Classical Papillary Carcinoma Research Articles

Correlation of FNAC with Histopathology in the Diagnosis of Differentiated Thyroid Carcinoma

Background: Fine-needle aspiration cytology (FNAC) is an important diagnostic tool for differentiating between neoplastic and non-neoplastic lesions of the thyroid. The current study was carried out to observe the comparison between preoperative fine needle aspiration cytology (FNAC) and postoperative Histopathology in the diagnosis of Differentiated Thyroid Carcinoma. Methods: This cross-sectional observational study was conducted in the department of Pathology, Rajshahi Medical College (RMC), Bangladesh from January 2019 to December 2020. Clinically suspected and diagnosed by FNAC, a total of forty patients of differentiated thyroid carcinoma attending outpatient and inpatient department of Otolaryngology, RMCH were enrolled in this study. Biopsy material was examined for histopathological diagnosis. Results: In this study, out of forty cases, 35 were papillary and 5 were follicular carcinoma. Mean age was 25.48+9.70 years and Male: Female was 1:6. Among 40 cases of FNAC findings, 33 cases (82.5%) were classic papillary carcinoma, 01(2.5%) case was follicular variant of papillary carcinoma, 5 cases were (12.5%) were follicular lesion and 01(2.5%) case was nodular goitre. Among 40 cases of histopathological findings, 32(80%) cases were classic papillary carcinoma, 03(7.5%) were follicular variant of papillary carcinoma and 5 cases were follicular carcinoma. In histopathological findings, none of them was nodular goitre. So, all FNAC findings were consistent with histopathological findings except nodular goitre which was diagnosed as classic papillary carcinoma in histopathology. Conclusion: FNAC is a safe and relatively accurate method for preoperative evaluation of thyroid malignancy before surgery. Therefore it is a reliable diagnostic test for evaluation of thyroid carcinoma. J Shaheed Suhrawardy Med Coll 2022; 14(1): 28-31

Cytological Diagnosis of Follicular Patterned Lesion of Thyroid Nodule and its Follow-up Histopathology

The follicular patterned lesion of thyroid nodules is an exciting topic because it is not clear whether the lesion is benign or malignant. It comprises hyperplastic/adenomatoid nodules, follicular adenoma, follicular carcinoma and follicular variant of papillary carcinoma. The cytological diagnosis of atypia of undetermined significance/Follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm and suspicious for malignancy remains controversial in terms of management. The study aimed to examine the extent of invasion of malignant lesions in follow-up histopathology diagnosed as undetermined lesions cytologically. A total of 256 cases were included in this study; among these, 199 cases were benign lesions, 15 cases were non-diagnostic and 42 cases were diagnosed either of uncertainty for malignancy with cellular atypia or malignancy. Subsequent follow-up resection and histopathology were done with 48 cases (18.75%), which comprises 1 non-diagnostic, 10 benign lesions, 21 atypia of undetermined significance/Follicular lesion of undetermined significance, 7 Follicular neoplasm/Suspicious for a follicular neoplasm, 5 suspicious for malignancy and 4 malignancies. Also, 6 Follicular variant of papillary thyroid carcinoma, 6 classic papillary carcinoma, 5 follicular carcinoma and 1 anaplastic carcinoma were diagnosed in follow-up resection histopathology of 48 cases. Thirty eight cases were of undetermined significance of malignancy with cytological features of the follicular lesion. Four Follicular variant of papillary thyroid carcinoma, 2 follicular carcinoma and 1 papillary carcinoma were diagnosed in 21 resected cases cytologically reported as Atypia of undetermined significance/Follicular lesion of undetermined significance with malignancy risk of 33.33%. Three malignancies in follicular neoplasm/suspicious for a follicular neoplasm with a risk of 42.85% and 4 malignancies in suspicious malignancy group with a risk of 80% were found. The average risk of malignancy of these three undetermined categories was reduced to 24.24% from 42.42% upon reclassification of the Follicular variant of papillary thyroid carcinoma. All the Follicular variants of papillary thyroid carcinoma diagnosed by histopathology were non-invasive regarding lymph node involvement and microvascular or capsular invasion. Mediscope 2023;10(2): 68-77

TALL CELL VARIANT PAPILLARY THYROID CARCINOMA IN A PEDIATRICPATIENT: A CASE REPORT AND REVIEW OF THE LITERATURE

Paediatric thyroid cancer is uncommon and classical papillary carcinoma is the most represented histological type. Variant high cell papillary carcinoma (VHCPC) is an extremely rare entity in the paediatric age group, aggressive and a marker of poor prognosis, as well as poor survival. The presence and percentage of a minority high cell contingent should be mentioned in the histopathological report. We report the case of a 9-year-old female patient with no previous history of cancer who presented with a 5 cm long left cervical nodule. Macroscopic examination showed the presence of several poorly bounded, fleshy, homogeneous beige coloured, non-encapsulated nodules. On microscopic examination, the tumour showed a papillary, focally solid architecture. The tumour cells were 2-3 times taller than they were wide, with abundant eosinophilic cytoplasm, sharp borders, and oval nuclei, with incisions and numerous intranuclear pseudo inclusions. The tumour protruded beyond the thyroid capsule and came into contact with the surgical borders, with the presence of vascular emboli. Our work aims to highlight the anatomopathological and diagnostic particularities of this sub-variant of papillary carcinoma.

Clarion and Protuberant-Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is a malignant thyroid neoplasm exhibiting histological subtypes as classic papillary carcinoma, tall cell, micro-carcinoma, follicular, oxyphilic, diffuse sclerosing, cribriform morular, solid or insular variant. Tumefaction enunciates distinctive nuclear features as altered nuclear magnitude and outline, nuclear enlargement or elongation, nuclear overlapping, and ground glass nuclei. Genomic fusions of BRAF, RET, PPARG, NTRK1, NTRK3, ALK, LTK, MET, FGFR2 or THADA genes may be observed. Initial disease representation emerges as 67% singular thyroid nodules, 13% thyroid nodules combined with cervical lymph node metastasis and 20% neoplasms confined singularly to lymph nodes

PSAT252 Primary Papillary Thyroid Carcinoma Arising from a Thyroglossal Duct Cyst

Abstract Background Thyroglossal duct cysts (TGDC) are remnants of the thyroglossal duct tract that do not atrophy and disappear, instead undergoing cystic expansion and often presenting as a midline neck mass. Rarely, carcinomas of the thyroglossal duct cyst occur, either arising as a primary carcinoma or as a cystic metastasis from a primary thyroid cancer; the former are particularly rare. These thyroglossal duct cyst carcinomas most commonly present in the adult population. Case Report We present the case of a 32-year-old female without any significant past medical history who presented with a non-tender midline neck mass identified as a thyroglossal duct cyst and completely excised; pathology results were positive for a primary papillary thyroid carcinoma with a tumor measuring 1.3 cm in diameter within the TGDC. Thyroid Ultrasound also showed the presence of two nodules measuring 1.4 cm on the right and 1.2 cm on the left, respectively, with fine needle aspiration (FNA) of both the nodules confirming papillary thyroid carcinoma as well. Lymph node FNA was negative for metastatic carcinoma. The patient underwent a thyroidectomy which definitively confirmed both a classic papillary carcinoma as well as an encapsulated, non-invasive follicular variant. In keeping with the original finding of the patient having a primary thyroglossal duct cyst carcinoma, samples from the thyroidectomy had negative tumor margins, and were also negative for any angioinvasion, lymphatic invasion, or extrathyroidal extension. Conclusion While thyroglossal duct cysts are the most common type of congenital neck cyst, primary carcinomas arising from thyroglossal duct cysts are rare. Masses that occur anywhere along the thyroglossal duct tract should be investigated for malignancy, with additional investigation of the thyroid gland for either a primary or secondary thyroid cancer. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Metastasis of Differentiated Thyroid Carcinoma: A Descriptive Study of 75 Patients

Introduction: Differentiated Thyroid Carcinoma (DTC) is the most common endocrine malignancy, and is generally of favorable prognosis. However, this latter is significantly worse when initial distant metastasis is present. The aim of our study is to describe the clinical, paraclinical, and therapeutic aspects of metastatic carcinomas in patients followed-up at the Endocrinology Department of the CHU Ibn Rochd in Casablanca, Morocco. Methods: This is a retrospective descriptive study of patients diagnosed with metastatic differentiated thyroid cancers and followed in the endocrinology service at the university hospital of Ibn Rochd in Casablanca over a 34 years period (1986- 2020). The variables studied were age, histological type and features, TNM stage, and metastasis localizations. Data analysis was performed using SPSS 22.0 software. Results: We included 75 patients in our study. The mean age at diagnosis was 46.4 years ± 14.2 years. The sex ratio M / F: 0.1. Metastases were revelatory of DTC in 19 cases. Fifty-seven patients had lymph node metastasis, 17 patients had bone metastasis and 15 patients had lung metastasis. The most frequent histological types were classical papillary carcinoma (47%), papillary carcinoma with vesicular differentiation (21%), then vesicular carcinoma (11%). Regarding the histological characteristics, capsular effraction was found in 35% of cases, vascular emboli in 18% and multifocality in 23% of cases. Analysis of the variables studied showed that gender was not a predictive factor for the appearance of a certain type of metastasis. However, patients older than 55 were significantly more likely to develop lung metastases (p=0.01). Concerning histological features, the existence of vascular emboli was significantly associated with the apparition of lymph node and bone metastases (p=0.01) as well as lung metastases, although not significantly (p=0.1). The mortality rate in our sample was relatively low at 8%. Conclusion: Patients with vascular emboli were more likely to develop lymph nodes and bone metastases, and patients older than 55 were more likely to develop lung metastases. Even if metastases occur, prognosis is generally favorable for DTCs compared to other types of thyroid cancers.

Papillary thyroid carcinoma in thyroglossal cyst in a young female

ABSTRACT Ectopic thyroid tissue is rare, with a reported incidence of 1 in 300,000. A thyroglossal duct cyst is the most common developmental anomaly of the thyroid gland. The probability of carcinoma arising in such tissue is <1%. The incidence of papillary carcinoma of the thyroid is more in 30–50 years. Here, we report a case of an 18-year-old female presenting with anterior neck swelling, found to have a thyroglossal cyst, fine-needle aspiration cytology (FNAC) of which showed a cystic mass with sparse epithelial cells. After the Sistrunk surgery, biopsy showed classic papillary carcinoma of the thyroid. She underwent total thyroidectomy followed by thyroxine replacement. Thyroglossal cyst papillary carcinoma of the thyroid is a rare entity in young whose diagnosis is easily missed on FNAC; a thorough examination of the biopsy specimen is required. Management should be considered based on multiple associated factors. Overall, the prognosis of it is very good, with a 5-year survival rate of 95%.

DIFFERENCES IN AGE CHARACTERISTICS, TUMOR MACROSCOPIC SIZE AND HORMONE PROFILE BETWEEN CLASSIC PAPILLARY CARCINOMA PATIENTS AND FOLLICULAR VARIANTS IN Dr. KARIADI HOSPITAL, SEMARANG

Background: New cases of Papillary Thyroid Carcinoma and Carcinoma patients at Dr. Kariadi Hospital, Semarang is quite high, where the most types are Classical Papillary Thyroid Carcinoma and Follicular Variant Papillary Thyroid Carcinoma. On the other hand, in diagnosing PTC, histopathological examination which is a gold standard sometimes has a subjective value. Therefore, it is necessary to have a correlation with the clinical characteristics of the patient in order to get a correct diagnosis. Aim: Understanding the differences in age characteristics, tumor macroscopic size and hormone profile between Classical Papillary Thyroid Carcinoma and Follicular Variant patients at Dr. Kariadi Hospital, Semarang. Method: Analytic observational research with cross sectional design. The number of samples was 38 medical records in which 18 cases of Classic Papillary Thyroid Carcinoma and 20 cases of Follicular Variant Papillary Thyroid Carcinoma. Data with a nominal scale, namely age were analyzed using the Fisher exact test, while the data with a numerical scale, namely the macroscopic size of the tumor and the hormone profile, were tested for normality of Saphiro Wilk then continued with the Mann-Whitney test. Result: Based on the Fisher exact test, there was significant difference (p = 0,009) between age characteristics and Classical Papillary Thyroid Carcinoma and Follicular Variant. In the Mann-Whitney test there was no significant difference (p = 0.3) between the macroscopic size of the classical papillary carcinoma and follicular variant and there was no significant difference TSHs (p = 0.501) and fT4 (p = 0.953) hormone profiles between Classic Papillary Thyroid Carcinoma and Follicular Variants. Conclusion: There was significant difference between the characteristics of age at diagnosis, and there was no significant difference between the macroscopic size of the tumor and the hormonal profile of Classical Papillary Carcinoma and Follicular Variants in Dr. Kariadi Hospital, Semarang.

Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

BackgroundParathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review.Case presentationWe herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma.ConclusionsOur experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.

DIFFERENCES IN HISTORY of PREVIOUS THYROID DISEASE, METASTASIS AND ULTRASOUND INSPECTION ABNORMALITIES BETWEEN CLASSICAL PAPILLARY THYROID CARCINOMA PATIENTS AND FOLLICULAR VARIANTS IN Dr. KARIADI HOSPITAL SEMARANG

Background: Papillary thyroid carcinoma (PTC) is the most common carcinoma, accounting for more than 90% of all malignancies, where the most variants are classic papillary thyroid carcinoma and follicular variant papillary thyroid carcinoma (PTCVF). The characteristics of previous thyroid disease history, regional metastases, and ultrasound examination results can influence the clinical examination between the two variants of PTC, namely classic PTC and PTCVF. Aim: Understanding the differences in the history of previous thyroid disease, metastases, and ultrasound examination abnormalities between Classical Papillary Carcinoma and Follicular variants at Dr. Kariadi Hospital, Semarang. Methods: A cross sectional study with consecutive sampling method in classic PTC and PTCVF patients in Dr. Kariadi Hospital, Semarang who was diagnosed in the period January to June 2019. In this study, the number of samples obtained was 18 medical records with classic PTC cases and 20 medical records with PTCVF cases. The dependent variables, namely history of previous thyroid disease, regional metastases, and ultrasound examination abnormalities, all of which were on an ordinal scale, were analyzed using non-parametric chi-square test and Fisher's Exact test. Results: In the non-parametric chi-square test and Fisher's Exact test, the results were not significant (p = 0.474), regional metastases were not significant (p = 0.359), ultrasound size abnormalities were not significant (p = 0.323), and abnormalities. ultrasound nodal was not significant (p = 0.595). Conclusion: There was no statistically significant difference in the history of previous thyroid disease, regional metastases, and ultrasound examination abnormalities between classic PTC and PTCVF patients at Dr. Kariadi Hospital, Semarang.

Metastatic Renal Cell Neoplasm Within a Papillary Thyroid Carcinoma as Incidental Finding in an Asymptomatic Patient: a Case Report

Tumor-to-tumor metastasis is a rare phenomenon affecting the thyroid gland. Otherwise, it is not unusual for a neoplasm to be detected incidentally, without clinical symptoms. But what is exceptionally rare is that a malignant neoplasm debuts as an incidental finding in the form of a tumor-to-tumor metastasis. We contribute with the case of a previously healthy 41-year-old woman who presented an asymptomatic 39-mm-sized nodule on the left thyroid lobe in a routine health checkup. Ultrasound-guided fine needle aspiration cytology confirmed a papillary thyroid carcinoma. Because of the size, a total thyroidectomy was performed. In the surgical specimen, in addition to a classic papillary carcinoma with an extensive follicular pattern (pT2 pN0), a second component was identified, consisting of a clear cell population with immunostaining profile of renal origin. Subsequent studies found a 110-mm-sized left renal mass. A nephrectomy was performed and the pathological exam confirmed a renal cell carcinoma, pT2 pNX pM1, with metastasis also to the adrenal gland. To our knowledge, this is the first case described of this clinical presentation involving those two neoplasms. We present herein such an unusual clinical case along with a brief clinical and pathological review on tumor-to-tumor metastasis, with special emphasis on renal-to-thyroid ones.

SUN-489 MetastaticThyroidCancer

Background In many cases, thyroid cancer leads to metastasis; however, isolated metastasis to the liver from thyroid cancer is a rare event. When this occurs, patients have a very poor prognosis. Case Study A clinical case of a 33-year-old woman, born in Piura and coming from Lima, with no major history, diagnosed with a 4-month-old cervical tumor is presented. An ultrasound scan and a further biopsy were performed before an eventual diagnosis of papillary thyroid carcinoma. Operation was performed, and a classical papillary carcinoma of 0.90 inches was detected, along with macro-metastasis in a parathyroid ganglion. Post-surgical thyroglobulin was 1071 ng/ml (n< 50 ng/ml). The tomography in her lung showed three nodules in the middle lobe. A further dose of 150 millicuries of radioactive iodine (I-131) was given, with whole-body scanning, post positive in both lung fields and right lank pain. The tomography in the abdomen revealed a hepatic pedicle injury, compatible with teratoma. A liver resection surgery was scheduled, and metastatic papillary carcinoma was identified. A V600 mutation in BRAF gene was present in thyroid gland and not detectable in the liver. Conclusions This case shows an example of thyroid cancer with uncommon metastasis in the liver, which occurs in 0.5% of all thyroid metastases. It is even rarer that positive iodine was found. Liver metastasis represents a poor prognosis, however it has been reported that resective surgery offers patients a better chance of survival. Multiple factors influence its pathogenesis, including BRAF mutations. In this case, mutation was detected in thyroid gland, but not in liver metastasis, which could represent diverse BRAF mutations.

Experience with Active Surveillance of Thyroid Low-Risk Carcinoma in a Developing Country.

Background: The incidence of thyroid carcinoma is growing worldwide. More than 50% of new malignant tumors are classified as classical papillary carcinomas in low-risk category with a low rate of recurrence and high long-term survival. Active surveillance is a strategy to control low-risk tumor evolution with the intention to avoid unnecessary treatments and maintain thyroid function. The aim of this study was to report a cohort of patients with thyroid nodules classified as Bethesda V-VI and who are under active surveillance in Colombia. Methods: A prospective cohort was assembled since January 2015. All patients had been evaluated clinically, biochemically with ultrasonography and fine needle aspiration biopsy previous to the first evaluation. Active surveillance was proposed to patients with asymptomatic low-risk carcinoma (<1.5 cm, encapsulated, without evidence of lymph node metastasis), independent of sex or age. The strategy included a specific discussion about the surgical option and expected risk of complications, risk of long-term thyroxine support, and the active surveillance strategy. The data on age, sex, reason for an ultrasound examination, ultrasound risk by American Thyroid Association (ATA) classification, size and volume of the nodule, reason to consider active surveillance and follow-up ultrasounds, and surgical decision were recorded prospectively. A Kaplan-Meier curve was constructed for the rate of growth and increase in volume of the nodule, growth >3 mm and increase in volume >50%, and need of operation. Results: One hundred two patients were analyzed. Seventy-five percent of patients had a nodule smaller than 1 cm. Only 24/102 (23%) nodules were classified as ATA low risk. Thirty-four of 102 (33.3%) nodules were classified as Bethesda VI and the others were Bethesda V. The median follow-up was 13.9 months, and 32.3% of patients had more than 24 months of follow-up. Only 11/102 (10.8%) nodules grew more than 3 mm and 26/102 (25.5%) nodules grew more than 50% in volume. 12.7% patients were submitted to surgery. The overall stability rate without growth >3 mm, without volume increase >50%, and without surgery at 24 months were 89.8%, 77.0%, and 85.5%, respectively Conclusions: Active surveillance is possible in developing Western countries with similar results to those provided by Asian and American authors.

MON-LB098 Socioeconomic Status and Racial/Ethnic Factors Do Not Affect Thyroid Cancer Staging in an Urban Hospital with a Diverse Population Using the ThyroCARE Registry

Background: Socioeconomic status (SES) and racial/ethnicity (R/E) may influence the stage, response to therapy and risk of death of thyroid cancer. We examined our comprehensive THYROid CAncer REgistry (ThyroCARE) at an urban tertiary care hospital with a diverse, urban population, many of whom are from minority and international backgrounds for the effect of SES and R/E on staging of thyroid cancer. METHODS: The ThyroCARE registry contains 1208 data points related to patient management. Data are captured via individual record review. Based on the patient’s zip code, the median household income is inferred from the 2016 US census data. RESULTS: ThyroCARE contains 1,212 patients (78.3% female; 21.7% male) enrolled between January 2000-present. Patients in ThyroCARE were 68.4% Caucasian, 10.3% Black, 13.4% Hispanic, 4.5% Asian, and 3% other, of which, 31% are foreign born. A difference in education was seen. More Caucasian patients received 2-4 years of college as well as graduate or professional education compared to patients from non-Caucasian R/E (31.4% vs. 12.0% and 19.8% and 8.2%, p<0.01). Caucasian patients have a higher median household income than African American, Hispanic, and Asian patients. ($79,545 vs. $57,056, p<0.001; $79,545 vs. $52,125, p<0.001; $79,545 vs $65,173.5, p<0.005, respectively). Caucasian patients have more classic papillary carcinoma than other R/E (75.8% vs. 70.4% p<0.01). Other R/E had more follicular variant PTC than Caucasians (23.3% vs. 18.5%, p<0.05). No significant differences in the initial ATA staging (2015) or AJCC staging (8th edition) among all racial groups were found. There was no significant correlation between income and the AJCC staging of the cancer at initial presentation (r=-0.003, p=0.895). Within each race, there was no significant correlation between income and the AJCC staging (Asian r=0.094, p=0.536; Black r=0.069, p=0.486; Hispanic r=0.035, p=0.694; and Caucasian r=-0.035, p=0.386). CONCLUSIONS: ThyroCARE is a large, comprehensive longitudinal thyroid cancer registry based in an urban, academic center whose patients are racially, ethnically, and socioeconomically diverse. Query of this registry did not demonstrate a difference in the ATA initial staging or AJCC 8th edition clinical staging based on SES or R/E factors. These results suggest that other factors in our medical center including access to high quality medical care contribute to the initial staging and response to therapy of thyroid cancer rather than SES and R/E. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Clinical utility of EZH1 mutations in the diagnosis of follicular-patterned thyroid tumors

Follicular-patterned tumors of the thyroid gland are characterized by a predominantly follicular growth pattern. They frequently harbor RAS mutations, not BRAF mutations. Technological advances in molecular testing have discovered novel RAS-type mutations. However, clinical significance of these mutations remains unknown. We investigated the prevalence and clinical impact of mutations of BRAF, NRAS, HRAS, KRAS, EZH1, EIF1AX, and TERT genes by Sanger sequencing in a series of 201 follicular-patterned thyroid tumors including follicular adenoma (n = 40), Hürthle cell adenoma (n = 54), noninvasive follicular thyroid neoplasms with papillary-like nuclear features (n = 50), follicular thyroid carcinoma (n = 40), Hürthle cell carcinoma (n = 10), and poorly differentiated thyroid carcinoma arising in a well-differentiated follicular neoplasm (n = 7), and 120 classic papillary carcinoma. Two hotspots of EZH1 mutations were only found in RAS-negative follicular-patterned tumors. EZH1 mutations were detected in 3% of follicular adenoma and in 20% of Hürthle cell adenoma, and one minimally invasive Hürthle cell carcinoma. Thyroid tumors with EZH1 mutations reported in the literature were benign in most cases. Otherwise, they were minimally invasive or noninvasive cancer. EIF1AX mutation was found in one follicular adenoma. We confirmed the presence of RAS mutations and BRAF K601E mutation in benign, borderline, and malignant follicular-patterned tumors. No BRAF V600E was found in all follicular-patterned tumors. This study also confirmed the occurrence of TERT promoter mutations in high-risk thyroid cancers. These genetic markers can be used for the diagnostic purpose and risk stratification of thyroid nodules.

The role of laryngectomy in locally advanced thyroid carcinoma. Review of 16 cases

Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharyngeal invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.

An International Interobserver Variability Reporting of the Nuclear Scoring Criteria to Diagnose Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: a Validation Study.

The aim of the study was to assess interobserver variation in reporting nuclear features of encapsulated follicular variant of papillary thyroid carcinoma, newly reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), based on a proposed standardized scoring system. An education module was individually reviewed as a pre-evaluation teaching guide of the specific features of classical papillary carcinoma, the specific inclusion and exclusion features for the diagnosis of NIFTP, and a catalog of the standardized scoring system of the nuclear features of papillary carcinoma used to reach this diagnosis. Participants subsequently reviewed 30 cases of thyroid lesions previously scored by members of the Endocrine Pathology Society Working Group for the Re-evaluation of the Encapsulated Follicular Variant of Papillary Thyroid Carcinoma. There was one uninvolved reference image to demonstrate fixation, processing, and cell size and one image from each case for scoring, with results recorded for each participant. The location of training (country and program), years as a practicing pathologist, and approximate number of thyroid gland surgical cases diagnosed per year were recorded. The degree of agreement between participants was assessed by kappa statistics, using the individual criteria and the average composite scores of the Working Group as a point of comparison. Using the Nuclear Standardized Scoring System, the interobserver agreement for final diagnosis score was generally excellent: unweighted and weighted kappa values between individual observers ranging from 0.242 to 0.930 (average 0.626). There was significant agreement between observers in reaching an interpretation of the presence or absence of nuclear features to diagnose NIFTP (score 0-1 versus score of 2-3), with California pathologists, 0.63 (median 0.66, SD 0.15); Japanese pathologists, 0.64 (median 0.66, SD 0.16); and UK pathologists, 0.60 (median 0.57, SD 014) compared to the expert panel, 0.70 (median 0.73, SD 0.19). The use of the nuclear scoring system to evaluate the nuclear features of papillary thyroid carcinoma as applied to reach the diagnosis of NIFTP shows a good to substantial interobserver agreement, suggesting that consensus can be reached in diagnosing the nuclear features required for this newly reclassified neoplasm.

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): impact on the reclassification of thyroid nodules

The 2017 edition of the WHO book on Classification of Tumours of Endocrine Organs includes a new section entitled 'Other encapsulated follicular-patterned thyroid tumours', in which the newly created NIFTP (non-invasive follicular thyroid neoplasm with papillary-like nuclear features) is identified and described in detail. Despite deleting the word 'carcinoma' from its name, NIFTP is not a benign tumor either and is best regarded as a neoplasm with 'very low malignant potential'. The main goal of the introduction of NIFTP category is to prevent overdiagnosis and overtreatment. Sampling constraints, especially when dealing with heterogeneous and/or large nodules, and difficulties in the invasiveness evaluation, are the major weaknesses of the histological characterization of NIFTP. At the cytological level, NIFTP can be separated from classic papillary carcinoma (cPTC) but not from encapsulated, invasive follicular variant PTC. The impact of NIFTP individualization for cytopathology is the drop of rates of malignancy for each Bethesda category in general and for indeterminate categories in particular. The biggest impact will be seen in institutions with a high frequency of FVPTC. The introduction of NIFTP has changed the utility of predictive values of molecular tests because RAS mutations and PAX8-PPARg rearrangements are frequently detected in NIFTP. This turns less promising the application of mutation detection panels as indicators of malignancy and will probably contribute to switch to a rule-out approach of molecular testing. Selection for surgery will go on being determined by a combined detection of clinical, cytological and ultrasound suspicious features.

Dose aggressive variants of papillary thyroid carcinoma have worse clinical outcome than classical papillary carcinoma?

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

Importance of cytological subclassification of thyroid nodules with Bethesda category III cytology (AUS/FLUS) into architectural atypia only and nuclear atypia: A prospective study.

The objective of this study was to compare two cytological subcategories of thyroid nodules with Bethesda category III initial cytology. This was a prospective study. All patients with thyroid nodules > 1 cm were eligible and 98 patients with category III cytology were selected. Cytology was subcategorized into architectural atypia only (AA, n = 45) and nuclear atypia (NA, n = 53). All patients underwent a second fine-needle aspiration (FNA). Only patients whose second cytology was benign and ultrasonography was non-suspicious were not referred for surgery. In these patients, the nodules were considered benign. The second FNA more frequently revealed "benign cytology" in the AA subcategory (44.4% vs. 24.5% in the NA subcategory). The second cytology suggested "follicular neoplasm" or was "suspicious for follicular neoplasm" (category IV) in 5 patients (11.1%) of subcategory AA and was "suspicious for malignancy" (category V) in 13 (24.5%) of subcategory NA. Finally, malignancy was diagnosed in 15.5% of cases of subcategory AA and in 41.5% of subcategory NA. Follicular carcinoma was more frequent in subcategory AA, while classical papillary carcinoma was more frequent in subcategory NA. Excluding cases of the noninvasive encapsulated follicular variant of papillary carcinoma, malignancy was diagnosed in 11.1% of patients of subcategory AA and in 35.8% of subcategory NA. The results showed that subclassification of the Bethesda category III improves cancer risk prediction, with potential repercussions for clinical practice. Diagn. Cytopathol. 2017;45:604-607. © 2017 Wiley Periodicals, Inc.