Features Of Papillary Thyroid Carcinoma Research Articles

Is ultrasonographic evaluation sensitive enough to detect multicentric papillary thyroid carcinoma?

This study aimed to investigate the preoperative ultrasonographic (US) evaluation of multicentric papillary thyroid carcinoma (PTC) and to evaluate the association of US findings with lymph node metastasis and extracapsular extension in PTC. Preoperative US evaluations of patients with PTC who underwent total thyroidectomy were retrospectively investigated. Pathological perspectives and US features of PTC were analyzed. The sensitivity of US in detecting multicentric PTC was evaluated. The present study included 89 PTC patients who underwent total thyroidectomy. In total, 164 nodules were detected by preoperative US. Significant differences in US pattern were found between benign and malignant nodules. Of the 89 patients with PTC, 33 (37.08%) cases were confirmed as multicentric PTC by operation and pathological examination, 22 (66.67%) of which were bilateral. Before surgery, only 23 patients were suspected as multicentric PTC based on US findings. Pathological examination revealed that malignant nodules in 17 (51.51%) patients with multicentric PTC had been missed by preoperative US. The malignant nodules that went undetected by US were micronodulars (1-4 mm). Furthermore, ultrasonography was less sensitive for the diagnosis of metastatic lymph nodes in the neck. US had more than 80% sensitivity for detection of extracapsular extension of cases. US evaluation is not sensitive enough to detect multicentric PTC. The minute size of some nodules in multicentric PTC, may lead to them being missed by US evaluation. Ultrasonography is an optional tool for the detection of extracapsular extension, but it is less sensitive for diagnosing lymph node metastasis.

Effect of BRAF V600E mutation detection of fine-needle aspiration biopsy on diagnosis and treatment guidance of papillary thyroid carcinoma

ObjectiveThe aim of this study was to evaluate the diagnostic value of detection of BRAF V600E mutation in the fine-needle aspiration cytology (FNAC) specimens of thyroid nodules and the relationship between BRAF V600E mutation and the clinicopathological characteristics of papillary thyroid carcinoma (PTC). MethodsA total of 252 patients who underwent initial thyroid surgery were retrospectively analysed. All the patients underwent a preoperative FNAC at our institution, and the thyroid puncture cell fluid was used for both the cytological diagnosis and BRAF V600E mutational analysis using quantitative polymerase chain reaction. The Cochran-Mantel-Haenszel test was used to evaluate the diagnostic value of BRAF V600E mutation in FNAC fluid in diagnosing PTC. The association between BRAF V600E mutation and the clinicopathological parameters of PTC was analysed using the χ2 test. ResultsThrough FNAC, 21 (8%), 60 (24%), and 171 (68%) cases were cytologically diagnosed as benign, indeterminate, and malignant, respectively. Postoperatively, 242 cases were histopathologically diagnosed as PTCs and 10 as goitre nodules. In the FNAC samples, 12 (57 %) of the 21 benign, 48 (80 %) of the 60 indeterminate, and 152 (88.9 %) of the 171 malignant cases showed BRAF V600E mutation. The histopathological diagnosis was used as the gold standard. The sensitivity and specificity of BRAF V600E mutational analysis in the FNAC samples for the diagnosis of PTC were 91.7 % and 100 % in benign, 82.8 % and 100 % in the indeterminate, and 89.4 % and 100 % in the malignant cases, respectively. ConclusionBRAF V600E mutational analysis in FNAC samples of thyroid nodules can be used an effective supplementary diagnostic method at our institution. However, BRAF V600E mutation was not associated with aggressive characteristics in PTC.

Circular RNA expression and association with the clinicopathological characteristics in papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Circular RNAs (circRNAs) are a novel class of RNAs, with higher stability and tissue specificity, which may be of value as novel clinical markers. High-throughput RNA sequencing was used to profile the expression of circRNAs in 5 pairs of cancer and normal tissues, and reverse transcription-quantitative PCR (RT-qPCR) analysis was employed to verify the results of the RNA sequencing in 45 cases of PTC. The dysregulated circRNA expression and clinicopathological characteristics were assessed and the potential roles of circRNAs in the cellular miRNA and mRNA network were predicted using bioinformatics analysis. The results demonstrated that, compared with normal tissues, a total of 53 circRNAs were dysregulated in tumour tissues, and 8 circRNAs were validated at the mRNA level (P<0.001 and P<0.01). Among those, the expression of chr5:161330882-161336769- (P=0.015), chr9:22046750-22097364+ (P=0.041) and chr8:18765448-18804898- (P=0.036) were obviously associated with the BRAFV600E mutation, chr12:129699809-129700698- was associated with capsular invasion (P=0.025) and chr5:38523418-38530666- was associated with pT stage (P=0.037) and lymph node metastasis (P=0.002). Therefore, some dysregulated circRNAs were found to be associated with BRAFV600E mutation, capsular invasion, advanced pT stage and lymph node metastasis of PTC, indicating that circRNAs may be involved in tumourigenesis and cancer progression, and they may be putative biomarkers for the diagnosis and evaluation of progression of PTC.

SUN-483 A Retrospective Diagnosis of Malignant Struma Ovarii After Discovery of Pulmonary Metastases

Background: Malignant struma ovarii is a rare ovarian tumor that is histologically identical to differentiated thyroid carcinoma.1 We present a case of a struma ovarii that was recognized as being malignant only after the discovery of pulmonary metastases. Clinical Case: A 29 year old female presented to the hospital with acute right lower abdominal pain, suspicious for ovarian torsion. She underwent urgent right salpingoopherectomy and pathology demonstrated a mature cystic teratoma with benign struma ovarii. Two years later, a CT of the abdomen incidentally revealed bilateral pulmonary nodules. Review of the imaging showed that these pulmonary nodules were also present two years prior, and had since become larger. Video-assisted thoracoscopic surgery was performed and lung biopsy was positive for well-differentiated thyroid carcinoma. The patient then underwent total thyroidectomy which revealed a 0.3 x 0.3 cm infiltrative papillary thyroid cancer, follicular variant, without lymphovascular invasion. Thyroglobulin level decreased from 169 ng/mL pre-operatively to 80 ng/mL post-operatively, but then continued to be variable ranging from 56 to 252 ng/mL (1.6-50 ng/mL). Thyroglobulin antibodies remained negative.Pathology from right ovary was re-reviewed at a second institution and found to be consistent with highly differentiated thyroid carcinoma with characteristic nuclear features of papillary thyroid carcinoma.A diagnostic whole body I-131 scan showed uptake within the thyroid bed, bilateral lung nodules, left distal thigh and right mid thigh. These thigh lesions were not visualized on lower extremity ultrasound. After dosimetry was performed, the patient received radioactive iodine-131 200 mCI. Post-therapy scan six days later demonstrated uptake in the thyroid bed, bilateral lungs and bilateral thighs. About five months later, thyroglobulin level had decreased to 0.4 ng/mL with a suppressed TSH. A repeat CT chest demonstrated that the lung nodules had all decreased in size, largest from 0.5 cm to 0.3 cm. Conclusion: Careful examination of struma ovarii pathology should be performed to evaluate for malignant features since benign appearing histology can present diagnostic difficulty.2 In this case, thyroglobulin level was lower than reported in previous cases; however, sites of metastases were responsive to radioactive iodine therapy indicating well differentiated disease and a favorable prognosis.

Clinical Analysis of BRAFV600E Mutation and Its Correlation With Sonographic Image Characteristics in Papillary Thyroid Carcinoma in Chinese Coastal Areas.

This study analyzed the characteristics of BRAFV600E mutation in papillary thyroid carcinoma (PTC) in Chinese coastal areas. We intended to identify noninvasive methods to determine BRAFV600E status in thyroid nodules prior to surgery. BRAFV600E mutation and the sonographic characteristics of thyroid nodules were investigated in 670 PTC patients in our hospital. We aimed to determine the relationship between BRAFV600E mutation and the clinicopathological and sonographic imaging characteristics of PTC. The mutation rate of the BRAFV600E was 78.2%. BRAFV600E mutation was significantly associated with central node (univariate analyses, P = .005; multivariate analyses, P < .001, odds ratio [OR] = 10.255) and lateral node metastases (univariate analyses, P = .001; multivariate analyses, P < .001, OR = 22). It was less frequent in PTC coexisting with Hashimoto's thyroiditis (univariate analyses, P = .016; multivariate analyses, P < .001, OR = .034). Nodules without blood flow had a significantly higher mutation rate of BRAFV600E in PTC patients (univariate analyses, P = .026). BRAFV600E mutation was significantly associated with high suspicion in the Thyroid Imaging Reporting and Data System 5 (univariate analyses, P = .004; multivariate analyses, P = .014, OR = 6.456). Our results strongly suggest that BRAFV600E mutation plays a potential role in lymph node metastasis (central node metastasis, OR = 10.225; lateral node metastasis, OR = 22). Some sonographic imaging features might be helpful in estimating the status of BRAFV600E preoperatively.

Correction to: Redox Status and Antioxidative Cofactor Metals Influence Clinical and Pathological Characteristics of Papillary Thyroid Carcinoma and Colloid Goiter.

The original version of this article unfortunately contained a mistake.

Impact of Age-Related Genetic Differences on the Therapeutic Outcome of Papillary Thyroid Cancer.

The incidence of papillary thyroid carcinoma (PTC) has been increasing worldwide. PTC is the most common type of differentiated thyroid cancer and usually shows good prognosis. However, some PTC is driven to advanced stage by epithelial-mesenchymal transition (EMT)-mediated drug resistance, which is particularly noticeable in pediatric patients. There are limited options for systemic treatment, necessitating development of new clinical approaches. Here, we aimed to clarify genetic differences due to age of patients with PTC, and thereby aid in developing novel therapeutics. Patients with biochemically and histologically confirmed PTC were included in this study. PTC cells were acquired from young and older patients showing drug resistance, and were compared via microarray analysis. Cellular proliferation and other properties were determined after treatments with lenvatinib and sorafenib. In vivo, tumor volume and other properties were examined using a mouse xenograft model. Lenvatinib-treated group showed obvious suppression of markers of anti-apoptosis, EMT, and the FGFR signaling pathway, compared with control and Sorafenib-treated group. In the xenograft models, lenvatinib treatment induced significant tumor shrinkage and blocked the proto-oncogene Bcl-2 (B cell lymphoma/leukemia gene-2) and FGFR signaling pathway, along with reduced levels of EMT markers, compared with control and Sorafenib-treated group. Our findings clarify the age-dependent characteristics of pediatric PTC, giving insights into the relationship between young age and poor prognosis. Furthermore, it provides a basis for developing novel therapeutics tailored to the age at diagnosis.

Suspicious ultrasound and clinicopathological features of papillary thyroid carcinoma predict the status of TERT promoter.

To investigate the value of ultrasound (US) and clinicopathological features of papillary thyroid cancer (PTC) in predicting Telomerase Reverse Transcriptase (TERT) promoter mutations. Preoperative US images of 351 surgically confirmed PTCs were evaluated in terms of PTCs size and US features. The basic clinicopathological features were also retrieved. Univariate and multivariate analyses were performed to identify the risk factors for TERT promoter mutations. A scoring system was developed based on the cumulative number of risk factors. The area under the receiver operating characteristic curve (AUC) and cut-off value were calculated to evaluate the diagnostic performance of the scoring system for predicting TERT promoter mutations. TERT promoter mutations were found in 4.84% (17/351) of patients with PTCs. Patient age >50 years (OR: 6.244, P = 0.006), multifocality (OR: 21.071, P = 0.022), taller-than-wide shape (OR: 4.934, P = 0.029), microlobulated margin (OR: 4786, P = 0.032), and capsule contact or involvement (OR: 4.668, P = 0.030) were independent risk factors for TERT promoter mutations. TERT promoter mutations were relevant to more suspicious US and clinicopathological features than TERT promoter wild-type PTC (median, 4 vs. 1, P < 0.001). The cut-off value was 2.5 and the associated AUC was 0.908 (P < 0.001). The probability of TERT promoter mutations increases along with the suspicious US features and clinicopathological characteristics, which may help to recognize patients who deserve a different approach, in terms of management and follow-up, in view of the worst outcome associated to this mutation.

Prognostic Signature: Immune Confrontation in the Papillary Thyroid Carcinoma Microenvironment

Background: Papillary thyroid carcinoma (PTC) is considered an inflammation-driven cancer. However, a systematic investigation of the relationship between the tumour immune microenvironment and prognosis in PTC has not been conducted. Methods: A prognostic model based on differentially expressed genes (DEGs) and progression-free survival (PFS) data from the Cancer Genome Atlas (TCGA) was established by least absolute shrinkage and selection operator (LASSO) and multivariate Cox analyses. 502 PTC cases were divided into low prognostic riskscore (PR) (L-PR) and high PR (H-PR) groups according to the median PR. We compared the immune characteristics between groups and verified these differences in validation cohorts. Furthermore, we explored cancer stem cells (CSCs) and tumour mutation burden (TMB) to explain the prognostic results. Findings: A prognostic signature (PR) based on 13 DEGs performed well in prognostic prediction (5-year area under the curve (AUC)= 0.861). The PR was positively correlated with age, stage, T classification, metastasis, RAS mutation, and subtypes as follicular or tall cell PTC. Importantly, the H-PR group, which had poor prognostic features, exhibited four main characteristics: comprehensive weakening of the immune system (immune escape) that was not observed in the L-PR group, a higher ratio of tumour-promoting immune cells, more CSCs, and a higher TMB than the L-PR group. Interpretation: Our prognostic model can effectively predict the prognosis and immune characteristics of PTC and revealed that immune escape, tumour-promoting immune infiltration patterns and tumour heterogeneity in the tumour microenvironment (TME) could be mechanisms of poor prognosis in PTC. Funding Statement: National Natural Science Foundation of China (81600602). Declaration of Interests: The authors stated: None. Ethics Approval Statement: Not required.

Clinicopathological features of papillary thyroid carcinoma: A single-centre experience in Turkey

Aim: The goal of this study was to determine the incidence of papillary thyroid carcinoma (PTC) at our centre and examine the clinicopathological features of the tumours.Material and Methods: The study included 823 patients who underwent thyroidectomies in our centre between January 2013 and June 2017 and were examined histopathologically at the Pathology Clinic. We examined their demographic characteristics, preoperative diagnoses, operative procedures, FNAC diagnoses, histopathological characteristics, and postoperative prognoses.Results: Out of the 823 patients, 16.3% were diagnosed with malignancy. Of these diagnoses, 89.6% were papillary carcinomas, 3.7% were follicular carcinomas, 3% were lymphomas, 1.5% was medullary carcinomas, 1.5% were anaplastic carcinomas, and 0.7% were poorly differentiated carcinomas. The rate of PTC incidence in thyroidectomy specimens was 14.6%. In our cases, the multifocality rate of tumours was 31.7%, and the rate of bilateral disease was 24.2%. Neck dissection was performed in 11 PTC patients. Seven of these patients (5.8%) had lymph node metastasis. Of all patients, 46.7% received postoperative radioactive iodine (RAI) therapy. No recurrence or distant metastasis was detected in any of the cases.Conclusion: PTC is the most common type of thyroid carcinoma at our centre. Fine-needle aspiration cytology (FNAC) is valuable for diagnosing classical PTC. Because of the high occurrence of bilateral and multifocal disease in PTC, performing total thyroidectomy is appropriate. Long-term life expectancy is good for these patients.

Nuclear CK19-immunopositive pseudoinclusions as a new additional objective diagnostic feature of papillary thyroid carcinoma.

One ofthekey parameters in thediagnosis ofpapillary thyroid carcinoma (PTC) are true nuclear pseudoinclusions (NPs), which constitute invaginations ofthecytoplasm into thenucleus. On theother hand, strong cytoplasmic expression ofCK19 is awell-known attribute ofPTC tumor cells. We analyzed NPs using CK19 immunohistochemistry in histological sections of52 PTCs and seven noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs). Strong CK19+ NPs were present in 77% ofPTCs, whereas NPs in hematoxylin and eosin (HE)-stained slides (HE NPs) were identified in only 48% ofPTCs. Detection ofCK19+ NPs enabled easier and objective recognition ofNPs and better discrimination ofNPs from pseudo-pseudoinclusions than detection ofHE NPs. In the15 ofthe27 (55.5%) PTCs in which we could not discern HE NPs, strong CK19+ NPs could be identified reliably, quickly and easily. Moreover, all NIFTPs were negative for both CK19+ NPs and HE NPs. Detection ofCK19+ NPs may refine theassessment ofthis important diagnostic feature and, hence, themicroscopic diagnostic criteria ofPTC. Thus, these findings may have implications for theaccurate diagnosis ofPTC and NIFTP.

Coexistence of BRAFV600E mutation and EGFR overexpression is highly associated with adverse clinicopathological features of papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) generally has a good prognosis, but in a subset of patients it progresses to aggressive forms. Analysis of molecular alterations in relation to clinical phenotype may help in risk stratification of patients by predicting tumor aggressiveness. We analyzed the expression profiles of epidermal growth factor receptor (EGFR) using immunohistochemistry and the presence of BRAF(V600E) mutation by mutant allele-specific PCR in PTC tissue samples (n=92) in relation to clinicopathological parameters. BRAFV600E was detected in 46.7% of patients and correlated with the presence of lymph node metastasis (LNM, p=0.035) and extrathyroid invasion (EI, p&lt;0.0001). EGFR overexpression was detected in 52.2% of the patients and also correlated with LNM (p&lt;0.0001) and EI (p=0.027). Among patients with a single alteration, the presence of BRAFV600E impacted EI, while EGFR overexpression alone had a greater impact on LNM. The strongest association with adverse features was found in PTC patients with coexisting BRAFV600E and EGFR overexpression (28.3%), among whom LNM and EI were evident in 73% and 69%, respectively (p&lt;0.0001, for both). Thus, the coexistence of BRAFV600E mutation and EGFR overexpression identifies high-risk PTC patients, who should be considered for combined molecular therapy offering a better long-term therapeutic outcome.

The Expression of Tumor-Associated Macrophages and Multinucleated Giant Cells in Papillary Thyroid Carcinoma.

BACKGROUND:Inflammation that occurred in the tumor microenvironment was characterized by abundant macrophage infiltration, playing role in innate immunity. Multinucleate giant cells (MGCs) occur in a variety of inflammatory, hyperplastic, and neoplastic thyroid disorders. They also have been recognized as a feature of papillary thyroid carcinoma (PTC).AIM:The aim of this study was to evaluate cases of PTC for the presence of macrophages, and estimate CD68+ TAMs density in tumor stroma, margin and the surrounding tissue. We assessed also MGCs.METHODS:Macrophages and MGCs densities were correlated with clinicopathologic parameters to assess the possible prognostic significance. We investigated 56 patients immunohistochemically and immunofluorescence with antibodies against CD68 and IL-17.RESULTS:A statistically significant correlation was established between PTC patients in III stage, containing many MGCs, and PTC in I and II stage, with many MGCs. Eighty Percent of patients in III stage showed many MGCs in comparison with patients in I and II stage, where many MGCs were found only in 21,1% (χ2 = 6.189, p = 0.013).CONCLUSION:Our study demonstrates that the increased density of MGCs is associated with advanced stage of PTC, and therefore with tumor progression and that cases of PTC should be carefully screened for their presence.

Redox Status and Antioxidative Cofactor Metals Influence Clinical and Pathological Characteristics of Papillary Thyroid Carcinoma and Colloid Goiter.

Papillary thyroid carcinoma (PTC) is the endocrine neoplasm that occurs the most often worldwide, and its molecular pathophysiology is still not well characterized. Redox status is recognized as an important factor of carcinogenesis, but its influence on the PTC's clinical course needs to be better elucidated. The aim of this research was to determine the tissue redox status of 65 PTC and 45 colloid goiter (CG) patients together with antioxidative cofactor metal profiling. The malondialdehyde (MDA) concentration was used to access the prooxidation level, while antioxidant mechanisms were estimated by assaying the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR). The antioxidative cofactor metals included quantification of Se, Cu, Zn, and Mn concentration. PTC tissues had normal prooxidation levels and increased GPx and GR activity. The activity of SOD has been significantly reduced in multicentric PTC dissemination and increased in smokers. SOD activity was directly dependent on MDA levels in CG tissues. CG patients with retrosternal goiter had reduced MDA concentration and SOD activity. Numerous correlations between redox parameters in PTC tissues reveal good co-activation of antioxidative mechanisms and cooperative response on prooxidation. PTC tissues had decreased Se levels and increased concentration of Cu and Mn in comparison to other tissues. MDA concentration and SOD activity were significant predictors of PTC's multicentric dissemination and for the existence of lymph node metastases, respectively. Particularly, the concentration of Cu predicted the retrosternal localization in CG patients. Significant findings presented in this study provide a possibility for development of novel prognostic molecular biomarkers of PTC and CG.

Prognostic implications of the BRAF-V600E mutation in papillary thyroid carcinoma based on a new cut-off age stratification.

The BRAF-V600E mutation is the most common and specific oncogenic event known in papillary thyroid carcinoma (PTC). However, it remains controversial whether there is an association between the BRAF-V600E mutation and clinicopathologically aggressive characteristics of PTC. The purpose of the present retrospective study was to investigate the significance of the BRAF-V600E mutation in predicting prognostic and aggressive clinicopathological characteristics according to a new age-based stratification. Clinical data and the BRAF-V600E mutation status of 475 patients with PTC were downloaded from The Cancer Genome Atlas database. The association between BRAF-V600E status and clinicopathological characteristics was analyzed by χ2 test or Fisher's exact test. Recurrence-free survival rate (RFS) was analyzed using the Kaplan-Meier method. Aggressive clinicopathological factors associated with recurrence were analyzed by Cox multivariate regression. This study was conducted on 219 cases of patients with PTC with a known BRAF-V600E mutational status. In the ≥55 years age group, BRAF-V600E was found to be significantly associated with aggressive PTC characteristics, including tumor size, PTC subtype, radioactive iodine (RAI) dose, follow-up time, recurrence, recurrence risk stage, advanced T stage, advanced N stage and American Joint Committee on Cancer (III/IV) stage (all P<0.05). RFS was analyzed by the log-rank test and exhibited statistically significant differences in the ≥55 years group (P=0.041), but there was no significant difference in the <55 group (P=0.757), according to the BRAF-V600E mutation status. The BRAF-V600E gene was excluded from the recurrence Cox multivariate regression model. The BRAF-V600E mutation was found to better predict aggressive and recurrent PTC based on age stratification with the cut-off age of 55 years. The synergistic interaction between BRAF-V600E mutation and the new age stratification may help clinicians reach the optimal decision in terms of surgical approach and the extent of surgery.

The Clinicopathological Features of Papillary Thyroid Carcinoma Patients with Positive Hepatitis B Surface Antigen

Background: Hepatitis B virus infection has been reported to be associated with some kinds of cancer. The aim of this study was to investigate clinicopathological features of papillary thyroid carcinoma (PTC) patients with positive hepatitis B surface antigen (HBsAg). Materials and Methods: A total of 569 PTC patients were analyzed retrospectively in this study. The relationships of HBsAg with clinicopathologic features of PTC were analyzed by univariate analysis. The relationships of central lymph node metastasis (CLNM) with clinicopathological features of PTC were analyzed by univariate and multivariate logistic regression analysis. Results: The incidence of CLNM in PTC with positive HBsAg was higher than that in PTC with negative HBsAg (71.4 vs. 60.0%, p = 0.047). Univariate analysis showed that positive HBsAg was significantly associated with bilateral tumors (p = 0.043) and lymph node metastasis (LNM) (p = 0.047) in PTC patients. In addition, the incidence of CLNM in patients with PTC was 61.7% (351 of 569 cases). Univariate analysis showed that CLNM of patients with PTC was significantly associated with positive HBsAg (p = 0.047). Multivariate logistic regression analysis revealed that positive HBsAg (p = 0.038) was an independent predictor of CLNM in patients with PTC. Conclusions: The incidence of CLNM in PTC patients with positive HBsAg was significantly higher than that of patients with negative HBsAg. Positive HBsAg was correlated with LNM and bilateral tumors. In addition to gender, age <45 years, tumor size >2 cm, and lateral LNM, positive HBsAg was also an independent predictor of CLNM in PTC patients.

Clinicopathological significance of Golgi phosphoprotein 3 expression in papillary thyroid carcinoma

Objective: To investigate the expression of Golgi phosphoprotein 3 (GOLPH3) in papillary thyroid carcinoma (PTC) and its relationship with clinicopathological characteristics of PTC and American Thyroid Association (ATA) risk of recurrence stratification. Methods: The mRNA expression level of GOLPH3 in PTC tissues and the matched adjacent noncancerous tissues from 30 cases of PTC undergoing surgical operation in Fujian Provincial Hospital between March 2017 and April 2018 was detected by reverse transcription-quantitative PCR (RT-qPCR). The protein expression of GOLPH3 in PTC tissues and the matched adjacent noncancerous tissues of 135 cases of PTC between January 2013 and April 2018 was measured by immunohistochemistry. The correlation between the expression of GOLPH3 in PTC and clinicopathologic characteristics and ATA risk of recurrence stratification was analyzed. Results: The mRNA level of GOLPH3 in PTC tissues was significantly higher than that in adjacent noncancerous tissues (7.53±1.32 vs 3.64±1.44, P<0.001). The protein expression level of GOLPH3 in PTC tissues was significantly higher than that in adjacent noncancerous tissues [66(30, 95) vs 34(20, 72), P<0.001]. The expression of GOLPH3 was significantly correlated to the tumor size (P=0.026), extrathyroid invasion (P=0.016), lymph node metastasis (P=0.001) and TNM stage (P=0.027) in PTC. Multivariate logistic regression analysis showed that GOLPH3 expression was independently correlated to tumor size (OR=3.58, 95%CI: 1.19-15.46, P=0.017) and lymph node metastasis (OR=7.28, 95%CI: 2.43-10.08, P=0.002). The expression of GOLPH3 was positively correlated to ATA risk of recurrence stratification (P=0.041). Conclusions: Overexpression of GOLPH3 is associated with the development of PTC and poor prognosis in patients with PTC. Detection of GOLPH3 expression can help evaluate proliferative and metastatic potential of PTC, as well as the risk of postoperative recurrence in patients with PTC.

Comparative analysis of CT in the diagnosis of papillary thyroid carcinoma and nodular goiter

Objective: To investigate the Computed Tomography (CT) features of papillary thyroid carcinoma and nodular goiter. METHODS: Ninety patients were enrolled in this study. All patients were treated with thyroid disease admitted to our hospital from January 2016 to December 2018. Among them, sixty patients with thyroid papillary carcinoma and thirty patients with nodular goiter were examined by CT scan and enhanced examination. RESULTS: There was no statistically significant difference in the volume index of left lobe, right lobe and isthmus in thyroid patients (P&gt;0.05). There were significant statistical differences in the growth site, morphology, border, density, calcification and enhancement mode of nodules ( P &lt; 0.05). Conclusion: CT examination has significant diagnostic value in the differential diagnosis of papillary thyroid carcinoma and nodular thyroid.

Intramedullary Spinal Cord Metastasis as the Presenting Feature of Papillary Thyroid Carcinoma

The objective of this report is to present an unusual case of intramedullary spinal cord metastasis (ISCM) as the presenting feature of papillary thyroid carcinoma (PTC). The presented case includes clinical, biochemical, and imaging findings as well as surgical and pathology reports. Treatment with radioactive iodine (RAI) and the response to this treatment are presented. A 71-year-old woman was evaluated for debilitating low back pain and walking disability. Magnetic resonance imaging demonstrated an oval, lumbar, intramedullary mass with benign features and surgery was scheduled. On preoperative evaluation for the lumbar mass, a multinodular thyroid goiter (unfortunately overlooked previously) was noticed, causing severe narrowing of the trachea. Total thyroidectomy was performed with a pathology diagnosis of PTC. In a second operation, the lumbar lesion was removed and proved to represent metastatic PTC. External beam radiation was subsequently administered to the thyroid bed, lumbar spine, and other skeletal metastases, followed by 150 milliCurie of RAI. A post-treatment scan showed high uptake over the lumbar spine, and skeletal and lung lesions. Clinically, the patient restored her walking ability and back pain improved. ISCM rarely is the presenting feature of PTC. Our patient presented with back pain which is the typical, though non-specific symptom, of ISCM. She showed good clinical response to multimodal treatment which is in line with the few other differentiated thyroid cancer patients with ISCM reported in the literature. Prompt surgical resection, followed by external beam radiation and RAI, may improve neurological signs, alleviate pain, and improve quality of life.

Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma.

Background: The 2017 World Health Organization (WHO) Classification of Tumors of Endocrine Organs defines poorly differentiated thyroid carcinoma (PDTC) as a tumor with conventional criteria of malignancy (capsular penetration or vascular invasion) with solid, insular, or trabecular growth, a lack of nuclear features of papillary thyroid carcinoma, and increased mitotic activity, tumor necrosis, or convoluted nuclei. The extent of invasion has been shown to be prognostic in follicular thyroid carcinoma and Hürthle cell carcinoma. Our aim was to evaluate how extent of invasion impacts clinical outcome for PDTC. Methods: We retrospectively identified 47 consecutively diagnosed cases of PDTC that were resected between 2005 and 2018. All cases were reviewed to confirm that the tumors met the 2017 Endocrine WHO criteria of PDTC. In addition, tumors were categorized as follows: encapsulated with capsular penetration only, encapsulated with focal vascular invasion (fewer than four foci), encapsulated with extensive vascular invasion (four or more foci), or widely invasive. Histopathologic characteristics and clinical outcome data were recorded. Results: A total of 47 cases of PDTC, including 15 oncocytic tumors, were identified from 28 (60%) women and 19 (40%) men (mean age of 57 years at diagnosis). The mean tumor size was 4.3 cm. Mitoses numbered 8 per 10 high-power fields (HPF) on average (range: 1-34), and necrosis was present in 21 (45%) cases. Eight (17%) cases were encapsulated with capsular penetration only, 5 (11%) were encapsulated with focal vascular invasion, 18 (38%) were encapsulated with extensive vascular invasion, and 16 (34%) were widely invasive. Of the 42 (89%) patients with follow-up data, 7 (17%) died of disease (with a mean survival time of 6.4 years), 11 (26%) have distant metastatic disease, and 24 (57%) have no evidence of disease (mean follow-up 5.6 years). Eight (19%) patients presented with M1 disease at diagnosis. The 5-year disease-free survival (DFS) for patients with M0 disease at diagnosis was 100% for patients with tumors with capsular invasion only or focal vascular invasion (n = 7), 73% for patients with encapsulated tumors with extensive vascular invasion (n = 11), and 17% for patients with widely invasive PDTCs (n = 6). DFS estimates by Kaplan-Meier analysis were significantly different between these groups (p = 0.0016). Conclusions: Extent of invasion appears to be an important parameter that affects clinical outcome for patients with PDTC. In our cohort, patients with encapsulated PDTC with capsular invasion only or focal vascular invasion had an excellent outcome.