Adenomatous Goiter Research Articles

Ectopic colloid goiter in mediastinum with normal thyroid gland

Ectopic thyroid tissue is a rare developmental abnormality involving aberrant embryogenesis of the thyroid gland during passage from the primitive foregut to the pretracheal position. The most frequent position is the base of the tongue (lingual thyroid); however, it has been described in other sites, such as the submandibular region, trachea, mediastinum, and subdiaphragmatic regions.Here, we report a case of an adenomatous goiter that developed in mediastinal thyroid tissue without any connection to the pretracheal thyroid gland.

Tumor tissue samples collection for scientific research in morphology and molecular oncology

Purpose of the study. Is to describe the experience of creating a collection of biological images of tumor tissues and biomaterials, which are control samples, for scientific research in morphology and molecular oncology.Materials and methods. We studied the molecular markers of cell cycle regulation, apoptosis, oncogenesis and angiogenesis, the expression of proteins that regulate inflammation and tumor infiltrate cells in biocollections of verified tumors of common localizations: e. g. thyroid cancer, colorectal cancer, breast cancer, prostate adenocarcinoma, endometrioid adenocarcinoma. Also, tissue fragments with normal structure or non-tumor pathology (autoimmune thyroiditis, adenomatous and thyrotoxic goiter, benign formations of the colon, fibrocystic disease of the mammary glands, benign prostatic hyperplasia, endometrial hyperplasia) were used as control samples or comparison groups. The total number of tissue samples is n = 7000.Results. It is reasonable to gather the collection in a pathomorphological laboratory according to the profile of the medical institutions, which has a sufficient volume of incoming target material and specialized morphologists to verify tumors of a given localization. It is necessary to consider the regional and ethnic specifics of the population, which determines the sampling and mutational load. The laboratory must initiate an addition to the informed consent of patients about the possibility of conducting morphological and molecular genetic studies for scientific purposes and publishing their results in a depersonalized form for the development of new elaborations, when signing the contracts with legal entities and individuals and when serving patients within an institution. When working with biocollections, it has to consider having registers of tissue biomaterials of target disorder groups of main localizations with downloading by year from an accessible information system, consider external factors affecting the database (changes in clinical recommendations and classifications, the population of patients served, pandemics and other significant events). The standard of the preanalytical stage, data collection, development of protocols for analytical molecular genetic studies and their evaluation, the utilization of the capabilities of working with reagents for scientific tasks and modeling experiments on laboratory animals are crucial.Conclusion. The formed biocollection made it possible to carry out a number of initiative and funded domestic and international scientific projects at the request of clinicians and fundamental researchers, as well as to improve the quality standards of morphological and molecular genetic oncology diagnostics. Biobanking makes the pathological archive more accessible for review and use, significantly expanding its scientific and practical potential. Scientific and medical research do not conflict and can be used within the same laboratory.

PERBANDINGAN HASIL PEMERIKSAAN FINE NEEDLE ASPIRATION BIOPSY (FNAB) DENGAN GAMBARAN HISTOPATOLOGI PADA TUMOR TIROID

The endocrine system is frequently impacted by thyroid cancers. Thyroid tumors account for 95% of all endocrine malignancies. Carcinomas, or malignancies, can occur in thyroid tumors. An FNAB examination is used to identify thyroid malignancies prior to surgery. The histological analysis of the surgical specimen is the gold standard for diagnosing thyroid tumors. This study compares the histological findings of thyroid cancers with the results of fine needle aspiration biopsy (FNAB). This study utilized an analytical observational design with a cross-sectional approach, involving 40 samples from secondary data. The data analysis revealed an average age of 45.48 (12.11) years, and the majority of cases were in females, with a total of 32 patients (80%). The FNAB examination results showed that 15 patients (37.5%) had malignant thyroid tumors, with the most common type being Papillary Tyroid Carcinoma in 13 patients (32,5%), and 25 patients (62.5%) had benign tumors, with the most common type being Adenomatous Goiter in 23 patients (57,5%). Histopathological findings indicated that 21 patients (52.5%) had malignant thyroid tumors, with Papillary Thyroid Carcinoma being the most common type in 14 patients (35%), and 19 patients (47.5%) had benign tumors, with Adenomatous Goiter being the most common type in 12 patients (30%). The sensitivity was 66.6%, specificity was 94.7%, accuracy was 80%, and the Kappa value was 0.605 with a p-value of 0.000, indicating good agreement according to the Cohen's Kappa value.

Downhill varices in the hypopharynx due to huge thyroid tumor: a case report.

Downhill varices are usually caused by superior vena cava (SVC) obstruction due to bronchogenic carcinoma or mediastinal tumors. These structures show retrograde blood flow and are located in the proximal esophagus. Varices in the hypopharynx resulting from mediastinal thyroid tumor are extremely rare. A 70-year-old man visited a local hospital with a 35-year history of enlarging thyroid tumor in the right neck. Fine needle aspiration cytology of the tumor revealed benign goiter. Contrast-enhanced computed tomography showed a huge tumor (13×10×5 cm) in the right to left lobe of the thyroid extending into the mediastinum. Further, a well-enhanced mass mimicking hypopharyngeal cancer was identified in the hypopharynx. Endoscopic examination demonstrated varices in the postcricoid region, so we avoided biopsy. The preoperative diagnosis was huge adenomatous goiter and hypopharyngeal varices caused by obstruction of the internal jugular and brachiocephalic vein by the goiter. Total thyroidectomy was performed and hypopharyngeal varices had disappeared by the next day. The histopathological diagnosis of the thyroid tumor was poorly differentiated carcinoma. Mediastinal thyroid tumor rarely causes downhill varices due to SVC obstruction. However, in this case, signs of SVC obstruction were absent and varices were found not in the upper esophagus, but in the hypopharynx. Obstructed venous flow from the thyroid plexus might circulate via superior laryngeal vein and cause varices in the postcricoid region. When a patient with large mediastinal tumor shows a tumor-like lesion in the hypopharynx, considering the possibility of downhill varices is important before conducting immediate biopsies.

HISTOPATHOLOGICAL SPECTRUM OF THYROID LESIONS AT TERTIARY CARE HOSPITAL IN WESTERN RAJASTHAN

Objective: The objective of the study is to determine the proportion of different patterns (colloid goiter, colloid cyst, papillary carcinoma, etc.) of thyroid lesions among the patients who have undergone surgical treatment. Methods: This was prospective and retrospective study to be conducted on 100 thyroidectomy specimens received in 5-year period (2016–2020) in Department of Pathology in Dr. S.N. Medical College, Jodhpur. Results: Age ranged from 10 days to 85-year-old, Peak incidence of thyroid diseases was seen in the third to fifth decade, 78% non-neoplastic lesion, Adenomatous goiter was the most common non-neoplastic lesion (65%), Papillary carcinoma was the most common malignant lesion encountered. Conclusion: Although non-invasive techniques like aspiration cytology provide a diagnosis in most, the ultimate answer often rests with histopathological examination of thyroidectomies, which forms the mainstay for a definitive diagnosis. Thorough gross and microscopic evaluation of thyroidectomies is mandatory even for non-neoplastic lesions as they sometimes harbor neoplasms.

The value of deep neural networks in the pathological classification of thyroid tumors

BackgroundTo explore the distinguishing diagnostic value and clinical application potential of deep neural networks (DNN) for pathological images of thyroid tumors.MethodsA total of 799 pathological thyroid images of 559 patients with thyroid tumors were retrospectively analyzed. The pathological types included papillary thyroid carcinoma (PTC), medullary thyroid carcinoma (MTC), follicular thyroid carcinoma (FTC), adenomatous goiter, adenoma, and normal thyroid gland. The dataset was divided into a training set and a test set. Resnet50, Resnext50, EfficientNet, and Densenet121 were trained using the training set data and tested with the test set data to determine the diagnostic efficiency of different pathology types and to further analyze the causes of misdiagnosis.ResultsThe recall, precision, negative predictive value (NPV), accuracy, specificity, and F1 scores of the four models ranged from 33.33% to 100.00%. The area under curve (AUC) ranged from 0.822 to 0.994, and the Kappa coefficient ranged from 0.7508 to 0.7713. However, the performance of diagnosing FTC, adenoma, and adenomatous goiter was slightly inferior to other types of pathological tissues.ConclusionThe DNN model achieved satisfactory results in the task of classifying thyroid tumors by learning thyroid pathology images. These results indicate the potential of the DNN model for the efficient diagnosis of thyroid tumor histopathology.

Some aspects of surgical strategies in patients with thyroid cancer with metastatic lesions of the neck lymph nodes

Objective — to improve the surgical treatment of patients with thyroid cancer with metastatic lesions of the neck lymph nodes by means of an individual approach to diagnostics, intraoperative imaging, and choice of optimal surgical technique.
 Materials and methods. The analysis involved results of examinations and treatment of 749 patients. The following was taken into account: complaints, thyroid and lymph nodes ultrasound, thyroid hormones level, results of general clinical examinations. Levels of parathyroid hormone, vitamin D, magnesium, total and ionic calcium were determined at the preoperative stage. In some cases, computer tomography results were included. A fine‑needle aspiration (FNA) biopsy was performed to all patients. Women prevailed: 607 from 749 (81.0%; 95% CI 78.0—83.8). The mean age of the patients was 51.3% (45.6—59.1) years. The causes of disease included: colloid nodular goiter 566 (75.6%; 95% CI 72.3—78.6), nodular (adenomatous) goiter with follicular neoplasm 72 (9.6%; 95% CI 7.6—12.0), papillary carcinoma 54 (7.2%; 95% CI 5.5—9.3), suspicious for papillary thyroid carcinoma (according to the cytology results) 17 (2.3%; 95% CI 1.3—3.6), medullary carcinoma 12 (1.6%; 95% CI 0.8—2.8), anaplastic thyroid cancer 6 (0.8%; 95% CI 0.3—1.7), other tumors 22 (2.9%; 95% CI 1.8—4.4). Statistical processing of the obtained results was carried out by using the standard program package «Statistica 6.0 for Windows» (StatSoft, USA).
 Results. Surgical interventions were performed in 89 of 749 (11.9%; 95% CI 9.7—14.4) patients with malignant tumors of the thyroid gland. The variety of surgical procedures performed on the thyroid gland: thyroidectomy performed in 81 of 89 patients (91%; 95% CI 83.1—96.0), hemithyroidectomy in 8 of 89 patients (9.0%; 95% CI 4.0—16.9). The reasons for the hemithyroidectomy: in 2 of 89 patients (2.2%; 95% CI 0.3—7.9) the diagnosis was not confirmed by express histological examination with suspicion for papillary thyroid carcinoma. In 6 other cases, single micro adenocarcinomas that ranged in size from 0.4 to 0.8 mm were found, without invasion into the tumor capsule, which was confirmed during a planned pathological examination. Lymphodisection of the central tissue, as an addition to thyroidectomy, was performed by us in 76 of 89 cases (85.4%; 95% CI 76.3—92.0). Metastatic lesions of the central tissue during pathological examination were found in 29 (32.6%; 95% CI 23.0—43.3) patients with papillary carcinoma, in 5 with medullary cancer (5.6%; 95% CI 1.8—12.6), in 6 cases with anaplastic thyroid cancer (6.7%; 95% CI 2.5—14.1). In 11 patients (12.4%; 95% CI 6.3—21.0) due to the metastatic spread to the platysma of the lateral triangle of the neck, its excision was performed. In 9 (10%; 95% CI 4.7—18.3) patients were performed thyroidectomy with sheath‑fascial excision (removal) of the neck tissue. The precession method was used to visualize the upper laryngeal nerve in order to prevent traumatization. The upper parathyroid glands served as the first anatomical landmark of the recurrent nerve, which were identified in 72 (80.9%; 95% CI 71.2—88.5) patients. Temporary unilateral vocal fold paresis was observed in 3 (3.4%; 95% CI 0.7—9.5) patients. Wound drainage was carried out separately by leaving micro‑drainage, for active aspiration, which was evacuated in 2 days.
 Соnclusions. One of the main prerequisites for the high‑quality performance surgery of thyroid gland is the precise nature of surgical manipulations with careful observance of tactical and technical requirements for a surgeon: timely identify and precisely mobilize. The choice of the final surgical intervention on lymphatic collectors in thyroid cancer is directly dependent on the preoperative and intraoperative pathological examination. However, given the substantial proportion of metastatic lesions of the central zone lymph nodes (level VI), the technical complexity of repeated operative interventions in this area, it is recommended to perform a preventive removal of the central fiber.

Iodine in the Therapy of Graves' Disease: A Century After Henry S. Plummer.

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Frequency of Thyroid Lesions in a Tertiary Care Hospital in Peshawar

Objective: To determine the frequency spectrum of all thyroid lesions in terms of histopathological patterns presented to the Pathology Department of the Combined Military Hospital Peshawar. Methodology: A retrospective observational study was conducted at the Combined Military Hospital, Peshawar, from September 2015 to December 2020. A total of 235 thyroidectomy specimens, over a period of 5 years, were included in the study period. Information was collected on age, gender, clinical presentation, and histopathological diagnosis. Results: A total of 235 cases were studied over a period of five years, of which 188 (80%) were females and 47 (20%) were males, with a male to female ratio of 1:4. The patients’ ages ranged from 14 years to 85 years, with a mean age of 41 years, and the relative peak age of incidence was seen from 21 to 40 years of age. Total 193 cases (82.1%) belonged to the non-neoplastic category out of which adenomatous colloid goiter was the most common (180 cases, 93.3%). The neoplastic lesions (total cases 42) were 17.9% of all of the cases, out of which benign lesions i.e. adenoma comprised 20 cases (47.7%) and malignant lesions were 22 (52.3%). Among the malignant lesions papillary carcinoma was the most common (16 cases) comprising of 73% of all of the malignant lesions. Conclusion: Thyroid lesions are more common in females, with peak incidence in the second and third decades. The non-neoplastic lesions are more common, with the adenomatous goiter being most prevalent. In the neoplastic lesions, follicular adenoma constitutes the main lesion in the group of benign neoplasms and papillary carcinoma being the most common lesion among the malignant neoplasms.

Incidentally detected retrosternal goitre with posterior mediastinal extension causing compression of airway: a case report

<p class="abstract">Retrosternal goitre (RG) is an enlarged thyroid gland which extends below the clavicle and sternum. Most patients have slow-growing enlargement without any symptoms but may develop symptoms related to compression of aerodigestive tract like dyspnoea, choking, sleep disturbance, dysphagia and hoarseness. Surgical removal is the treatment of choice either through a cervical approach or combination with sternotomy or thoracotomy. Here we present a case of a 51 years female without any symptoms, detected incidentally to have mediastinal mass on imaging during routine health checkup. On evaluation, she was found to have no significant neck swelling or any evidence of vascular obstruction or neurological compression. Contrast enhanced computed tomography showed large heterogeneous mass lesion extending from posteroinferior aspect of (right) thyroid lobe extending into mediastinum till tracheal bifurcation. Due to the mediastinal extension, multispecialty team approach involving oncosurgeon, ear nose and throat (ENT) surgeon and cardiothoracic surgeon was done. The patient underwent (R) hemithyroidectomy with excision of posterior mediastinal component through combined cervical and mediastinal approach under general anaesthesia. Histopathological examination revealed adenomatous goitre. Post operatively patient was symptom free and is on regular follow-up.</p>

Case report: surgical management of symptomatic pretracheal thyroid gland in a patient with dual ectopic thyroid

BackgroundDual ectopic thyroid, a very rare condition, is defined as the simultaneous presence of ectopic thyroid tissue in two abnormal locations. Here, we report the surgical management of a patient with dual ectopic thyroid.Case presentationThe patient was a 12-year-old boy with right para-midline swelling for 2 months. On physical examination of the upper anterior neck, there was a 4 cm × 3 cm mass that was soft, mobile, smooth, and painless. Blood examination showed euthyroidism. Neck ultrasonography showed a well-circumscribed multilocular cyst. We followed up by observation only because the patient had no local symptoms or malignancy. After 2 years, the mass gradually enlarged, so we performed surgery to improve cosmetic outcomes. Preoperative neck CT revealed both a high-density solid mass at the base of the tongue and a central low-density region surrounded by a high-density area at the pretracheal region below the hyoid. The infrahyoid mass was surgically removed, and the sublingual mass was left intact. Pathological findings showed the growth of multiple-size follicles, leading to a diagnosis of adenomatous goiter. Postoperative 123−I scintigraphy showed radioactive iodine uptake in the sublingual lesion, but none in the normal thyroid bed despite the extirpation of thyroid tissue. Postoperative thyroid hormone replacement was started for subclinical hypothyroidism. One year postoperatively, the patient became euthyroid.ConclusionSurgical excision was used to manage a symptomatic cervical infrahyoid mass related to dual ectopic thyroid. Postoperatively, thyroid hormone replacement was required both to prevent enlargement of the remaining sublingual thyroid and to maintain adequate thyroid hormone levels.

PSAT289 Extranodal Marginal Zone B-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue (MALT) Type of the Thyroid: A Rare Tumor That Requires a Second Look

Abstract Background Extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type of the thyroid, or MALT lymphoma of the thyroid, is a rare, indolent tumor that accounts for only 1-2% of extranodal lymphomas. It is often associated with lymphocytic thyroiditis - a benign condition that might not be given additional investigation. Clinical case A 79-year-old male consulted due to a 3-year history of a gradually enlarging, painless anterior neck mass accompanied by hoarseness. He denied fever, weight loss, dysphagia, dyspnea, palpitations, heat or cold intolerance, or changes in bowel movement. On physical exam, a 4×3×1 cm firm, fixed, non-tender right anterior neck mass and a 2×2 cm right supraclavicular mass were palpated. Thyroid function tests showed: TSH 3.301 uIU/mL (0.55 - 4.78 uIU/ml), FT3 2.560 pg/mL (2.30 - 4.20 pg/mL) and FT4 0.720 ng/dL (0.89 - 1.76 ng/dL). Neck ultrasound revealed multiple cervical lymph nodes measuring 1-2 cm in the right anterior, posterior, submandibular, and left submandibular areas. A lobulated heterogeneous mass measuring 9.7×2.9×4.3 cm occupied almost the entire right thyroid lobe, with intralesional and peripheral vascularity. The left thyroid lobe had an irregular, solid, isoechoic nodule measuring 0.9×0.5×0.9 cm. Fine needle aspiration biopsy of the right thyroid mass showed lymphocytic thyroiditis (Bethesda category II). The patient underwent total thyroidectomy with frozen section and selective neck dissection on the right (levels II, III, IV, and V). Final histopathology and immunohistochemical stains revealed extranodal marginal zone lymphoma of the thyroid gland, with high grade transformation to diffuse large B-cell lymphoma in 10% of the tumor. Level II, III and V lymph nodes were positive for marginal zone lymphoma. Histopathology also showed an adenomatous goiter with lymphocytic thyroiditis. The patient was started on levothyroxine 75 mcg once daily. He completed 1 cycle of chemotherapy (R-CHOP). Two weeks after chemotherapy, he developed febrile neutropenia and expired due to sepsis. Conclusion In thyroid nodules and masses where lymphocytic thyroiditis is identified on fine needle aspiration biopsy, particularly in large masses accompanied by cervical lymphadenopathy, the possibility of an existing MALT lymphoma of the thyroid should be considered, and further investigation may be warranted. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

ПОИСК МАРКЕРОВ МОЛЕКУЛЯРНОЙ ДИАГНОСТИКИ ДЛЯ ОПТИМИЗАЦИИ ХИРУРГИЧЕСКОЙ ТАКТИКИ ПРИ ЗАБОЛЕВАНИЯХ ЩИТОВИДНОЙ ЖЕЛЕЗЫ

The routine execution of a fine-needle aspiration puncture biopsy is the most informative method for the preoperative diagnosis of thyroid neoplasms, as well as a promising base for improving molecular diagnostics in an endocrine surgery clinic in conjunction with a pathological laboratory. The aim of our work was a comparative analysis of the expression of cell cycle signaling molecules in various thyroid diseases: toxic goiter, adenomatous goiter, autoimmune thyroiditis and papillary cancer. We investigated the quantitative ratio of expression of apoptosis markers CD-95 (Fas-R) and Ki-67 mitosis detected in thyrocytes by immunocytochemistry and immunohistochemistry using standard protocols. The index Z = Fas / (Ki67 + 1) is proposed.
 The performed cluster analysis of the Z-index calculated on the basis of punctate immunocytochemistry material allowed us to identify a group of patients relatively uniform in value (in this group, after the operation, the diagnosis of papillary cancer was histologically confirmed in all patients). Marker expression values were 2,3–9,0 for Ki67 and 0,9–4,1 for Fas, and the Z-index was in the range 0,6–3,9. It can be useful for the differential diagnosis of thyroid cancer based on punctate material, which is important when deciding on the amount of surgical intervention, as well as in the morphological substantiation of the prognosis of the disease.
 Mathematical analysis showed that if the percentage of fissile nuclei visualized immunohistochemically with the Ki-67 marker is unpromising as a singular diagnostic indicator, then in combination with the apoptosis marker it plays an important role in a comprehensive assessment. These data are also interesting in the context of the pathophysiological pattern of inhibition of the expression of CD95 by tumor cells. This is important to justify the approaches of chemotherapy or immunotherapy of cancer of different tissue belonging.

Mediastinal aberrant goiter characterized by high radiodensity on non-enhanced computed tomography: a case report

BackgroundA mediastinal aberrant goiter is extremely rare, characterized by independence from the thyroid gland. This tumor most commonly develops in the anterior mediastinum and should be differentiated from a thymoma. Moreover, as mediastinal aberrant goiters frequently have a blood supply arising from the thoracic great vessels, preoperative diagnosis and evaluation of the feeding vessel are vital for safe surgery. Herein, we report a rare case of mediastinal aberrant goiter characterized by high radiodensity on non-enhanced computed tomography (CT).Case presentationA 77-year-old woman underwent non-enhanced CT, which showed a 2.2-cm, well-circumscribed, homogeneous anterior mediastinal nodule with high radiodensity. The CT attenuation value of the nodule was as high as 91.9 Hounsfield units. A thymoma or mediastinal goiter was suspected owing to the tumor location and the lack of a cystic component. We performed anterior mediastinal tumor resection using video-assisted thoracoscopic surgery. Pathologically, variably sized follicles, indicative of thyroid tissue, were observed with hemorrhage and hemosiderin deposition. Moreover, papillary projections of small follicles (Sanderson’s polsters) were scattered without atypia of the follicular epithelium, indicative of an adenomatous goiter. The diagnosis of a mediastinal aberrant goiter was supported by the absence of an anatomical connection with the thyroid gland. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.ConclusionThe thyroid gland has a high radiodensity on non-enhanced CT, which correlates with iodine concentration. This radiological feature may be useful for the preoperative differentiation of mediastinal aberrant goiters containing thyroid tissue.

Techniques for Treating a Single Cold Thyroid Nodule

Background: The goal of this article is to raise awareness of malignancy and surgical options for the solitary inflection point of the cold nodule thyroid. Methods: People mentioned after the community or hospitalized straight via Observational Patient Treatment Tartary care hospital kpk with a diagnosis of a single cold nodule thyroid gland were accounted for in the study. Results: The patients' ages varied from 15 to 65, with a mean of 35 10 years, and 90% were female. Sixty-four percent of patients had problems in the right lobe of the thyroid gland, whereas only two percent had problems in the isthmus. Each patient had had surgery and was deemed euthyroid. In 50% of patients, FNAC revealed adenomatous colloid goiter, while in 5%, FNAC revealed papillary cancer of the thyroid gland. Mainly, lobectomy with isthmusectomy was done (95%), whereas complete thyroidectomy was done (5%). Adenomatous colloid goiter was found in 45% of patients, whereas 9% had thyroid cancer that forms in follicles, and 3% had cancer of the follicle based on the histopathology report. In 7% of those who needed it, complete thyroid removal was accomplished. Postoperatively, 5% of patients had an infection at the surgical site, and 3% experienced temporary hypocalcemia. People didn't die outright or anything like that. Conclusion: Women are more likely to have a single cold nodule in their thyroid gland. The most effective surgical procedure is a combination of lobectomy and isthmusectomy. When a single cold nodule develops in the thyroid, papillary carcinoma is the most prevalent kind of cancer that may develop there. Keywords: Techniques, Treating, Cold Thyroid, Nodule

Expression of T-cell immunoreceptor with immunoglobulin and tyrosine-based inhibitory motif domains (TIGIT) in anaplastic thyroid carcinoma

BackgroundImmune checkpoint proteins have not been fully examined in follicular cell-derived thyroid carcinoma and medullary thyroid carcinoma (MTC). Anaplastic thyroid carcinoma (ATC) is one of the most aggressive carcinomas. Even multimodal treatment does not result in favorable clinical outcomes for patients with ATC. Anti-tumor immunity has therefore been highlighted as having therapeutic promise for ATC.MethodsWe examined a novel immune checkpoint receptor, T-cell immunoreceptor with immunoglobulin and tyrosine-based inhibitory motif domains (TIGIT), in variable thyroid lesions: adenomatous goiter, follicular adenoma, and thyroid carcinoma (TC) using immunohistochemistry (IHC).ResultsOur IHC results showed that TIGIT expression was detected in cancer cells of MTC and high-grade TC: poorly differentiated thyroid carcinoma (PDTC) and ATC. Neoplastic cells were positive for TIGIT in four of five MTCs (80.0%), 17 of 31 ATCs (54.8%) and in 3 of 12 PDTCs (25.0%). TIGIT was not detected in any adenomatous goiters, thyroid benign tumors, or differentiated thyroid carcinoma (DTCs). Intriguingly, ATC cells showing pleomorphic/giant cell features were positive for TIGIT, while ATC cells with other cell morphologies lacked the immunoreactivity. Intra-tumoral immune cell was inclined to be enriched in TIGI-positive ATC. Although coexisting papillary thyroid carcinoma (PTC) components demonstrated high-grade microscopic features, neither the PTC nor follicular thyroid carcinoma (FTC) components expressed TIGT in any composite ATCs.ConclusionTIGIT was immunohistochemically found in MTC with high frequency and partially in high-grade TC. TIGIT expression in cancer cells may be beneficial for a potential utility in MTC and a subset of high-grade TC, especially ATC therapy.

Surgical Management of 48 Patients with Retrosternal Goiter and Tracheal Stenosis: A Retrospective Clinical Study from a Single Surgical Center

BackgroundBenign retrosternal thyroid goiters can become large enough to compress the trachea and result in tracheomalacia and stenosis. This retrospective study from a single surgical center aimed to study the surgical management of 48 patients with retrosternal goiter and tracheal stenosis diagnosed and treated from January 2017 to December 2021.Material/MethodsAll preoperative contrast-enhanced CT scans showed retrosternal goiter and tracheal stenosis. RG was classified into type I in 28 patients, type II in 12 patients, and type III in 8 patients. TS was classified into grade I in 31 patients, grade II in 11 patients, and grade III in 6 patients. All patients were referred for surgery. Clinicopathologic features and surgical outcomes were recorded.ResultsAll operations were successfully performed. There were 41 patients with transcervical incision, 4 with cervical incision+sternotomy, 2 with cervical incision and thoracoscopic surgery, and 1 with cervical incision and surgery via the subxiphoid approach. Two patients presented recurrent laryngeal nerve injury. One patient showed short-term hand and foot numbness. The patients were pathologically diagnosed as simple nodular goiter (n=27), nodular goiter combined with cystic change (n=6), adenomatous nodular goiter (n=10), and thyroid adenoma (n=5). There was no prominent tumor recurrence or gradual TS remission.ConclusionsThis study has highlighted that patients with retrosternal goiter and tracheal stenosis may have comorbidities and require a multidisciplinary approach to management. The choice of anesthesia, surgical approach, and maintenance of the airway during and after surgery should be individualized.

Molecular Pathological Characteristics of Thyroid Follicular-Patterned Tumors Showing Nodule-in-Nodule Appearance with Poorly Differentiated Component.

Simple SummaryPoorly differentiated thyroid carcinoma (PDTC) is aggressive and is reportedly evoked by well-differentiated thyroid follicular-patterned tumors (TFTs). TFTs showing nodule-in-nodule (NN) appearance with PD component (PDc) but neither invasion nor metastasis are uncommon and are regarded as benign nodules despite their high-grade histological features. Our study aimed to preliminarily assess the potential role of PDc in NN in PDTC carcinogenesis using dual-color immunofluorescence of 53BP1 as a DNA damage response (DDR) molecule and the Ki-67, NRAS codon 61, and TERT-promoter (TERT-p) mutations. The prevalence of abnormal type 53BP1 expression and NRAS and TERT-p mutations in PDc was comparable to that of carcinomas. Because co-expression of 53BP1 and Ki-67 can be an indicator of altered DDR, the development of PDc in NN may be associated with DDR impairments after harboring NRAS and TERT-p mutations. Therefore, PDc in NN is potentially a precursor lesion associated with PDTC.Thyroid follicular-patterned tumors (TFTs) showing nodule-in-nodule (NN) appearance with poorly differentiated component (PDc) but neither invasion nor metastasis are diagnosed as benign nodules. Although PDc exhibits histologically aggressive features relative to the outer nodule (Out-N), its pathological significance remains unclear. TP53 binding protein-1 (53BP1) is a DNA damage response (DDR) molecule that rapidly localizes at DNA double-strand breaks. Using dual-color immunofluorescence with Ki-67, the profile of 53BP1 expression is shown to be significantly altered during diverse tumorigenesis. In this study, we aimed to elucidate the malignant potential of PDc at the molecular level. We analyzed the profile of 53BP1 expression and NRAS codon 61 and TERT-promoter (TERT-p) mutations in 16 cases of TFTs showing NN with PDc compared to 30 adenomatous goiters, 31 follicular adenomas, 15 minimally invasive follicular carcinomas (FCs), and 11 widely invasive FC cases. Our results revealed that the expression level of abnormal type 53BP1 and incidence of NRAS and TERT-p mutations in PDc were comparable to FCs, suggesting a malignant potential. Because co-expression of 53BP1 and Ki-67 can be an indicator of altered DDR, the development of PDc in NN may be associated with DDR impairments after harboring NRAS and TERT-p mutations.

Morphological features of thyroid benign focal neoplasms in Graves’ disease

Background. The morphology of the thyroid in Graves’ disease (GD) can be quite diverse: in most cases there is a diffuse enlargement of the thyroid gland (diffuse goiter), in some cases it is not increased, and in some patients there are focal neoplasms (single and multiple), including thyroid cancer. According to some studies, in patients with Graves’ disease, focal formations are observed in 10–31% of cases, and in half of the patients, they appear against the background of treatment with thionamides. The purpose of this paper was a retrospective study of the morphological features of benign thyroid neoplasms due to GD based on the results of cytological and pathomorphological studies. Materials and methods. The study was performed at the clinic of the State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”. All patients with GD who were operated in the Department of Endocrine Surgery from 2008 to 2019 (1854 patients) were first selected, and then those who had benign focal formations according to the pathohistological examination were selected among them. Results. The frequency of benign thyroid neoplasms in GD is 22.06% in women aged 26 to 55 years. Cytological studies of thyroid neoplasm punctures in GD made it possible to clearly establish their benign nature (BSRTC-2) in 94.3% of cases. In 5.7% of cases, cytological categories BSRTC-3 and BSRTC-4 were established. Positive immunocytochemical reactions to thyroid peroxidase and thyroglobulin, and the absence of CK17 allow avoiding cytological overdiagnosis, characteristic of benign neoplasms of the thyroid gland in GD. Conclusions. Among pathohistologically confirmed benign neoplasms of the thyroid gland in GD, in 63.82% of cases a histological diagnosis was adenomatous or colloid goiter, in 34.47%— signs of nodular hyperplasia, in 1.71%— the presence of thyroiditis.

Rapid diagnosis of papillary thyroid carcinoma with machine learning and probe electrospray ionization mass spectrometry.

Frozen section examination could provide pathological diagnosis for surgery of thyroid nodules, which is time-consuming, skill- and experience-dependent. This study developed a rapid classification method for thyroid nodules and machine learning. Total 69 tissues were collected including 43 nodules and 26 nodule-adjacent tissues. Intraoperative frozen section was first performed to give accurate diagnosis, and the rest frozen specimen were pretreated for probe electrospray ionization mass measurement. By multivariate analysis of mass scan data, a series compounds were found downregulated in the extraction solution of papillary thyroid carcinoma (PTC), but some were found upregulated by mass spectrometry imaging. m/z 758.5713 ([PC[34:2] + H]+ ), m/z 772.5845 ([PC[32:0] + K]+ ), and m/z 786.6037 ([PC[36:2] + H]+ ) were firstly identified as potential biomarkers for nodular goiter (NG). Machine learning was employed by means of support vector machine (SVM) and random forest (RF) algorithms. For classification of PTC from NG, SVM and RF algorithms exhibited the same performance and the concordance was 94.2% and 94.4% between prediction and pathological diagnosis with positive and negative mass dataset, respectively. For the classification of PTC from PTC adjacent tissues, SVM was better than RF and the concordance was 93.8% and 83.3% with positive and negative mass dataset, respectively. With the identified compounds as training features, the sensitivity and specificity are 87.5% and 88.9% for the test set. The developed method could also correctly predict the malignancy of one medullary thyroid carcinoma and one adenomatous goiter (benign). The diagnosis time is about 10min for one specimen, and it is very promising for the intraoperative diagnosis of papillary thyroid carcinoma.