Case Of Follicular Thyroid Carcinoma Research Articles

Simultaneous occurrence of follicular and papillary thyroid carcinomas in same thyroid lobe: A case series of six patients from Qatar

BackgroundPapillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported. Presentation of casesWe report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. ConclusionsWe present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety.

Application of Galectin-3, HBME-1, Cytokeratin-19, and CD56 in the Diagnosis of Thyroid Neoplasm

Objective: The purpose of this study was to investigate the effectiveness of immunohistochemical thyroid malignancy markers Galectin-3, HBME-1, Cytokeratin-19, and CD56 in the diagnosis of thyroid neoplasm. Methods: The study included a total of 53 cases of thyroid neoplasm on which immunohistochemical IHC staining was performed using the manual staining method. Results: The histopathological diagnosis of thyroid nodules was papillary thyroid carcinoma in 40 (75.5%), follicular thyroid carcinoma in 3 (5.7%), follicular adenoma in 8 (15.1%), medullary thyroid carcinoma in 1 (1.9%), and Hurthle cell carcinoma in 1 (1.9%). Out of 40 cases of papillary thyroid carcinoma, Galectin-3 and CK19 were positive in 36 (90%) cases while expression of HBME1 was seen in 32 (80%) papillary thyroid carcinoma cases, and 16 (40%) stained positive for CD56. For the three follicular thyroid carcinoma cases, CD56 was positive in one case, but the marker was positive in 7 out of 8 cases (87.5%) of follicular adenoma. Conclusion: Our results suggest Galectin-3 and HBME-1 are the most sensitive diagnostic markers for differentiating papillary carcinoma from follicular neoplasm.

Comparison of PTEN expression in hashimoto thyroiditis, follicular adenoma, papillary and follicular carcinomas

Aim: Thyroid malignancies account for approximately 3% of all human cancers. A loss or reduction in the expression of a tumor suppressor gene, PTEN has been observed in approximately 40% of thyroid tumors. This change in PTEN expression has been shown to be due to PTEN mutation or deletion. The aim of this study was to compare the PTEN expression among Hashimoto thyroiditis, follicular adenomas and malignant tumors originating from thyroid follicle epithelial cells. Material and Methods: 101 cases of thyroid carcinoma were studied and classified into differentiated types including 15 cases of follicular thyroid carcinomas (FTC), 28 cases of papillary thyroid carcinomas (PTC), 29 cases of follicular adenomas (FA) and 29 cases of Hashimoto thyroiditis (HT). PTEN expression in all the cases were analyzed immunohistochemically. Results: The cytoplasmic and nuclear staining intensity in Hashimoto thyroiditis showed minimal loss of PTEN expression. The nuclear and cytoplasmic staining intensity and percentage in Hashimoto thyroiditis and follicular adenomas were similar. In most of the papillary carcinoma samples, PTEN expression was lost as deduced from cytoplasmic and nuclear staining intensity. While the loss of nuclear PTEN expression was the highest in follicular carcinoma, the cytoplasmic loss was minimal. Conclusions: Loss of PTEN expression is more pronounced in papillary and follicular carcinomas than benign lesions. PTEN has been shown to play an oncogenic role in papillary and follicular carcinoma. PTEN expression loss can be used as a new biomarker in PTC and FTC cases.

Preoperative sonographic features of follicular thyroid carcinoma predict biological behavior: A retrospective study.

Little is known regarding biological behavior of follicular thyroid carcinomas (FTCs) according to ultrasonography features. We investigated whether there was a difference in biological behavior between benign-looking FTCs (B-FTCs) and malignant-looking FTCs (M-FTCs).A total of 55 cases of FTC between January 2000 and December 2015 were included. B-FTCs were defined as showing none of the accepted ultrasonography criteria for malignancy, and M-FTCs were defined as showing at least one of the accepted ultrasonography criteria for malignancy. Clinicopathologic factors and sonographic features were compared between B-FTCs and M-FTCs. Based on the degree of invasiveness, FTCs were divided into minimally invasive FTCs (MI-FTCs) and widely invasive FTCs (WI-FTCs) on pathology. Sonographic features were compared between MI-FTCs and WI-FTCs.Compared with the patients with B-FTCs (31/55, 56.4%), the patients with M-FTCs showed a significantly higher prevalence of WI-FTCs, central lymph node metastases, lateral lymph node metastases as well as extrathyroidal extension (P < .001, P = .012, P = .031, and P = .032, respectively). M-FTCs with more than one malignancy features on ultrasonography showed a significantly higher prevalence of extrathyroidal extension than M-FTCs with only one ultrasonography malignancy feature (P = .022). Compared with MI-FTCs (41/55, 74.5%), an irregular shape, a spiculated/microlobulated boundary, no peripheral halo ring, hypoechogenicity and microcalcification were more frequent in WI-FTCs (P < .001, P = .003, P = .002, P = .015, and P = .016, respectively).Our results demonstrated that B-FTCs had better prognostic indicators than M-FTCs. Therefore, preoperative US features can serve as a useful tool for predicting biological behavior in FTC.

CRABP1, C1QL1 and LCN2 are biomarkers of differentiated thyroid carcinoma, and predict extrathyroidal extension

BackgroundThe prognostic variability of thyroid carcinomas has led to the search for accurate biomarkers at the molecular level. Follicular thyroid carcinoma (FTC) is a typical example of differentiated thyroid carcinomas (DTC) in which challenges are faced in the differential diagnosis.MethodsWe used high-throughput paired-end RNA sequencing technology to study four cases of FTC with different degree of capsular invasion: two minimally invasive (mFTC) and two widely invasive FTC (wFTC). We searched by genes differentially expressed between mFTC and wFTC, in an attempt to find biomarkers of thyroid cancer diagnosis and/or progression. Selected biomarkers were validated by real-time quantitative PCR in 137 frozen thyroid samples and in an independent dataset (TCGA), evaluating the diagnostic and the prognostic performance of the candidate biomarkers.ResultsWe identified 17 genes significantly differentially expressed between mFTC and wFTC. C1QL1, LCN2, CRABP1 and CILP were differentially expressed in DTC in comparison with normal thyroid tissues. LCN2 and CRABP1 were also differentially expressed in DTC when compared with follicular thyroid adenoma. Additionally, overexpression of LCN2 and C1QL1 were found to be independent predictors of extrathyroidal extension in DTC.ConclusionsWe conclude that the underexpression of CRABP1 and the overexpression of LCN2 may be useful diagnostic biomarkers in thyroid tumours with questionable malignity, and the overexpression of LCN2 and C1QL1 may be useful for prognostic purposes.

Expression of PSMA in Thyroid follicular neoplasms: Utility for differentiating between benign from malignant lesions

Back ground: Prostate-Specific membrane Antigen has been known as a tumor associated neovasculature marker in some solid malignant tumors and targeting of that by cytotoxic- conjugated antibody can represent powerful tool for vascular targeted therapy in malignant tumors. In thyroid, it appears that angiogenesis factors are involved in neoplastic growth and aggressiveness of tumors. This study was conducted to evaluate the expression of PSMA as an angiogensis factor by immunohistochemistry in neovasculature of thyroid follicular neoplasms to determine its usefulness for distinguishing between adenoma and carcinoma . Methods: Paraffin Blocks of formalin fixed samples representing 48 cases of Follicular Thyroid adenoma and 15 cases of Follicular Thyroid Carcinoma were evaluated. Results: Among Carcinomas, capsular and vascular invasion were present in 12 and 11 cases , respectively. The intensity of PSMA staining was significantly higher in carcinoma group(p=0.028). However, no significant difference in extent of PSMA expression in adenoma and carcinoma groups was observed(p=0.239).Thyroid follicular cells in adenoma, carcinoma also non neoplastic area were negative for PSMA. Conclusion: Our findings do not support usefulness of PSMA in differentiating between FTA and FTC. However ; expression in neovasculature of differentiated thyroid tumors can represent a potential utility for PSMA-targeted radionuclide therapy in advanced differentiated thyroid cancers. DOI:10.21276/APALM.1511

BRAF V600E/TERT promoter mutations and NIS/TSHR expression in differentiated thyroid carcinoma and their clinical significance ⁎

Abstract Objective Telomerase reverse transcriptase (TERT) promoter mutations have recently been described in thyroid carcinoma. The purpose of this study was to investigate the clinical significance of (v-raf murine sarcoma viral oncogene homolog B1) BRAF V600E and TERT promoter mutations in differentiated thyroid carcinoma (DTC). The relationship between the two mutations and NIS/TSHR expression was also analyzed. Methods We have detected BRAF V600E and TERT promoter mutations by direct sequencing and NIS/TSHR expression by immunohistochemistry in 229 cases of DTC, 52 cases of benign nodular goiter, and 31 cases of normal thyroid tissue. Results The BRAF V600E mutation was detected in 142 (62.0%) of 229 cases of DTC [141 cases of papillary thyroid carcinoma (PTC) and 1 case of follicular thyroid carcinoma (FTC)]. TERT promoter mutations were detected in 18 (7.9%) of 229 cases of DTC (14 cases of PTC and 4 cases of FTC), including the mutations C228T (0.9%) and C250T (7.0%), which were mutually exclusive. Moreover, 11 (61.1%) cases also harbored the BRAF V600E mutation, which was not associated with gender, age, tumor size, lymph node metastasis, and recurrence risk stratification (P &gt;0.05). The rate of TERT promoter mutation was higher in males, age ≥45, and in the middle/high-risk group (P &lt;0.05), and the rate of simultaneous BRAF V600E and TERT promoter mutations were higher in the middle/high-risk group (P &lt;0.05). In addition, NIS positive rate in the concurrent BRAF V600E and TERT promoter mutation group (45.5 %) was lower than in other groups (that is, the DTC group with BRAF V600E or TERT promoter mutations (55.1%), the DTC group with no BRAF V600E or TERT promoter mutation (57.5%), the nodules and normal group (75.9%); | r | = 0.171, P = 0.002). Conclusion TERT promoter mutations were lower in patients with DTC, with the C250T mutation being the most common. The detection of BRAF V600E mutation combined with TERT promoter mutations was instructive for the prognosis assessment and treatment of DTC.

Metastatic follicular thyroid carcinoma mimicking sacroiliitis

Sacroiliac joint involvement is not specific to seronegative spondyloarthropathies (SpA). There are some rare reports of conditions which mimic sacroiliitis. This paper reports a case of follicular thyroid carcinoma in a patient who had been referred to a rheumatology clinic with hip pain. Sacroiliac joint involvement was her presenting feature before she was correctly diagnosed. The patient was a female, 63 years of age, who referred to a rheumatologist because of unilateral hip pain. Patrick's test on her right side was positive, and the range of motion of her right hip was restricted. Imaging studies included conventional hip radiography and magnetic resonance imaging (MRI) revealed sacroiliitis with surrounding destructive lesion. In review of systems and physical examination, a thyroid nodule was found. Computed tomography (CT)-guided needle biopsy of her hip and fine needle aspiration (FNA) of the thyroid nodule established follicular thyroid carcinoma. In approach to sacroiliitis, rare differential diagnoses (besides SpA) and mimickers of sacroiliitis such as neoplastic lesions should also be considered to avoid misdiagnosis.

Comprehensive screening for PD-L1 expression in thyroid cancer.

PD-L1 expression is being considered a potential biomarker for response of anti-PD-1 or anti-PD-L1 agents in various tumors. The reported frequency of PD-L1 positivity varies in thyroid carcinomas, and multiple factors may contribute to the variability in PD-L1 positivity. We evaluated the PD-L1 expression in various thyroid cancers on a large scale. A total of 407 primary thyroid cancers with a median 13.7-year of follow-up were included. We evaluated the frequency of PD-L1 expression using a rabbit monoclonal antibody (clone SP142). In addition, we analyzed the relationships between PD-L1 expression and clinicopathologic factors, including TERT promoter, BRAF status and disease progression. Tumoral PD-L1 was expressed in 6.1% of papillary thyroid carcinomas, 7.6% of follicular thyroid carcinomas and 22.2% of anaplastic thyroid carcinomas. The distribution of PD-L1 positivity was different according to cancer histology types (P < 0.001). All PD-L1-positive cases of follicular thyroid carcinoma and anaplastic thyroid carcinoma showed strong intensity. The proportions of positivity in PD-L1 positive anaplastic thyroid carcinomas were more than 80%. PD-L1 in immune cells was positive in 28.5% of papillary thyroid carcinoma, 9.1% of follicular thyroid carcinomas and 11.1% of anaplastic thyroid carcinomas. There was no significant association between clinicopathologic variables, disease progression, oncogenic mutation and PD-L1 expression. PD-L1 was highly expressed in a subset of patients with advanced thyroid cancer, such as follicular and anaplastic thyroid carcinoma. Identification of PD-L1 expression may have direct therapeutic relevance to patients with refractory thyroid cancer.

Follicular thyroid carcinoma presenting as skull metastasis: A rare case report and literature review

Follicular thyroid carcinoma (FTC) is considered to be a well-differentiated thyroid carcinoma since it shows a low progression. Metastases occur in advanced stage by hematogenous route. Lung and bone are the two most common sites of metastases. In most of the reported cases of FTC metastasizing to the skull, metastases occurred long time after the diagnosis and establishment of adequate treatment for the primary cancer. Very few cases have been reported with FTC presenting as skull metastasis. We report the case of a 35-year-old female patient presented with a massive swelling of the right parietal skull region. Histopathologic examination confirmed that it is a FTC bone metastasis. A gross total resection of the tumor was performed. Two months later, a total thyroidectomy and lymph node resection were performed. The patient underwent radioactive-iodine (RAI) therapy and was given adjunctive Levothyroxine therapy. Five years of follow-up did not show any recurrence of the disease. Correct diagnosis of skull metastasis from preoperative FTC is difficult because of its rarity. Patients can survive several years after the therapy including total resection of metastatic tumor, radical operation of thyroid carcinoma, and adjunctive therapy by Levothyroxine and RAI therapy.

Follicular thyroid carcinoma with NRAS Q61K and GNAS R201H mutations that had a good (131)I treatment response.

SummaryWe report a case of follicular thyroid carcinoma with concomitant NRAS p.Q61K and GNAS p.R201H mutations, which manifested as a 13.5 cm thyroid mass with lung, humerus and T9 spine metastases, and exhibited good response to radioactive iodine treatment.Learning points GNAS p.R201H somatic mutation is an activating or gain-of-function mutation resulting in constitutively activated Gs-alpha protein and downstream cAMP cascade, independent of TSH signaling, causing autonomously functioning thyroid nodules. NRAS p.Q61K mutations with GNAS p.R201H mutations are known for a good radioactive iodine treatment response.Further exploration of the GNAS-activating pathway may provide therapeutic insights into the treatment of metastatic follicular carcinoma.

Follicular Carcinoma of Thyroid with Bone Metastasis

Figure 1: Huge mass in front of neck, cheek and forehead. Figure 2: Bone scan showing sites of metastasis. Introduction Bone metastasis is said to be one of the commonest site for metastasis, among them the most common primary is from breast cancer, followed by lung, prostrate. Thyroid carcinomas presenting with bone metastasis is very rare with frequency of about 2.5%. The most common subtype of thyroid cancer causing bone metastasis is follicular thyroid carcinoma. Here we are presenting a case of follicular carcinoma thyroid along with bone metastasis. Case Blog Sixty tears old female patient presented to the ENT OPD with complaints of swelling in front of the neck for the past fifteen years (Figure 1). Swelling over cheek, parietal region for the past five years. The patient was investigated and general examination was done. FNAC from the thyroid mass was found to be follicular neoplasm. To confirm the diagnosis, biopsy was taken from the cheek swelling which revealed metastatic deposits from the follicular thyroid carcinoma. As there was extensive spread of the disease, the patient was planned for whole body bone scan, which revealed, multiple metastatic lesion involving the left fronto parietal region of the skull, photopenic area over forehead, right 7th rib, left scapular spine, L5 and S1 segment of the lumbosacral spine (Figure 2). As there was extensive bony spread, surgical excision was impossible in this tumour. The patient was referred to radiotherapy department for opinion. Then the patient was planned for palliative therapy. After making cytological diagnosis as metastasis from follicular carcinoma, the patient was started on palliation therapy and is being regularly followed up. After the tissue cytopathological confirmation, the patient has been followed up for two years. Discussion Thyroid cancer is the most common endocrine malignancy. There are four major types of thyroid carcinoma among them papillary and follicular carcinoma together termed differentiated thyroid cancer is most common. In very less number of patients about 5-20% there are chances of bone metastasis. Among the types of thyroid cancers, anaplastic carcinoma has the worst prognosis. Metastasis to bones from papillary thyroid carcinoma often involves ribs, vertebrae and sternum, but metastasis to skull bones is extremely rare. Metastasis to skull from thyroid cancer is mostly from the follicular thyroid carcinoma Total excision of the tumour remains the main step in management, however in this case, it was impossible for complete resection of tumours as, patient presented in a very late stage. Hence this patient was started with external beam radiotherapy. But in cases with severe bone metastasis, even with radiotherapy outcome is generally poor. One of the study showed expectancy of life is less than 3 years. Hence we are reporting a case of follicular thyroid carcinoma that presented to our department with skull metastasis, that is a very rare presentation in cases of follicular carcinoma of thyroid. Conclusion Skull metastasis from thyroid carcinoma though rare, we must always keep in mind the possibility. Swelling in the neck that are presenting at later stages of life with a history of long duration has all the possibilities of distant metastasis. Imaging characteristics, systematic multi-disciplinary approach must be carried out. In cases with late presentation, radiotherapy is the only choice to give palliative care to the patient as thyroid carcinoma with bone metastasis outcome is very poor.

Follicular Thyroid Carcinoma: How Have Histologic Diagnoses Changed in the Last Half-Century and What Are the Prognostic Implications?

Follicular thyroid carcinoma (FTC) comprises 10% of differentiated thyroid cancers. Diagnostic controversy and interobserver variability render the practical diagnosis of FTC difficult. Overall survival rates vary (46-97%). The aims of this study were to review FTC histologically at the authors' tertiary care institution and to evaluate long-term survival and recurrence. Diagnostic slides from 66 FTC cases (1965-2007) were reviewed by three pathologists from two institutions (blinded to clinical outcomes), and consensus was obtained. Patient demographics, tumor characteristics, and treatment, survival, and recurrence data were collected. Thyroid cancer-specific and recurrence-free survival were calculated by original and reclassified diagnoses. Forty-seven cases (71%) were reclassified: 24 (36%) to papillary thyroid carcinoma (PTC), 18 (27%) to follicular adenoma (FA), and five (8%) to poorly differentiated carcinoma (PDC). Nineteen (29%) maintained a diagnosis of FTC. The extent of surgical resection and rates of radioiodine treatment did not differ by reclassification diagnosis. Pre-review FTC-specific survival was 83.5% and 75.1% at 10 and 20 years, respectively. Following contemporary reclassification, FTC-specific survival was 77% and 33.7% at 10 and 20 years, respectively. There were no cancer-specific deaths in the FA or PTC groups. Over the past 50 years, changes in our understanding of the pathogenesis, histology, and behavior of thyroid carcinoma may partially account for the changes in histologic diagnosis. Elimination of PTC and FA "contaminants" led to decrease in survival following reclassification. Variability in histologic interpretation contributes to diagnostic challenges in follicular lesions. Histologic review of thyroid tumors for research studies is crucial, especially given the ever-changing diagnostic criteria.

Argyrophilic nucleolar organizing region associated protein synthesis for cytologic discrimination of follicular thyroid lesions

Fine needle aspiration biopsy (FNAB) of the thyroid gland is an important tool for preoperative diagnosis; however, its benefit is limited for follicular lesions. Nucleolar organizer regions (NORs) are ribosomal gene regions that stain with silver (Ag) when they are active. These regions can be used to differentiate neoplastic and non-neoplastic lesions. We used a new AgNOR technique to investigate FNAB of cases diagnosed as follicular adenoma and carcinoma. Fourteen cases of follicular thyroid carcinoma (FTC) and 28 cases of thyroid follicular adenomas (FA) were stained using the silver NOR-associated protein (AgNOR) technique. One hundred nuclei per sample were examined, AgNORs were counted, and the total AgNOR area/nuclear area (TNORa/Na) ratio of each cell was calculated. We found that cases with FTC had significantly higher TNORa/Na than cases of FA. Also, cases with FTC had significantly higher AgNOR counts than cases with FA. AgNOR counting may help discriminate FTC and FA by routine cytopathology before surgery.

Immunohistochemical expression of HBME-1 and galectin-3 in the differential diagnosis of follicular-derived thyroid nodules

BackgroundThyroid nodules are common among adults with only a small percentage being malignant and histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management. The determination of malignancy in follicular patterned thyroid lesions is based on postoperative histological findings. Therefore, affected patients are referred for surgery, although only 10% will have a final diagnosis of malignancy. The aim of this study was to investigate the ability of two immunohistochemical (IHC) markers; galectin-3 and Hector Battifora mesothelial-1 (HBME-1) individually or in combination, to distinguish between benign (non-neoplastic and neoplastic) and malignant (follicular and papillary carcinomas) thyroid lesions removed by surgical resection. MethodsWe investigated the immunoexpression of galectin-3 and HBME-1 in 50 cases of benign and malignant thyroid nodules. The benign group included 13 cases of thyroid nodular goiter (NG) and 9 cases of follicular adenoma (FA). The malignant group included 5 cases of follicular thyroid carcinomas (FC), 18 cases of classic papillary thyroid carcinoma and 5 cases of follicular variant papillary carcinoma (FVPC). ResultsThe staining results showed that malignant tumors expressed galectin-3 and HBME-1 significantly more than benign nodules. The sensitivity of these markers for the distinction between benign and malignant lesions ranged from 89.3% to 92.9%. Co-expression of galectin-3 and HBME-1 was seen in 82.1% of carcinomas, but in none of the benign nodules. Immunoexpression was usually diffuse in malignant tumors, and focal in the benign lesions. ConclusionOur findings indicate that these immunohistochemical markers are significantly more expressed in malignant tumors compared to benign lesions and may be of additional diagnostic value when combined with routine histology. Galectin-3 has higher sensitivity and specificity of immunoexpression in thyroid malignancy than HBME-1, and the combined use of galectin-3 and HBME-1 can increase the specificity of immunoexpression in malignant tumors.

Sonographic and CT Features of Follicular Thyroid Carcinoma with Interrupted Eggshell Calcification Presenting with Renal and Bony Metastases: A Case Report

Follicular thyroid carcinoma (FTC), which is the second common malignancy of the thyroid gland following papillary thyroid carcinoma (PTC), is usually diagnosed histologically by capsular and/or vascular invasion on permanent section. Meanwhile, it is more likely to metastasize to distant organs rather than to regional lymph nodes. The FTC may present with metastatic disease and the diagnosis can be made by histological examination of the metastatic disease (1). It is now well-known that the eggshell calcification of the thyroid nodule occurs in various benign and malignant diseases of the thyroid gland. Our review of the literature yielded four cases of FTC with eggshell calcification, with three of them presenting with distant metastasis and one with thyroid incidentaloma (2, 3). We report here of a case of FTC in a 74-year-old male, with the interrupted eggshell calcification, presenting with renal and bony metastases along with the findings of primary and metastatic lesions at gray-scale, power Doppler ultrasonography (PD US), and CT scan.

Multinodular goitre turning into follicular carcinoma thyroid after a latency of seven years

Follicular carcinoma thyroid (FTC) is the second most common category after papillary variety with relative incidence estimated from 10-20%. Follicular thyroid carcinoma (FTC) rarely develops in a preexisting multinodular goiter (MNG) and tends to metastasize to lungs and bone through the blood-stream. The latency period for conversion varies significantly. We herein report a 48-year-old female presented with thyroid swelling since seven years with recent onset of multiple painful swellings over sternum and skull confirmed as a case of FTC on core needle biopsy. Considering her low socioeconomic status and advanced stage of the disease, she was treated with external beam radiotherapy (EBRT) and showing good response to EBRT at 6 months follow-up without any new bone secondaries thereafter.

Skeletal Muscle Metastasis as an Initial Presentation of Follicular Thyroid Carcinoma: A Case Report and a Review of the Literature

Introduction. Follicular thyroid carcinoma (FTC) frequently metastasizes to the lungs and bones. However, metastasis to the skeletal muscles is an extremely rare manifestation of FTC. To date, only seven cases of FTC have been reported in the literature. Skeletal muscle metastases from FTC usually remain asymptomatic or manifest as swelling and are associated with dismal prognosis. Case Presentation. A 45-year-old Saudi woman presented with right buttock swelling since 8 months. Physical examination revealed right gluteal mass of size 13 × 10 cm and right thyroid lobe nodule. The rest of examination was unremarkable. Magnetic resonance imaging (MRI) showed 13 × 11.7 × 6.8 cm lobulated mass arising from the gluteus medius muscle, and tru-cut biopsy confirmed the metastatic papillary carcinoma of thyroid origin. The patient subsequently underwent palliative radiotherapy followed by total thyroidectomy and radioactive iodine ablation. At the time of publication, the patient was alive with partial response in gluteal mass. Conclusion. Skeletal muscles metastases are a rare manifestation of FTC, and searching for the primary focus in a patient with skeletal muscle metastasis, thyroid cancer should be considered as differential diagnosis.

Usefulness of Cytokeratin-19, Galectin-3, and Hector Battifora Mesothelial-1 in the Diagnosis of Benign and Malignant Thyroid Nodules

Having been asymptomatic, most thyroid nodules are found incidentally. In the absence of a specific diagnostic marker of malignant thyroid nodules, it is difficult to microscopically diagnose the benign or malignant nature of nodules. In the present study, the goal is to investigate the expression of cytokeratin-19 (CK-19), galectin-3 (Gal-3), and Hector Battifora mesothelial-1 (HBME-1) in thyroid nodules, and to assess their diagnostic value as markers in the differential diagnoses of benign and malignant thyroid nodules. Conventional Immunohistochemistry (IHC) was used on formalin-fixed, paraffin-embeded blocks of 150 cases of benign and malignant thyroid lesions. The benign group included 28 cases of follicular adenoma (FA) and 44 cases of thyroid nodular goiter. The malignant group included 72 cases of papillary thyroid carcinoma (PTC) and 6 cases of follicular thyroid carcinomas (FTC). It was statistically found that there were strikingly significant differences for the three markers in the distinguishing diagnosis of malignant and benign thyroid nodules (p < 0.01). However, there were no significant differences for the expression of the three markers among two different subtypes in the malignant group. What is more, no significant relationship was found between the expression of CK-19, Gal-3, or HBME-1 and gender, age, tumor size, focal lymphocytic infiltration, or lymph node metastasis in thyroid nodules. The combined use of CK19, Gal-3, and HBME-1 is of practical value in the diagnosis and differential diagnosis of benign and malignant thyroid nodules.

Trefoil Factor 3 (TFF3) mRNA Expression Level in Follicular Thyroid Tumors Using Formalin-Fixed, Paraffin-Embedded (FFPE) Blocks

Background: Differential diagnosis of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is often difficult since presence or absence of capsular/vascular invasion can not be determined by preoperative fine needle aspiration cytology, and may not be judged unanimously on permanent sections even among experienced pathologists. Determination of molecular-genetic factors such as trefoil factor 3 (TFF3) mRNA in the follicular thyroid tumors may be useful aid to improve the accuracy of diagnosis, though it is considered to be unstable and relatively low concentrated genetic substance. Purpose of our study is to investigate expression level of TFF3 mRNA of thyroid follicular tumors using formalin-fixed, paraffin-embedded (FFPE) tissue. Methods: Study population included FFPE sections from 19 FTC cases, 20 FTA cases, 11 adenomatous goiter (G) cases and 12 samples of normal thyroid tissue (N) adjacent to thyroid tumors. RNeasy FFPE kit was used for extraction of total RNA. Purification and concentration values were determined by spectrophotometer. Extracted RNA was used for cDNA synthesis in reverse transcription. Synthesized cDNA subsequently proceeded for relative quantification of TFF3 mRNA by RT-qPCR using TFF3 primers. Glyceroldehyde-3-phosphate dehydrogenase (GAPDH) and hypoxanthin phosphorobosyltransferase1 (HPRT1) were used as control genes. The mean and standard deviation of TFF3 mRNA expression level were analyzed by software Multiplate RQ. Results: Extraction by the FFPE kit yielded high concentration of RNA in all cases. Purification values were 1.8 in average. Concentration values were significantly higher in FTC and FTA relative to G and N tissues, possibly due to high density of thyrocytes in the samples. Relative quantification of TFF3 mRNA expression level showed broad ranges both in FTC and FTA, while the analyses in G and N tissues indicated narrow ranges. Conclusion: FFPE tissues from thyroid follicular tumors can be used for measurement of unstable and low concentrated genetic substances such as TFF3 mRNA. Its diagnostic value yet remains to be determined.