Case Of Follicular Thyroid Cancer Research Articles

A case of follicular thyroid cancer in a girl with Graves' disease

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

DIFFICULTIES IN DIFFERENTIAL DIAGNOSIS OF THYROID NODULAR PATHOLOGY. A CASE REPORT

This paper presents a clinical case of follicular thyroid cancer, the importance of multiparametric ultrasound in the early detection of thyroid cancer is shown. To diagnose follicular thyroid cancer, multiparametric ultrasound examination was performed in B-mode, color Doppler mapping mode, sonoelastography and in contrast enhancement mode. Based on the results, indications for fine needle aspiration puncture biopsy were determined and further management tactics for the patient with follicular thyroid cancer were determined. Thus, a timely diagnosis and a correct chosen tactics for treating follicular thyroid cancer resulted in a favorable disease outcome.

Temporal Trends in Papillary and Follicular Thyroid Cancer Incidence from 1995 to 2019 in Adults in Denmark According to Education and Income.

Background: Thyroid cancer incidence has increased over the past decades. Differences in incidence trends have been observed depending on socioeconomic status. Here, we describe trends in the incidence of papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) in Denmark by level of education and income. Methods: All PTC and FTC cases registered in the Danish Cancer Registry from 1995 to 2019 were identified. Individual-level information on education and income was obtained from nationwide registries. We calculated age-standardized incidence rates according to sex, tumor size, education and income, and estimated incidence trends by average annual percentage change (AAPC) and corresponding confidence intervals [CIs] for the periods 1995 to 2004 and 2005 to 2019 by using Poisson regression models. Results: We identified 3454 cases of PTC and 972 cases of FTC. From 2005 to 2019 among women, the incidence of PTC increased across all levels of education (AAPCshort education = 12.5% [CI 9.8 to 15.3]; AAPCmedium education = 8.1% [CI 6.4 to 9.9]; AAPClong education = 7.3% [CI 5.4 to 9.2]). The same pattern was seen for income. The incidence of FTC increased in all levels of education (AAPCshort education = 10.5% [CI 5.8 to 15.4]; AAPCmedium education = 4.0% [CI 0.9 to 7.3]; AAPClong education = 4.3% [CI 0.6 to 8.1]), with the same pattern for income. Similar trends were observed among men, in both small (≤2 cm) and large (>2 cm) PTCs and from 1995 to 2004 in both sexes. Conclusions: Enhanced detection of thyroid cancer among all levels of education and income cannot be ruled out, and in addition, our results may suggest a true increase in the incidence of differentiated thyroid cancer.

Metabolic reprogramming related to whole-chromosome instability in models for H\xfcrthle cell carcinoma

Hürthle cell carcinoma (HCC) is a recurrent subtype of non-medullary thyroid cancer. HCC is characterized by profound whole-chromosome instability (w-CIN), resulting in a near-homozygous genome (NHG), a phenomenon recently attributed to reactive oxygen species (ROS) generated during mitosis by malfunctioning mitochondria. We studied shared metabolic traits during standard and glucose-depleted cell culture in thyroid cancer cell lines (TCCLs), with or without a NHG, using quantitative analysis of extra and intracellular metabolites and ROS production following inhibition of complex III with antimycin A. We found that the XTC.UC1 and FTC-236 cell lines (both NHG) are functionally impaired in complex I and produce significantly more superoxide radicals than SW579 and BHP 2–7 (non-NHG) after challenge with antimycin A. FTC-236 showed the lowest levels of glutathione and SOD2. XTC.UC1 and FTC-236 both exhibited reduced glycolytic activity and utilization of alternative sources to meet energy demands. Both cell lines also shared low levels of α-ketoglutarate and high levels of creatine, phosphocreatine, uridine diphosphate-N-acetylglucosamine, pyruvate and acetylcarnitine. Furthermore, the metabolism of XTC.UC1 was skewed towards the de novo synthesis of aspartate, an effect that persisted even in glucose-free media, pointing to reductive carboxylation. Our data suggests that metabolic reprogramming and a subtle balance between ROS generation and scavenging/conversion of intermediates may be involved in ROS-induced w-CIN in HCC and possibly also in rare cases of follicular thyroid cancer showing a NHG.

MON-451 An Unusual Case of Follicular Thyroid Cancer with Pulmonary Metastasis and Concurrent Hyperthyroidism

Introduction: Follicular Thyroid Cancer (FTC) accounts for approximately 12 % of all thyroid cancers and is the second most common cause of differentiated thyroid cancer. However, coexisting hyperthyroidism and thyroid malignancy is considered a rare event and is thought to have a prevalence of 0.21–9.0 %. We describe a compelling case of metastatic FTC initially presenting with subclinical hyperthyroidism progressing to overt hyperthyroidism.Clinical Case: An 88-year-old man with a history of prostate cancer, previous tobacco dependence, and hypertension initially presented with complaints of a chronic non-productive cough associated with unintentional weight loss and fatigue. Initial imaging included a chest CT that showed several bilateral pulmonary nodules suspicious for metastatic disease, as well as an enlarged left-sided thyroid mass, which extended from the inferior pole into the mediastinum. FDG PET/CT showed avid disease identified in the lung. CT-guided lung biopsy was performed, and histopathology revealed FTC. Thyroid function tests (TFTs) revealed a Tg level of 1427 (0.00–33.70), TgAb <1.0 (< 13.6), TSH 0.05 (0.40–4.50), FT4 1.1 (0.8–1.8) and FT3 3.4 (2.3–4.2). Biochemical testing was consistent with subclinical hyperthyroidism. Neck ultrasound showed bilateral thyroid nodules, the largest located on the left mid-pole measuring 3.4 x 3.2 x 3.7 cm. He underwent a whole-body I-131 diagnostic scan, which showed intense uptake of the radionuclide within the thyroid gland, more evident on the left, but additional metastatic lesions elsewhere in the visualized body were not possible. TFTs were repeated, which showed a TSH of 0.01, FT4 of 2.0, and FT3 of 6.4. He was subsequently started on methimazole daily and eventually became euthyroid. Due to advanced age, significant mediastinal extension, and lung metastasis, the patient was not a candidate for surgical resection and treatment with a targeted tyrosine kinase inhibitor. He ultimately opted for an observational approach.Conclusion: Although metastatic FTC carries a poor prognosis, concurrent hyperthyroidism is thought to be associated with a more aggressive disease course and higher mortality compared to differentiated thyroid cancers in euthyroid patients.Sources: 1. Pazaitou-Panayiotou, K., Perros, P., Boudina, M., Siardos, G., Drimonitis, A., Patakiouta, F., & Vainas, I. (2008). Mortality from thyroid cancer in patients with hyperthyroidism: the Theagenion Cancer Hospital experience, European Journal of Endocrinology, 159(6), 799–803.2. Benjamin Momo Kadia, Christian Akem Dimala, Ndemazie Nkafu Bechem, Desmond Aroke. BMC Res Notes. 2016; 9: 369.3. Parameswaran R, Shulin Hu J, Min En N, Tan WB, Yuan NK. Patterns of metastasis in follicular thyroid carcinoma and the difference between early and delayed presentation. Ann R Coll Surg Engl. 2017;99(2):151–154.

Expression of Caveolin-1 Is Associated With Thyroid Function in Patients With Human Papillary Thyroid Carcinoma.

Objective:The aim of this study was to evaluate the levels of caveolin-1 in thyroid follicular epithelial cells of papillary thyroid cancer, follicular thyroid cancer, and nonmalignant thyroid nodule benign follicular adenoma, as well as to explore the relationship between the levels of caveolin-1 and thyroid function.Methods:Thirty cases of papillary thyroid cancer, 10 cases of follicular thyroid cancer, 32 cases of nonmalignant thyroid nodule benign follicular adenoma, and 30 controls were enrolled in this study. Caveolin-1 expression in tissue specimens obtained from these cases was evaluated by immunohistochemistry and Western blotting.Results:Caveolin-1 expression in thyroid epithelial cells of patients with papillary thyroid cancer, particularly female patients, was significantly higher than that in patients with follicular thyroid cancer and nonmalignant thyroid nodule benign follicular adenoma (P < .005). Serum thyroid-stimulating hormone (TSH) levels in the caveolin-1-positive expression group were lower than that in the caveolin-1-negative expression group, and the lowest expression of caveolin-1 was detected in tissues of patients with Graves’ disease. The serum TSH level was associated with caveolin-1 expression in thyroid epithelial cells.Conclusion:Caveolin-1 may participate in regulating thyroid function and is a potential biomarker of follicular thyroid cancer.

Follicular thyroid cancer avid on C-11 Methionine PET/CT.

SummaryA case of follicular thyroid cancer with intense focal Methionine uptake on 11C-Methionine PET/CT is reported here. The use of 11C-Methionine PET in differentiated thyroid cancer is currently being investigated as a surrogate tracer compared to the more widely used 18F-FDG PET. This case illustrates the potential incremental value of this modality, not only in the localizing of parathyroid adenoma, but also indicating that 11C-Methionine PET might have a potential of increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.Learning points:11C-Methionine PET/CT and 18F-Fluorocholine PET/CT often visualizes the parathyroid adenoma in case of negative Tc-99m-MIBI SPECT/CT.A cold nodule in Tc-99m Pertechnetat thyroid scintigraphy with a negative Sestamibi scintigraphy has a very low probability of being malignant.However, the pretest likelihood of thyroid cancer in a cold nodule with increased Sestamibi uptake is low.11C-Methionine PET might have a potential incremental value in increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.

Cervical soft tissue recurrence of differentiated thyroid carcinoma after thyroidectomy indicates a poor prognosis

BackgroundWe investigated cervical soft tissue recurrence of differentiated thyroid carcinoma (DTC) after thyroidectomy, and these lesions exhibited no evidence that they were lymph nodes (LNs). MethodsBetween January 2012 and April 2016, consecutive 6308 patients underwent thyroid surgery for DTC at our center. Among them, we encountered 21 patients with recurrent cervical soft tissue lesions, none of whom had previously undergone fine needle aspiration biopsy (FNAB). ResultsThe 21 patients accounted for 0.33% of all 6308 patients, including twenty cases of papillary thyroid carcinoma and one case of follicular thyroid cancer. Approximately half (52.3%) of the recurrence were first detected by ultrasound (US). Eighteen lesions underwent complete preoperative US, but 6 lesions were misdiagnosed as metastatic LNs by US. Therefore, 54 age- and gender-matched recurrent or persistent LNs derived from DTC were randomly selected from the same database. The soft tissue lesions (mean size, 2.30 cm) were larger than the LNs. Fewer hyperechogenic hila and punctuations were found in the group of soft tissue recurrence (P < 0.05). During follow-up, distant metastasis was detected in 38.1% of patients in the soft tissue recurrence group. The distant metastasis rates showed that local soft tissue recurrence led to a poorer prognosis than cervical LN persistence or recurrence (P = 0.00). ConclusionsAlthough the incidence of DTC recurrence in cervical soft tissue was low, it may be a predictor for distant recurrence. To minimize the risk, a long-term postoperative evaluation, preferably with US, should be performed.

Type 2 Myotonic Dystrophy Associated with Follicular Thyroid Cancer: A Case Report and Review of Literature

A patient with myotonic dystrophy and associated multinodular goiter, subclinical hyperthyroidism, and micro follicular thyroid cancer is described. To authors’ knowledge, at least 12 cases of thyroid cancer associated with myotonic dystrophy have been reported which were papillary, medullary, and unknown type. This is the first reported case of follicular thyroid cancer in type 2 myotonic dystrophy. Myotonic dystrophy commonly involved endocrine system and unstable neucleotide repeat expansions in myotonic dystrophy may predispose patients to develop cancer. The authors hypothesized that myotonic dystrophy might be one of risk factors for development of thyroid cancer.

Application of diffusion-weighted MR imaging in the diagnosis of thyroid disease

Objective To analyze and summarize the characteristics of thyroid diseases on the MR diffusion-weighted imaging.Methods Forty-two patients with thyroid lesions,including 10 males and 32 females [age range 20-72 years,mean age (42 + 13) years] underwent MR DWI before surgery and biopsy.The diagnoses of thyroid lesions were confirmed by pathological results.ADC values of benign and malignant nodules,with different b values (b values was 300,500 and 800 s/mm2),were generated by using post-processing software Functool of GE company(USA).The independent-samples t test was used and ROC curve was made to evaluate the diagnostic efficiency of the ADC values by using statistical software SPSS 12.0.Results Histologically,there were 28 benign lesions and 14 malignant lesions.Benign lesions included 20 cases of thyroid adenoma,6 cases of nodular goiter and 2 cases of Hashimoto's thyroiditis respectively.Malignant lesions consisted of 11cases of thyroid papillary carcinoma,2 cases of follicular thyroid cancer,and 1case of dysplasia.mean ADC value of benign thyroid lesions was (2.39 ±0.38) ×10 -3 mm2/s and mean ADC value of malignant thyroid lesions was ( 1.60 ± 0.56) × 10 -3 mm2/s with b value of 300 s/mm2.The statistical difference was significant between them( t =5.35,P ＜ 0.05 ).The statistical difference of mean A DC values,between benign and malignant nodules with b value of 500 s/mm2 [ (1.85 +0.33 ) × 10 -3 mm2/s and ( 1.65 ± 0.42 ) × 10 -3 mm2/s ],was insignificant ( t =1.70,P ＞ 0.05 ).The statistical difference of mean ADC values,between benign and malignant nodules with b value of 800 s/mm2 [ ( 1.61± 0.30) × 10 -3mm2/s and( 1.44 +0.29) × 10 -3mm2/s],was insignificant (t =1.76,P ＞0.05 ).ROC curve indicated that the ADC value of 1.98 × 10-3 mm2/s or higher was the cut-off value for differentiating benign from malignant cold thyroid nodules,with a sensitivity of 85.7％,and a specificity of 78.6％.Conclusions The image quality is best with b value of 300 s/mm2.Mean ADC value of benign lesions was significantly higher than mean ADC value of malignant lesions with b value of 300 s/mm2. Key words: Thyroid disease; Diffusion magnetic resonance imaging

Risk stratification of indeterminate thyroid fine-needle aspiration biopsy specimens based on mutation analysis

Mutation analysis is potentially a powerful tool to enhance the diagnostic accuracy of thyroid fine-needle aspiration (FNA) biopsy specimens. However, some clinicians may rely on a negative mutation panel to exclude malignancy. We aimed to determine the malignancy rate in indeterminate lesions with negative mutation analysis. A literature review established a mutation analysis model using the prevalence of BRAF, RET, RAS, and PAX8/peroxisome proliferator-activated receptor-γ mutations in indeterminate lesions. This model was applied retrospectively to a study cohort of 466 consecutive indeterminate lesions that underwent hemi- or total thyroidectomy for definitive diagnosis, to evaluate its accuracy for identifying malignancy. Of 466 indeterminate lesions in the study, 30% (139) were malignant. These included 66 cases of papillary thyroid cancer, 45 cases of follicular variant of papillary thyroid cancer, 18 cases of follicular thyroid cancer, and 10 others. The risk of malignancy was 42% when cytologic atypia was present vs 17% without. The mutation analysis model would correctly identify only 48 of 139 (34%) of malignant indeterminate lesions. Therefore, when mutation analysis is negative, the overall risk of malignancy would be 23%. When atypia is present, the risk of malignancy would be 31% vs 13% in lesions without. Indeterminate lesions with a negative mutation analysis still carry a significant risk of malignancy, especially in the presence of atypia, requiring surgery for definitive diagnosis.

ES18 *FOLLICULAR THYROID CANCER PRESENTING AS BONE METASTASES

Purpose: Follicular Thyroid cancer (FTC) is the second commonest thyroid malignancy. Between 5 and 20% of patients with FTC will have a distant metastasis at the time of presentation. The aim of the present study was to highlight: different modes of FTC presentation, especially bone metastases; the incidence of minimally invasive versus widely invasive cancer; patients presenting with distant metastasis with no evidence of FTC in the thyroid; and patients presenting with metastasis despite regular follow up for benign multi nodular goitre.Methods: A retrospective review of 26 cases of FTC identified from a database of 1670 prospectively collected thyroidectomies was undertaken.Results: There were 23 females and 3 males of median age 46 (range 25 to 92) years. In 17 (65%) patients, cytology showed a follicular lesion; necessitating a diagnostic hemithyroidectomy, and a 50% rate of two stage surgery. All patients were confirmed cases of FTC on histopathology. Six of twenty six patients had distant metastases in bone; two of these six did not have evidence of cancer in thyroid, one presented with metastasis despite regular follow up for benign multi nodular goitre and the remaining three with distant metastases in bone had evidence of cancer in thyroid. Nineteen of these were categorized as minimally invasive cancer compared to 5 who had widely invasive cancer.Conclusion: The present series highlights a rare subgroup of patients presenting with bone metastases without identifiable FTC in the thyroid gland.

Endobronchial metastasis of follicular thyroid carcinoma presenting as hemoptysis: A case report

Endobronchial metastasis secondary to follicular thyroid carcinoma is extremely rare. Here, we report a case of follicular thyroid cancer in 58-year-old male who presented with hemoptysis. Computed tomography of the chest revealed multiple lung metastases. Flexible fiberoptic bronchoscopy revealed a fragile polypoid mass 5 cm distal to the vocal cords; biopsy taken from this mass revealed follicular thyroid carcinoma.

Clinical study of thyroid cancer among a pediatric population born after Chernobyl (first report)

6069 Background: To evaluate the clinical and patologic results of surgical treatment of children born after Chernobyl and to compare these findings with well-known data of the group of patients who were children at the time of Chernobyl. To compare the clinical and pathologic features of thyroid cancer of children born after the Chernobyl versus those born prior to 1986. Methods: Comparison of clinical and pathologic result of surgical treatment of 141 patients born after Chernobyl (Group 1) and 589 patients (Group 2) aged 0–18 at the time of the disaster (1986) among the single institution clinical cohort within years 1995–2005. Results: In Group 1 there were 31 cancers (22%) vs. 243 (41%) in Group 2 (p&lt;0.05 between Group 1 and Group 2). The rate of extrathyroid invasion was 69% vs. 36% (p&lt;0.05 between Group 1 and Group 2). In Group 1, 17/21(80%) patients with extrathyroid invasion were found to have regional neck metastases (8 unilateral, 9 bilateral).The mean age in this subgroup was 13.4 ± 2.11 years but in the “benign subgroup” of Group 1 the mean age is 16.2 ± 0.77 years.In Group 2, 49/88 (55%) patients with extrathyroid invasion only had regional metastases. The mean age in this subgroup is 31.1 ± 4.7 years (p&lt;0.05 between Group 1 and Group 2). We found cancer multifocality in 1 patient (3%, Group 1) vs. 55 (23%, Group 2).There were 19 cases (13.5%) of atypical adenomas in Group 1 vs. 46 (8%) in Group 2 (p&lt;0.05 between Group 1 and Group 2). Histological types: solid follicular variant of papillary carcinoma (typical for radiation-induced children carcinomas with short latency) was found in 3 cases in Group 1 (9.5%) vs. 76 (31%) in the Group 2 (p&lt;0.05 between Group 1 and Group 2). There was only one case of follicular thyroid cancer in Group 1 (3%) vs. 9% in Group 2. We did not find any relationship of cases of cancer in Group 1 to the Chernobyl-polluted area (only 3 patients − 10% from the nearest to Chernobyl regions) vs. 192 patients (80%) in Group 2 (p&lt;0.05 between Group 1 and Group 2). Among patients with tumors of uncertain malignant potential 9 patients (6%) were from Chernobyl-polluted area vs.72% in Group 2 (p&lt;0.05 between Group 1 and Group 2). Conclusions: Our data demonstrates higher likelihood of aggressive well-differentiated thyroid cancer among a pediatric population independently from Chernobyl irradiation and connected with another etiological factors of genesis of tumor.The solid-follicular variant of papillary cancer and multifocality are typical for radiation-induced carcinoma in children. No significant financial relationships to disclose.

Thyroid cancer treated in Chang Gung Memorial Hospital (northern Taiwan) during the period 1979-1992: clinical presentation, pathological finding, analysis of prognostic variables, and results of treatment.

This study is a retrospective analysis of 248 thyroid cancer patients who received their primary treatment in the Chang Gung Memorial Hospital during the period January 1979 to December 1992. Among these cases, there were 173 papillary thyroid cancers (69.8%), 52 cases of follicular thyroid cancer (21%), 7 cases of medullary thyroid cancer (2.8%), and 16 cases of anaplastic thyroid cancer (6.5%). The subjects included 184 female patients with a mean age of 40.7 +/- 14.3 years and 64 males patients with a mean age of 49.2 +/- 14.3 years. Most of the cases had a nearly total thyroidectomy after the diagnosis was confirmed by frozen section during the operation. During the follow-up period, 19 (8.2%) patients diagnosed with well-differentiated thyroid cancer died of thyroid cancer in contrast to 12 patients (75%) with anaplastic thyroid cancer. The 1-year Greenwood survival probabilities after the disease is diagnosed in papillary, follicular, and anaplastic thyroid cancer are 0.98, 0.86, and 0.25, respectively. For the analysis of prognostic variables in well-differentiated thyroid cancer patients, 16 factors were entered for univariate and multivariate analysis. Using a log-rank univariate analysis, survival was significantly associated with the cell type of the primary tumor, age, clinical staging, postoperative 131I pattern, tumor size, postoperative thyroglobulin (Tg) level and postoperative x-ray results. In the Cox multivariate regression analysis the combination factors that gave the best prognostic value were the association of x-ray finding (P = .004), age (P = .017), and Tg level (P = 0.19). In conclusion, thyroid cancer is not an unusual disease in Taiwan. As previously reported anaplastic thyroid cancer has a poor prognosis. In this limited period of follow-up study, the patients' age with postoperative first positive x-ray finding and Tg level may provide the prognostic factors for patients with well-differentiated thyroid cancer.

Thyroid Carcinoma Presenting as an Autonomous Thyroid Nodule

A case of follicular thyroid cancer appearing as an autonomous nodule on Tc-99m and I-123 thyroid scintigraphy is presented in addition to a pertinent review of the literature.