NRAS Gene Mutation in Differentiated High-Grade Thyroid Carcinoma With Multiphenotypic Metastatic Pattern: A Case Report

Differentiated high-grade thyroid carcinoma (DHGTC) has a high mitotic count (≥5 mitoses per 2mm²) and/or tumor necrosis without anaplastic features. These tumors are rare, and the prevalence is not yet established among thyroid malignancies. BRAF andRAS mutations are the main driver mutations in these tumors. We present a case of a 43-year-old woman with DHGTC and NRASmutation, presenting with metastatic follicular component to the bone and papillary component to lymph nodes.

Papillary Carcinoma Within Thyroglossal Duct Cyst: A Rare Midline Coexistence

Thyroglossal duct cysts (TDCs) develop papillary carcinomas in very rare cases. Mostly, in such cases, the diagnosis is established after the excision of a clinically benign TDC. An anterior neck mass was found in a 43-year-old man with papillary carcinoma arising in a TDC. Clinical, radiological, and analytical controls are necessary for the management of papillary carcinoma in the TDC. There is no need for thyroidectomy unless there are palpable abnormalities in the gland or significant changes on an ultrasound. The outcome of the papillary carcinoma does not seem to be significantly impacted by routinely performed thyroidectomy.

Cytopathology of the distant metastasis of papillary carcinoma of thyroid

AIMS

To describe the cytomorphological features at distant metastatic sites apart from lymph nodes in papillary thyroid carcinoma (PTC).

MATERIALS AND METHODS

A total of eight cytology cases from seven patients reported as metastatic papillary carcinoma of thyroid were reviewed including available clinical and radiological details. The details clinical and cytological features were studied.

RESULTS

There were a total of five males and two female patients. Two of these patients presented with lung nodules, two patients had bony lesion and lesion in kidney respectively and one patient had both bony and soft tissue lesions. Pleural fluid and bronchoalveolar lavage were received from remaining two patients. Cytology smears revealed papillary clusters and sheets of tumor cells, having round to oval nuclei with pale powdery chromatin, inconspicuous nucleoli and scant to moderate amount of cytoplasm. Nuclear features such as longitudinal nuclear grooves, intranuclear cytoplasmic inclusions were seen in all but one case. Nuclear enlargement and overlapping were variably present.

CONCLUSIONS

The diagnosis of metastatic PTC at uncommon locations is difficult. Since many of these locations are amenable to fine needle aspiration or exfoliative cytology evaluation, clinical awareness, and identification of classic cytomorphologic features can offer quick and accurate diagnoses. In cases with occult or unknown PTC presenting with metastases, cytomorphology may help in the prompt suggestion of detecting primary tumor in the thyroid.

A red herring, a wild-goose chase, and an unexpected diagnosis of concomitant malignancy and sarcoidosis

A 49-year-old male was evaluated in our hospital for chronic cough, cervical lymphadenopathy, and a testicular mass. As a part of the management, he underwent a cervical lymph node biopsy, which showed metastatic deposits from papillary carcinoma thyroid. Subsequently, he underwent orchidectomy for suspected testicular malignancy, but the biopsy showed discrete granulomatous inflammation consistent with sarcoidosis. This was followed by total thyroidectomy with neck node dissection. Nodal histopathological examination, this time, revealed a single node containing both malignancy and granulomas. Prior to the thyroid surgery, he underwent a mediastinoscopic sampling of the mediastinal nodes, which also showed granulomatous inflammation consistent with sarcoidosis. Sarcoidosis affecting the genitourinary system is a rare entity. The coexistence of sarcoidosis and thyroid malignancy poses a diagnostic challenge. A thorough review of the literature was done, and there are no reports from India on the above association. This is a unique case, which could possibly suggest an association between sarcoidosis and malignancy and highlights the importance of obtaining a tissue diagnosis in such cases.

The management of thyroid cancer in adults: a review of new guidelines

The management of thyroid cancer has been facilitated by the recent publication of the Guidelines for the management of thyroid cancer in adults under the auspices of the British Thyroid Association and the Royal College of Physicians. This is a consensus document that has been developed by a number of key investigators in the field. The central tenet of the guidelines is that thyroid cancer is a disease which requires specialist care from a multidisciplinary team, including an endocrinologist, nuclear medicine physician, thyroid surgeon and endocrine pathologist. The guidelines are comprehensive and detailed, covering differentiated (papillary and follicular) and medullary cancer of the thyroid. They have been written in sections aimed at thyroid cancer specialists, primary care physicians, patients and their families. The guidelines are greatly welcomed and represent a major step forwards in the co-ordination of specialist care for thyroid cancer in the UK.