Impact of BRAFV600E Mutation on Event-Free Survival in Patients with Papillary Thyroid Carcinoma: A Retrospective Study in a Romanian Population

We aimed to evaluate the prognostic value of BRAFV600E mutation in a series of 127 papillary thyroid carcinoma (PTC) cases as a single factor, and in synergic interaction with other standard risk factors. BRAFV600E mutation was assessed by real-time PCR. Event-free survival (EFS) was calculated between the date of the first evaluation and the date of occurrence of an adverse event or the date of the last known status. The prevalence of BRAFV600E mutation was 57.2%. The Kaplan-Meier analysis showed a significant reduction of EFS among cases harboring BRAFV600E mutation compared to non-mutated cases (p = 0.010). In addition, BRAFV600E mutation was found to better predict adverse outcomes when associated with the following risk factors: age ≥ 55 years old (p < 0.001), male gender (p < 0.001), conventional (p = 0.005) and tall cell (p = 0.014) histology, tumor size > 40 mm (p = 0.001), extrathyroidal extension (p = 0.001), multifocality (p = 0.001) and lymph node metastasis (p < 0.001). In univariate analysis, a 3.74-fold increased risk for a reduced EFS (p = 0.018) was found for BRAFV600E-mutated cases, but no increased risk was further confirmed by multivariate analysis. Our results highlight that BRAFV600E mutation cannot be used alone as an independent predictive factor in PTC patients, but is prognostically valuable if integrated in the context of other clinicopathological risk factors.

Radioiodine-131 Therapy Used for Differentiated Thyroid Cancer Can Impair Titanium Dental Implants: An In Vitro Analysis

BACKGROUND

The aim was to assess, in vitro, the effects of radioiodine-131 (I-131) on the structure of titanium implants.

MATERIAL AND METHODS

A total of 28 titanium implants were divided into 7 groups (n = 4) and irradiated at 0, 6, 12, 24, 48, 192 and 384 hours. At the end of the experiment, each sample was investigated via scanning electron microscopy (SEM) and electrochemical measures.

RESULTS

The control sample revealed a smooth and compact surface. The small micro-sized porosity is slightly visible at the macroscopic level, but the precise details cannot be observed. A mild exposure to the radioactive solution for 6 to 24 h showed a good preservation of the macro-structural aspects such as thread details and surface quality. Significant changes occurred after 48 h of exposure. It was noticed that the open-circuit potential (OCP) value of the non-irradiated implants move toward more noble potentials during the first 40 min of exposure to the artificial saliva and then stabilizes at a constant value of -143 mV. A displacement of the OCP values toward more negative values was observed for all irradiated implants; these potential shifts are decreasing, as the irradiation period of the tested implants increased.

CONCLUSION

After exposure to I-131, the structure of titanium implants is well preserved up to 12 h. The eroded particles start to appear in the microstructural details after 24 h of exposure and their numbers progressively increase up to 384 h after exposure.

Low-Molecular-Weight Heparins (LMWH) and Synthetic Factor X Inhibitors Can Impair the Osseointegration Process of a Titanium Implant in an Interventional Animal Study

Background and objectives: Cementless total hip arthroplasty is a common surgical procedure and perioperative thromboprophylaxis is used to prevent deep vein thrombosis or pulmonary embolism. Osseointegration is important for long-term implant survival, and there is no research on the effect of different thromboprophylaxis agents on the process of osseointegration. Materials and Methods: Seventy rats were allocated as follows: Group I (control group), Group II (enoxaparin), Group III (nadroparin), and Group IV (fondaparinux). Ovariectomy was performed on all subjects, followed by the introduction of an intramedullary titanium implant into the femur. Thromboprophylaxis was administered accordingly to each treatment group for 35 days postoperatively. Results: Group I had statistically significantly lower anti-Xa levels compared to treatment groups. Micro-CT analysis showed that nadroparin had lower values compared to control in bone volume (0.12 vs. 0.21, p = 0.01) and percent bone volume (1.46 vs. 1.93, p = 0.047). The pull-out test showed statistically significant differences between the control group (8.81 N) compared to enoxaparin, nadroparin, and fondaparinux groups (4.53 N, 4 N and 4.07 N, respectively). Nadroparin had a lower histological cortical bone tissue and a higher width of fibrous tissue (27.49 μm and 86.9 μm) at the peri-implant area, compared to control (43.2 μm and 39.2 μm), enoxaparin (39.6 μm and 24 μm), and fondaparinux (36.2 μm and 32.7 μm). Conclusions: Short-term administration of enoxaparin, nadroparin, and fondaparinux can reduce the osseointegration of titanium implants, with nadroparin having the most negative effect. These results show that enoxaparin and fondaparinux are preferred to be administered due to a lesser negative impact on the initial implant fixation.

IMMUNOHISTOCHEMICAL MARKERS AND SPECT/CT SOMATOSTATIN-RECEPTOR (99MTC-TEKTROTYD) UPTAKE IN WELL AND MODERATELY DIFFERENTIATED NEUROENDOCRINE TUMORS

Context

Diagnosis of primary NETs (neuroendocrine tumors) is challenging and often late due to tumor heterogeneity, and a wide variety of general symptoms. Low grade NETs are often indolent and have a good prognosis, especially in the early stages. Even so, some tumors are diagnosed using SPECT/CT either in the metastatic stage or directly as a metastasis with an unknown primary tumor.

Objective

This study aims to characterize well and moderately differentiated NETs, using Tektrotyd SPECT/CT imaging as well as from the viewpoint of NET immunohistochemical biomarker expression.

Design

Patients diagnosed with low grade neuroendocrine tumors (carcinoids) investigated over a period of 2 years, using SPECT/CT with 99mTc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) and confirmed through at least two immunohistochemical neuroendocrine markers were evaluated.

Subjects and Methods

Twenty-seven cases with neuroendocrine tumors were analyzed. Four patients met the inclusion criteria. Staining intensity was scored using a weak, moderate, or strong scoring system. CD56 was quantified using criteria derived from Her2 cell membrane staining evaluations.

Results

Patients included in the study had two well differentiated (G1) NETs and two moderately differentiated (G2) NETs. SPECT/CT with Tektrotyd showed variable intensity ranging from discreet to strong. All tumors expressed chromogranin A with at least moderate intensity, weak to moderate intensity for synaptophysin and variable CD56 intensity.

Conclusions

Chromogranin A and synaptophysin staining patterns may aid in primary tumor identification. CD56 stain intensity showed an inverse correlation with Tektrotyd uptake in carcinoids. Additional studies merit further investigation for use in clinical settings.

Rationale for therapeutic decision-making in locally advanced and metastatic radioactive iodine (RAI)-refractory differentiated thyroid cancer, starting from a clinical case

Iodine uptake and organification are the hallmarks of thyroid cells differentiation. The loss of these characteristics in thyroid cancer leads to radioactive iodine refractoriness, a rare condition that bears a low survival rate and poor prognosis. We present a 52-year-old patient presenting dry cough and dyspnea in the supine position. Imaging examinations revealed a thyroid nodule with a high suspicion of malignancy in the right thyroid lobe, multiple laterocervical and mediastinal lymph nodes, lung, bone, and brain metastases. Fine needle aspiration cytologic features have advocated for papillary thyroid cancer (PTC). The patient underwent total thyroidectomy and selective lymphadenectomy. Subsequently, the patient received suppressive treatment with levothyroxine and four courses of radioactive iodine therapy. In addition, to treat bone and brain metastases, the patient experienced external radiotherapy and glucocorticoid therapy. Despite this rigorous therapeutic management, the patient obtained an incomplete structural and functional response. Although the last two posttherapeutic ¹³¹I whole-body scans were negative, the patient had elevated stimulated thyroglobulin levels and loco-regional recurrence by thyroid ultrasound. This aspect would suggest that thyroid cells become unable to uptake ¹³¹I, most likely through the emergence of new genetic mutations in the cancer cells. In conclusion, our patient’s case suggests a ¹³¹I-refractory PTC, requiring the initiation of novel targeted systemic agents such as tyrosine kinase inhibitors, in order to improve structural and functional outcomes of radioactive iodine therapy and to afford prolonged progression-free survival advantage.

SERS-based DNA methylation profiling allows the differential diagnosis of malignant lymphadenopathy

This study highlights the potential of surface-enhanced Raman scattering (SERS) to differentiate between B-cell lymphoma (BCL), T-cell lymphoma (TCL), lymph node metastasis of melanoma (Met) and control (Ctr) samples based on the specific SERS signal of DNA extracted from lymph node tissue biopsy. Differences in the methylation profiles as well as the specific interaction of malignant and non-malignant DNA with the metal nanostructure are captured in specific variations of the band at 1005 cm^-1, attributed to 5-methylcytosine and the band at 730 cm^-1, attributed to adenine. Thus, using the area ratio of these two SERS marker bands as input for univariate classification, an area under the curve (AUC) of 0.70 was achieved in differentiating between malignant and non-malignant DNA. In addition, DNA from the BCL and TCL groups exhibited differences in the area of the SERS band at 730 cm^-1, yielding an AUC of 0.84 in differentiating between these two lymphadenopathies. Lastly, using multivariate data analysis techniques, an overall accuracy of 94.7% was achieved in the differential diagnosis between the BCL, TCL, Met and Ctr groups. These results pave the way towards the implementation of SERS as a novel tool in the clinical setting for improving the diagnosis of malignant lymphadenopathy.

The international approach of pediatric thyroid nodules and thyroid differentiated carcinoma. The starting point for the Romanian pediatric guideline

Background. The incidence of pediatric differentiated thyroid carcinoma (DTC) is increasing even though that this is a rare disease. It is known that there are important differences between adults and children especially in clinical presentation and genetic alterations. The only guideline for the diagnostic and therapeutic approach for the children with thyroid nodules and differentiated thyroid carcinoma is the American Thyroid Association (ATA) guideline published in 2015, but there could be improvements that we need to highlight in order to reduce the apparition of comorbidities and to improve the quality of life. There is also no national guideline in Romania for the treatment of this pathology in children. Materials and methods. This study is a review of the literature published in the last 5 years concerning the diagnostic and treatment of the pediatric thyroid cancer. Results. The management of the children with the suspicion of thyroid nodule should be done in specialized centers in a specialized, multidisciplinary team, with high volume surgeons. The diagnostic approach should include genetic testing. The surgical management could be less radical in certain cases. The pre-surgical evaluation and intraoperative laryngeal nerve monitoring should reduce the apparition of comorbidities. Conclusion. A European and also a national guideline for the management of pediatric thyroid nodules and thyroid carcinoma is mandatory to reduce the apparition of comorbidities and to improve the quality of life of the patients.

Thyroid carcinoma associated with other primary neoplasms, a single center study

Background and aims

Thyroid carcinoma is the most frequent endocrine malignancy. It develops following a complex interaction of environmental and genetic factors. Its incidence is on the rise mostly due to the frequent diagnosis of microcarcinomas (tumor <1 cm). In most cases, it has very good prognosis and survival rates. The incidence of a second primary malignancy in thyroid cancer patients is higher than in the general population. In this article, we focus on the role of BRAF V600E mutation in the development of other primary neoplasms associated with thyroid carcinoma.

Methods

This study was conducted in the department of Nuclear Medicine and Genetics of the “Prof. Dr. Ion Chiricuță” Institute of Oncology of Cluj-Napoca. We evaluated patients with thyroid carcinoma, who were diagnosed and treated for other malignancies such as breast, colorectal, lung cancer and malignant melanoma. In addition, we tested for the BRAF V600E mutation using paraffin samples of patients.

Results

We identified 17 patients that had thyroid carcinoma associated with other primary malignancies. Two of the patients included in the study had three associated primary cancers. The time interval between the diagnoses of two primary neoplasms in the same patient was 6.15 years, with a standard deviation (SD) of 5.39 years. The most common primary tumor associated with thyroid carcinoma in this study was breast cancer. We applied genetic testing for the BRAF V600E mutation in 12 patients. The BRAF V600E mutation positivity rate was 26.9% and most of the cancer associations were metachronous (occurring at least 6 months after thyroid cancer).

Conclusions

The BRAF V600E mutation is an important prognostic factor in the neoplasms included in this study, but its presence is not a predictive factor for the appearance of a metachronous or synchronous associated primary neoplasm to thyroid cancer.

Updates on the 2016 World Health Organization Classification of Pediatric Tumors of the Central Nervous System - a systematic review

Tumors of the central nervous system (CNS) represent the main cause of death through solid tumors in children and the second most frequent neoplasm in this patient group. The poor survival rate is due to many factors, such as the large diversity of morphological features, the particular micro-environmental characteristics of the nervous tissue, the relative rareness in relation to other childhood diseases, which leads to late diagnosis and the limited effectiveness of the available treatment options. Up until 2016, brain tumors were classified according to their histologic features. The new 2016 World Health Organization (WHO) Classification of CNS tumors incorporates molecular features, alongside the immunohistology, in order to provide a more accurate understanding of the disease. The treatment consists of surgery, radiation therapy and chemotherapy. We decided to review the literature on this pathology, in order to show the importance of the recent discoveries in this field.

A Comparative Study between 18F-FDG PET/CT and Conventional Imaging in the Evaluation of Progressive Disease and Recurrence in Ovarian Carcinoma

The aim of this study is to compare the efficiency of conventional imaging and 18F-FDG PET-CT in detecting progressive disease and recurrences over a period of one year (2018), in the case of ovarian cancer, and also to assess the importance of 18F-FDG PET/CT in changing the course of the treatment for these patients. This study included 29 patients diagnosed in various stages with ovarian carcinoma, most of them of epithelial origin. All patients were evaluated throughout their treatment using 18F-FDG PET/CT and various conventional techniques (computed tomography (CT), magnetic resonance imaging (MRI), abdominal and intravaginal ultrasound, chest X-ray). PET/CT was more useful and effective in our group of patients in detecting progressive disease compared with conventional imaging (37.93% vs. 17.24%) and also in establishing the recurrences (24.14% vs. 6.90%). Moreover, F18-FDG PET-CT led to a therapeutic change in 55.17% of the patients of our group, compared with only 17.24% after conventional imaging. This underlines the crucial aspect of the metabolic changes of tumors that should be assessed alongside the morphological ones, with PET-CT imaging remaining the only viable tool for achieving that at present. PET/CT with 18F-FDG represents one of the most important imaging techniques used in the diagnosis and management of ovarian carcinoma. Our results seem to fall in line with what other authors reported, indicating that 18F-FDG PET-CT is potentially gaining more ground in the management of ovarian carcinoma, by influencing therapeutic strategies and by being able to detect relapse and progression accurately.

Thyroid Microcarcinoma in Pediatric Population in Romania

Thyroid microcarcinoma in pediatric population in Romania Non-medullary thyroid cancer (TC) is the most common endocrine malignancy, with an increasing incidence in the recent years, due to the increase of the thyroid microcarcinoma. Thyroid microcarcinoma (mTC) is defined, according to WHO criteria, as ≤1 cm dimension thyroid carcinoma, being a rare disease in children population. In adults, the current guidelines recommend a limited surgical approach. In children, however, there are no specific guidelines for mTC. Due to the scarcity of these tumors, mTC in children have largely been understudied, to our knowledge with only one previous publication reporting on the outcomes of a large historic series of patients with mTC from the USA. In Romania, the incidence of TC is rising, one of the reason may be the effect of Chernobyl nuclear accident in the past and the iodine deficiency. The purpose of this study was to describe the characteristics and outcome of children diagnosed with mTC in Romania diagnosed from 1 January 2000 to 31 December 2018. During the study period we identified 77 cases of differentiated TC (papillary and follicular) and of these 20 cases (19.4%) were mTC. The mTC represented roughly one fifth of our nationwide pediatric population diagnosed in the last 20 years, the majority of cases being recorded in adolescents aged between 15–18 years. Although patients with apparently more unfavorable local phenotype were identified, this was not reflected in the outcome of the patients in terms of remission of the disease and survival. Our study illustrates the heterogeneity of the real-life practice with respect to the pediatric mTC, and underscores the need for carefully designed multicenter international studies, including larger cohorts of patients in order to provide the data required for establishing evidence based uniform protocols. The European Reference Networks (ERN), such as the ERN for Rare Endocrine Diseases (Endo-ERN) provides an ideal platform to initiate such collaborative studies.

Does Surgical Margin Width Remain a Challenge for Triple-Negative Breast Cancer? A Retrospective Analysis

Background and Objectives: Local and distant relapse (LR, DR) in breast cancer vary according to its molecular subtypes, with triple-negative breast cancer (TNBC) being the most aggressive. The surgical resection margin width (SRMW) for breast-conserving surgery (BCS) has been intensely debated, especially for the aforementioned subtype. The aim of this study was to examine the impact of SRMW on LR following BCS in TNBC patients. Materials and Methods: We conducted a retrospective study including all patients with TNBC for whom BCS was performed between 2005 and 2014. Results: Final analysis included a total of 92 patients, with a median tumor size of 2.5 cm (range 0-5 cm) and no distant metastasis at the time of diagnosis. A total of 87 patients had received neoadjuvant and/or adjuvant chemotherapy, and all patients had received adjuvant whole-breast radiotherapy. After a median follow-up of 110.7 months (95% CI, 95.23-126.166), there were 5 local recurrences and 8 regional/distant recurrences with an overall LR rate of 5.4%. The risk of LR and DR was similar between groups of patients with several SRMW cut-off values. Conclusions: Our study supports a safe "no ink on tumor" approach for TNBC patients treated with BCS.

Asymptomatic COVID-19 cancer patients incidentally discovered during F18-FDG PET/CT monitoring

Background

The aim of the study was to present the PET/CT imaging features in a small series of asymptomatic patients with known cancer pathologies, infected with the SARS-CoV-2 virus, which were incidentally discovered during their monitoring scan of F18-FDG PET/CT.

Methods

We included in our study a number of five cases (3 female and 2 male) out of 478 patients examined by F18-FDG PET/CT between March - April 2020, with confirmed diagnostic of cancer. Four patients had lung damages suggestive for the mentioned viral infection and 1 patient had multiple lung metastases from thyroid cancer. All patients were asymptomatic for acute respiratory disease at the time of examination, being subsequently confirmed for the viral infection by specific PCR analysis.

Results

The asymptomatic positive SARS-CoV-2 cancer patients discovered incidentally in PET/CT F18-FDG represent 0.83% and their imaging characteristics were suggestive for high FDG activity in the lung despite the lack of respiratory symptoms.

Conclusion

The SARS CoV-2 viral infection in asymptomatic cancer patients is a very rare possibility, but represents a challenging scenario both for the differential diagnosis in cancer and also for the epidemiologic context.

Diagnostic Performance of F18-FDG PET/CT in Male Breast Cancers Patients

INTRODUCTION

F18-FDG PET/CT is the most important hybrid imaging used in the diagnostic, staging, follow-up, and treatment evaluation response in cancer patients. However, it is well-known that in breast cancer the use of F18-FDG is not included in the first line protocol of initial diagnostic, both in female and male breast cancer patients. F18-FDG PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases, and other occult primary cancers. This study assesses F18-FDG PET/CT systemic staging in male patients with diagnosed breast cancer and determines detection rates for unsuspected distant metastases and synchronous malignancies.

METHODS

We analyzed a number of 170 male patients with breast cancer, seen between 2000-2020, in a tertiary center. From this group, between 2013-2020 a number of 23 patients underwent F18-FDG PET/CT. Rates of upstaging were determined for each case and the detection of other primary malignancies was analyzed.

RESULTS

Median age of male breast cancer group was 61.3 y (range, 34-85 y), most had intraductal carcinoma (82.4%) and unsuspected distant metastases, which increased patient stage to IV, observed in 27%. In 4 out 23 patients (17.4%), F18-FDG PET/CT identified synchronous cancers (2 prostate cancers, 1 thyroid and 1 colon cancer).

CONCLUSION

F18-FDG PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases, and other occult primary cancers. Baseline F18-FDG PET/CT has a substantial impact on the initial staging and on clinical management in male breast patients and should be considered for use in newly diagnosed patients.

Pituitary Metastases Discovered by 18F-FDG PET/CT During Other Cancers Monitoring: Are There Any Differences of SUVs Between Benign and Malignant Diseases?

F-FDG PET/CT might discover incidental pituitary lesions. We present the case of a 46-year-old woman with breast cancer metastasis in her pituitary. We analyzed 10,347 FDG PET/CT examinations from a tertiary center, finding 4 cases (0.038%) of pituitary metastatic disease from other cancers. We analyzed the differences between SUVmax in cases of physiological high uptake, primary tumor, and hypophysis metastases from other cancers in our database compared with the literature.

Differentiated Thyroid Cancer in Children in the Last 20 Years: A Regional Study in Romania

Pediatric thyroid carcinoma is a current area of interest, because there are few studies in this field; the current classification and treatment guidelines are extrapolated from adults, sometimes leading to overly aggressive treatments or incomplete treatment of the disease. The purpose of this retrospective study is to analyze the presentation, diagnosis, treatment, complications, and outcome of children diagnosed with thyroid cancer in the last two decades (2000–2018) at the Oncological Institute “Prof. Dr. Ion Chiricuță” Cluj-Napoca (IOCN) Romania, a tertiary center in a region with environmental influences from both the nuclear fallout of the Chernobyl accident and from iodine deficiency. The results were compared with those obtained in a previous study carried out in the same institution between 1991–2010, and with those obtained in a similar study carried out in Netherlands between 1970–2013, a cohort of children not exposed to the post-Chernobyl fallout. We statistically analyzed 62 patients. Papillary form was present in the majority of cases, and we highlighted the occurrence of thyroid microcarcinoma in children. A total of 85.4% of patients received radioiodine, the total activity being significantly lower compared with the data from literature. In our study, the prognosis of the disease was excellent, with 100% overall survival.

Disorders of Dental Hard Tissues Induced by Radioiodine-131 (I-131) Therapy Used in Differentiated Thyroid Cancer: An In Vitro Study

This study aimed to evaluate, in vitro, the effects of I-131 on enamel and dentin in healthy human incisive permanent maxillary teeth. Our in vitro model analogue with the in vivo conditions of differentiated thyroid carcinoma patients treated with I-131, consisted in a solution of I-131 dissolved in artificial saliva. A total of 48 teeth were divided into eight groups (n = 6): control, irradiation groups at 3, 6, 12, 24, 36, 48, and 192 h, respectively. At the end of radiation exposure, radioiodine activity of specimens was assessed. Fine microstructure, nanostructure, surface roughness, and hidroxyapatite (HAP) crystallite diameter were investigated by atomic force microscopy (AFM) to both enamel and dentin structures. There is a constant increase of radioactivity in dental structures at 3, 6, 12, 24 h, due to progressive retention and I-131 migration, with a maximum at 36 h. Enamel showed notable alterations, which was correlated with the increase of the treatment time. A relevant visible distance between the HAP prisms was observed after 24 h. The surface suffered a loss in its compact structure. I-131 acts in the same way on HAP crystallites in dentin as in those in enamel. It was noticed that their morpho-dimensional changes occurred only after 12 h of treatment. Radioiodine-131 determines degradation of enamel and dentin by starting from the alteration of the crystalline network of HAP prisms, transforming them from compact materials into an agglomeration of rocky submicron structures.

Akt1 genetic variants confer increased susceptibility to thyroid cancer

The PI3K-Akt-mTOR pathway plays a central role in the development of non-medullary thyroid carcinoma (NMTC). Although somatic mutations have been identified in these genes in NMTC patients, the role of germline variants has not been investigated. Here, we selected frequently occurring genetic variants in AKT1, AKT2, AKT3, PIK3CA and MTOR and have assessed their effect on NMTC susceptibility, progression and clinical outcome in a Dutch discovery cohort (154 patients, 188 controls) and a Romanian validation cohort (159 patients, 260 controls). Significant associations with NMTC susceptibility were observed for AKT1 polymorphisms rs3803304, rs2494732 and rs2498804 in the Dutch discovery cohort, of which the AKT1 rs3803304 association was confirmed in the Romanian validation cohort. No associations were observed between PI3K-Akt-mTOR polymorphisms and clinical parameters including histology, TNM staging, treatment response and clinical outcome. Functionally, cells bearing the associated AKT1 rs3803304 risk allele exhibit increased levels of phosphorylated Akt protein, potentially leading to elevated signaling activity of the oncogenic Akt pathway. All together, germline encoded polymorphisms in the PI3K-Akt-mTOR pathway could represent important risk factors in development of NMTC.

FOLLICULAR THYROID CARCINOMA - CLINICAL AND DIAGNOSTIC FINDINGS IN A 20-YEAR FOLLOW UP STUDY

Context

Follicular thyroid carcinomas (FTC) represent 6-10 % of all thyroid carcinomas; the evolution of FTC is quite controversial, partly due to frequent changes of the histopathological definition (minimally invasive-MIFTC or widely invasive carcinoma-WIFTC) and treatment strategies adjustments.

Objective

This research aims to examine the diagnostic procedure, therapeutic attitude and survival rates of patients with FTC, over a period of 16 years in the same institution, with a follow-up of at least 4 years, by analyzing correlations between histology subtype, treatments and the rate of recurrent disease.

Subjects and methods

We have studied 5891 patients with thyroid carcinomas who have undergone surgical or oncological treatment within the institution, between 1^st January 2000 - 31^st December 2015; among them we found 133 patients (2.25%) with "pure" follicular thyroid carcinoma: 114 (86%) women and 19 (14%) men, with a female-male ratio of 6:1. The age of the patients ranged from 10 to 76 years, with an average of 47.8 years. Statistical analysis was done comparing differences among groups of MIFTC and WIFTC.

Results

There was an unexpected high percentage of WIFTC and also an increased number of biochemically persistent and/or recurrent disease in patients with MIFTC. A stronger correlation was observed with the tumour dimensions, rather than with the histopathological subtype.

Conclusions

This research observed that overall survival was associated with tumour size rather than histopathological subtype and there is an important need to perform further studies to assess the effectiveness of treatment strategies.

Challenges in the Correct Assessment of a Case of Aggressive Thyroid Carcinoma with Synchronous Breast Cancer: A Case Report and Review of the Literature of Essential Role of Radiopharmaceuticals

Thyroid carcinoma represents a complex pathology that can still be considered a medical challenge, despite having a better prognosis and life expectancy than most other neoplasms; also the scenario of multiple malignancies involving thyroid cancer is nowadays a common reality.

MATERIALS AND METHODS

We reviewed the literature regarding the aggressive presentation of synchronous thyroid and breast cancer. In the current paper, we report the case of a 59 years-old woman, diagnosed with invasive ductal breast carcinoma and papillary thyroid carcinoma, presenting a natural history of both aggressive synchronous tumors. At the moment of hospitalization, the diagnosis was breast carcinoma with multiple secondary lesions, suggestive of lung and bone metastases, and nodular goiter.

RESULTS

Searching the literature in PUBMED with the terms "thyroid carcinoma and synchronous breast carcinoma, we found 86 studies; introducing the term "aggressive," the result included 4 studies, among which, none showed to be relevant to the terms aggressive and synchronous. A similar search was done in SCOPUS finding 92 documents and after introducing the term aggressive, the number of papers was 8, none including the literature on synchronous aggressive metastatic thyroid and breast carcinoma. A majority of imaging diagnostic tools were used in this particular medical case in order to ensure the best potential outcome. The final diagnosis was papillary thyroid carcinoma with lung and unusual multiple bone metastases and synchronous invasive ductal breast carcinoma with subcutaneous metastases.

CONCLUSION

The case illustrates the challenges in the correct assessment of oncologic patients, despite the advances in medical imaging and technologies and underlines the essential role of nuclear medicine procedures in the diagnostic and therapy protocols.

Is there a place for F18-FDG PET/CT in the diagnosis of primary breast cancer?

PURPOSE

With the improvement of techniques and the update of diagnostic protocols in breast cancer, modern imaging proves to be effective in the diagnosis of this pathology, as well as in its prognosis. This study aimed to evaluate the effectiveness of these modern imaging techniques through a systematic assessment of the most recent studies.

METHODS

A PUBMED search, using certain key combinations ("breast cancer", "F18 FDG PET-CT", "MRI", "staging", "diagnosis") and some inclusion and exclusion criteria, yielded 24 articles published during 2014-2018.

RESULTS

Using these 24 articles, the various statistical tests showed a significant difference between modern imaging techniques, with respect to prognosis (p<0.05), in close correlation with the immunohistochemical profile of the tumor.

CONCLUSIONS

Modern imaging techniques (F18-FDG/PET-CT, F18-FDG/PET-MRI) were validated to formulate a better prognostic value than conventional imaging, presenting a sustainable higher sensitivity and specificity in evidencing the locoregional invasion and the recurrence of this pathology.

A 15 year institutional experience of well-differentiated follicular cell-derived thyroid carcinomas; impact of the new 2017 TNM and WHO Classifications of Tumors of Endocrine Organs on the epidemiological trends and pathological characteristics

PURPOSE

Our study aimed to describe the evolution of the rate of pathological subtypes of well-differentiated follicular-cell derived thyroid carcinomas (DTCs) in the Department of Pathology, Emergency County Hospital Targu-Mures, Romania over a 15 year period and to assess the impact the new 2017 WHO and TNM classifications of thyroid tumors had on our cases.

METHODS

The pathological data were retrieved from the original pathological reports. After applying the exclusion criteria the remaining cases were reviewed on a double-headed microscope and reclassified according to the 2017 WHO and TNM staging system. The follow-up data were collected from the Institute of Oncology Cluj-Napoca, Romania.

RESULTS

Our study included 396 cases of DTCs (375 papillary, 11 follicular, and 10 Hürthle cell carcinomas). PTCs revealed a significant increasing trend over the study period, whereas follicular and Hurthle cell carcinomas remain rare; 125/131 of noninvasive encapsulated follicular variant PTC (EFVPTC) were reclassified as noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), resulting in a 33.3% reduction in the number of PTCs. According to 2017 TNM stage-grouping 31% of 271 patients with DTC were downstaged. Follow-up data were available for most of the patients (65.7%, mean period 58.1 months). All patients with noninvasive EFVPTC were disease free at the last clinical assessment.

CONCLUSIONS

The increasing rate of PTC was maintained even after exclusion of NIFTP. By applying 2017 TNM criteria, a significant number of DTC cases were downstaged into a more favorable group. Follow-up data highlight the indolent behavior of noninvasive EFVPTCs reclassified as NIFTPs.

Stability and Compatibility Studies of Levothyroxine Sodium in Solid Binary Systems-Instrumental Screening

The influence of excipients on the stability of sodium levothyroxine pentahydrate (LTSS) under ambient conditions and thermal stress was evaluated. Since LTSS is a synthetic hormone with a narrow therapeutic index, the interactions of LTSS with excipients can lead to a drastic diminution of therapeutic activity. Ten commonly used pharmaceutical excipients with different roles in solid formulations were chosen as components for binary mixtures containing LTSS, namely, starch, anhydrous lactose, D-mannitol, D-sorbitol, gelatin, calcium lactate pentahydrate, magnesium stearate, methyl 2-hydroxyethyl cellulose (Tylose), colloidal SiO₂ (Aerosil) and talc. As investigational tools, universal attenuated total reflectance- Fourier transform infrared spectroscopy UATR-FTIR spectroscopy and thermal analysis were chosen and used as follows: UATR-FTIR spectra were drawn up for samples kept under ambient conditions, while thermoanalytical tools (TG/DTG/HF data) were chosen to evaluate the inducing of interactions during thermal stress. The corroboration of instrumental results led to the conclusion that LTSS is incompatible with lactose, mannitol and sorbitol, and these excipients should not be considered in the development of new generic solid formulations.

Current evidence on thyroid related adverse events in patients treated with protein tyrosine kinase inhibitors

Tyrosine kinase inhibitors (TKI) are gaining more ground in oncology, they are widely used in the treatment of multiple types of cancers; still important side effects limit their efficacy. The aim of this study is to evaluate the existing medical literature on TKI induced thyroid dysfunction, to assess the adverse effects of targeted therapy on thyroid function in oncological patients and to evaluate the effects of thyroid dysfunction on disease prognosis. We included in this review 22 original studies published between 2010 and 2019. We used the PubMed database to search for articles upon the development of hypothyroidism and hyperthyroidism in TKI treated patients. After a careful review of the existing literature, we selected the relevant studies and cross-referenced the bibliography of each paper. A number of 1641 patients were included in our review. We found that thyroid dysfunction is not a rare side effect of TKI treatment, approximately 33% of the total number of patients presented clinical hypothyroidism. We also studied the necessity of thyroid hormone substitution treatment, a quarter of evaluated patients needed substitution therapy. Multiple studies showed that there is a link between a patient developing hypothyroidism and progression free survival. Hypothyroidism is a frequent side effect of TKI treatment, which affects the quality of life, sometimes even determines physicians to stop TKI treatment altogether. Our study underlines the necessity of TSH baseline testing and monitoring in patients treated with TKI agents.

A review on immunohistochemical and histopathologic validation in PET-CT findings with consideration to microRNAs

Purpose

This review provides an overview of some of the most recent clinical trials which investigated various types of cancer and other diseases, through the use of PET-CT imaging, highlighting the use of immunohistochemical stains or conventional histopathology for the validation or contradiction of their hypothesis. Furthermore, we investigate a potential new direction of research by analyzing the upcoming role of microRNAs in disease confirmation.

Methods

An extensive search of MEDLINE/PubMed and SCOPUS electronic databases was made, using the MeSH terms "positron emission tomography computed tomography" and "immunohistochemistry" as well as "SUV" and "immunohistochemistry", restricting the search by clinical trials and time period. Further searches were made for articles regarding Ki-67 and microRNAs in correlation with metabolic PET-CT uptake.

Results

Out of all 389 initial search results, 27 original articles were found relevant to the topic. Their contents were synthesized and discussed regarding the matter at hand. No relevant clinical trials involving microRNAs were found.

Conclusions

Immunohistochemical and histopathologic results remain widely used and indispensable in modern research, concerning PET-CT validation. Possible candidates for diagnosis confirmation, in future research, may reside in the further development of microRNAs.

18F-FDG PET/CT IN DIFFERENTIATED THYROID CARCINOMA

Aim

Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) become an important tool in oncology by combining the metabolic information from 18F-FDG PET with the morphological information of CT. The main objective of this study was to assess the diagnostic value of PET/CT in patients with differentiated thyroid carcinoma (DTC).

Material and Methods

We analyzed 173 PET/CT scans of patients with DTC presenting elevated thyroglobulin (Tg) levels, negative Tg-antibodies levels, negative Iodine-131 whole-body scanning (I-131 WBS) and without any signs of clinical or other imaging technique for tumor recurrence/metastases.

Results

PET/CT scans were positive in 38% of cases (65/173). The sensitivity, specificity, positive predictive values and the accuracy of PET/CT imaging were 88.09%, 98.6%, 93.1% respectively 96.53%. After the PET/CT scan 29 patients underwent surgery, 24 of them continued radio-iodine therapy, 5 patients initiated tyrosine kinase inhibitors treatment and external radiotherapy.

Conclusion

18F-FDG PET/CT is a valuable imaging technique which has the capability of identifying those cases of thyroid recurrence/metastases with elevated Tg levels and negative I-131 WBS. The treatment strategy was changed in 89.2% cases of positive PET/CT scans which shows us that 18F-FDG PET/CT imaging should be integrated into the follow-up programs for DTC patients.

Next-generation sequencing-based characterization of the invasion by anatomical contiguity in a primary osseous diffuse large B-cell lymphoma. Correlation between the genetic profile of the malignancy and the clinical outcome of the patient

Primary bone lymphoma is now a well-described entity in the World Health Organization (WHO) Classification of Tumors of Soft Tissue and Bone as a malignancy of the lymphoid tissue, with at least one mass within bone, without involvement of supraregional lymph nodes or other extranodal sites. In the current paper, we describe the complete characterization of the mutational landscape of a diffuse large B cell non-Hodgkin's lymphoma (DLBLCL) of the tibial plateau. Currently, there is very little data about the genetic landscape of primary osseous lymphomas and about the genetic background of this type of malignancy, resistant to chemotherapy and invading the surrounding tissues. In the current paper, we describe the complete characterization of the mutational landscape of a DLBCL of the tibial plateau. Our data is consistent with already published data, that have shown that MKI67 activation is correlated with lymphoma progression. Along with a high Ki67 index, resistance to chemotherapy occurs with neurogenic locus notch homolog protein 1 (Notch) and KRAS activation. This is the first molecular characterization for the invasion by anatomical contiguity for a primary bone lymphoma and while we only characterized one case and further deep sequencing analyses are required, we can explain the clinical dismal evolution of the patient by correlating them with the genetic landscape of this type of lymphoma.

Follicle-stimulating hormone receptors: A comparison of commercially-available monoclonal and polyclonal antibodies as immunohistochemical markers for cancer research

PURPOSE

In recent studies, follicle-stimulating hormone receptors (FSHRs) have been reported in a wide range of malignant and benign tumours, depending on the type of antibody used. Using two commercially available antibodies (monoclonal and polyclonal), the current research attempted to demonstrate the usefulness of each antibody for investigating FSHRs in non-canonical tissues. Further, we sought to replicate the results of a major study which demonstrated the presence of FSHRs in the endothelial cells of perineoplastic blood vessels.

METHODS

Immunostaining was performed on 16 surgically excised benign and malignant tumor tissue samples using both monoclonal and polyclonal anti-FSHR antibodies.

RESULTS

Positive staining of FSHRs was heterogeneous among the tissue samples used for analysis, and was confirmed not only in tumour and endothelial cells of perineoplastic blood vessels, but also in benign and normal cells. Based on our findings, FSHR staining using a polyclonal antibody appeared to be highly sensitive, but with a relatively low specificity. Comparatively, immunoreactivity using a monoclonal antibody appeared to show high specificity, but relatively low sensitivity. Although the selected monoclonal antibody for FSHRs seemed to be more specific than the polyclonal variant, neither exhibited a high overall specificity. Neither of the antibodies assessed in the present research could replicate the results of the aforementioned major study.

CONCLUSIONS

In conclusion, neither of the two commercially available antibodies seem to be appropriate for investigating FSHRs in non-canonical tissues and, by extension, their role in carcinogenesis.

The Role of Radiopharmaceuticals in Amiodarone-Induced Thyroid Pathology

BACKGROUND AND OBJECTIVE

The use of amiodarone for the treatment of ventricular and supraventricular dysrhythmias brings in organism an increased amount of iodine, interfering with thyroid function. If the treatment needs to be interrupted, iodine remains at abnormal levels for months or even years. The aim of the study was to review the literature regarding the optimal tests for early diagnostic and to analyze the role of nuclear medicine tests in the differential and correct assessment of the amiodarone-induced thyroid pathology.

METHODS

We made a review of available publications in PUBMED referring the amiodaroneinduced thyroid pathology, focusing on the differential diagnosis, made by nuclear medicine tests, of hypothyroidism (AIH) and hyperthyroidism expressed as: type I amiodarone induced thyrotoxicosis (AIT I), type II amiodarone induced thyrotoxicosis (AIT II), and less frequently as a mixt form, type III amiodarone induced thyrotoxicosis (AIT III). We presented cases from the database of a tertiary center in Cluj-Napoca, Romania.

RESULTS

Despite the frequent complication of thyroid function, this pathology is underestimated and diagnosed. There is a limited number of studies and clear protocols, especially in the mixed forms cases. This increase in iodine uptake interferes seriously with thyroid hormone production and release. The nuclear medicine tests are essential in the correct assessment and differential diagnosis of different forms of induced thyroid dysfunction. The destruction of the follicular cells can result in the release of excessive thyroid hormone into the circulation, with potential development of atrial fibrillation, worsening the cardiac disease, so any benefic therapeutic procedure should be known; the use of radioiodine as therapy alternative, despite the known limitations induced by blockade was clear benefic in the case presented. A special attention needs to be addressed to those patients with differentiated thyroid cancer, which will be submitted to radioiodine therapy and are under chronic therapy with amiodarone.

CONCLUSION

The nuclear medicine procedures are essential in the correct assessment and differential diagnosis of different forms of induced thyroid dysfunction. The radioiodine is not recommended in AIT, due to stunning effect induced by iodine excess, but in some special, lifethreatening condition, radioiodine I-131 might be a treatment option.

CIRCULATING TUMOR CELLS IN MINIMALLY INVASIVE FOLLICULAR THYROID CARCINOMA AND BENIGN THYROID TUMORS WITH A FOLLICULAR PATTERN: PILOT EXPERIENCE

Purpose

Minimally invasive follicular thyroid carcinomas (MIFCs) are uncommon; literature offers limited guidance on their natural history and management. Starting January 2015 we measured circulating tumor cells (CTCs) in patients with MIFC (n=22) or benign thyroid tumors with follicular features (n=4).

Methods

In a retrospective analysis, we assessed detectability of and serial changes in CTC, compared demographic/clinical differences between CTC-positive versus CTC-negative subgroups using Student's t-test, and examined correlations between CTC status and serum thyroglobulin using Spearman's test. CTCs were quantitated via immunomagnetic separation/microscopic inspection.

Results

Thirteen patients (50%: 12/22 MIFC, 1/4 benign tumor) were initially CTC-positive; 3 remained CTC-positive in ≥1 subsequent measurement. CTC-positive patients had larger tumors and more frequent multifocality and vascular invasion versus CTC-negative patients (n=13). However, no tested variable differed significantly between the subgroups. After 17.2±10.5 months, neither subgroup showed evidence of disease. Significant correlation was absent (p ≥ 0.263) between CTC and Tg negativity (r = 0.243; n=13 evaluable) or initial CTC positivity and Tg positivity (r = -0.418; n=9 evaluable).

Conclusions

In the studied settings, CTC measurement is feasible, has unclear clinical/outcome implications, but may provide different information versus thyroglobulin testing. Lengthier assessment is warranted in larger series.

Follicle-stimulating hormone receptors: a new immunohistochemical marker in cancers?

PURPOSE

Follicle-stimulating hormone receptors (FSHR) have been reported in ovarian cancer and prostate cancer cells, but recent studies have highlighted their presence in the endothelium of blood vessels belonging to multiple neoplasias. Current research attempts to determine the role of FSHR in neoplastic proliferation and possible therapeutic or diagnostic implications. This paper aimed to analyze articles that have revealed the presence and/or role of FSHR in various neoplasms in humans.

METHODS

After performing an extensive search of MEDLINE/ PubMed using MeSH terms "follicle-stimulating hormone receptors" and "cancer", 22 original articles were found relevant for the subject proposed for analysis.

RESULTS

FSHR were found in all neoplasms studied, being present in both tumor cells and endothelial cells of intraand perineoplasic blood vessels. Although, the presence of these receptors seemed to be ubiquitary, conclusion and the exact role of these receptors could not be stated due to heterogeneous nature of the existing studies.

CONCLUSIONS

Although extensive research studies are needed in order to elucidate the exact role of FSHRs and their utility in clinical practice, joint efforts in studying their implication in neoplastic processes can lead to the use of new diagnostic and therapeutic strategies for cancer patients.

Circulating tumor cells in thyroid carcinoma - the prognostic role of this biomarker. Review of the literature

Thyroid cancer is a disease with a good prognosis and high survival rates, but having a marked growth of incidence all over the world in the last years. This fact requires special attention of researchers for understanding the behavior of this disease and to establish a correct therapy. Analysis of circulating tumor cells in patients with different malignancies is nowadays a new and exciting research tool, which can improve the diagnosis and prevent the metastatic disease. In the case of thyroid carcinoma there are few studies which explore these biomarkers and investigate the prognostic significance of circulating tumor cells. With this review we seek to emphasize the role of these cells to better understand the mechanisms of invasion or metastasis and to establish a new research base to treat aggressive forms of this type of cancer. Most of the included studies demonstrate the efficacy of these markers for diagnosis and follow up.

Association of NF-κB polymorphisms with clinical outcome of non-medullary thyroid carcinoma

The NF-κB inflammatory pathway plays a major role in cancer development and clinical progression. Activation of NF-κB signaling is promoted by NFKB1 and inhibited by NFKBIA. The present study aimed to determine the relevance of NFKB1 rs4648068 and NFKBIA rs2233406 genetic variants for non-medullary thyroid cancer (NMTC) susceptibility, progression and clinical outcome. This case-control and cohort study consists of a Romanian discovery cohort (157 patients and 258 controls) and a Dutch validation cohort (138 patients and 188 controls). In addition, patient cohorts were analyzed further for the association of genetic variants with clinical parameters. Functional studies were performed on human peripheral blood mononuclear cells. No associations were observed between the studied genetic variants and TC susceptibility. Although no statistically significant associations with clinical parameters were observed for NFKB1 rs4648068, the heterozygous genotype of NFKBIA rs2233406 was correlated with decreased radioactive iodide sensitivity requiring higher cumulative dosages to achieve clinical response. These findings were discovered in the Romanian cohort (P < 0.001) and confirmed in the Dutch cohort (P = 0.01). Functional studies revealed that this NFKBIA rs2233406 genotype was associated with elevated TLR4-mediated IL-1β production. In conclusion, genetic variation in NFKBIA, an inhibitor of NF-κB signaling, is associated with clinical response to RAI therapy and with increased production of the pro-inflammatory cytokine IL-1β, providing a potential mechanism for the observed clinical associations. These data suggest that NF-κB signaling is involved in NMTC pathogenesis and that the inflammatory tumor microenvironment could contribute to RAI resistance.

Tumor infiltrating lymphocytes as a prognostic factor in malignant melanoma. Review of the literature

Malignant melanoma represents the major cause of mortality among skin cancers, with increasing incidence and mortality rates worldwide. Despite the numerous public health campaigns and the efforts undertaken in the last decade regarding the establishment of a rapid diagnostic and an efficient treatment for these patients, the long-term prognosis has not been significantly improved. Thus, numerous studies were conducted in order to establish a more accurate prognosis, tumor infiltrating lymphocytes (TILs) being considered in many studies as independent prognostic factors of lymph node metastasis and overall survival in patients with melanoma. Moreover, immunotherapy has been intensively studied and evolved in recent times, and represents a promising treatment option for patients with advanced stage (metastatic) malignant melanoma. In this review article, we provided a literature overview on the histological classification, the history and the essential role of TILs, as well as the implications of regulatory T (Treg) cells and FOX P3 transcription factor in malignant melanoma.

Human Exposures to Bisphenol A, Bisphenol F and Chlorinated Bisphenol A Derivatives and Thyroid Function

Although the increasing prevalence of thyroid nodular disease (TND) has been partially attributed to the more frequent usage of improved diagnostics, environmental factors, such as exposures to thyroid-disrupting chemicals may contribute to TND and altered thyroid function. We investigated the association between exposures to bisphenol A (BPA), its chlorinated derivatives (ClxBPA), and bisphenol F (BPF) with TND and thyroid measures in adult women. A case-control study in Cyprus and Romania (n = 212) was conducted, where cases were those with thyroid nodules (diameter >3mm), and controls without nodules. Serum TSH and free thyroxine and urinary levels of BPA, BPF and ClxBPA were measured using immunoassays and tandem mass spectrometry, respectively. The association between exposures to BPA compounds and TND, adjusting for age, BMI, thyroid hormones and urinary iodine was assessed using logistic regression. Linear regression was used to explore associations between urinary BPA, BPF and ClxBPA and serum thyroid hormones. With the exception of a chlorinated BPA compound (30%), the rest of bisphenols were quantified in 100% of urine samples. A positive and significant (p<0.05) association was observed between urinary BPA and serum TSH that remained after adjusting for urinary creatinine, age, BMI, study site and disease status; there was no significant association between BPF or ClxBPA with TSH. None of the BPA compounds were associated with higher odds of TND. Our study found associations of urinary BPA with TSH but not with BPF or ClxBPA. A larger study would be justified.

Primary hyperparathyroidism-jaw tumor syndrome: a confusing and forgotten diagnosis

Background

Primary hyperparathyroidism is caused by the excessive growth of parathormone secretion, its consequence being hypercalcemia. The parathyroid adenoma is responsible for over half of primary hyperparathyroidism cases. The mandibular tumor can be the initial sign in the case of primary hyperparathyroidism.

Case presentation

We present the case of a 33 year old patient with history of a mandibular operated tumor, repetitive pathological fractures and hypercalcemia manifestations. The level of the parathormone at the first measurement indicated a very high value. The parathyroid scintigraphy with 99mTc-MIBI (methoxy-isobutyl-isonitrile) evidenced a high uptake of the tracerin the superior mediastinum, suggestive for an ectopic parathyroid adenoma. The histopathological examination after surgery leads to the diagnosis of parathyroid adenoma.

The association between the primary hyperparathyroidism, the mandibular tumour, the clinical history and the nuclear imaging lead to the diagnosis of primary hyperparathyroidism – Jaw tumor syndrome.

Conclusion

The hyperparathyroidism - Jaw tumor syndrome has a special clinical importance because of the severe and progressive symptomatology, and because of the risk of developing neoplasia of parathyroid glands, which have a reserved prognosis.

Second malignancies in patients with differentiated thyroid carcinoma treated with low and medium activities of radioactive I-131

Background and aim

This study aimed at determining whether there is a risk regarding the development of second primary malignancies after patient exposure to the low and medium radioiodine activity used during the treatment of differentiated thyroid cancers (DTC).

Methods

Second primary malignancies that occurred after DTC were detected in 1,990 patients treated between 1970 and 2003. The mean long-term follow-up period was 182 months.

Results

Radioiodine I-131was administrated at a mean dose of 63.2 mCi. There were 93 patients with at least one second primary malignancy. The relative risk of development of second malignancy in DTC patients was increased (p<0.0001) for breast, uterine and ovarian cancers compared with the general population.

Conclusions

The overall risk concerning the development of second primary malignancies was related to the presence of DTC, but not to exposure to the low and medium activities of radioiodine administered as adjuvant therapy.