Features Of Papillary Thyroid Carcinoma Research Articles

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.

Association analysis and the clinical significance of BRAF gene mutations and ultrasound features in papillary thyroid carcinoma.

The aim of the present study was to evaluate the associations between the B-Raf proto-oncogene serine/threonine kinase (BRAF)V600E mutation and conventional and contrast-enhanced ultrasonographic features in patients with papillary thyroid carcinoma (PTC), and to subsequently investigate the clinical value of these associations. In total, 207 thyroid nodules (diameter ≤2 cm) were selected. Conventional ultrasound, contrast-enhanced ultrasound, BRAFV600E mutational analysis and ultrasound-guided fine-needle aspiration biopsy were preoperatively performed, and histopathological assessment of PTC was postoperatively confirmed. The nodules were divided into 2 groups based on the BRAFV600E mutational analysis, namely the mutant or the wild-type variant groups, and the association analyses of the ultrasonographic features between these 2 groups were performed. Overall, 74.9% (155/207) of the PTC nodules had the BRAFV600E mutation, while 25.1% (52/207) had the wild-type BRAF allele. The 2 groups were analyzed using univariate logistic regression analysis, which demonstrated no significant differences regarding morphology, boundary, hypoechogenicity of the nodules, blood flow signal, enhancement uniformity, enhancement degree and clearance time (P>0.05). Moreover, the 2 groups demonstrated significant differences regarding the aspect ratio, microcalcification, nodule size following enhancement, enhancement mode and enhancement time (P<0.05). A multivariate logistic regression analysis was performed to further validate the association of these features with the BRAFV600E mutation; however, only microcalcification [odds ratio (OR), 2.256; 95% confidence interval (CI), 1.160–5.500; P=0.020] and nodule size following enhancement (OR, 2.119; 95% CI, 1.039–4.321; P=0.039) were associated with the BRAF mutational status. The associations found between the two ultrasonographic features and BRAFV600E mutation indicate that they can predict the BRAF mutational status to provide a reliable basis for clinical diagnosis and treatment.

Clinical and morphological characteristics of papillary thyroid carcinoma associated withhashimoto's thyroiditis

The aim of the work is to study the clinical and morphological features of papillary thyroid carcinoma (PTC) with the autoimmune thyroiditis Hashimoto (TH)Material and methods. 236 clinical observations of patients with PTC of the surgical hospital of he State Institution of Science "Research and Practical Centre of Preventive and Clinical Medicine" State Administrative Department during 2012-2018 were investigated. We study the size of the tumor, the presence of invasions in the thyroid tissue and in the capsule of the gland, multifocal growth, metastases in the lymph nodes of group 6 and metastases in the lymph nodes of 2,3,4 groups. For statistical analysis, Fischer' sex act test and Student's t-criterion were used. Valuesare interpreted by the trueat p &lt;0,05.Results.Of the 236 cases of PTC, TH was found in 72 patients (30.5%), in 56 cases- other proliferative-hyperplastic processesor nodal thyroid pathology (23.7%), and 108 cases (45.8%) were without concomitant pathology. There were 142 (60.2%)women with PTC, and 94 (39.8%) men, p &lt;0.05. In patients with PTC and TH were 53 women (73.6%) and 19 men (26.3%), p &lt;0.05. In patients with TH in comparison with the group without concomitant thyropathology, a significantly higher number of microcarcinoma was noted, the size of tumors in TH was lower (with TH 23 (31.9%), without TH 57 (52.8%), p &lt;0.05 ). In patients without TH, carcinoma invasion was more likely to occur in the thyroid tissue (with TH 32 (44.4%), without TH 66 (61.1%), p &lt;0.05), invasion to the capsule of the gland with extra thyroid invasion (with TH 17 (23.6%), without TX 42 (38.9%), p &lt;0.05), multifocal growth (with TH 15 (20.8%), without TH 48 (44.4%), p &lt;0 , 05). Patients with TH more often had metastasis to the lymphnodes of group 6 (with TH36 (50.0%), without TH 43 (39.8%), p &lt;0.05), and in patients without TH, more often in lateral cervical lymphnodes (with TC 7 (9.7%), without TH 31 (28.7%), p &lt;0.05).Conclusions. 1) PTC with TH more often occur in women. 2) PTC with TH has a less aggressive course regarding the size of the tumor node, intratireoid and extrathyroid invasion, multifocal growth, and metastasis in lateral cervical lymphnodes.

Relationship between BRAF V600E and clinical features in papillary thyroid carcinoma.

ObjectiveTo investigate the mutant status of BRAF gene and analyze its relationship to epidemiological risk factors and clinical outcomes among patients with papillary thyroid cancer (PTC) in the largest, single-institution Chinese cohort to date.MethodsThe medical records of 2048 PTC patients were reviewed in this retrospective study. Single-factor and multiple logistic regression analyses were applied to identify risk factors for BRAF V600E mutation. Survival outcomes including distant metastatic and persistent or recurrent PTC were examined, with a mean follow-up time of 23.4 (5–47) months.ResultsThe BRAF V600E mutation was present in 83.7% of patients (1715 of 2048). Correlation was found between BRAF V600E mutation and several epidemiological features, including age, concomitant hypertension and Hashimoto thyroiditis (HT). For the clinicopathological features, BRAF V600E was significantly associated with bilateral multifocality (odds ratio (OR) 1.233, 95% confidence interval (CI) 1.063–1.431, P < 0.01) and less lateral lymph node metastases (OR 0.496, 95% CI 0.357–0.689, P < 0.01). Smaller tumor size and advanced disease stage were significant in single-factor analyses but became insignificant after multivariate adjustment. No association was found between BRAF V600E mutation and extrathyroidal invasion, distant metastatic and disease persistence or recurrence.ConclusionPart of epidemiological features are independent risk or protective factors for BRAF V600E mutation. The presence of BRAF V600E mutation is not an aggressive prognosis on poor clinical outcomes in PTC. However, the high prevalence of BRAF V600E may provide guidance for surgery strategy and opportunity for targeted treatment in recurrent and advanced stage disease.

Magnetic Resonance Imaging Characteristics of Papillary Thyroid Carcinoma for the Prediction of Cervical Central Compartment Lymph Node Metastasis.

Cervical lymph node metastasis (LNM) is associated with local recurrence and distant metastasis in papillary thyroid carcinoma (PTC). This study was to assess magnetic resonance imaging (MRI) characteristics for predicting cervical LNM in PTC. A total of 119 patients with 154 PTC examined by MRI were assessed. According to inclusion and exclusion criteria, 78 subjects (78 tumors) were included in the final analysis. Conventional MRI findings and apparent diffusion coefficient were recorded. Descriptive statistics for LNM, sensitivity, specificity, and accuracy of various features were obtained. Multivariate logistic regression was performed for identifying independent variables for predicting LNM. Receiver operating characteristic curves were used to assess the diagnostic performance of the independent variables and model. There were 31 node-positive and 47 node-negative PTCs in this study. Node-positive patients significantly differed from the node-negative group in age (P = 0.039), long/short diameter of lymph nodes (both P < 0.001), lymph nodes cystic change (P = 0.005), tumor size (P < 0.001), poorly defined tumor margin in contrast-enhanced imaging (P < 0.001), and thyroid contour protrusion sign (P < 0.001). Satisfactory interobserver agreement was obtained between the 2 examiners (Cohen κ of 0.871 and 0.872). Thyroid contour protrusion sign and poorly defined tumor margin were identified as independent predictive factors of LNM in PTC (both P < 0.05), with area under the curves of 0.813 and 0.851, and accuracies of 0.810 and 0.838. When the independent factors were combined, the diagnostic performance was improved with an area under the curve of 0.944 and an accuracy of 0.884. Thyroid contour protrusion sign and poorly defined tumor margin in contrast-enhanced imaging could be 2 important predicted findings for cervical LNM in PTC.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a review for clinicians.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an encapsulated or clearly delimited, noninvasive neoplasm with a follicular growth pattern and nuclear features of papillary thyroid carcinoma (PTC). It is considered a 'pre-malignant' lesion of the RAS-like group. Ultrasonography (US), cytology and molecular tests are useful to suspect thyroid nodules that correspond to NIFTP but there is wide overlap of the results with the encapsulated follicular variant of PTC (E-FVPTC). In these nodules that possibly or likely correspond to NIFTP, if surgery is indicated, lobectomy is favored over total thyroidectomy. The diagnosis of NIFTP is made after complete resection of the lesion by observing well-defined criteria. In the case of patients who received the diagnosis of FVPTC and whose pathology report does not show findings of malignancy (lymph node metastasis, extrathyroidal invasion, vascular/capsular invasion), if the tumor was encapsulated or well delimited, the slides can be revised by an experienced pathologist to determine whether the diagnostic criteria of NIFTP are met, but special attention must be paid to the adequate representativeness of the capsule and tumor. Since NIFTP is not 'malignant', tumor staging is not necessary and patients are not submitted to thyroid cancer protocols or guidelines. We believe that patients with NIFTP without associated malignancy and without nodules detected by US of the remnant lobe (if submitted to lobectomy) can be managed like those with follicular adenoma.