Cases Of Thyroid Carcinoma Research Articles

Current Approach of Small Field Electron Beam for Head and Neck Cases

Regarding the increasing use of small-field photons in clinical treatment, in this study, we investigate the use of small-field electron beams in clinical treatment. This study aimed to evaluate small-field electron beam dosimetry of the nasopharyngeal, thyroid, and ethmoid sinus carcinoma cases. Dose measurement was done using EBT3 film. In nasopharyngeal cases with a homogenous area and irregular surface, the dose discrepancies for 6 MeV energy were unpredictable except for the 5×5 cm2 field size. For all energies in 5×5 cm2 field size, the dose discrepancies were less than 3%. In these cases, we found that a smaller electron beam field will increase the percentage of the dose discrepancy. This is caused by the effect of the lateral scatter disequilibrium in a small field electron beam. For ethmoid sinus cases, dose discrepancy depends on the field size and inhomogeneity of bone and tissue organ. Based on the evaluation of doses on the spinal cord, chiasm, and larynx (OAR), it can be seen that these organs received a very small dose. From this result, a small field electron beam is recommended for cases with a homogeneous target. However, in cases with a heterogenous target, further investigation is needed.

Molecular genetics features of anaplastic thyroid carcinoma

INTRODUCTION: Anaplastic thyroid carcinoma (ATC) is the most aggressive type of thyroid cancer accounting for 12% of all malignancies. Systemic therapy remains the main treatment strategy. Targeted therapy and immunotherapy are prescribed when certain molecular genetic aberrations are detected.
 THE AIM: To investigate the molecular genetic profile of samples of anaplastic thyroid carcinoma.
 MATERIALS AND METHODS: The study included 37 patients with ATC. Mutation V600E BRAF, mutations in the gene NRAS and KRAS were detected by allele-specific polymerase chain reaction (AS-PCR). Microsatellite instability (MSI) was determined by fragment analysis in according to ESMO recommendations. Mutations in the promoter region of the TERT gene were used by Sanger sequencing. NTRK1, EML4-ALK, PAX8/PPARy и RET/PTC translocations were determined in all patients with ATC by real-time polymerase chain reaction (PCR).
 RESULTS: According to the results of the study, the frequency of the V600E mutation in the BRAF gene was 32.4% (12/37). The frequency of aberrations in the NRAS, KRAS genes in anaplastic thyroid carcinoma was 13.5% (n=5). The prevalence of point mutations in the promoter gene TERT in food samples of ATC was 24.3% (n=9). MSI was found in 2.7% (1/37) of cases of anapalastic thyroid carcinoma. NTRK1, EML4-ALK, PAX8/PPARy and RET/PTC translocations were not detected in cases with anaplastic thyroid carcinoma.
 CONCLUSION: The further study of the main specific molecular targets in cancer cells will allow to personalize the tactics of patients with anaplastic thyroid carcinoma.

Abstract #1412768: A Case Report of Metastatic Medullary Thyroid Carcinoma

Medullary thyroid carcinoma is rare condition representing 1-2% of thyroid cancers originating from parafollicular calcitonin producing cells. Mutations are either sporadic or hereditary, the latter of which is associated with MEN2A/B and RET germline mutations. In this report, we present a case of medullary thyroid carcinoma in an 80-year-old male identified by an incidental ultrasound finding. Patient is an 80-year-old male who originally presented to an ophthalmologist with chief complaint of vision loss. Ophthalmologic evaluation was consistent with ocular vein occlusion. The patient was sent for a carotid doppler which revealed an incidental finding of a large thyroid nodule. Dedicated thyroid ultrasound measured the left sided thyroid nodule to be 4.5cm. FNA and tissue pathology was consistent with follicular neoplasm, Bethesda Category 5 tissue that was highly suspicious for malignancy. Thyroseq TM molecular analysis revealed a KRAS-G12R mutation and overexpression miR375 suggestive of medullary thyroid carcinoma. He was referred to ENT surgery and obtained preoperative urine metanephrines, PTH, CEA and Calcitonin. His CEA and Calcitonin were both elevated (183 ng/mL and 10,103 pg/mL respectively) with a normal PTH (55 pg/mL) and urine metanephrines (146 ug/mL). During planned total thyroidectomy via radical left neck dissection, patient had signal loss of the left vagus nerve. Unfortunately, the right thyroidectomy was aborted with plans for completion thyroidectomy after recovery of the vagus nerve. Post-operative pathology revealed a 5.5 cm medullary thyroid carcinoma confined to the thyroid with fifteen lymph nodes positive for metastatic disease. Oncologic workup consisted of PET CT which revealed multiple sites of intrathoracic hypermetabolism and hilar lymphadenopathy consistent with metastatic disease. Most concerning was involvement of the pleural surface. In addition, there was a residual nodule detected in the remnant right thyroid lobe. Due to the disease burden, however, the decision was ultimately to not pursue completion thyroidectomy. Biopsy of the hilar lymph nodes was performed via endobronchial ultrasound with transbronchial needle aspiration. Tissue analysis did not reveal malignant cells. Currently, he awaits an official tissue diagnosis which delays chemotherapy. The ideal treatment of medullary thyroid carcinoma involves early identification and total thyroidectomy. As an adjunct in advanced disease, the approach to surgery can be a more palliative focus to preserve function rather than disease eradication. Identification of the mutations as sporadic or hereditary also guides treatment as nearly all hereditary MEN2A/B, and 50% of sporadic mutations are of the RET proto-oncogene. In sporadic mutations, 18-80% of carcinomas that lack RET mutations have mutations of HRAS, KRAS or NRAS. In the case presented, chemotherapy will begin once pending mutation analysis is received.

Unusual spread of the follicular thyroid carcinoma, metastases to liver and pancreas

We report a multimetastatic follicular thyroid carcinoma(FTC) with match lesions between 18F-FDG PET/CT and post-treatment 131I imaging. The patient had a history of thoracic vertebra corpectomy surgery and liver tru-cut biopsy; both resulted in metastases of FTC. After total thyroidectomy surgery, the patient was referred to the 18F-FDG PET/CT to investigate other possible metastatic foci. 18F-FDG PET/CT showed increased FDG uptakes on a cervical lymph node, bones, lung, liver, and pancreas. After treatment of 131I, post-treatment iodine scintigraphy demonstrated iodine uptakes in the same areas as the 18F-FDG PET/CT scan and at the thyroid bed. All the matched lesions were concluded as a spread of the FTC. Here we describe an infrequent differentiated thyroid carcinoma case with metastases to the liver and pancreas. This case report also highlights the importance of 18F-FDG PET/CT in determining the extent of thyroid cancer.

The necessity of resection of suprasternal fossa fat in total endoscopic thyroidectomy via the areola approach.

The identification of a lower boundary for the central lymph node (CLN) of the neck in total endoscopic thyroidectomy via the areola approach (ETA) is important for its radical dissection. We found that resection of the suprasternal fossa fat (SFF) was beneficial for exposing the lower boundary and preventing suprasternal swelling after the operation. This retrospective analysis included 470 papillary thyroid carcinoma (PTC) cases, with some treated by unilateral lobectomy, some by central lymph node dissection (CLND) through ETA (n = 193), and the others by conventional open thyroidectomy (COT, n = 277). The main observation indicators included the total number of CLNs, CLND operative time, visualization of the upper pole of the thymus before removing the CLN, and postoperative suprasternal swelling. The SFF retention group and COT group had a similar percentage of women (78.65% vs. 79.42%, P = 0.876) lower than that in the SFF resection group (95.19%, P < 0.001). The percentage of the visualized upper pole of the thymus before CLN removal was notably higher in the SFF resection group than that in the SFF retention group (63.46 vs. 29.21%, P < 0.001) but notably lower than that in the COT group (63.46% vs. 100%, P < 0.001). A total of 43.82% and 23.1% of patients in the SFF retention and COT groups showed suprasternal swelling, respectively. No patient exhibited such swelling in the SFF resection group (23.1% vs. 0, P < 0.001). Resection of SFF in ETA easily identified the lower boundary for CLND and prevented suprasternal fossa swelling.

Identification of Novel Candidate Genes for Familial Thyroid Cancer by Whole Exome Sequencing.

Thyroid carcinoma (TC) can be classified as medullary (MTC) and non-medullary (NMTC). While most TCs are sporadic, familial forms of MTC and NMTC also exist (less than 1% and 3-9% of all TC cases, respectively). Germline mutations in RET are found in more than 95% of familial MTC, whereas familial NMTC shows a high degree of genetic heterogeneity. Herein, we aimed to identify susceptibility genes for familial NMTC and non-RET MTC by whole exome sequencing in 58 individuals belonging to 18 Spanish families with these carcinomas. After data analysis, 53 rare candidate segregating variants were identified in 12 of the families, 7 of them located in previously TC-associated genes. Although no common mutated genes were detected, biological processes regulating functions such as cell proliferation, differentiation, survival and adhesion were enriched. The reported functions of the identified genes together with pathogenicity and structural predictions, reinforced the candidacy of 36 of them, suggesting new loci related to TC and novel genotype-phenotype correlations. Therefore, our strategy provides clues to possible molecular mechanisms underlying familial forms of MTC and NMTC. These new molecular findings and clinical data of patients may be helpful for the early detection, development of tailored therapies and optimizing patient management.

Tiroid Karsinomu Tanısı – Problem Çözücü Olarak Dinamik Manyetik Rezonans Görüntüleme

Objective: Comparison of the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) with color Doppler US and Fine Needle Aspiration Cytology (FNAC) in the differential diagnosis of thyroid carcinoma cases.&#x0D; Materials and methods: Study group comprised 28 women and 6 men and all of them had thyroid hormone disorders in their routine examinations. 38 nodules were examined. After radiologic examinations, FNAC and thyroidectomy were applied.&#x0D; Results: The dynamic MR was found to have the highest sensitivity and specificity between the color-Doppler US, FNAC, and dynamic MR modalities for the diagnosis of carcinoma. In the dynamic MR examination, the difference between the peak-contrast signal intensity values (p = 0.018) and the minimum-contrast signal intensity values (p = 0.023) calculated at the p &lt; 0.05 level were statistically significant between the malignant and benign nodules.&#x0D; Conclusions: We consider that the differential diagnosis of thyroid nodules can be made by analyzing the dynamic MRI data. Malignant thyroid nodules show typical time-signal intensity curves, and we believe that dynamic MRI will be valuable for preoperative assessment of the thyroid nodules in certain conditions like radiology–pathology mismatch.

Expression of CK19 in papillary thyroid carcinoma in comparison with benign thyroid lesions

Background: The Papillary variant of thyroid carcinoma is one of the common types of thyroid malignancies , the commonest. Its diagnosis usually is microscopic which based on nuclear features. Objective: To assess the immunohistochemical expression of cytokeratin 19 (CK19) in PTC and compare its reactivity with other thyroid conditions to approve its importance as a useful test for diagnosing PTC. Patients and Methods: Twenty- cases of papillary thyroid carcinoma (with different variants), five follicular adenomas and ten multinodular goiters (MNG) were collected over three years (2018-2021).10% formalin-fixed sections were collected from thyroidectomy specimens. Stained with Hematoxylin and eosin then immunohistochemical staining for immune-marker CK 19 was done using standard techniques. The results were quantitatively scored as the following: score 0 (negative ), score 1+ (&lt;5%) positive cells), score 2+ (5- 25%), score 3+ (25-75%) ,finally score 4+ (&gt;75%) positive cells), and then calculated. Results: An 18 (90%) papillary carcinomas show diffuse and strong (3+ and 4+) expression of CK19 . ,three out of ten (30%) MNG were weakly positive(1+ and 2+) and focal in distribution while in follicular adenoma all cases were negative for CK19 . Conclusion: Ck 19 can stain benign and malignant thyroid tissue, but strong membranous staining applied in cases of papillary ca , thus can be used as confirmatorytool for PTC diagnosis.

Expression of CK19 in papillary thyroid carcinoma in comparison with benign thyroid lesions

Background: The Papillary variant of thyroid carcinoma is one of the common types of thyroid malignancies , the commonest. Its diagnosis usually is microscopic which based on nuclear features.&#x0D; Objective: To assess the immunohistochemical expression of cytokeratin 19 (CK19) in PTC and compare its reactivity with other thyroid conditions to approve its importance as a useful test for diagnosing PTC.&#x0D; Patients and Methods: Twenty- cases of papillary thyroid carcinoma (with different variants), five follicular adenomas and ten multinodular goiters (MNG) were collected over three years (2018-2021).10% formalin-fixed sections were collected from thyroidectomy specimens. Stained with Hematoxylin and eosin then immunohistochemical staining for immune-marker CK 19 was done using standard techniques. The results were quantitatively scored as the following: score 0 (negative ), score 1+ (&lt;5%) positive cells), score 2+ (5- 25%), score 3+ (25-75%) ,finally score 4+ (&gt;75%) positive cells), and then calculated.&#x0D; Results: An 18 (90%) papillary carcinomas show diffuse and strong (3+ and 4+) expression of CK19 . ,three out of ten (30%) MNG were weakly positive(1+ and 2+) and focal in distribution while in follicular adenoma all cases were negative for CK19 .&#x0D; Conclusion: Ck 19 can stain benign and malignant thyroid tissue, but strong membranous staining applied in cases of papillary ca , thus can be used as confirmatorytool for PTC diagnosis.

Unusual papillary thyroid carcinoma with hyalinizing trabecular tumor-like feature in a young female patient: a case report

BackgroundHyalinizing trabecular tumor is a rare follicular cell-derived thyroid neoplasm that is considered to be a borderline tumor with malignant potential rather than a benign tumor. The detection of RET/PTC rearrangements and nuclear cytologic features suggests a relationship between hyalinizing trabecular tumor and papillary thyroid carcinoma. Some recent observations of pathogenic genetic alterations in hyalinizing trabecular tumor have indicated that hyalinizing trabecular tumor is not related to papillary thyroid carcinoma, and should be considered an independent entity. Here we present a case of papillary thyroid carcinoma with hyalinizing trabecular tumor-like features and discuss its interesting aspects and diagnostic issues from a histopathological perspective.Case presentationA 19-year-old Japanese woman with an enlarged thyroid gland was admitted to our hospital. Based on fine-needle aspiration cytology, the enlarged nodule was suspected to be a follicular lesion or follicular tumor. A nodular lesion approximately 3 cm in diameter was detected in the left lobe of the thyroid gland. Histological analysis revealed that the tumor cells were mainly arranged in follicles. Solid nests with occasional trabecular arrangements and papillary structures were intermingled, and the tumor cells showed ground-glass nuclei and occasional nuclear grooving. Petaloid and block-like periodic-acid-Schiff and periodic-acid-methenamine-positive basement membrane components were observed in the interstitium of the solid portions of the tumor. Incomplete membranous immunoreactivity of MIB-1 (Ki-67 (cell prolferation marker)) was also observed in the cells within the solid areas. Moreover, this tumor displayed extracapsular invasion and metastasis to the perithyroidal lymph nodes, suggesting that it may be a malignant tumor. However, BRAFV600E mutation, RET/PTC rearrangements, and PAX8/GLIS 1 and PAX8/GLIS 3 rearrangements were not detected.ConclusionWe diagnosed the tumor as a papillary thyroid carcinoma with characteristic features of hyalinizing trabecular tumor. Importantly, this case may indicate a possible relationship between papillary thyroid carcinoma and hyalinizing trabecular tumor, although specific genetic alterations could not be detected. We also discuss the preoperative diagnostic difficulties with fine-needle aspiration cytology and the unusual pathological findings in this case.

Multiple Metastases of Parathyroid and Papillary Thyroid Carcinoma in a Female Patient Treated with Long-Term Hemodialysis

Parathyroid cancer is a rare, clinically aggressive malignancy with a prevalence of approximately 0.005% relative to all carcinoma cases and 1-5% among patients with primary hyperparathyroidism. Prognosis largely depends on the extent of the primary surgery. Non-radical surgical treatment increases the risk of local and distant metastases of the parathyroid cancer associated with limited treatment options. The combination of thyroid and parathyroid disorders has been described rather well for the general population; however, cases of parathyroid and thyroid carcinoma in the same patient are extremely rare (1 case per 3000 patients with parathyroid disorders). We present a rare clinical case of combination of parathyroid and thyroid cancers with metastases of both tumors to the neck lymph nodes in a woman with a mutation in the MEN1 gene (NM_130799.2): c.658T > C p.Trp220Arg (W220R), who has been exposed to radiation for 20 years before diagnosis of thyroid cancer and received renal replacement therapy with long-term hemodialysis before the diagnosis of parathyroid cancer. The patient underwent several surgeries because of metastases of the parathyroid cancer in the neck lymph nodes. Surgeons used intraoperative navigation methods (single-channel gamma detection probe, Gamma Probe 2, and fluorescence angiography with indocyanine green (ICG)) to clarify the volume of surgery. Currently, the patient is still in laboratory remission, despite the structural recurrence of tumors.

Hot Thyroid Nodule Revealing a Papillary Microcarcinoma: A Case Report

Introduction: Autonomously hyperfunctioning thyroid nodules, also known as "hot nodules", are defined by increased uptake of radiotracers compared to the surrounding thyroid parenchyma on scintigraphy. It has been believed that hot nodules have a low rate of malignancy, while an increasing number of thyroid carcinoma cases are being diagnosed in patients with hyperthyroidism. Case Presentation: A. J, a 50-year-old patient. She presented with signs of hyperthyroidism. Laboratory tests showed peripheral hyperthyroidism with an inhibited TSH of 0.03 μIU/ml and T4L of 37 pmol/L. The scintigraphy revealed a focus of hyper fixation almost completely affecting the right lobe which corresponded to a hot nodule most likely pre-extincted in the remaining parenchyma. The patient was initiated on synthetic antithyroid medication and, after achieving euthyroidism, she was referred to surgery. Right loboishmectomy was performed. The histological study revealed a 0.5 cm intralobular non-encapsulated microcarcinoma papillary on a background of thyroid dystrophy. Discussion: The initial evaluation of a thyroid nodule begins is the measurement of serum TSH and the performance of a thyroid ultrasound, followed by a thyroid radionuclide scan if the TSH is subnormal. Malignant nodules are usually non-functioning. The prevalence of malignancy associated with a hot nodule range between 1-10.3%. In many cases, thyroid cancer is not known preoperatively but is found incidentally during the postoperative histological examination of the thyroid. Most of these malignancies were of papillary carcinoma and less often follicular or Hurthle histological types, and they are small in size, and the majority are microcarcinomas. Conclusion: Further evaluation and characterization of the association between a hot thyroid nodule and malignancy are needed. In the case of our patient, the discovery of papillary carcinoma was incidental and was made during the postoperative histological examination .......

“HISTOPATHOLOGICAL STUDY OF THYROID NEOPLASMS WITH SPECIAL REFERENCE TO EXPRESSION OF GALECTIN-3 IN THYROID NEOPLASMS IN A TERTIARY CARE CENTRE”

Background: Globally, the number of thyroid cancer cases was estimated to be 586,000, ranking it 9th in 2020 and the incidence rate in women is 10.1 per 100,000 which is 3-fold higher than that in men (1). Benign neoplasms outnumber thyroid carcinomas, commonly occurring during 3rd to 6th decades of life. Despite histopathology being the mainstay for diagnosis, immunohistochemical markers have been invariably used in the recent years to aid in cases posing morphological diagnostic dilemma. To st Aims and objectives: udy the histopathological spectrum of thyroid neoplasms and expression of Galectin-3 in thyroid neoplasms. This is a one-year c Methodology: ross-sectional study (2021-2022) carried out in a tertiary care hospital of North East India. A total of histopathologically diagnosed 70 cases were studied and evaluated for immunohistochemical expression of Galectin-3. Majority (58.50%) of thyroid neoplasms were found to be benign, mostly Results: affecting the age group of (31- 40) years with female: male ratio being 7.75:1. Amongst the benign cases, all were diagnosed as follicular adenoma and amongst the malignancies, conventional papillary thyroid carcinoma constituted majority of the cases (58.62%). Galectin-3 was expressed signicantly in the malignant cases and the maximum expression was noted in 15 out of 17 cases (88.23%) of conventional papillary thyroid carcinoma. Thyroid Conclusion: neoplasms are highly curable with early detection and appropriate management. Hence, in diagnostically challenging cases, the utility of immunohistochemical markers along with the histomorphological interpretation becomes important.

Expanding the Spectrum of BRAF Non-V600E Mutations in Thyroid Nodules: Evidence-Based Data from a Tertiary Referral Centre.

The BRAF p.V600E mutation represents the most specific marker for papillary thyroid carcinoma and is potentially related to aggressive behavior and persistent disease. BRAF alterations other than the p.V600E are less common in thyroid carcinoma and represent an alternative mechanism of BRAF activation with unclear clinical significance. The study aims to describe the frequency and clinicopathologic characteristics of BRAF non-V600E mutations in a large cohort (1654 samples) of thyroid lesions characterized by next-generation sequencing. BRAF mutations have been found in 20.3% (337/1654) of thyroid nodules, including classic (p.V600E) mutation in 19.2% (317/1654) of samples and non-V600E variants in 1.1% of cases (19/1654). BRAF non-V600E alterations include 5 cases harboring p.K601E, 2 harboring p.V600K substitutions, 2 with a p.K601G variant, and 10 cases with other BRAF non-V600E alterations. BRAF non-V600E mutations have been reported in one case of follicular adenoma, three cases of conventional papillary thyroid carcinoma, eight cases of follicular variant of papillary carcinomas, one case of columnar cell variant papillary thyroid carcinoma, one case of oncocytic follicular carcinoma, and two bone metastasis of follicular thyroid carcinoma. We confirm that BRAF non-V600E mutations are uncommon and typically found in indolent follicular-patterned tumors. Indeed, we show that BRAF non-V600E mutations can be found in tumors with metastatic potential. However, in both aggressive cases, the BRAF mutations were concomitant with other molecular alterations, such as TERT promoter mutation.

An unusual case of papillary thyroid carcinoma presenting as Graves’ disease

ABSTRACT Thyroid cancer in patients with Graves’ disease (GD) was reported with incidences varying from 2.3% to 21.1%. The prognosis of thyroid cancer in patients with GD has been debatable. Here we present a rare case of papillary thyroid carcinoma associated with GD in a 23-year-old female presenting with goiter and thyrotoxicosis symptoms, diagnosed with GD, who because of suspicious findings, underwent further investigations and was found to have thyroid carcinoma. The patient underwent surgery preceded by antithyroid medications. Histopathological examination confirmed malignancy and further management was done.

Acrometastasis: The Tip of the Iceberg of Metastatic Disease from Thyroid Cancer. Two Cases Report.

Acrometastasis, especially in the hands and fingers, is a rare clinical condition resulting from primary cancers such as lung, breast, kidney, and, rarely, thyroid cancer. Acrometastasis tends to be the tip of the iceberg in patients with extensive systemic disease, which could be regional, pulmonary, skeletal, neurological, or all of them combined. Even though these tumors are clearly visible and symptomatic, the diagnosis is usually misleading because such distal metastatic disease is not thought of at first. In general, systemic treatments should be given to any patient presenting digital acrometastasis. We describe two cases of papillary thyroid carcinoma and digital acrometastasis as a sign of advanced disease.

MicroRNA expression profiling of RAS-mutant thyroid tumors with follicular architecture: microRNA signatures to discriminate benign from malignant lesions

PurposeRAS mutations represent common driver alterations in thyroid cancer. They can be found in benign, low-risk and malignant thyroid tumors with follicular architecture, which are often diagnosed as indeterminate nodules on preoperative cytology. Therefore, the detection of RAS mutations in preoperative setting has a suboptimal predictive value for malignancy. In this study, we investigated differentially expressed microRNA (miRNA) in benign and malignant thyroid tumors with follicular architecture carrying mutations in RAS genes.MethodsTotal RNA was purified from 60 RAS-mutant follicular-patterned thyroid tumors, including follicular adenoma (FA), noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), papillary and follicular thyroid carcinoma cases (PTC, FTC); 22 RAS-negative FAs were used as controls. The expression analysis of 798 miRNAs was performed by digital counting (nCounter nanoString platform).ResultsComparing RAS-mutant and RAS-negative FAs, 12 miRNAs showed significant deregulation, which was likely related to the oncogenic effects of RAS mutations. Twenty-two miRNAs were differentially expressed in RAS-mutant benign versus malignant tumors. Considering the tumor type, 24 miRNAs were deregulated in PTC, 19 in NIFTP, and seven in FTC and compared to FA group; among these, miR-146b-5p, miR-144-3p, and miR-451a showed consistent deregulation in all the comparisons with the highest fold change.ConclusionsThe miRNA expression analysis of follicular-patterned thyroid tumors demonstrated that RAS mutations influences miRNA profile in benign tumors. In addition, several miRNAs showed a histotype-specific deregulation and could discriminate between RAS-mutant benign and RAS-mutant malignant thyroid lesions, thus deserving further investigation as potential diagnostic markers.

Findings of I-131 SPECT/CT, 18F-FDG, and 68Ga-FAPI-04 PET/CT Imaging in a Patient Treated with Radioiodine Therapy for Metastatic Papillary Thyroid Carcinoma.

A 50-year-old man undergone total thyroidectomy and histopathology revealed papillary thyroid carcinoma with a tumor size of 4.5 cm. The patient was referred to a nuclear medicine clinic for radioiodine therapy. Since the thyroglobulin level before the treatment was 495 ug/L, low-dose (185 MBq) I-131 scan was performed. In addition to multiple liver metastases, bone metastases were detected in the sacrum and right 7th rib in I-131 whole body scanning and single photon emission computed tomography/computed tomography (CT) imaging at the time of initial staging. We present a case of multiple metastatic papillary thyroid carcinoma whose radioiodine treatment response and clinical outcome were evaluated with 18F-fluorodeoxyglucose and Gallium-68 FAPI-04 positron emission tomography/CT.

Papillary Thyroid Carcinoma Arising in Thyroglossal Duct Cyst and Locally Infiltrated to Hyoid Bone: Issue of Individualized Management

Thyroglossal duct cyst (TGDC) is the most common developmental anomaly of the thyroid gland, while TGDC carcinoma with local infiltration to the hyoid bone is extremely rare. The reported case of papillary thyroid carcinoma (PTC) was diagnosed in TGDC along with local infiltration to the hyoid bone and needed individualized management. A 70-year-old male patient presented with a history of PTC arising in TGDC and locally infiltrated to the hyoid bone followed by total thyroidectomy and radical sistrunk operations and was referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for radioactive iodine therapy (RAIT). His post-operative ultrasound of the neck revealed an irregular shaped, fungating, grossly non-homogenous mixed echogenic mass lesion invading the hyoid bone, measuring about 25 X 28 mm. Radioactive iodine(131I) of 150 mCi was administered because the residual hyoid bone mass was inoperable and he was on thyroxine suppression therapy. The post-therapy 131I scan (RxWBS) showed two intense foci of radiotracer concentration (RTC) in the upper area (above the thyroid bed) and an intense focal RTC in the fundal region of the stomach. The activity in the stomach region was evaluated by ultrasound imaging, which revealed a soft tissue mass or thickening of the mid-region of the posterior wall of the stomach (3.3 cm X 1.6 cm). A CT scan of the chest was also performed to rule out metastasis, and it revealed multiple nodular lesions in both lung fields (most likely secondary) as well as tiny subcentric lymphnodes in the lower pre- and right paratracheal regions after nearly one month of RAIT when the patient was stable for examination. EBRT is still under consideration as adjuvant therapy. Tyrosine kinase inhibitors (TKI) may be considered in cases of refractoriness to radioiodine and disease progression. Bangladesh J. Nuclear Med. 26(1): 67-70, 2023

Grading system for medullary thyroid carcinoma; an institutional experience

ObjectiveMedullary thyroid carcinoma (MTC) is a rare type of thyroid malignancy. Recently, a two-tier grading system (GS) for MTC has been suggested. We conducted this study to evaluate the generalizability, as well as application of recently proposed GS to our cohort of Medullary thyroid carcinoma (MTC) cases. MethodsWe assigned grades to MTC cases and divided them into two groups by using morphologic criteria only as suggested by recent studies: low-grade (LG, <5 mitosis per 2 mm2, and no necrosis) and high-grade (HG, ≥5 mitosis per 2mm2 or necrosis). ResultsA total of 59 MTC cases were evaluated and of those 52 (88 %) were LG and 7 (12 %) were HG. Vascular invasion (VI) (p = 0.017), distant metastasis (DM) (p < 0.0001), nuclear pleomorphism (NP) (p = 0.017) and prominent nucleoli (p = 0.03) were prominently noted in the HG group. After controlling for demographics using multivariate cox regression, tumor grade and necrosis remained significantly associated with the overall survival (HR = 22.7, p < 0.01 and HR = 11.1, p = 0.008, respectively). Upon comparing the cases with and without nodal disease, we found that nodal disease is more strongly associated with NP (p = 0.029), tumor fibrosis (p = 0.0001), VI (p = 0.001) and DM (p = 0.005). ConclusionsWe applied the two-tier GS for MTC to our cohort of cases and found statistically significant differences in the overall survival among the two groups. Adding the grading to the pathology report communicates additional information regarding risk stratification in MTC.