SUN-305 A case of Metastatic Mammary Carcinoma initially mistaken for papillary thyroid cancer

Epidemiology of Thyroid Cancer.

Fine needle aspiration (FNA) biopsy is an established procedure by which to sample thyroid nodules to ascertain etiology and produce a diagnosis conveying risk of malignancy with recommended patient follow-up. This procedure is well-tolerated and endorsed given the accessibility and vascularity of the thyroid gland. FNA cytopathology has proven efficacious for the primary assessment of thyroid nodules. Well-differentiated papillary thyroid carcinoma (PTC) and benign lymphocytic (Hashimoto) thyroiditis (HT) are distinct thyroid lesions that may be reported with diagnostic confidence based on their characteristic cytomorphologic features. However depending on the adequacy of FNA sampling and the morphology of aspirated cellular material, thyroid nodules with coexisting PTC and HT may pose diagnostic pitfalls. This may be dependent upon: (a) the architectural nature of the coexisting lesions in-vivo; (b) whether both lesions are adequately sampled through FNA; and (c) which of the cell types and cytomorpholo...

Molecular Rearrangements and Morphology in Thyroid Cancer

Author for correspondence: Genomic Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, NE-50, Cleveland, OH 44195, USA and Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA and Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA and Thyroid Cancer Center, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, USA and Stanley Shalom Zielony Institute of Nursing Excellence, Cleveland Clinic, Cleveland, OH 44195, USA and Department of Genetics, & CASE Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA Tel.: +1 216 444 3440 Fax: +1 216 636 0655 engc@ccf.org Thyroid cancer genetics: how close are we to personalizing clinical management?

Short Call Abstracts

Germline Mutations and Variants in the Succinate Dehydrogenase Genes in Cowden and Cowden-like Syndromes

Background: Both thyroid and breast cancers occur more frequently in women than in men. Some suggest that estrogen plays a role in the tumorigenesis of both cancers. The aim of this study was to identify the prevalence and clinico-pathologic characteristics of primary thyroid cancer in patients with breast cancer. Methods: We retrospectively obtained clinical and pathologic data for 112 patients diagnosed with both thyroid and breast cancer from a single center. Patients with thyroid cancer were grouped according to the chronological sequence of tumor diagnosis. When thyroid and breast cancers were diagnosed within 12 months of each other, they were considered to have been diagnosed simultaneously. Female patients who had only papillary thyroid cancer were used as a historic control. Results: Between 1994 and 2008, 7,827 patients at our hospital were diagnosed with breast cancer and 6,571 patients with thyroid cancer. There were 112 patients who had both thyroid and breast cancer. All thyroid cancers (111/112) except one hurthle cell cancer were papillary thyroid cancers. Average tumor size of thyroid cancer cases diagnosed 1) after or 2) simultaneously with the diagnosis of breast cancer was significantly lower than that for 3) thyroid cancer cases found before breast cancer diagnosis or 4) historical controls with papillary thyroid cancer [sizes (in cm), respectively, were: 1) 0.9 ± 0.6 2) 0.9 ± 0.5 vs 3) 1.4 ± 0.9 4) 1.4 ± 1.1, P < 0.05]. No patients had distant metastases and there were no statistically significant differences in known risk factors for recurrence and survival of patients with thyroid cancer. Conclusion: Thyroid cancer is the most common second primary malignancy in patients with breast cancer and most of them are papillary thyroid cancers. There are no differences in risk factors for tumor recurrence and patient survival compared with those with conventional papillary thyroid cancer except for differences in tumor size. These difference in size may reflect an increase in medical surveillance in patients after they are diagnosed with breast cancer. (J Korean Endocr Soc 24:240~246, 2009) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

SummaryWe report a rare case of concurrent medullary thyroid cancer (MTC) and papillary thyroid cancer (PTC) with intermixed disease in several of the lymph node (LN) metastases in a patient who was subsequently diagnosed with clear cell renal cell carcinoma (RCC). A 56 year old female presented with dysphagia and was found to have a left thyroid nodule and left superior cervical LN with suspicious sonographic features. Fine needle aspiration biopsy (FNAB) demonstrated PTC in the left thyroid nodule and MTC in the left cervical LN. Histopathology demonstrated multifocal PTC with 3/21 LNs positive for metastatic PTC. One LN in the left lateral neck dissection exhibited features of both MTC and PTC within the same node. In the right lobe, a 0.3 cm focus of MTC with extra-thyroidal extension was noted. Given persistent calcitonin elevation, a follow-up ultrasound displayed an abnormal left level 4 LN. FNAB showed features of both PTC and MTC on the cytopathology itself. The patient underwent repeat central and left radical neck dissection with 3/6 LNs positive for PTC in the central neck and 2/6 LNs positive for intermixed PTC and MTC in the left neck. There was no evidence of distant metastases on computed tomography and whole body scintigraphy, however a 1.9 x 2.5 cm enhancing mass within the right inter-polar kidney was discovered. This lesion was highly suspicious for RCC. Surgical pathology revealed a 2.5 cm clear cell RCC, Fuhrman grade 2/4, with negative surgical margins. She continues to be observed with stable imaging of her triple malignancies.Learning points:Mixed medullary-papillary thyroid neoplasm is characterized by the presence of morphological and immunohistochemical features of both medullary and papillary thyroid cancers within the same lesion. Simultaneous occurrence of these carcinomas has been previously reported, but a mixed disease within the same lymph node is an infrequent phenomenon.Prognosis of mixed medullary-papillary thyroid carcinomas is determined by the medullary component. Therefore, when PTC and MTC occur concurrently, the priority should be given to the management of MTC, which involves total thyroidectomy and central lymph node dissection.Patients with thyroid cancer, predominantly PTC, have shown higher than expected rates of RCC. To our knowledge, this is the first report describing the combination of MTC, PTC, and RCC in a single patient.

Fine needle aspiration (FNA) is a valuable technique in the evaluation of thyroid nodules. A total of 182 FNAs of the thyroid performed at the Sultan Qaboos University Hospital were reevaluated and 153 were found to be adequate (84%). The cytological results of FNA were divided into neoplastic and non-neoplastic groups. Subsequent histology was obtained in 53 patients with an intraoperative frozen actions (FS) in 27 patients. Papillary carcinoma was found to be the most common, accounting for 70% of these cases with histological follow-up in the neoplastic group. The utility of performing FNA in all thyroid nodules and an intraoperative frozen section only in selected cases is discussed.

Simple SummaryThyroid cancer is a rare disease in childhood; however, its incidence is rising. Thyroid cancer consists of three main types: Papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and medullary thyroid cancer (MTC). The aim of our retrospective study was to investigate the incidence and survival trends of these three thyroid cancer types in Dutch children, adolescents, and young adults over a 30-year life span. In total, 839 patients aged 0–24 years had been diagnosed with thyroid cancer between 1990 and 2019. The incidence of PTC increased significantly over time, the incidence of FTC showed a stable trend, while the incidence of MTC decreased significantly. Overall, the 10-year survival rates over the last decades were high (>95%) for PTC, FTC, and MTC in young individuals.Thyroid cancer is the most common endocrine malignancy in children. A rising incidence has been reported worldwide. Possible explanations include the increased use of enhanced imaging (leading to incidentalomas) and an increased prevalence of risk factors. We aimed to evaluate the incidence and survival trends of thyroid cancer in Dutch children, adolescents, and young adults (0–24 years) between 1990 and 2019. The age-standardized incidence rates of differentiated thyroid cancer (DTC, including papillary and follicular thyroid cancer (PTC and FTC, respectively)) and medullary thyroid cancer (MTC), the average annual percentage changes (AAPC) in incidence rates, and 10-year overall survival (OS) were calculated based on data obtained from the nationwide cancer registry (Netherlands Cancer Registry). A total of 839 patients aged 0–24 years had been diagnosed with thyroid carcinoma (PTC: 594 (71%), FTC: 128 (15%), MTC: 114 (14%)) between 1990 and 2019. The incidence of PTC increased significantly over time (AAPC +3.6%; 95%CI +2.3 to +4.8), the incidence rate of FTC showed a stable trend ((AAPC −1.1%; 95%CI −3.4 to +1.1), while the incidence of MTC decreased significantly (AAPC: −4.4% (95%CI −7.3 to −1.5). The 10-year OS was 99.5% (1990–1999) and 98.6% (2000–2009) in patients with DTC and 92.4% (1990–1999) and 96.0% (2000–2009) in patients with MTC. In this nationwide study, a rising incidence of PTC and decreasing incidence of MTC were observed. For both groups, in spite of the high proportion of patients with lymph node involvement at diagnosis for DTC and the limited treatment options for MTC, 10-year OS was high.

Medullary thyroid cancer (MTC) is a relatively rare thyroid malignancy, constituting a small percentage of all thyroid cancer cases. Even more rare is the occurrence of mixed MTC and papillary thyroid cancer (PTC), found in a very small fraction of MTC cases. These cancers originate from different cell types with distinct developmental origins. The coexistence of MTC and PTC in the same patient raises questions about whether this occurrence is merely coincidental or if there is an underlying genetic link. We present the case of a woman with metastatic mixed MTC and PTC.A 61-year-old woman with a history of Hashimoto's disease was found to have bilateral thyroid nodules; the largest (1.7 cm) was in the right lobe. This nodule met fine needle aspiration (FNA) biopsy criteria and was found to have a follicular neoplasm of undetermined significance. The patient elected to pursue total thyroidectomy instead of lobectomy given the presence of bilateral nodules. Postoperative pathology showed mixed medullary carcinoma (pT3b) and follicular variant papillary thyroid microcarcinoma (pT1a) involving the right lobe with positive anterior and posterior margins and lymphovascular invasion. Preoperative calcitonin was not checked. However, post-thyroidectomy calcitonin was 1599 pg/mL. She underwent central and right lateral neck dissection which showed 27 out of 35 lymph nodes were positive for malignancy. Postoperative calcitonin dropped to 38.7 pg/mL. She then established care in our endocrine clinic. Screening for pheochromocytoma and primary hyperparathyroidism was normal. She underwent external beam radiation of the neck. A year after her initial surgery, her neck ultrasound and computed tomography (CT) studies show no signs of local or distant anatomic recurrence. Her thyroglobulin level remains undetectable, carcinoembryonic antigen (CEA) within normal range, and calcitonin stable at about 20 pg/mL. She is on levothyroxine 100 mcg daily with thyroid-stimulating hormone (TSH) at a suppression goal of <0.1 mIU/L. Mixed PTC and MTC is poorly studied due to its rarity. The origin of these mixed tumors is unclear, but some suggest that they arise from neoplastic changes of remnant multipotent cells in the thyroid. While patients with PTC often have a favorable prognosis following surgical therapy, MTC has a more aggressive course. We suggest monitoring patients like ours for both MTC and PTC, as if present in isolation. Our case highlights the clinical aspects of this condition and our current knowledge of its pathophysiology.

The association of Hashimoto thyroiditis and Graves' disease with papillary, follicular, and medullary thyroid cancer has not been comprehensively investigated until now. This comparative clinicopathological study of consecutive patients thyroidectomized at a surgical referral center aimed to explore interdependencies between chronic autoimmune thyroiditis and thyroid cancer. Altogether, there were 852 (58.4%) patients with papillary thyroid cancer, 181 (12.4%) patients with follicular thyroid cancer, and 426 (29.2%) patients with sporadic medullary thyroid cancer, of whom 75 (5.1%) patients also had Hashimoto thyroiditis and 40 (2.7%) patients also had Graves' disease. Patients with papillary (medians of 42 vs. 48 years; P =0.008) and follicular (medians of 33 vs. 63 years; P=0.022) thyroid cancer, unlike patients with medullary thyroid cancer (medians of 57.5 vs. 57 years; P=0.989), were younger at thyroidectomy when they had Hashimoto thyroiditis concomitantly. No such associations were seen with Graves' disease. Primary thyroid cancers tended to be more localized in conjunction with Hashimoto thyroiditis, and less so with Graves' disease, although patterns were not consistent across tumor types. In conclusion, Hashimoto thyroiditis, but not Graves' disease, may be associated with differentiated (papillary and follicular) thyroid cancer but not with medullary thyroid cancer.

Part I. The Thyroid Nodule. The Thyroid Nodule: Pathogenesis, Evaluation, and Risk of Malignancy, Leonard Wartofsky. Nonisotopic Imaging of the Neck in Patients with Thyroid Nodules or Cancer, Manfred Blum. The Thyroid Nodule: Fine Needle Aspiration Biopsy, Yolanda C. Oertel. The Thyroid Nodule: Medical Management, Leonard Wartofsky. Thyroid Nodules and Cancer Risk: Surgical Management, Orlo H. Clark. Part II. Thyroid Cancer: General Considerations. Molecular Pathogenesis of Thyroid Cancer, James Figge. Epidemiology of Thyroid Cancer, James Figge. Radiation and Thyroid Cancer, James Figge, Timothy Jennings, and Gregory Gerasimov. Classification of Thyroid Malignancies, James Oertel and Yolanda Oertel. Thyroid Cancer in Children and Adolescents, Merrily Poth. Immunologic Aspects of Thyroid Follicular Neoplasms, James R. Baker, Jr. Radioiodine Therapy of Thyroid Cancer: General Considerations-I, Gerald Johnston and Diane Sweeney. Radioiodine Therapy of Thyroid Cancer: General Considerations-II Side Effects of Radioiodine Therapy for Thyroid Cancer, Diane Sweeney and Gerald Johnston. Recombinant Human Thyrotropin, Matthew D. Ringel. Chemotherapy for Thyroid Cancer, Lawrence S. Lessin and Myo Min. Part III. Differentiated Tumors of the Thyroid Gland: A. Papillary Carcinoma. Papillary Carcinoma: Clinical Aspects, Leonard Wartofsky. Papillary Carcinoma: Cytology and Pathology, James Oertel and Yolanda Oertel. Surgical Approach to Papillary Carcinoma, Orlo H. Clark. Differentiated Thyroid Carcinoma: Radioiodine Therapy-I, Gerald Johnston and Diane Sweeney. Chemotherapy of Differentiated (Papillary or Follicular) Thyroid Carcinoma, Lawrence S. Lessin and Myo Min. Management of Papillary Thyroid Carcinoma: External Radiation Therapy, Robert L. White. Papillary Thyroid Cancer: Follow-Up, Henry B. Burch. Radioiodine Treatment of Thyroid Cancer-II: Maximizing Therapeutic and Diagnostic 131I Uptake, Diane Sweeney and Gerald Johnston. An Approach to the Management of Patients with Scan Negative, Thyroglobulin Positive, Differentiated Thyroid Cancer: Alternative Imaging Procedures, Leonard Wartofsky. Papillary Thyroid Cancer: Prognosis, Henry B. Burch. Papillary Cancer: Special Aspects in Children, Merrily Poth. Part IV. Differentiated Tumors of the Thyroid Gland: B. Follicular Carcinoma. Follicular Thyroid Carcinoma: Clinical Aspects, Leonard Wartofsky. Pathology of Follicular Cancer, James Oertel and Yolanda Oertel. Surgical Management of Follicular Cancer, Orlo H. Clark. Follicular Carcinoma of the Thyroid: External Radiation Therapy, Robert L. White and Leonard Wartofsky. Follicular Thyroid Cancer: Follow-Up, Henry B. Burch. Follicular Thyroid Cancer: Prognosis, Henry B. Burch. Follicular Thyroid Cancer: Special Aspects in Children and Adolescents, Merrily Poth. Part V. Undifferentiated Cancers: A. Anaplastic Carcinoma. Anaplastic Carcinoma: Clinical Aspects, Steven I. Sherman. Anaplastic Carcinoma: Pathology, James Oertel and Yolanda Oertel. Anaplastic Carcinoma Management: Surgery, Orlo H. Clark. Chemotherapy of Anaplastic Thyroid Cancer, Lawrence S. Lessin and Myo Min. Management of Anaplastic Carcinoma: External Radiation Therapy, Robert L. White and Leonard Wartofsky. Anaplastic Carcinoma: Prognosis, Steven I. Sherman. Part VI. Undifferentiated Cancers: B. Lymphoma. Thyroid Lymphoma, Steven I. Sherman. Thyroid Lymphoma: Pathology, James Oertel and Yolanda Oertel. Part VII. Undifferentiated Cancers: C. Medullary Carcinoma. Medullary Thyroid Carcinoma, Douglas W. Ball. Medullary Thyroid Cancer: Pathology, James Oertel and Yolanda Oertel. Medullary Carcinoma of the Thyroid: Nuclear Medicine Imaging and Treatment, Diane Sweeney and Gerald Johnston. Management of Medullary Carcinoma of the Thyroid: Surgery, Orlo H. Clark. Medullary Carcinoma Management: External Radiation Therapy, Robert L. White and Leonard Wartofsky. Medullary Carcinoma of the Thyroid: Chemotherapy, Lawrence S. Lessin and Myo Min. Part VIII. Miscellaneous and Unusual Cancers of the Thyroid. Pathology of Miscellaneous and Unusual Cancers of the Thyroid, James Oertel and Yolanda Oertel. Clinical Aspects of Miscellaneous and Unusual Types of Thyroid Cancers, Matthew D. Ringel, Kenneth D. Burman, and Barry M. Shmookler. Part IX. Future Directions. Thyroid Cancer: DNA Ploidy, Tumor Markers, and Cancer-Causing Genes, Michael McDermott. New Approaches to Chemotherapy for Thyroid Cancer, Lawrence S. Lessin and Myo Min. Advances in Radiotherapy For Thyroid Cancer, Robert L. White. Index.

MicroRNA analysis as a potential diagnostic tool for papillary thyroid carcinoma

81st Annual Meeting of the American Thyroid Association SHORT CALL ABSTRACTS