of neutrotrophic tropomyosin receptor kinase (NTRK), ROS1, and anaplastic lymphoma kinase fusions. The experience regarding ATC and other thyroid carcinomas, particularly in the neoadjuvant setting, is minimal. Case report We present a case of a 51-year-old female patient presenting with a bulky mass of the left thyroid lobe measuring 100 × 108 × 80 mm that was considered surgically unresectable. While waiting for next-generation sequence (NGS) profiling, lenvatinib was initiated. There was an initial clinical and imagiologic response; however, progression occurred after 12 weeks, and at this time NGS identified an ETV6-NTRK3 fusion and entrectinib was started. After 12 weeks, tumor diameters reduced to a minimum of 68×60×49 mm, and the patient underwent total thyroidectomy plus central lymphadenectomy. Histological diagnosis confirmed an ATC (pT4a R2 N1a). Adjuvant radiotherapy (RT) (60 Grays) with weekly paclitaxel (45 mg/m2) was then administered followed by maintenance entrectinib 600 mg daily. Fluorodeoxyglucose positron emission tomography performed 3 months after completion of RT showed only non-specific uptake in the posterior wall of the hypopharynx and larynx, suggestive of inflammation. Conclusion We report the first case of an ATC with a dramatic response to neoadjuvant therapy with entrectinib, which enabled surgical resection of an ab initio unresectable tumor.
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Affiliation(s)
- Inês Damásio
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Joana Simões-Pereira
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Mariana Horta
- Radiology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon Portugal
| | - Branca Maria Cavaco
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Miguel Rito
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Pedro Gomes
- Head and Neck Surgery Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
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da Silva TN, Rodrigues R, Saramago A, Pires C, Rito M, Horta M, Martins C, Leite V, Cavaco BM. Target therapy for BRAF mutated anaplastic thyroid cancer: a clinical and molecular study. Eur J Endocrinol 2023; 188:6979712. [PMID: 36651156 DOI: 10.1093/ejendo/lvac011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Anaplastic thyroid carcinoma (ATC) has a poor survival. The combination of Dabrafenib plus Trametinib (DT) had a significant impact in survival of BRAF p.V600E patients. However, durable responses may be compromised by resistance. We aim to present our experience with DT in BRAF positive ATC patients and compare the outcomes with usual therapy, and to study tumor molecular alterations in the DT group. METHODS Patients treated between May 2018 and April 2022 in a tertiary referral center, assessed for BRAF status were included. Patients were divided in three groups: BRAF p.V600E treated with DT, BRAF wild type (WT) under multimodal therapy (MT), and BRAF WT under compassionate care (CC). Response was assessed monthly in the first 6 months and every 3 months afterwards, by RECIST 1.1. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method and compared with the log-rank test. RESULTS Twenty-seven ATC patients were included (DT = 9, MT = 8, and CC = 10). Median OS was 475 days for DT, 156 days for MT, and 39 days for CC (P < .001). At 12 months, only patients in the DT group were alive (71%). Median PFS was 270 days, in the DT group, compared with less than 32 days in BRAF WT (P < .001). No severe adverse events were reported. Molecular profiling showed that in one of the four clinical progressions, a pathogenic NRAS mutation was found. CONCLUSIONS Our results show a significant real-world efficacy of Dabrafenib plus Trametinib in both survival and recurrence compared with standard treatment, with a good safety profile.
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Affiliation(s)
- Tiago Nunes da Silva
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
| | - Ricardo Rodrigues
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
| | - Carolina Pires
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
| | - Miguel Rito
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Mariana Horta
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Carmo Martins
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
- NOVA Medical School-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, Lisboa 1099-023, Portugal
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Figueiredo AA, Esteves S, Moura MM, Marques P, Simões-Pereira J, Leite V. Preoperative serum inflammation-based scores in medullary thyroid cancer. Endocrinol Diabetes Nutr (Engl Ed) 2023; 70:48-55. [PMID: 36764748 DOI: 10.1016/j.endien.2022.06.015] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/15/2022] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) are prognostic factors in several tumours, though little is known in medullary thyroid cancer (MTC). OBJECTIVE To evaluate the association between preoperative NLR, PLR and SII with MTC clinicopathological and molecular features, and their predictive value for lymph node and distant metastasis. METHODS We retrospectively analysed 75 patients with MTC who underwent surgery at our institution. The familial form of MTC was found in 12% of patients. RESULTS In our cohort, 56% were females, the median age at diagnosis was 57 years (44-69), the median tumour diameter was 25mm (15-50); 21.3% were multifocal and 34.7% had extrathyroidal extension. Lymph node and distant metastasis were observed in 36 (48.0%) and 8 (10.7%) patients, respectively. Higher NLR was associated with preoperative calcitonin, angioinvasion, extrathyroidal extension, moderate/severe fibrosis; higher PLR was associated with extrathyroidal extension and advanced T stages; lower SII and NLR were associated with biochemical cure after surgery. Increased PLR, NLR and SII were associated with advanced MTC stages. In the univariate analysis, only NLR was associated with lymph node metastasis (odds ratio (OR)=2.69, 95% confidence interval (CI): 1.50-5.84; p=0.004); however, in the multivariate model, NLR was no longer a predictive factor for lymph node metastasis. None of these serum inflammatory markers predicted the occurrence of distant metastasis. CONCLUSION In conclusion, NLR, PLR and SII are associated with aggressive MTC, but do not predict lymph node or distant metastasis.
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Affiliation(s)
- Ana Abrantes Figueiredo
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal.
| | - Susana Esteves
- Unidade de Investigação Clínica, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Margarida Maria Moura
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Pedro Marques
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal
| | - Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Nova Medical School
- Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Campo Mártires da Pátria, n° 130, 1169-056 Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Nova Medical School
- Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Campo Mártires da Pátria, n° 130, 1169-056 Lisboa, Portugal
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Muacevic A, Adler JR, Cabrera R, Simões-Pereira J, Leite V. Malignant Hypercalcemia Due to the Ectopic Production of Calcitriol by an Abdominal Liposarcoma. Cureus 2023; 15:e33446. [PMID: 36751194 PMCID: PMC9897700 DOI: 10.7759/cureus.33446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/07/2023] Open
Abstract
Hypercalcemia of malignancy (HM) is a common form of paraneoplastic syndrome associated with a poor prognosis of the disease. In solid tumors, HM occurs mainly due to the production of parathyroid hormone-related peptide (PTHrP). We present a case of a 60-year-old male with a 25 cm retroperitoneal liposarcoma diagnosed with severe hypercalcemia (16.8 mg/dL) by a preoperative blood sampling. Hypercalcemia workup showed suppressed parathyroid hormone (PTH), normal PTHrP, and high 1,25-dihydroxyvitamin D (1,25(OH)2D) serum levels. After surgery, hypercalcemia and calcitriol levels normalized. Immunohistochemical analysis of the tumor showed 1α-hydroxylase expression by tumor cells. To our knowledge, this is the first case of liposarcoma-associated hypercalcemia caused exclusively by the ectopic production of calcitriol. Despite being a rare cause of hypercalcemia, measuring 1,25(OH)2D should be considered in the workup of a patient with high serum calcium levels, suppressed PTH, and normal PTHrP.
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Muacevic A, Adler JR, Pinheiro S, Esteves S, Leite V, Santos R. Differentiated Thyroid Cancer in a Pediatric Population: Estimating the Risk of Recurrence and Evolution Over Time. Cureus 2023; 15:e34313. [PMID: 36860222 PMCID: PMC9970399 DOI: 10.7759/cureus.34313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 01/29/2023] Open
Abstract
Background Differentiated thyroid cancer (DTC) is the most common endocrine cancer during childhood, and the prognosis is usually good. The 2015 American Thyroid Association (ATA) pediatric guidelines for DTC classify patients into three categories (low, intermediate, and high) that represent the risk for persistent/recurrent disease. The "Dynamic Risk Stratification" (DRS) System showed that, in adults, reassessment of disease status during follow-up was a better predictor of disease status at the end of follow-up when compared to ATA risk stratification. This system is still not validated for the pediatric population with DTC. Our aim was to evaluate the usefulness of the DRS system in predicting DTC disease behaviour in this specific population. We also aimed to evaluate potential clinical-pathological factors associated with persistent disease at the end of follow-up. Methods A retrospective analysis of 39 pediatric patients (≤18 years) with DTC was conducted in our institution between 2007 and 2018, including 33 patients who had follow-up ≥ 12 months; these were classified into ATA risk groups and re-stratified according to their response to treatment at 12-24 months of follow-up. The associations between the ordinal variables of the baseline ATA risk group and the disease status re-evaluated 12-24 months after diagnosis (as per the DRS system) and at the end of follow-up were evaluated using a linear-by-linear association test. Gender, age at diagnosis, tumor size, multicentricity, extrathyroid extension, vascular invasion, lymph node metastasis, distant metastasis, and stimulated thyroglobulin (sTg) during the first RAI administration were evaluated as potential factors associated with persistent disease at 27 months after diagnosis using Firth's bias-reduced penalized-likelihood logistic regression. Results In this study, 39 patients were retrospectively analyzed, including 33 patients who had follow-ups ≥ 12 months with a median time of 56 (27-139) months who were classified in ATA risk groups and then re-stratified depending on their response to treatment between 12 and 24 months of follow-up. There was a statistically significant association between ATA risk groups and re-evaluation at 12 and 24 months (p=0.001) and between these two stratifications and the state of disease at final follow-up (p<0.001 for both). Factors with a statistically significant association with persistent disease at 27 months of follow-up were male sex, lymph node metastases at diagnosis, distant metastasis, extrathyroidal extension, and stimulated Tg values. Conclusions The assessment of the response to treatment between 12 and 24 months and at the end of follow-up refines the initial ATA risk stratification, confirming that dynamic risk evaluation is also helpful in the pediatric population.
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Figueiredo AA, Esteves S, Moura MM, Marques P, Simões-Pereira J, Leite V. Preoperative serum inflammation-based scores in medullary thyroid cancer. ENDOCRINOL DIAB NUTR 2023. [DOI: 10.1016/j.endinu.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Maciel J, Cavaco D, Silvestre C, Simões Pereira J, Vilar H, Leite V. Clinical outcomes of a cohort of 271 patients with lung metastases from differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2022; 97:814-821. [PMID: 35192239 DOI: 10.1111/cen.14700] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/15/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
CONTEXT Lung is the most common site of distant metastases from differentiated thyroid carcinoma (DTC). OBJECTIVE To investigate the outcomes of a cohort of patients with DTC and lung metastases (LM). METHODS A retrospective analysis of a cohort of 271 patients with LM was performed. RESULTS The female-to-male ratio was 1:1 and the median follow-up time was 5.9 (1.1-38.4) years. Papillary thyroid carcinoma (PTC) was the most frequent type (83.4%), mainly the classic variant, followed by follicular thyroid carcinoma (FTC, 10.3%) and Hürthle cell carcinoma (HTC, 6.3%). The prevalence of PTC, FTC and HCC was different between the micronodular and macronodular LM groups [87.4%, 6.3% and 6.3% vs. 74.6%, 19.0% and 6.3%, respectively (p = .013)]. Only 5.0% of the patients had LM diagnosed after a period of remission. LM were submitted to radioactive iodine treatment (RAIT) in 84.5% (52.8% showed 131 iodine avid metastases). Complete remission was only achieved in 12.2%. Micronodular disease and age <55 years at LM diagnosis were associated with a better prognosis (p < .05). We found no difference in survival between patients with LM treated or not with RAIT. However, in patients submitted to RAIT, there was a tendency for longer survival in the group of patients with 131 I avid lesions. CONCLUSION The classic variant of PTC was the most frequent histology found in LM of DTC. LM are rarely diagnosed in the follow-up when complete remission is achieved after surgery and 131 I. Younger age at LM diagnosis and a micronodular pattern are associated with a better prognosis.
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Affiliation(s)
- Joana Maciel
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Daniela Cavaco
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Catarina Silvestre
- Endocrinology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal
| | - Joana Simões Pereira
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Vilar
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Cunha C, Pinheiro SL, Donato S, Tavares Bello C, Simões H, Nunes Silva T, Prazeres S, Doutel D, Cavaco BM, Leite V. Parathyroid carcinoma: Single centre experience. Clin Endocrinol (Oxf) 2022; 97:250-257. [PMID: 35120263 DOI: 10.1111/cen.14684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Parathyroid Carcinoma is a rare malignant neoplasm, accounting for less than 1% of primary hyperparathyroidism cases. Parathyroid carcinomas are characterized by markedly elevated levels of PTH, severe hypercalcemia and established target organ damage. The authors report the experience of a single centre regarding the management and outcome of patients with parathyroid carcinomas and revise relevant literature. DESIGN Retrospective review of all patients with parathyroid carcinoma evaluated at a tertiary oncologic centre from 1991 until 2021. RESULTS Seventeen patients were identified (10 males), with a mean age at diagnosis of 53 ± 16 years and a median follow-up of 16.5 years. Most patients presented with hypercalcemia (n = 15), with a mean serum calcium concentration of 13.5 mg/dl (9.6-16.5) and mean PTH of 1173 pg/ml (276-2500). Hyperparathyroidism-mediated organ damage was observed in most patients (n = 16), with predominant renal (n = 12) and skeletal (n = 9) complications. En bloc surgical resection was performed in nine patients. Three patients underwent adjuvant radiotherapy. Recurrence was observed in 8 cases (47.1%) after a median of 24 months following surgery and no independent predictors of recurrence were identified. The overall survival and disease specific survival at 5-year was 88% and 94%, respectively. CDC73 mutations were present in 38.5% of analysed patients and one patient was diagnosed with MEN1. CONCLUSION Parathyroid carcinoma is associated with a significant rate of recurrence and limited effective treatment beyond initial complete surgical resection. Therefore, preoperatively high index of suspicion is paramount to optimize patient care. This is, to our knowledge, the largest Portuguese cohort published so far.
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Affiliation(s)
- Clara Cunha
- Department of Endocrinology, Hospital de Egas Moniz, Lisboa, Portugal
| | - Sara Lomelino Pinheiro
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Sara Donato
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Helder Simões
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Tiago Nunes Silva
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Susana Prazeres
- Laboratory of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Delfim Doutel
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca M Cavaco
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Molecular Pathobiology Research Unit (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Simões-Pereira J, C Ferreira T, Limbert E, Cavaco BM, Leite V. Response to "Radioiodine Is Molecular Radiotherapy Governed by Predictable Deterministic Radiobiology Expressed in Gray, Not Millicuries" by Kao. Thyroid 2022; 32:342-343. [PMID: 35045760 DOI: 10.1089/thy.2021.0644] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Teresa C Ferreira
- Serviço de Medicina Nuclear, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Edward Limbert
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca Maria Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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Maciel J, Vilar H, Ferreira TC, Leite V. Isolated adrenal metastases of papillary thyroid carcinoma. Endokrynol Pol 2022; 73:167-168. [PMID: 35119097 DOI: 10.5603/ep.a2021.0104] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Joana Maciel
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
| | - Helena Vilar
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Teresa C Ferreira
- Nuclear Medicine Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.,Nova Medical School, New University of Lisbon, Lisbon, Portugal
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Abstract
Recurrence of Cushing's syndrome due to functional metastasis from adrenocortical carcinoma (ACC) after adrenalectomy is extremely rare. We describe a case of a 56-year-old woman who presented with Cushing's syndrome due to an ACC. Abdominal CT showed a heterogeneous left adrenal tumour of 8 cm as well as a right adrenal nodule with 3 cm. An 18F-fluorodeoxyglucose positron emission tomography-CT (18F-FDG/CT PET) revealed an increased uptake of both adrenal lesions (maximum standardised uptake values, 17.7 and 10.4 for left and right adrenal lesions, respectively). Patient underwent bilateral adrenalectomy with R0 resection. Pathological examination revealed a left ACC with a Weiss' score of 7, Ki67 10%, stage II European Network for the Study of Adrenal Tumours and a right adrenal adenoma. After surgery, clinical improvement was noted. Two months later, she noticed recurrence of hypercortisolism and multiple liver and lung metastasis were demonstrable, without evidence of local recurrence on the 18F-FDG/CT PET and abdominal MRI.
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Affiliation(s)
- Clara Cunha
- Endocrinology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Sara Donato
- Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Tiago Silva
- Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Valeriano Leite
- Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Cavaco D, Martins AF, Cabrera R, Vilar H, Leite V. Diffuse sclerosing variant of papillary thyroid carcinoma: outcomes of 33 cases. Eur Thyroid J 2022; 11:e210020. [PMID: 34981753 PMCID: PMC9142808 DOI: 10.1530/etj-21-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Diffuse sclerosing variant of PTC (DSV-PTC) is an uncommon subtype of thyroid cancer. Although an aggressive behavior is often recognized, prognostic significance is still under debate. OBJECTIVES To describe the clinicopathological features and outcomes of a series of DSV-PTC patients. METHODS Retrospective data collection involving 33 patients diagnosed with DSV-PTC followed at the Endocrine Department of the Portuguese Institute of Oncology in Lisbon between 1981 and 2020. RESULTS Twenty-six patients (78.8%) were females with a mean age at presentation of 29.4 ± 11.7 years old. Mean time of follow-up was 19.5 ± 10.6 years (range 0.5-39). Histologically, bilateral tumors were present in 72.7% patients (n = 24), thyroid capsular invasion was documented in 57.6% (n = 19), 45.4% (n = 15) had extrathyroidal extension, and 42.4% (n = 14) had lymphovascular invasion. Most patients were staged pT3 (42.4%, n = 14) and pN1 (81.8%, n = 27). Median lymph nodes resected were 16. None of the patients showed distant metastases at presentation. All patients were treated at least once with 131I. During follow-up, four patients (14.8%), with persistent neck disease, were diagnosed with distant metastases, all of them in the lung. Two patients (1.8%) presented recurrent disease in the neck after being considered with no evidence of disease. At the last appointment, 18 patients (54.5%) were in remission, 4 (12.1%) had biochemical evidence of disease, 6 had structural disease, and for 5 patients disease status was considered as undetermined. There was no disease related mortality. DISCUSSION/CONCLUSION Our study confirms that DSV-PTC is diagnosed more often in young patients and exhibits a local extensive disease at presentation. On the other hand, even in the presence of distant metastases, no patient died during follow-up.
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Affiliation(s)
- Daniela Cavaco
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Correspondence should be addressed to D Cavaco:
| | - Ana Filipa Martins
- Department of Endocrinology and Diabetes, Hospital da Luz, Lisbon, Portugal
| | - Rafael Cabrera
- Department of Patology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Helena Vilar
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
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Chaves C, Nunes da Silva T, Dias Pereira B, Anselmo J, Claro I, Cavaco BM, Saramago A, Leite V. A case report of multiple endocrine neoplasia type 1 and autoimmune disease: Coincidence or correlation? Medicine (Baltimore) 2021; 100:e28145. [PMID: 34889280 PMCID: PMC8663848 DOI: 10.1097/md.0000000000028145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Multiple Endocrine Neoplasia type 1 (MEN1) is a familial syndrome that results from the disruption of a tumor suppressor protein called MENIN. Its management is challenging, as MEN1 affects different endocrine tissues and predisposes to both benign and malignant tumors. MENIN-deficient cells have recently been recognized to play a role in triggering autoimmunity. Herein, we present a case of MEN1 with multiple endocrine and autoimmune disorders. PATIENT CONCERNS A 50 years old female with a 25 years history of complicated nephrolithiasis presented with primary hyperparathyroidism. DIAGNOSES Over several decades, she was diagnosed with recurrent primary hyperparathyroidism, autoimmune thyroiditis, multinodular goiter, pernicious anemia, metastatic gastric type 1 neuroendocrine tumor, macroprolactinemia, gonadotropin deficiency, mucosa-associated lymphoid tissue lymphoma of the thyroid gland, positive anti-calcium sensor receptor antibodies, and BRCA 1/2-negative invasive breast cancer. The autoimmune regulator gene was sequenced, but no pathogenic variants were found. Next-generation sequencing revealed both a pathogenic MEN1 mutation and a benign CDC73 gene variant. Familial genetic screening revealed a large kindred with multiple carriers of one or both genetic variants (MEN1 = 19; CDC73 = 7). INTERVENTIONS The patient underwent surgical excision of three parathyroid glands, total thyroidectomy and breast tumorectomy plus tamoxifen, and monthly injections of octreotide. The patient and family members with the MEN1 mutation are under a life-long surveillance program for MEN1 prototypic tumors. OUTCOMES The patient was stable and alive during a 24-years follow-up period. LESSONS With the present case, the authors highlight a new interplay between MENIN and the immune system, which may have implications for future targeted life-long surveillance and treatment of MEN1 patients.
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Affiliation(s)
- Carolina Chaves
- Serviço de Endocrinologia e Nutrição, Hospital Divino Espírito Santo de Ponta Delgada, Azores Islands, Portugal
| | - Tiago Nunes da Silva
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Bernardo Dias Pereira
- Serviço de Endocrinologia e Nutrição, Hospital Divino Espírito Santo de Ponta Delgada, Azores Islands, Portugal
| | - João Anselmo
- Serviço de Endocrinologia e Nutrição, Hospital Divino Espírito Santo de Ponta Delgada, Azores Islands, Portugal
| | - Isabel Claro
- Serviço de Gastroenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Branca M. Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
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Cavaco DR, Alves Rafael A, Cabrera R, Vilar H, Leite V. Case Report: A Rare Association of Diffuse Thyroid Lipomatosis with Amyloid Deposition. Eur Thyroid J 2021; 10:528-532. [PMID: 34956925 PMCID: PMC8647057 DOI: 10.1159/000518444] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Diffuse thyroid lipomatosis is a rare histopathological condition of unknown etiology, characterized by diffuse fatty infiltration of the thyroid stroma, which can result in diffuse goiter with compressive symptoms. We report a case of a 46-year-old man with 1-year history of progressive goiter enlargement with compressive symptoms. Imaging studies revealed multiple coalescent nodules. The patient underwent surgery, and the microscopic appearance revealed a diffuse infiltration of thyroid stroma by mature adipose tissue with associated amyloid deposition. A final diagnosis of diffuse lipomatosis of the thyroid gland was established. This patient represents one of the few reported cases of diffuse lipomatosis with coexisting deposition of amyloid protein of the thyroid gland and contributes to the better understanding of this extremely rare condition.
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Affiliation(s)
- Daniela Rodrigues Cavaco
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- *Daniela Rodrigues Cavaco,
| | - Ana Alves Rafael
- Department of General Surgery, CUF Academic Center − Hospital CUF Sintra and Hospital CUF Cascais, Lisbon, Portugal
| | - Rafael Cabrera
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Helena Vilar
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School/New University of Lisboa, Lisbon, Portugal
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Donato S, Simões H, Leite V. Malignant Struma Ovarii with Concurrent Thyroid Cancer: Outcomes during and after Pregnancy. Eur Thyroid J 2021; 10:523-527. [PMID: 34956924 PMCID: PMC8647070 DOI: 10.1159/000512735] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/31/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. CASE PRESENTATION A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng/mL. After delivery, Tg decreased to 14 ng/mL but, 6 months later, rose again and reached 31.9 ng/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. DISCUSSION/CONCLUSION As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and/or by the high levels of hCG which is known to stimulate TSH receptors.
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Affiliation(s)
- Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
- *Sara Donato, Endocrinology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, PT–1099-023 Lisbon (Portugal),
| | - Helder Simões
- Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
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Simões-Pereira J, Ferreira TC, Limbert E, Cavaco BM, Leite V. Outcomes of Thyrotropin Alfa Versus Levothyroxine Withdrawal-Aided Radioiodine Therapy for Distant Metastasis of Papillary Thyroid Cancer. Thyroid 2021; 31:1514-1522. [PMID: 34155923 DOI: 10.1089/thy.2021.0013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Thyrotropin alfa (rhTSH) is not currently approved by the Food and Drug Administration or European Medicines Agency for the preparation of radioactive iodine therapy (RAIT) in patients with distant metastatic papillary thyroid cancer (PTC). There are only a few studies comparing rhTSH with levothyroxine withdrawal (LTW) in this context. Our main aim was to compare the two methods of RAIT preparation in terms of avidity and structural/biochemical response in distant metastatic PTC. We also intended to evaluate whether the two methods of RAIT preparation represented independent prognostic factors for progression-free survival (PFS) and disease-specific survival (DSS) in this subset of patients. Methods: We performed a retrospective analysis of all patients with PTC treated with RAIT for distant metastatic disease between 2006 and 2018. We included 95 PTC patients-27 (28.4%) had LTW and 68 (71.6%) had rhTSH for RAIT. Results: The two groups presented similar clinicopathological characteristics, except for median age at PTC diagnosis, which was higher in the rhTSH group (p = 0.001), but the median age at first RAIT for distant metastatic disease was not different between the two methods of preparation, 63 years old (interquartile range [IQR] 23) in the LTW group versus 70 (IQR 26.75), p = 0.06. Avidity was similar between the two groups (p = 0.973). Median estimate PFS (p = 0.076) and DSS (p = 0.084) were also similar between LTW and rhTSH. Regarding RAIT-related side effects, only 1 (3.7%) patient and 5 (7.4%) patients in the LTW and rhTSH groups, respectively, reported sialadenitis (p = 0.670). Conclusions: There were no differences between the two methods of RAIT preparation regarding avidity and clinical response. rhTSH may be used as an alternative method of preparation for RAIT in patients with known distant lesions, as it presents similar clinical outcomes to LTW and a good safety profile.
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Affiliation(s)
- Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Unidade de Investigação em Patobiologia Molecular (UIPM), Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Teresa C Ferreira
- Serviço de Medicina Nuclear, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Edward Limbert
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca Maria Cavaco
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Unidade de Investigação em Patobiologia Molecular (UIPM), Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Unidade de Investigação em Patobiologia Molecular (UIPM), Lisboa, Portugal
- NOVA Medical School | Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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Simões-Pereira J, Mourinho N, Ferreira TC, Limbert E, Cavaco BM, Leite V. Avidity and Outcomes of Radioiodine Therapy for Distant Metastasis of Distinct Types of Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2021; 106:e3911-e3922. [PMID: 34134139 DOI: 10.1210/clinem/dgab436] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The recommendations for radioactive-iodine treatment (RAIT) in metastatic differentiated thyroid cancer (DTC) are mostly based in the experience with papillary histotype and do not consider the differences within the distinct types of DTC, in terms of RAIT uptake and response. OBJECTIVE This work aims to investigate the association between histology and RAIT avidity and response, and to evaluate whether histotype was an independent prognostic factor in progression-free survival (PFS) and disease-specific survival (DSS) after RAIT for distant metastatic disease. METHODS A retrospective analysis was conducted of all DTC patients who underwent RAIT for distant metastatic disease, from 2001 to 2018, at a thyroid cancer referral center. We included 126 patients: 42 (33.3%) classical variant papillary thyroid cancer (cvPTC), 45 (35.7%) follicular variant PTC (fvPTC), 17 (13.5%) follicular thyroid cancer (FTC) and 22 (17.5%) Hürthle cell carcinoma. Main outcome measures included RAIT avidity and response. RESULTS RAIT avidity was independently associated with histology (P < .001) and stimulated thyroglobulin (Tg) at first RAIT for distant lesions (P = .007). Avidity was lowest in HCC (13.6%), intermediate in cvPTC (21.4%), and highest in fvPTC (75.6%) and FTC (76.5%). Regarding RAIT response, HCC and FTC were not different; both showed significantly more often progression after RAIT than fvPTC and cvPTC. Histology influenced PFS (P = .014), but tumor type was not a significant prognostic factor in DSS. Instead, age at diagnosis, resection status, and stimulated Tg at the first RAIT were significantly associated with DSS. CONCLUSION DTC histotype influenced RAIT avidity and PFS. It is crucial to better detect the metastatic patients that may benefit the most from RAIT.
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Affiliation(s)
- Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Nádia Mourinho
- Serviço de Endocrinologia, Hospital Beatriz Ângelo, 2674-514 Loures, Portugal
| | - Teresa C Ferreira
- Serviço de Medicina Nuclear, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
| | - Edward Limbert
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
| | - Branca Maria Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
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Marques IJ, Gomes I, Pojo M, Pires C, Moura MM, Cabrera R, Santos C, van IJcken WFJ, Teixeira MR, Ramalho JS, Leite V, Cavaco BM. Identification of SPRY4 as a Novel Candidate Susceptibility Gene for Familial Nonmedullary Thyroid Cancer. Thyroid 2021; 31:1366-1375. [PMID: 33906393 DOI: 10.1089/thy.2020.0290] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The molecular basis of familial nonmedullary thyroid cancer (FNMTC) is still poorly understood, representing a limitation for molecular diagnosis and clinical management. In this study, we aimed to identify new susceptibility genes for FNMTC through whole-exome sequencing (WES) analysis of leukocyte DNA of patients from a highly informative FNMTC family. Methods: We selected six affected family members to conduct WES analysis. Bioinformatic analyses were undertaken to filter and select the genetic variants shared by the affected members, which were subsequently validated by Sanger sequencing. To select the most likely pathogenic variants, several studies were performed, including family segregation analysis, in silico impact characterization, and gene expression (messenger RNA and protein) depiction in databases. For the most promising variant identified, we performed in vitro studies to validate its pathogenicity. Results: Several potentially pathogenic variants were identified in different candidate genes. After filtering with appropriate criteria, the variant c.701C>T, p.Thr234Met in the SPRY4 gene was prioritized for in vitro functional characterization. This SPRY4 variant led to an increase in cell viability and colony formation, indicating that it confers a proliferative advantage and potentiates clonogenic capacity. Phosphokinase array and Western blot analyses suggested that the effects of the SPRY4 variant were mediated through the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway, which was further supported by a higher responsiveness of thyroid cancer cells with the SPRY4 variant to a MEK inhibitor. Conclusions: WES analysis in one family identified SPRY4 as a likely novel candidate susceptibility gene for FNMTC, allowing a better understanding of the cellular and molecular mechanisms underlying thyroid cancer development.
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Affiliation(s)
- Inês J Marques
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Chronic Diseases Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Inês Gomes
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Marta Pojo
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Carolina Pires
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Margarida M Moura
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Rafael Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Catarina Santos
- Serviço de Genética, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Wilfred F J van IJcken
- Center for Biomics, Department of Cell Biology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manuel R Teixeira
- Serviço de Genética, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - José S Ramalho
- Chronic Diseases Research Centre, Universidade Nova de Lisboa, Lisboa, Portugal
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Valeriano Leite
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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30
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Pires C, Marques IJ, Dias D, Saramago A, Leite V, Cavaco BM. A pathogenic variant in CHEK2 shows a founder effect in Portuguese Roma patients with thyroid cancer. Endocrine 2021; 73:588-597. [PMID: 33683595 DOI: 10.1007/s12020-021-02660-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Germline mutations in DNA repair-related genes have been recently reported in cases with familial non-medullary thyroid carcinoma (FNMTC). A Portuguese family from the Roma ethnic group with four members affected with papillary thyroid carcinoma (PTC), and three members with multinodular goiter (MNG) was identified. The aim of this study was to investigate the involvement of DNA repair-related genes in the etiology of FNMTC in this family and in the Roma ethnic group. METHODS Ninety-four hereditary cancer predisposition genes were analyzed through next-generation sequencing. Sanger sequencing was used for variant confirmation and screening. Twelve polymorphic markers were genotyped for haplotype analysis in the CHEK2 locus. RESULTS A germline pathogenic frameshift variant in the CHEK2 gene [c.596dupA, p.(Tyr199Ter)] was detected in homozygosity in the proband (PTC) and in his brother (MNG), being heterozygous in his mother (PTC), two sisters (PTC), and one nephew (MNG). This variant was absent in 100 general population controls. The screening of the CHEK2 variant was extended to other Roma individuals, being detected in 2/33 Roma patients with thyroid cancer, and in 1/15 Roma controls. Haplotype segregation analysis identified a common ancestral core haplotype (Hcac), covering 10 Mb in the CHEK2 locus, shared by affected CHEK2 variant carriers. Analysis of 62 individuals CHEK2 wild-type indicated that none presented the Hcac haplotype. The estimated age for this variant suggested that it was transmitted by a relatively recent common ancestor. CONCLUSIONS We identified a founder CHEK2 pathogenic variant, which is likely to underlie thyroid cancer and other cancer manifestations in the Roma population.
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Affiliation(s)
- Carolina Pires
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Inês Jorge Marques
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Chronic Diseases Research Centre (CEDOC), Universidade Nova de Lisboa, Lisboa, Portugal
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Daniela Dias
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Branca Maria Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal.
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31
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Moura MM, Cabrera RA, Esteves S, Cavaco BM, Soares P, Leite V. Correlation of molecular data with histopathological and clinical features in a series of 66 patients with medullary thyroid carcinoma. J Endocrinol Invest 2021; 44:1837-1846. [PMID: 33575974 DOI: 10.1007/s40618-020-01456-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/18/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Medullary thyroid carcinoma (MTC) displays a wide variety of histopathological features, and several histological variants have been described. In follicular cell-derived thyroid carcinomas, there is a good correlation between genotype and phenotype. In this study, we investigated whether such a correlation is also present in MTC. METHODS The histopathological features were evaluated in a series of 66 molecularly characterised tumours and correlated with the clinical characteristics. RESULTS Most MTC exhibited the classical variant (83.3%). Other variants included spindle cell (6.1%), pseudopapillary (4.5%), paraganglioma-like (3.0%), angiosarcoma-like (1.5%), and oncocytic follicular (1.5%). Tumours were classified into four groups: group 1, with somatic p.Met918Thr and p.Ala883Phe RET mutations; group 2, with other RET mutations; group 3, with RAS mutations; and group 4, without RET or RAS mutations. Tumours from groups 1 and 4 were typically associated with the classical variant, with abundant fibrosis, lymphovascular invasion, extrathyroidal extension, and more advanced stages of disease, whereas group 2 included histological variants other than the classical variant (namely, pseudopapillary and paraganglioma-like), with tumours that were highly cellular, less invasive, and with a better overall prognosis. In tumours from group 4, amyloid deposition was characteristically absent or low. The spindle cell variant appeared only in tumours from group 3, which had high cellularity and a degree of invasion and prognosis intermediate between groups 1 and 2, but better than group 4. The grade of fibrosis correlated directly with the clinical outcome. CONCLUSION Our results support the idea that a genotype-phenotype correlation does, indeed, exist in MTC. However, further studies are warranted to confirm these findings in a larger sample size.
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Affiliation(s)
- M M Moura
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal.
| | - R A Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 , Lisboa, Portugal
| | - S Esteves
- Unidade de Investigação Clínica (UIC), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 , Lisboa, Portugal
| | - B M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - P Soares
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia, Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135, Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-135, Porto, Portugal
| | - V Leite
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 , Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal
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Faias S, Prazeres S, Cunha M, Pereira L, Roque R, Chaves P, Cravo M, Claro I, Silveira M, Leite V, Dias Pereira A. Chromogranin A and NSE in cystic pancreatic neuroendocrine tumors. Clin Res Hepatol Gastroenterol 2021; 45:101601. [PMID: 33386244 DOI: 10.1016/j.clinre.2020.101601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Sandra Faias
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal; Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal.
| | - Susana Prazeres
- Clinical Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Mario Cunha
- Clinical Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Luisa Pereira
- Center of Mathmatics and Applications (CMA-UBI), Universidade da Beira Interior, Covilhã, Portugal.
| | - Ruben Roque
- Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Paula Chaves
- Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Marília Cravo
- Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Isabel Claro
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Margarida Silveira
- Clinical Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal; Faculty of Medical Sciences of Lisbon, Lisboa, Portugal.
| | - A Dias Pereira
- Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, EPE, Lisboa, Portugal.
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Maciel J, Donato S, Simões H, Leite V. Clinical outcomes of a conservative approach in cervical lymph node metastases of thyroid cancer. Clin Endocrinol (Oxf) 2021; 94:460-465. [PMID: 32757319 DOI: 10.1111/cen.14306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/27/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022]
Abstract
CONTEXT Lymph node metastases (LNM) can be present in 35% of patients with differentiated thyroid cancer (DTC), and the management of persistent/recurrent nodal disease has been controversial. Watchful waiting may be a reasonable approach in selected patients, but uncertainty about clinical outcomes remains a concern. OBJECTIVE To investigate the outcomes of patients with DTC with recurrent/persistent confirmed LNM under surveillance. METHODS Patients with LNM from DTC were selected from databases of needle washout thyroglobulin measurements and fine-needle aspiration biopsies performed in our institution. Patients with confirmed metastases, in whom active surveillance was initially proposed, were selected. Main clinical outcomes were analysed. RESULTS We found 89 patients with LNM under surveillance. Classic papillary was the most frequent variant (44%). During a median follow-up of 3 (0.5-17.2) years, different treatments were needed in 35 (39.3%) patients: radioactive iodine (RAI) in 23 (25.8%), surgery in 9 (10.1%) and radiotherapy (RT) in 3 (3.4%). From those submitted initially to RAI, progression of disease was observed in 8 patients, 4 requiring other treatment modalities: surgery (n = 2), RT (n = 1) and RAI (n = 1). The remaining 54 (60.7%) patients maintained surveillance. In this group, progression of disease was observed in 26 (48.1%), due to increase in the number and/or volume of metastases, but further treatments were not required. CONCLUSION In a group of patients with cervical LNM under active surveillance, only 16.9% (n = 15) required invasive intervention (surgery or RT).
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Affiliation(s)
- Joana Maciel
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E, Lisbon, Portugal
| | - Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E, Lisbon, Portugal
| | - Helder Simões
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E, Lisbon, Portugal
- Faculty of Medical Sciences of Lisbon, Lisbon, Portugal
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Dias D, Vilar H, Passos J, Leite V. Central diabetes insipidus caused by a pituitary stalk germinoma resembling infundibuloneurohypophysitis. BMJ Case Rep 2020; 13:13/9/e234724. [PMID: 32912882 DOI: 10.1136/bcr-2020-234724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We report the case of a pituitary stalk germinoma initially misdiagnosed and treated as infundibuloneurohypophysitis (INH). A 27-year-old man presented with a 1-year history of polydipsia, polyuria, nycturia consistent with central diabetes insipidus and a hyperintense pituitary stalk lesion on MRI. A possible INH diagnosis was considered, after excluding other pathologies. Lesion biopsy was discarded at that time on the ground of a small target and the high risk of added morbidity. Oral desmopressin led to initial symptoms resolution but, in the following months, an anterior panhypopituitarism developed, in spite of appropriate treatment and, by that time, the brain MRI also revealed lesion growth, which prompted a biopsy recommendation. The pathology analysis revealed a germinoma. After chemotherapy and radiotherapy, there was complete disappearance of the pituitary lesion, but the panhypopituitarism persisted. In conclusion, this case highlights the importance and difficulty of precise diagnosis in the initial assessment of pituitary stalk lesions and the need for close monitoring of treatment response. Diagnostic reassessment and biopsy in atypical cases is the only path to achieve the correct diagnosis and treatment.
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Affiliation(s)
- Daniela Dias
- Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Helena Vilar
- Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - João Passos
- Neurology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal.,Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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35
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Cavaco D, Carvalhal S, Leite V. Palliative Electrochemotherapy Treatment of Cutaneous Metastases in a Patient with Advanced Thyroid Papillary Carcinoma. Eur Thyroid J 2020; 9:221-224. [PMID: 32903929 PMCID: PMC7445661 DOI: 10.1159/000507888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022] Open
Abstract
Advanced papillary thyroid carcinoma (PTC) with cutaneous metastases may cause pain, ulceration, and bleeding. Electrochemotherapy (ECT) is a minimally invasive treatment of tumors located in the skin and subcutaneous tissue. The electric pulses potentiate the toxicity of cytostatic agents entering the tumor cell. It is highly effective especially to relieve pain and improve the quality of life. The adverse events are local and transient. A case of progressive metastatic PTC who developed bleeding cutaneous metastases treated with ECT is described.
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Affiliation(s)
- Daniela Cavaco
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- *Daniela Cavaco, Department of Endocrinology Instituto Português de Oncologia de, Lisboa Francisco Gentil, Rua Prof. Lima Basto, PT–1099-023 Lisbon (Portugal),
| | - Sara Carvalhal
- Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Martins RG, Cunha N, Simões H, Matos MJ, Silva J, Torres I, Rodrigues F, Leite V, Teixeira MR, Bugalho MJ. Surveillance of succinate dehydrogenase gene mutation carriers: Insights from a nationwide cohort. Clin Endocrinol (Oxf) 2020; 92:545-553. [PMID: 32181896 DOI: 10.1111/cen.14184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Mutations in the genes coding for succinate dehydrogenase (SDHx) are the most frequent germline alterations in pheochromocytomas and paragangliomas. Evidence for the advantages associated with presymptomatic screening for SDHx mutation carriers is scarce. This study describes a nationwide cohort of these mutation carriers and aims to compare patients with clinical manifestations of the disease and those diagnosed through genetic screening. DESIGN Cross-sectional study. PATIENTS SDHx mutation carriers (n = 118) followed through the Portuguese Oncology referral centres: 41 probands and 77 nonprobands. MEASUREMENTS All participants were subjected to biochemical and body imaging examinations for a complete assessment of the extent and spread of disease. Clinical data obtained this way were further analysed. RESULTS The mean age of this cohort was 44.5 ± 17.4 years, and more than half carried the same founder SDHB mutation. About 50.8% of the mutation carriers developed pheochromocytomas or paragangliomas. Compared to patients diagnosed through genetic screening, those diagnosed clinically were characterized by larger tumours (P < .001), more frequent metastases (P = .024), were more frequently subjected to surgery (P = .011) and radiotherapy (P = .013), and had worse outcomes, such as macroscopic positive margins (P = .034). Persistent and/or unresectable disease and disease-related mortality were also more frequent in symptomatic patients compared to those diagnosed through genetic screening (P = .014). CONCLUSIONS In this nationwide cohort study, a large proportion of mutation carriers were found to develop SDHx-related neoplasia. Genetic testing and subsequent follow-up resulted in the diagnosis of smaller and nonmetastatic tumours, fewer treatment procedures, fewer complications and greater number of disease-free patients.
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Affiliation(s)
- Raquel G Martins
- Endocrinology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Porto, Porto, Portugal
- Research Centre, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Nuno Cunha
- Clinical Laboratory Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Helder Simões
- Endocrinology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
- Faculty of Medical Sciences, Nova Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Maria João Matos
- Endocrinology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - João Silva
- Genetics Department and Research Centre, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Isabel Torres
- Endocrinology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Fernando Rodrigues
- Endocrinology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Valeriano Leite
- Endocrinology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
- Faculty of Medical Sciences, Nova Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Manuel R Teixeira
- Genetics Department and Research Centre, Portuguese Oncology Institute of Porto, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Maria João Bugalho
- Endocrinology, Diabetes and Metabolism Department, CHULN-Hospital Santa Maria, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Souteiro P, Donato S, Costa C, Pereira CA, Simões-Pereira J, Oliveira J, Belo S, Santos AP, Cardoso H, Leite V, Carvalho D, Torres I. Diagnosis, treatment, and survival analysis of adrenocortical carcinomas: a multicentric study. Hormones (Athens) 2020; 19:197-203. [PMID: 31823340 DOI: 10.1007/s42000-019-00161-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Current guidelines specify controversial areas in adrenocortical carcinomas (ACC), such as optimal follow-up time after remission and identification of prognostic markers. We aim to address these topics by analyzing four reference centers in our country. METHODS Cross-sectional multicentric study of 69 patients (mean age: 51.7 ± 16.7 years-old; women, 72.5%). Kaplan-Meier survival curves and Cox regression analysis were used to calculate overall survival and its predictors. RESULTS Thirty-eight individuals (55.0%) had hormonal autonomous production, and 40.6% of the patients presented with metastasis. Surgery was performed in 84.1% of them. Most of these patients (72.4%) were then assigned to adjuvant therapy, while 27.6% were actively surveilled. Among patients undergoing surgery, those who achieved transient remission presented a longer survival time (66 months) than those who never reached the disease-free status (21 months) (p = 0.021). One patient presented with recurrence more than 7 years after complete tumor resection. The lowest overall survival was observed in patients (n = 11) assigned to palliative care since diagnosis (9 months). Tumor stage was identified as the only independent predictor of survival in our cohort (p = 0.006). Five-year survival was 67% for tumors confined to the adrenal space (stage I/II), 56% for locally advanced disease (stage III), and 0% for metastatic disease (stage IV). CONCLUSION This study reinforces the dismal prognosis of ACC, the need for long-term follow-up, and tumor stage as the most important survival predictor. Reviewing medical records in such rare conditions is an opportunity to identify insufficiencies and to improve medical care.
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Affiliation(s)
- Pedro Souteiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Faculty of Medicine, Universidade do Porto, Porto, Portugal.
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - Sara Donato
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Cláudia Costa
- Department of Endocrinology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Catarina A Pereira
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Simões-Pereira
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Joana Oliveira
- Department of Endocrinology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Paula Santos
- Department of Endocrinology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Helena Cardoso
- Department of Endocrinology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Valeriano Leite
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Isabel Torres
- Department of Endocrinology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
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Martins AC, Simões H, Leite V. Primary hyperparathyroidism: a retrospective study over 18 years in an oncology center. International Journal of Endocrine Oncology 2019. [DOI: 10.2217/ije-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To study primary hyperparathyroidism (pHPT) in an oncology center, including its possible association with malignancy and ionizing radiation. Methods: Retrospective analysis of 188 patients with sporadic pHPT treated with parathyroidectomy between 2000 and 2018. We studied the etiology, clinical and biochemical features of pHPT, history of malignancies and exposure to radiotherapy. Results: pHPT was caused by parathyroid adenoma in 90.4%, hyperplasia in 5.3% and carcinoma in 4.3%. Cure and recurrence rates of pHPT were 99 and 4.3%, respectively. Median follow-up time was 19 months. Prevalence of malignancies was 30%, mostly thyroid and breast cancer. Radiotherapy of the head, neck or thorax (8.5%) was not associated with worse hypercalcaemia or recurrence. Males had larger adenomas, higher calcium and parathyroid hormone (p < 0.01). Conclusion: Prevalence of parathyroid carcinoma and other malignancies was higher than reported in other studies. Ionizing radiation exposure was unrelated with pHPT severity. Men had more severe pHPT. High cure and low recurrence rates were achieved.
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Affiliation(s)
- Ana C Martins
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Endocrinology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Helder Simões
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Pinto AT, Pojo M, Simões-Pereira J, Roque R, Saramago A, Roque L, Martins C, André S, Cabeçadas J, Leite V, Cavaco BM. Establishment and characterization of a new patient-derived anaplastic thyroid cancer cell line (C3948), obtained through fine-needle aspiration cytology. Endocrine 2019; 66:288-300. [PMID: 31368081 DOI: 10.1007/s12020-019-02009-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/06/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Anaplastic thyroid cancer (ATC) is among the most aggressive and unresectable tumors, presenting a bad prognosis. A better comprehension of the functional and molecular mechanisms behind the aggressiveness of this cancer, as well as new biomarkers for aggressiveness, prognosis, and response to therapy are required. However, owing to their irresectability, ATC tissue is not always accessible. Here we describe the establishment and characterization of a new patient-derived cell line, obtained from an unresectable ATC through fine-needle aspiration cytology (FNAC). METHODS The morphology, expression of epithelial and thyroid markers, cytogenetic, mutational and gene expression profiles, doubling time, and drug-resistance profile of the new cell line, designated C3948, were investigated using several methodologies: immunostaining, karyotype analysis, comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH), next-generation sequencing (NGS), Sanger sequencing, gene expression microarrays, cell counting, and IC50 determination. RESULTS Results indicate that C3948 cell line has a histological phenotype representative of original ATC cells and a completely aberrant karyotype with many chromosomal losses and gains; harbors mutated TP53, STK11, and DIS3L2 genes; presents a gene expression profile similar to C643 ATC commercial cell line, but with some unique alterations; has a doubling time similar to C643; and the IC50 profile for paclitaxel, doxorubicin, and cisplatin is similar to C643, although higher for cisplatin. CONCLUSIONS These observations are consistent with a typical ATC cell profile, supporting C3948 cell line as a novel preclinical model, and FNAC as a useful approach to better study anaplastic thyroid cancer, including testing of new anticancer therapies.
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Affiliation(s)
- Ana T Pinto
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Marta Pojo
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Joana Simões-Pereira
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
- Faculdade de Ciências Médicas, Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
| | - Ruben Roque
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Lúcia Roque
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Carmo Martins
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Saudade André
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - José Cabeçadas
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - Valeriano Leite
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
- Faculdade de Ciências Médicas, Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal
| | - Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) E.P.E., Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal.
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Sousa Santos F, Joana Santos R, Leite V. Sorafenib and Sunitinib for the Treatment of Metastatic Thyroid Cancer of Follicular Origin: A 7-Year Single-Centre Experience. Eur Thyroid J 2019; 8:262-267. [PMID: 31768337 PMCID: PMC6873046 DOI: 10.1159/000501680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) is a rare form of DTC which poses a therapeutic challenge due to the scarcity of effective treatment options. In recent years several tyrosine kinase inhibitors targeting specific molecular pathways involved in its pathogenesis have been investigated, such as sorafenib, lenvatinib, and sunitinib. These appear to be associated with improved progression-free survival (PFS). OBJECTIVES We aim to describe our experience with sorafenib and sunitinib in the treatment of RAI-refractory metastatic DTC and to evaluate and compare their efficacy and adverse effect profiles. METHOD A total of 28 patients with RAI-refractory metastatic DTC were included - 26 had first-line treatment with sorafenib (8 subsequently switched to sunitinib, most due to disease progression) and 2 with sunitinib. We evaluated PFS and best radiological response achieved with each agent as primary endpoints. The secondary objective was to describe adverse effects and safety profile. RESULTS Mean PFS was 10.8 months with sorafenib and 6 months with sunitinib as a second-line treatment. Best overall response was partial remission (PR) with either agent - PR rate of 30.7% with sorafenib and 37.5% with second-line sunitinib. All treatment courses had registered adverse effects and 13.9% justified definitive treatment cessation. CONCLUSIONS Sorafenib and sunitinib appear to be effective treatment options in delaying disease progression of patients with RAI-refractory metastatic DTC, with an acceptable safety profile. Interestingly, sunitinib appears to show some efficacy even in patients who experience disease progression on sorafenib.
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Affiliation(s)
- Francisco Sousa Santos
- Endocrinology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- *Francisco Sousa Santos, Endocrinology Department, Centro Hospitalar Lisboa Ocidental, Hospital de Egas Moniz, Rua da Junqueira 126, PT–1349-019 Lisbon (Portugal), E-Mail
| | - Rita Joana Santos
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Faculty of Medical Sciences of Lisbon, Lisbon, Portugal
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Donato S, Simões H, Pinto AT, M Cavaco B, Leite V. SDHx-related pheochromocytoma/paraganglioma - genetic, clinical, and treatment outcomes in a series of 30 patients from a single center. Endocrine 2019; 65:408-415. [PMID: 31104306 DOI: 10.1007/s12020-019-01953-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Germline mutations in the four genes that encode the succinate dehydrogenase complex (SDHx) are a risk factor for developing pheochromocytomas and/or paragangliomas. The precise genotype-phenotype correlations are still uncertain and the most common SDHx genetic defects in the Portuguese population are poorly described. The objectives of our study were to characterize the genetic alterations, clinical features, and treatment outcomes of a cohort of SDHx-related pheochromocytomas and/or paragangliomas patients. METHODS Single center, retrospective analysis based on the presence of a SDHx mutation in cases diagnosed from 1986 until October 2016. RESULTS Thirty cases were included. The mean age at diagnosis was 36.8 years (±15.4 years) and 53.3% were females. Remission was observed in 33.3% and stable disease (including partial responses) in 53.0%. SDHC and SDHD patients were prone to develop single and multiple head and neck paragangliomas, respectively. SDHB patients carried an increased risk of malignancy. Deletions in SDHB exon-1 and in SDHD exon-4 were the most common genetic findings. SDHB patients and head and neck paragangliomas had the worse prognosis, the former related to malignancy, and the latter to cranial nerve deficits, unresectable disease, and multimodality interventions. Peptide receptor radionuclide therapy and radioactive iodine MIBG therapy proved to be ineffective. Radiotherapy represented a good alternative in unresectable head and neck paragangliomas and in bone metastases. CONCLUSION This single center study is the most complete Portuguese cohort in the literature and helps to understand the behavior of tumors based on their genotype and anatomical location.
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Affiliation(s)
- Sara Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
| | - Helder Simões
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Teresa Pinto
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Sousa DP, Pojo M, Pinto AT, Leite V, Serra AT, Cavaco BM. Nobiletin Alone or in Combination with Cisplatin Decreases the Viability of Anaplastic Thyroid Cancer Cell Lines. Nutr Cancer 2019; 72:352-363. [DOI: 10.1080/01635581.2019.1634745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Diana P. Sousa
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Professor Lima Basto, Lisboa, Portugal
| | - Marta Pojo
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Professor Lima Basto, Lisboa, Portugal
| | - Ana T. Pinto
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Professor Lima Basto, Lisboa, Portugal
| | - Valeriano Leite
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Professor Lima Basto, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Professor Lima Basto, Lisboa, Portugal
| | - Ana Teresa Serra
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa (ITQB NOVA), Oeiras, Portugal
| | - Branca M. Cavaco
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Professor Lima Basto, Lisboa, Portugal
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Lopes-Ventura S, Pojo M, Matias AT, Moura MM, Marques IJ, Leite V, Cavaco BM. The efficacy of HRAS and CDK4/6 inhibitors in anaplastic thyroid cancer cell lines. J Endocrinol Invest 2019; 42:527-540. [PMID: 30191474 DOI: 10.1007/s40618-018-0947-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Anaplastic thyroid carcinomas (ATCs) are non-responsive to multimodal therapy, representing one of the major challenges in thyroid cancer. Previously, our group has shown that genes involved in cell cycle are deregulated in ATCs, and the most common mutations in these tumours occurred in cell proliferation and cell cycle related genes, namely TP53, RAS, CDKN2A and CDKN2B, making these genes potential targets for ATCs treatment. Here, we investigated the inhibition of HRAS by tipifarnib (TIP) and cyclin D-cyclin-dependent kinase 4/6 (CDK4/6) by palbociclib (PD), in ATC cells. METHODS ATC cell lines, mutated or wild type for HRAS, CDKN2A and CDKN2B genes, were used and the cytotoxic effects of PD and TIP in each cell line were evaluated. Half maximal inhibitory concentration (IC50) values were determined for these drugs and its effects on cell cycle, cell death and cell proliferation were subsequently analysed. RESULTS Cell culture studies demonstrated that 0.1 µM TIP induced cell cycle arrest in the G2/M phase (50%, p < 0.01), cell death, and inhibition of cell viability (p < 0.001), only in the HRAS mutated cell line. PD lowest concentration (0.1 µM) increased significantly cell cycle arrest in the G0/G1 phase (80%, p < 0.05), but only in ATC cell lines with alterations in CDKN2A/CDKN2B genes; additionally, 0.5 µM PD induced cell death. The inhibition of cell viability by PD was more pronounced in cells with alterations in CDKN2A/CDKN2B genes (p < 0.05) and/or cyclin D1 overexpression. CONCLUSIONS This study suggests that TIP and PD, which are currently in clinical trials for other types of cancer, may play a relevant role in ATC treatment, depending on the specific tumour molecular profile.
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Affiliation(s)
- S Lopes-Ventura
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - M Pojo
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - A T Matias
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - M M Moura
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - I J Marques
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Centro de Estudos de Doenças Crónicas (CEDOC), Rua Câmara Pestana nº 6, 6-A, Edifício CEDOC II, 1150-082, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056, Lisbon, Portugal
| | - V Leite
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056, Lisbon, Portugal
| | - B M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal.
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Chaves C, Chaves M, Serpa S, Saramago A, Leite V, Cavaco B, Anselmo JDTS, Cesar R. SUN-447 Screening of Genetic Alterations in Patients with Giant Prolactinomas. J Endocr Soc 2019. [PMCID: PMC6552917 DOI: 10.1210/js.2019-sun-447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Prolactinomas are the most common pituitary adenomas. The majority occurs sporadically in women at childbearing age. Only 5% have a genetic etiology usually in the context of MEN1 syndrome, Carney Complex or McCune-Albright Syndrome. Mutations of the AIP gene (aryl hydrocarbon receptor interacting protein) are also associated with familial cases of pituitary adenomas, however with low penetrance (20-23%) (1). Specific characteristics of pituitary adenomas, as the size of the tumor, age of onset and the existence of multiples cases in the same family, may predict a genetic origin. Giant prolactinomas are the largest prolactinomas and contrasting with micro and macroprolactinomas they are found mainly in young males. We wondered whether these tumors have a genetic etiology. With this purpose in mind, we studied four male patients, aged 26 to 42 years who presented pituitary adenomas (>4 cm in diameter) with prolactin levels above 4000 ng/ml (normal 10-21 ng/ml). Diagnosis of large pituitary adenomas in young males, from the same small community, pointed to a possible common genetic origin. After extraction of peripheral blood DNA, samples were analyzed by Next Generation Sequencing (NGS) and using the TruSightCancer Gene Set (Illumina) methodology. Investigation of significant deletions and/or duplications was performed using the MLPA (Multiplex ligation-dependent probe amplification) technique. No mutation in the MEN1 gene was detected. A mutation of the AIP gene c.47G>A expecting to lead to a substitution of arginine by histidine at position 16 (p.Arg16His) of the aryl hydrocarbon receptor interacting protein, was identified in two patients. Both inherited the mutation from their fathers. The mutation was not found in other members of their families. The prolactin level in one of the affected fathers was 240 ng/ml and the CT scan showed a microprolactinoma of 6 mm. No pituitary alterations were found in the other progenitor harboring the mutation. This variant of the gene AIP (p.Arg16His) is described in a database of 1000 Genomes and ExAC with an allelic frequency in the European population of 0.3%. Insilico analysis and the information available in the literature as well as in databases are not concordant regarding the pathogenicity of this alteration in AIP gene. However, the familial segregation study in our patients is in favor of its pathogenicity. In conclusion, the variant of the AIP gene identified in the present study may be associated with giant prolactinomas. 1)Hernández-Ramírez LC et al.; International FIPA Consortium. Landscape of familial isolated and young-onset pituitary adenomas: prospective diagnosis in AIP mutation carriers. J Clin Endocrinol Metab 2015;100:E1242-4. 2) Aflorei ED et al.; In vivo bioassay to test the pathogenicity of missense human AIP variants. J Med Genet 2018;0:1-8. Doi:10.1136/jmedgenet-2017-105191
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Affiliation(s)
- Carolina Chaves
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Mariana Chaves
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Sara Serpa
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Ana Saramago
- Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, , Portugal
| | - Valeriano Leite
- Servico Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, , Portugal
| | - Branca Cavaco
- Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, , Portugal
| | - Joao D T S Anselmo
- Serv de Endo and Nutrition, Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Rui Cesar
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
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Chaves C, Chaves M, Pereira B, Silva D, Saramago A, Leite V, Cavaco B, Anselmo JDTS, Cesar R. OR15-3 Extreme Phenotypic Variability of a Novel Mutation of MEN1 Gene in a Family with 14 Carriers across 3 Generations. J Endocr Soc 2019. [PMCID: PMC6554855 DOI: 10.1210/js.2019-or15-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disease characterized by the development of tumoral lesions usually benign in different glands. The most common tumors involve the parathyroid, pituitary and endocrine pancreas. Over 1300 mutations of MEN1 gene have been identified in approximately 4000 patients. Attempts to identify a correlation between genotype and phenotype have been unsuccessful as symptoms can vary among families and even among relatives that share the same mutation. The aim of this work is to characterize a family with a new mutation of MEN1 gene, through clinical findings, biochemical tests, and morphologic exams. The index case is a 38 years-old man with recurrent renal lithiasis during the last 20-years. In addition to the primary hyperparathyroidism, the patient also presented a pituitary microadenoma with hyperprolactinemia. The coexistence of these two manifestations suggested the diagnosis of MEN1. Genetic tests detected a new heterozygous germinal mutation in the exon 9 of the gene MEN1: c.1321_1323 dup TGG, which is expected to lead to a duplication of the tryptophan (p.Trp 441dup) of the MENIN protein. This variant is not described in the available databases (1000 Genomes e ExAC) nor in the ClinVar (online public archive). The analysis in silico performed with the software Mutation Taster classified this variant as the “pathogenic.” The family history of the patient was collected and a genealogical tree of the family was made. Written informed consent was obtained. The genetic diagnosis proposed to the members of this family identified 14 carriers of the mutation across 3 generations (including the index case), aged between 5 and 71 years old. A screening program to search for alterations in MEN1 positive carriers showed that primary hyperparathyroidism was the most common manifestation involving 6 patients. However, only 50% (2/4) of the subjects above 60 years-old were affected what is in favor of a low penetrance of this mutation. In three adult carriers, the only clinical manifestation was the presence of non-functional pancreatic (3) and lung (1) neuroendocrine tumors; Cushing's disease was the first and so far unique manifestation of the disorder in an 18-year-old girl. Despite sharing the same mutation and being exposed to similar environmental conditions as they all live on the same island, carriers of the mutation in this family presented variable phenotypes. This finding suggests that the nature and effect of the second hit that triggers the tumoral lesion in patients that carry the genomic mutation are mainly unknown. On the other side, this phenotypic variability demands the definition of a screening protocol, to correctly value the clinical manifestations and biochemical tests with implication in the prognosis of these patients.
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Affiliation(s)
- Carolina Chaves
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Mariana Chaves
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Bernardo Pereira
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - David Silva
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Ana Saramago
- Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, , Portugal
| | - Valeriano Leite
- Servico Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, , Portugal
| | - Branca Cavaco
- Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, , Portugal
| | - Joao D T S Anselmo
- Serv de Endo and Nutrition, Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
| | - Rui Cesar
- Hospital Divino Espirito Santo de Ponta Delgada, EPER, Ponta Delgada, , Portugal
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Matta-Coelho C, Simões-Pereira J, Vilar H, Leite V. Bone Metastases from Thyroid Carcinoma of Follicular Origin: A Single Institutional Experience. Eur Thyroid J 2019; 8:96-101. [PMID: 31192149 PMCID: PMC6514504 DOI: 10.1159/000494719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Overall, 2-13% of patients with thyroid cancer develop bone metastases (BM). In addition to decreased survival, patients with BM may present skeletal-related events (SRE) that impair the quality of life. Our objectives were to characterize clinical features, treatment approaches, and outcomes of patients with thyroid cancer and BM. MATERIAL AND METHODS We identified patients diagnosed with thyroid carcinoma of follicular origin and BM followed at the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisbon, Portugal, from 1991 to 2017. SRE were defined as the need for bone irradiation, bone surgery, spinal cord compression, or pathologic fractures. RESULTS The final cohort consisted of 86 patients, with a median follow-up time of 54 months (IQR 22.8-82.8), mainly women (67.4%), and a median age of 64 years (IQR 53.6-71.2). BM was the initial presentation of thyroid cancer in 36.0% of the patients. Bone involvement was multiple in 59.3% of the cases. Papillary carcinoma was the most frequent histological type, present in 47.7% of the patients, of which 56.1% presented the follicular variant. SRE were found in 76.7% of the patients. The most frequent SRE was radiotherapy (66.3%). Treatment with bisphosphonates was initiated in 19.8% of the patients. The 5-year specific survival was 60%, whereas the 10-year specific survival decreased to 50%. There were no differences in 5- or 10-year specific survival regarding gender, the occurrence of SRE, or histological type. However, patients with initial radioiodine non-avid lesions had a lower 5- and 10-year specific survival (p = 0.002). DISCUSSION The high frequency of patients with SRE was notable. The follicular variant of papillary thyroid cancer was the variant most commonly associated with BM, reflecting a more similar behavior to follicular carcinoma than the classic variant.
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Affiliation(s)
- Claudia Matta-Coelho
- Serviço de Endocrinologia, Hospital de Braga, Braga, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Helena Vilar
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- *Valeriano Leite, MD, PhD, Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, PT–1099–023 Lisbon (Portugal), E-Mail
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Simões-Pereira J, Moura MM, Marques IJ, Rito M, Cabrera RA, Leite V, Cavaco BM. The role of EIF1AX in thyroid cancer tumourigenesis and progression. J Endocrinol Invest 2019; 42:313-318. [PMID: 29968046 DOI: 10.1007/s40618-018-0919-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The EIF1AX gene was recently described as a new thyroid cancer-related gene. Its mutations were mainly reported in poorly differentiated (PDTC) and anaplastic thyroid cancers (ATC), but also in well-differentiated thyroid cancer (WDTC) and in benign thyroid lesions, although less frequently. Our aim was to address whether EIF1AX mutations are present in the different stages of thyroid tumourigenesis (from hyperplasia to well-differentiated and to poorly differentiated/undifferentiated lesions), and to clarify its role in this process. METHODS We analysed the EIF1AX gene in a series of 16 PDTC and ATC cases with coexistent well-differentiated regions and/or benign lesions. In EIF1AX mutant cases we also assessed the presence of RAS genes mutations. RESULTS We identified the mutation p.Ala113_splice in the EIF1AX gene in two PDTCs (neither present in the well-differentiated counterparts nor in the benign areas). One of these tumours also evidenced the mutation p.Glu61Arg in NRAS in both poorly and well-differentiated regions, further suggesting that the EIF1AX p.Ala113_splice mutation could be associated with tumoural progression. In another patient we did not find any EIF1AX alteration in the PDTC component, but we detected the EIF1AX p.Gly6_splice mutation in the PTC area (both regions were RAS wild-type). This mutation did not seem to be related with dedifferentiation. CONCLUSIONS According to our results, distinct mutations on EIF1AX may be related to different phenotypes/behaviours. Despite being a small series, which reflects the difficulty in retrieving PDTC and ATC surgical samples with well-differentiated and/or benign areas, our study may provide new insights into thyroid cancer tumourigenesis and dedifferentiation.
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Affiliation(s)
- J Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, N.º 130, 1169-056, Lisboa, Portugal
| | - M M Moura
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
| | - I J Marques
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, N.º 130, 1169-056, Lisboa, Portugal
- Centro de Estudos de Doenças Crónicas (CEDOC), Câmara Pestana N.º 6, 6-A e 6-B, 1150-082, Lisboa, Portugal
| | - M Rito
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
| | - R A Cabrera
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
| | - V Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, N.º 130, 1169-056, Lisboa, Portugal
| | - B M Cavaco
- Unidade de Investigação em Patobiologia Molecular (UIPM), Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, 1099-023, Lisboa, Portugal.
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Nunes da Silva T, Limbert E, Leite V. Poorly Differentiated Thyroid Carcinoma Patients with Detectable Thyroglobulin Levels after Initial Treatment Show an Increase in Mortality and Disease Recurrence. Eur Thyroid J 2018; 7:313-318. [PMID: 30574462 PMCID: PMC6276766 DOI: 10.1159/000491996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/09/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The role of thyroglobulin (Tg) in predicting death and recurrence risk in patients with poorly differentiated thyroid carcinoma (PDTC) is not well established. We aimed to analyze Tg levels following total thyroidectomy and adjuvant radioiodine treatment (RAI) in PDTC patients and correlate Tg levels with survival and recurrence. METHODS A retrospective analysis was conducted on 101 patients with PDTC who were treated between 1986 and 2010. Among them, 38 had no distant metastases at presentation, were managed by total thyroidectomy and adjuvant RAI, and had negative anti-Tg antibodies. An unstimulated Tg level < 1 ng/mL was used as a cut-off point for undetectable Tg levels. Association of patient and tumor characteristics with Tg levels was examined by χ2 test. Overall survival, disease-specific survival (DSS), and recurrence-free survival (RFS), stratified by Tg levels, were calculated by the Kaplan-Meier method and compared by the log-rank test. RESULTS Compared to patients with undetectable Tg, cases with detectable Tg had a lower probability of achieving free surgical margins (21.7 vs. 46.7%; p = 0.04), higher node status (73.3 vs. 21.8%; p = 0.005), decreased 5-year DSS (65 vs. 100%; p = 0.009), and worse 5-year RFS (32 vs. 84%, p = 0.010), with a significant number of patients having a recurrence in the first year (50 vs. 12.5%; p = 0.021). Patients with detectable Tg levels also showed worse locoregional (55.6 vs. 90.9%; p = 0.014) and distant control (5-year distant control of 46.9 vs. 91%; p = 0.017). CONCLUSIONS Our results suggest that detectable Tg levels after surgery and RAI in a subset of PDTC patients appear to predict a higher rate of death and recurrence.
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Affiliation(s)
- Tiago Nunes da Silva
- *Tiago Nunes da Silva, Department of Endocrinology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto, PT–1099-023 Lisbon (Portugal), E-Mail
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Cavaco BM, Canaff L, Nolin-Lapalme A, Vieira M, Silva TN, Saramago A, Domingues R, Rutter MM, Hudon J, Gleason JL, Leite V, Hendy GN. Homozygous Calcium-Sensing Receptor Polymorphism R544Q Presents as Hypocalcemic Hypoparathyroidism. J Clin Endocrinol Metab 2018; 103:2879-2888. [PMID: 29846619 DOI: 10.1210/jc.2017-02407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/22/2018] [Indexed: 02/11/2023]
Abstract
CONTEXT Autosomal dominant hypocalcemia type 1 (ADH1) is caused by heterozygous activating mutations in the calcium-sensing receptor gene (CASR). Whether polymorphisms that are benign in the heterozygous state pathologically alter receptor function in the homozygous state is unknown. OBJECTIVE To identify the genetic defect in an adolescent female with a history of surgery for bilateral cataracts and seizures. The patient has hypocalcemia, hyperphosphatemia, and low serum PTH level. The parents of the proband are healthy. METHODS Mutation testing of PTH, GNA11, GCM2, and CASR was done on leukocyte DNA of the proband. Functional analysis in transfected cells was conducted on the gene variant identified. Public single nucleotide polymorphism (SNP) databases were searched for the presence of the variant allele. RESULTS No mutations were identified in PTH, GNA11, and GCM2 in the proband. However, a germline homozygous variant (c.1631G>A; p.R544Q) in exon 6 of the CASR was identified. Both parents are heterozygous for the variant. The variant allele frequency was near 0.1% in SNP databases. By in vitro functional analysis, the variant was significantly more potent in stimulating both the Ca2+i and MAPK signaling pathways than wild type when transfected alone (P < 0.05) but not when transfected together with wild type. The overactivity of the mutant CaSR is due to loss of a critical structural cation-π interaction. CONCLUSIONS The patient's hypoparathyroidism is due to homozygosity of a variant in the CASR that normally has weak or no phenotypic expression in heterozygosity. Although rare, this has important implications for genetic counseling and clinical management.
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Affiliation(s)
- Branca M Cavaco
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Lucie Canaff
- Departments of Medicine, Physiology, and Human Genetics, McGill University Health Centre Research Institute, McGill University, Montréal, Quebec, Canada
| | - Alexis Nolin-Lapalme
- Departments of Medicine, Physiology, and Human Genetics, McGill University Health Centre Research Institute, McGill University, Montréal, Quebec, Canada
| | - Margarida Vieira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Tiago N Silva
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ana Saramago
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Rita Domingues
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Meilan M Rutter
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan Hudon
- Department of Chemistry, McGill University, Montreal, Quebec, Canada
| | - James L Gleason
- Department of Chemistry, McGill University, Montreal, Quebec, Canada
| | - Valeriano Leite
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Geoffrey N Hendy
- Departments of Medicine, Physiology, and Human Genetics, McGill University Health Centre Research Institute, McGill University, Montréal, Quebec, Canada
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Germano A, Schmitt W, Almeida P, Mateus-Marques R, Leite V. Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females. Clin Imaging 2018; 50:289-293. [PMID: 29738997 DOI: 10.1016/j.clinimag.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND A higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders. METHODS Included were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression. RESULTS Of the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference. CONCLUSIONS A referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.
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Affiliation(s)
- Ana Germano
- Hospital Professor Doutor Fernando Fonseca, EPE; Serviço de Imagiologia. IC 19, Amadora, Portugal.
| | - Willian Schmitt
- Hospital Professor Doutor Fernando Fonseca, EPE; Serviço de Imagiologia. IC 19, Amadora, Portugal
| | - Pedro Almeida
- Instituto de Biofísica e Engenharia Biomédica; Faculdade de Ciências, Universidade de Lisboa, Campo Grande, Lisbon, Portugal.
| | - Rui Mateus-Marques
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, Lisbon, Portugal
| | - Valeriano Leite
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
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