Abstract
Fine needle aspiration biopsy (FNAB) is a standard procedure for the detection of thyroid nodules malignancy, yet 10-25% of the sample diagnosed may go undetermined or suspicious. The utility of cancer stem cell markers (CSCM) as a differential diagnosis molecular marker in nodules of suspicious decision in FNAB was hypothesized. Papillary thyroid carcinoma (PTC) and thyroid fibroadenoma (TFA) samples were selected to test the hypothesis. The samples employed in this study were from patients who had thyroid hyperplasia and a suspicious or undetermined diagnosis by FNAB. The patient underwent a successful thyroidectomy at Al-Yarmouk Teaching Hospital in Baghdad between January 2015 and December 2017. All nodule samples underwent a systematic histopathological examination after resection. Tumors diagnosed as PTC and those diagnosed as fibroadenoma (TFA) were selected for this study. Collectively 39 PTC and 11 TFA nodules were included. Quantitative reverse transcriptase real-time PCR (qRT-PCR) and immunohistochemistry (IHC) were used to determine levels of mRNA and proteins of CSCM ALDH1A1, CD44, ABCG2, and Oct3/4 in both types of tumors were used. This study revealed that the expression levels of CSCM were significantly increased in PTC tissues when compared to benign tissues and the positive correlation was found between the CSCM expression levels and tumor stage, size, and gender. In conclusion, for a more precise diagnosis, we suggest these markers be included in what is currently available to characterize malignancy from what is not in thyroid cancer, as well as for the staging process of PTC.
Highlights
Thyroid carcinoma is the fifth most frequent cancer diagnosed in the United States and eighth diagnosed in Iraqi women, and its incidence in Iraqi women has noticeably increased [1, 2]
The systematic histopathological staging of each sample after surgery revealed that, among papillary thyroid carcinoma (PTC) samples selected for this study, 25 (64%) of the samples were of stage I, 8 (21%) were of stage II, and 6 (15%) were of stage III
The four genes (ALDH1A1, CD44, OCT3/4, and ABCG2) chosen to detect their expression levels in all 39 samples of PTC as well as in 11 thyroid fibroadenoma samples were selected for their potential role as cancer stem cell markers in thyroid cancer and their potential importance in thyroid cancer initiation and progression [24,25,26]
Summary
Thyroid carcinoma is the fifth most frequent cancer diagnosed in the United States and eighth diagnosed in Iraqi women, and its incidence in Iraqi women has noticeably increased [1, 2]. The other model hypothesized that the cancer cells develop as progenies of a small subpopulation of cancerous cells called cancer stem cells (CSCs) [7]. These cells have the capacity for self-renewal and multilineage potential [8]. These two models are not mutually exclusive in the explanation of the cellular heterogeneity of cancers [9]. The concept that cancer might develop from a small population of cells termed CSCs came from earlier studies of hematopoietic malignancies and it was first recognized in solid tumors by Al-Hajj and colleagues.
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