Thyroid Follicular Adenoma Research Articles

Differences of HBME-1 Expression in Thyroid Follicular Adenoma and Follicular Thyroid Carcinoma by Ultrasound-Guided Fine-Needle Aspiration Biopsy.

To investigate the differences in human bone marrow endothelial cell marker 1 (HBME-1) expression in thyroid follicular adenoma (FA) and follicular thyroid carcinoma (FTC) by ultrasound-guided fine-needle aspiration biopsy. An observational study. The Department of Electrical Diagnosis, The Second Hospital of Jilin University, Jilin Province, China, from January 2017 to April 2018. Forty-five patients with FTC were selected as FTC group, and 45 patients with FA were selected as FA group. Ultrasound-guided fine-needle aspiration biopsy specimens from two groups were analyzed for HBME-1 expression. Sensitivity, specificity, and accuracy of HBME-1 expression by ultrasound-guided fine-needle aspiration biopsy specimens in FTC group were analyzed using HBME-1 expression in the pathological tissues as criteria. The positive expression rate of HBME-1 in ultrasound-guided fine-needle aspiration biopsy specimens was higher in the FTC group than that in the FA group (p=0.003). The sensitivity, specificity, and accuracy of HBME-1 expression by ultrasound-guided fine-needle aspiration biopsy specimens in the FTC group were 77.78% (28/36), 88.89% (8/9) and 80.00% (36/45), respectively. HBME-1 detection with ultrasound-guided fine-needle aspiration biopsy may be useful clinically to pick out cases with follicular thyroid carcinoma, and that thyroid follicular adenoma cases need close follow-up.

Study of histopathological spectrum of thyroidectomy specimens and their correlation with age and gender

Background: Goiter is defined as the enlargement of the thyroid gland. This might be diffuse in nature nodular or multi-nodular. We planned a retrospective study of 100 histopathologically diagnosed thyroidectomy specimens and evaluated their frequency in relation to age and sex of the patients. Material and methods: The study was conducted in the department of Pathology at a tertiary care hospital in Jaipur city. The material included 100 thyroidectomy specimens. In case of thyroidectomy specimens, multiple sections were made up to thickness of 3 to 5 mm. The slice in which tumor appears closest to the resection margin was submitted entirely after dividing into adequate number of sections. All the lesions were grouped into benign and malignant lesions and were correlated to Age and Gender. Histomorphological evaluation of thyroidectomy lesions was done thoroughly to plan a better management of malignant lesions. Results: The female: male ratio of 4.2:1. The mean age of patients with thyroid diseases was 40.3 years and the peak incidence (34%) seen in the age group of 31- 40 years. Non-neoplastic cases accounted for 51% of the cases and neoplastic cases accounted for 49% of the cases. Conclusion: The thyroid gland may be affected with various disorders. Thyroidectomy may have both therapeutic and diagnostic value. Non- neoplastic disorders are more common. Females accounted for 81% of patients with thyroid lesions and the incidence peaked at third to fourth decade. Papillary carcinoma was the most frequent thyroid cancer and follicular adenoma was the common benign tumor

Spectroscopic identification of benign (follicular adenoma) and cancerous lesions (follicular thyroid carcinoma) in thyroid tissues

Thyroid follicular nodules are quite common in the population, however only a small proportion is malignant. Thyroid cancer differs from adenoma by features of cellular atypia, angioinvasiveness and possibility of metastasis via blood vessels mainly in the lungs and bones. Pathomorphological examination of the postoperative material plays a significant role in the diagnosis of cystic thyroid lesions.De facto, there is no possibility to determine with certainty whether the lesion is benign or malignant before surgery, therefore new methods are being sought to meet clinical needs. The study aimed to investigate if Fourier-transform infrared spectroscopy (FTIR) spectroscopy and Raman spectroscopy combined with multidimensional analysis can be a useful tool in distinguishing between thyroid adenomas and carcinomas. The obtained results indicate quantitative and qualitative alterations within proteins and fats derived from patients’ tissues samples. Raman spectroscopy additionally shows significant changes in the amount of tissue collagen due to the pathogenic process. In the spectra of the second FTIR derivative, shifts of vibrations corresponding to the β-sheet and α-helix structure are observed towards the lower rates of wave numbers in the case of neoplastic tissues. Using the leave-one-out cross-validation, sensitivity and specificity calculated with Principal Component Analysis-Linear Discriminant Analysis (PCA-LDA) clearly shows the possibility to distinguish between pathologically changed and normal thyroid tissue as well as differentiate follicular thyroid adenoma (FTA) from widely invasive follicular thyroid carcinoma (WI-FTC) tissues.

Clinical impact of a cytological screening system using cyclin D1 immunostaining and genomic analysis for the diagnosis of thyroid nodules

BackgroundFine-needle aspiration (FNA) is the most reliable method for diagnosing thyroid nodules; however, some features such as atypia of undetermined significance or follicular lesion of undetermined significance can confound efforts to identify malignancies. Similar to BRAF, cyclin D1 may be a strong marker of cell proliferation.MethodsOne hundred two patients with thyroidal nodule were enrolled in this prospective study.Expression of cyclin D1 in thyroid nodules was determined by immunohistochemistry using both surgical specimens and their cytological specimens. The identification of the optimal cut off points for the diagnosis of malignancy were evaluated using the receiver operating characteristic (ROC) curves and the assessment of the area under the ROC curve (AUC). The specificity, sensitivity, positive predictive value (PPV) of markers were evaluated from crosstabs based on cut off points and significance were calculated. We also analyzed genetic variants by target NGS for thyroid nodule samples.ResultsThe positive predictive value (PPV) and median stain ratio (MSR) of cyclin D1 nuclear staining was determined in papillary thyroid carcinoma (PPV = 91.5%, MSR = 48.5%), follicular adenoma (PPV = 66.7%, MSR = 13.1%), and adenomatous goiter and inflammation controls (MSR = 3.4%). In FNA samples, a threshold of 46% of immunolabelled cells allows to discriminate malignant lesions from benign ones (P < 0.0001), with 81% sensitivity and 100% specificity. A 46% cutoff value for positive cyclin D1 immunostaining in thyroid cells demonstrated 81% sensitivity and 100% specificity. In surgical specimens, ROC curve analysis showed a 5.8% cyclin D1 immunostaining score predicted thyroid neoplasms at 94.4% sensitivity and 92.3% specificity (P = 0.003), while a 15.7% score predicted malignancy at 86.4% sensitivity and 80.5% specificity (P < 0.0001). Finally, three tested clinico-pathological variables (extra thyroidal extension, intraglandular metastasis, and lymph node metastasis) were significant predictors of cyclin D1 immunostaining (P < 0.001).ConclusionOur cytological cyclin D1 screening system provides a simple, accurate, and convenient diagnostic method in precision medicine enabling ready determination of personalized treatment strategies for patients by next generation sequencing using cytological sample.

Expression of SLC5A5 in Circulating Tumor Cells May Distinguish Follicular Thyroid Carcinomas from Adenomas: Implications for Blood-Based Preoperative Diagnosis.

Preoperative diagnosis of thyroid nodules reduces unnecessary surgery. Circulating tumor cells (CTCs) may contain information of primary tumor(s). We asked whether the peripheral blood expression of genes specific for circulating tumor cells (CTCs) differentiates benign thyroid nodules from malignant nodules. Peripheral blood mononuclear cells from thyroid nodule patients (n = 20) were isolated preoperatively and the expression of seven CTC-associated genes was measured in patients with thyroid nodule(s) (n = 20). Among the tested genes, the expression of SLC5A5 and LGALS3 were validated in a larger number of patients (n = 64) and our results show that SLC5A5 expression differentiated follicular adenomas from follicular carcinomas (area under the curve (AUC) = 0.831). The expression of SLC5A5 in CTCs may preoperatively distinguish thyroid follicular adenomas from follicular carcinomas.

Association between DNA methylation profile and malignancy in follicular-patterned thyroid neoplasms.

Molecular differentiation between benign (follicular thyroid adenoma, FTA) and malignant (follicular thyroid carcinoma, FTC) thyroid neoplasms is challenging. Here, we explored the genome-wide DNA methylation profile of FTA (n.10) and FTC (n.11) compared to normal thyroid (NT) (n.7) tissues. FTC featured 3,564 differentially-methylated CpGs (DMCpG), most (84%) of them hypermethylated, with respect to normal controls. At the principal component analysis (PCA), the methylation profile of FTA occupied an intermediate position between FTC and normal tissue. A large fraction (n. 2,385) of FTC-associated DMCpG were related (intragenic or within 1500 bp from the transcription start site) to annotated genes (n. 1,786). FTC-hypermethylated genes were enriched for targets of the Polycomb transcriptional repressor complex and the specific histone H3 marks (H3K4me2/me3-H3K27me3) found in chromatin domains known as "bivalent". Transcriptome profiling by RNAseq showed that 7.9% of the DMCpGs-associated genes were differentially expressed in FTC compared to NT, suggesting that altered DNA methylation may contribute to their altered expression. Overall, this study suggests that perturbed DNA methylation, in particular hypermethylation, is a component of the molecular mechanisms leading to the formation of FTC and that DNA methylation profiling may help differentiating FTCs from their benign counterpart.

Expression and clinicopathological role of miR146a in thyroid follicular carcinoma.

Dysregulation of microRNA expression has been involved in the development and progression of follicular thyroid carcinoma (FTC). The aim of this work was to study the expression of miRNA146a in FTC and the association with clinicopathological features of the disease. Thirty-eight patients affected by FTC were included in the study. Twenty patients carrying follicular thyroid adenoma (FA) were also enroled as the benign counterpart of FTC. Total RNA including miRNA146a was extracted from formalin-fixed paraffin-embedded (FFPE) pairs of affected/unaffected tissue and its expression was assessed by real-time PCR. Two selected target genes, TRAF6 (tumour necrosis factor receptor-associated factor 6) and IRAK1 (Il-1 receptor-associated kinase 1/2), were also analysed. miR146a expression in FTC tissue was overall not downregulated in malignant versus unaffected tissue, but its expression was inversely correlated with clinicopathological features of FTCs at diagnosis. A decreased expression of miR146a became apparent in FTC thyroid tissue of widely compared to minimally invasive tumours. However, miR146a expression differences between contralateral unaffected tissue (extra-FTC) and FTC were not observed regardless of clinicopathological features. IRAK1, a known target for miR146a, was upregulated in FTC and the increase was mainly appreciable in Hurtle FTC variant. Unexpectedly, miR146a did not correlate with TRAF6 showing an inverse trend compared to IRAK1 although both genes regulate the activity of nuclear factor- kB (NF-kB). The results of this study indicate that downregulation of miR146a, inversely correlated with clinicopathological features of FTCs at diagnosis and suggest a possible involvement of miR146a in FTC development. IRAK1 over-expression in FTC may be related to tumour development/progression. In vitro experiments are needed to support this hypothesis.

Computed Tomography Findings for Diagnosing Follicular Thyroid Neoplasms.

Since no diagnostic method has been established to distinguish follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), surgery has been the only way to reach a diagnosis of follicular neoplasm. Here we investigated the computed tomography (CT) features of follicular neoplasms, toward the goal of being able to identify specific CT features allowing the preoperative differentiation of FTC from FTA. We retrospectively analyzed the cases of 205 patients who underwent preoperative CT of the neck and were histopathologically diagnosed with FTC (n=31) or FTA (n=174) after surgery between January 2002 and June 2016 at several hospitals in Japan. In each of these 205 cases, non-enhanced and contrast-enhanced CT images were obtained, and we analyzed the CT features. On univariate analysis, inhomogeneous features of tumor lesions on contrast-enhanced CT were more frequently observed in FTC than in FTA (p=0.0032). A multivariate analysis identified inhomogeneous features of tumor lesions on contrast-enhanced CT images as an independent variable indicative of FTC (p=0.0023). CT thus offers diagnostic assistance in distinguishing FTC from FTA.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: An interobserver study of key cytomorphological features from a large academic medical centre.

Because of the indolent nature of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and potential requisite for a more conservative treatment, it is crucial to identify features of this entity preoperatively. Our group recently published findings that there are several cytomorphological features that may be used as clues to distinguish NIFTP, papillary thyroid carcinoma (PTC) and follicular adenoma (FA) on fine needle aspiration. Therefore, we aimed to determine the interobserver reproducibility of these findings. Presurgical fine-needle aspiration slides from NIFTP (n=30), classic PTC (n=30) and FA (n=30) collected from 1/2013-8/2016 were reviewed by seven cytopathologists blindly. Presence of selected cytomorphological features was recorded and compared to determine percent agreement and inter-rater reliability among study cytopathologists using Gwet's AC1 statistics. For all the cytomorphological features, the overall percent agreement amongst the pathologists ranged between 65.1% and 86.8% (Gwet's AC1 0.30-0.80). There was substantial or almost perfect agreement (Gwet's AC1>0.60) in seven cytomorphological features in the classic PTC group, in six features in the NIFTP group and in five features in the FA group. There were no features with poor agreement (Gwet's AC1<0.0). The current study supports the reproducibility of our previous findings. The high level of agreement amongst pathologists for these groups, and particularly the NIFTP group, supports the notion that when viewed in combination as a cytological profile, these cytomorphological features may assist the cytopathologist in raising the possibility of NIFTP preoperatively. This can potentially aid clinicians in deciding whether more conservative treatment may be appropriate.

Cystathione β-Synthase Is Increased in Thyroid Malignancies.

Cystathione β-synthase (CBS) catalyzes the conversion of homocysteine and cysteine to hydrogen sulfide (H2S) and cystathione, via the trans-sulfuration pathway. CBS protein expression levels are increased in several different human malignancies, with increased protein expression correlating with parameters such as tumor stage, anaplasia, metastases, and chemotherapy resistance. This study employed tissue microarrays to examine CBS expression in benign thyroid tissue, thyroid oncocytomas, thyroid follicular adenomas, and in follicular, papillary, anaplastic, and medullary thyroid carcinomas. CBS expression was increased in all thyroid carcinomas types compared to benign thyroid tissue, but not in thyroid follicular adenomas or oncocytomas. A similar pattern was observed for nicotinamide phosphoribosyltransferase (NAMPT) tissue microarray analysis comparing thyroid adenomas and follicular carcinomas. For the first time, we showed that an H2S-syntheszing enzyme plays a role in thyroid malignancies. Additionally, our data suggest that CBS and NAMPT immunohistochemistry may be useful in differentiating follicular adenomas from follicular carcinomas.

Analysis of RAS mutation in thyroid nodular hyperplasia and follicular neoplasm in a Korean population.

SummaryBackgroundTo investigate the difference in frequency of RAS mutations between nodular hyperplasia (NH), follicular thyroid adenomas (FTAs) and follicular thyroid carcinomas (FTCs) in a Korean population.Methods RAS mutations in 50 NH, 57 FTAs and 39 FTCs between January 2002 and May 2015 were analysed by pyrosequencing.ResultsNine nodules of 50 NHs (18%), 18 nodules of 39 FTCs (46.2%) and 19 nodules of 57 FTAs (33.3%) harboured RAS mutations. Three FTCs and three FTAs showed two point mutations simultaneously. N‐RAS codon 61 (n = 6 of 9, 66.7%) and H‐RAS codon 61 (n = 3 of 9, 33.3%) were found in NHs. K‐RAS codons 12‐13, K‐RAS codon 61, N‐RAS codons 12‐13 and H‐RAS codons 12‐13 were not found in NHs. N‐RAS codon 61 (n = 7 of 21, 33.3%), K‐RAS codons 12‐13 (n = 6 of 21, 28.6%), H‐RAS codon 61 (n = 4 of 21, 19.0%), K‐RAS codon 61 (n = 3 of 21, 14.3%) and N‐RAS codons 12‐13 (n = 1 of 21, 4.7%) were found in FTCs, and N‐RAS codon 61 (n = 10 of 22, 45.5%), K‐RAS codons 12‐13 (n = 5 of 22, 22.7%), H‐RAS codon 61 (n = 5 of 22, 22.7%), K‐RAS codon 61 (n = 1 of 22, 4.5%) and N‐RAS codons 12‐13 (n = 1 of 22, 4.5%) were observed in FTAs.ConclusionsThe frequencies of RAS mutations among our Korean population were 18% in NHs, 46.2% in FTC and 33.3% in FTAs. N‐RAS codon 61 was the most frequent mutation in NHs, FTCs and FTAs, and the frequency was not significantly different among the three groups. K‐RAS codons 12‐13 were the second most commonly involved site in FTCs and FTAs, whereas no mutation was detected at this site in NHs.

Reversibility of Proliferative Thyroid Lesions Induced by Iodine Deficiency in a Laboratory Zebrafish Colony.

A laboratory zebrafish colony developed red masses, predominantly under the jaw, in a significant portion of the population. The masses were diagnosed histopathologically as thyroid follicular hyperplasia, adenoma, or carcinoma in accordance with published morphologic criteria. After switching to a higher iodine brand of salt used to maintain a low level of salinity within the water system and a small diet change, the thyroid lesions regressed dramatically. Within 5 months the masses were no longer grossly visible. At the population level, external evaluations and histopathological assessments of whole-body sections document a regression in the prevalence of thyroid neoplasia and hyperplasia to normal thyroid conformation by 11 months after salt change. These findings suggest that a wide range of proliferative thyroid lesions, including neoplasms, in zebrafish may be hormone-dependent, even following lesion development. In addition, these results suggest that zebrafish have an adaptive ability to absorb iodine from water and food, which should be considered in discussions to standardize diets and when describing environmental parameters in publications.

Quantitative second harmonic generation microscopy for the structural characterization of capsular collagen in thyroid neoplasms.

Quantitative second harmonic generation microscopy was used to investigate collagen organization in the fibrillar capsules of human benign and malignant thyroid nodules. We demonstrate that the combination of texture analysis and second harmonic generation images of collagen can be used to differentiate between capsules surrounding the thyroid follicular adenoma and papillary carcinoma nodules. Our findings indicate that second harmonic generation microscopy can provide quantitative information about the collagenous capsule surrounding both the thyroid and thyroid nodules, which may complement traditional histopathological examination.

MOLECULAR-GENETIC MARKERS OF HIGH-DIFFERENTIATED FORMS OF THYROID CANCER

Highly differentiated carcinoma is becoming more generalized and socially significant disease. Being spread among the highly prevalent benign thyroid nodules, this pathology creates additional requirements for early diagnostics. Detection of certain mutations, like BRAF, RAS, PIK3CA, AKT1, PTEN, ТР53, TERT, RET/PTC, PAX8-PPARγ, CTNNB1 in the fine needle aspiration material of papillary, follicular, medullar and anaplastic thyroid carcinoma or follicular adenoma of the thyroid is used for the improved diagnostics and correct treatment of this conditions. Authors consider, that combination of two biomarkers and more in a single test-panel will provide a diagnostically significant result for the detection and prognosis of the development of the carcinoma, what is important for the creation of the patient’s follow up plan. As for the diagnostics of follicular neoplasias a diagnostic panel of 7 genes was proposed: BRAF, KRAS, HRAS, NRAS, RET/PTC1, RET/PTC3, PAX8/PPARγ with a sensitivity 57–75 % and specificity 97–98 %. In case of cytological result of “atipia of non identified malignancy potential” or “follicular lesion of non identified significance” usage of this panel will be highly effective. In case of papillary thyroid carcinoma suspicion a BRAF gene (sensitivity – 36 %, specificity – 98 %) or a gene-panel of BRAF, RAS, RET/PTC, PAX8/PPARγ (sensitivity – 50–68 %, specificity – 86–96 %) should be analyzed. Test-panels ThyroSeq (versions 1 and 2), ThyGenX, RosettaGXReveal and ThyroidPrintThyr with the sensitivity of about 90 % substantially increase the quality of diagnostics, however their cost and complexity in implication of this tests prevent their usage as routine methods.

Comparison between patients with thyroid follicular tumors in the histological pattern and size of follicular lesion

The main problem encountered in thyroid nodule is difficult to differentiate between a benign and malignant lesion. Differential between follicular thyroid cancer (FTC) and benign follicular thyroid adenoma (FTA) is a great challenge for even an experienced pathologist and requires special effort. A total of 120 paraffin block were included in the study, 30 blocks were (FC), 30 blocks were (FVPC). 30 blocks were (FA), 30 blocks were blocks thyroid follicular hyperplasia.20 blocks endocervical epithelium.20 paraffin blocks of colonic epithelium as control. From each paraffin block, 4 slides, each of thicken were taken, stained with Hematoxylin and Eosin (H&amp;E) for revision of histopathological diagnosis. The histological arrangement in follicular carcinoma and follicular adenoma was significant (P= 0.001) in trabecular pattern and the difference was significant (P= 0.016) in mixed pattern while no significance with microfollicular, macrofollicular and normofollicular pattern in both follicular carcinoma and adenoma. There was no significant difference in size follicular lesion among FA, FVPC and follicular hyperplasia (P&gt; 0.05) while, the size follicular lesion in of (FC) was significantly higher from all other groups (P&lt; 0.05).

Papillary Carcinoma Arising From Infrahyoid Ectopic Thyroid Tissue with Hemi-agenesis of Thyroid Gland and Follicular Adenoma with Hürthle Cell Changes in Existing Thyroid Lobe: A Rare Case Report

&lt;p&gt;Ectopic thyroid tissue is a rare developmental abnormality. An ectopic thyroid tissue can be subject to various pathological processes as normal thyroid tissue including tumorigenesis. This reported case is an extremely rare case of papillary thyroid carcinoma arising from infrahyoid ectopic thyroid tissue with hemiagenesis (left lobe) of thyroid gland and presence of follicular adenoma with Hürthle cell changes in the normal positioned enlarged right thyroid lobe.&lt;/p&gt;&lt;p&gt; Bangladesh J. Nuclear Med. 20(1): 59-62, January 2017&lt;/p&gt;

Comparison between patients with thyroid follicular tumors in the histological pattern and size of follicular lesion

The main problem encountered in thyroid nodule is difficult to differentiate between a benign and malignant lesion. Differential between follicular thyroid cancer (FTC) and benign follicular thyroid adenoma (FTA) is a great challenge for even an experienced pathologist and requires special effort.A total of 120 paraffin block were included in the study, 30 blocks were (FC), 30 blocks were (FVPC). 30 blocks were (FA), 30 blocks were blocks thyroid follicular hyperplasia.20 blocks endocervical epithelium.20 paraffin blocks of colonic epithelium as control. From each paraffin block, 4 slides, each of thicken were taken, stained with Hematoxylin and Eosin (H&amp;E) for revision of histopathological diagnosis.The histological arrangement in follicular carcinoma and follicular adenoma was significant (P= 0.001) in trabecular pattern and the difference was significant (P= 0.016) in mixed pattern while no significance with microfollicular, macrofollicular and normofollicular pattern in both follicular carcinoma and adenoma. There was no significant difference in size follicular lesion among FA, FVPC and follicular hyperplasia (P&gt; 0.05) while, the size follicular lesion in of (FC) was significantly higher from all other groups (P&lt; 0.05).

High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma

PurposePreoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC.MethodsWe analyzed retrospectively cytological Ki-67 index determined in routine clinical setting and clinical data for 61 patients with FTC, 158 patients with FTA and 15 patients with follicular tumor of uncertain malignant potential (FT-UMP) surgically treated and diagnosed by histopathology at Karolinska University Hospital 2006-2017 (Cohort A). A previously published cohort of 109 patients with follicular tumors was re-analyzed as well (Cohort B).Results:In Cohort A, patients with FTC had a higher Ki-67 index (p < 0.001), larger tumor size (p < 0.001) and higher age at diagnosis (p = 0.036) compared to patients with FTA or FT-UMP. Hürthle cell differentiation, present in 50 FTA, 20 FTC and 8 FT-UMP, was associated with higher Ki-67 index (p = 0.009). Multivariate analysis of Cohort A identified a high Ki-67 index (odds ratio [OR]: 1.215, p < 0.001) and large tumor size (OR: 1.038, p < 0.001) as independent predictors of FTC. Results remained consistent after exclusion of Hürthle cell tumors and in pooled analysis of Cohort A + B. The area under curve of the Ki-67 index for predicting FTC was 0.722 and a cut-off for Ki-67 index at above 5% resulted in a specificity at 93% and sensitivity at 31%. Subgroup analysis of FTCs in Cohort A showed an association of higher Ki-67 index to extrathyroidal extension (p = 0.001) as well as widely invasive subtype (p = 0.019) based on the WHO 2017 classification.ConclusionsPre-operative Ki-67 index may add diagnostic information for a subset of patients with follicular thyroid tumors.

Diagnostic value of CD56 immunohistochemistry in thyroid lesions.

The present study aimed to evaluate the diagnostic roles of CD56 immunohistochemistry in differentiating various thyroid lesions. A meta-analysis was performed to evaluate the rate of loss of CD56 immunohistochemistry expression from 13 eligible studies regarding various thyroid lesions, including papillary thyroid carcinoma, follicular carcinoma, and follicular adenoma. To confirm the value of CD56 immunohistochemistry in differentiating various thyroid lesions, a diagnostic test accuracy review was conducted. An 87.8%, 79.1%, 11.9%, 25.5%, and 19.6% loss of CD56 immunohistochemistry expression was identified in papillary thyroid carcinoma, follicular carcinoma, follicular adenoma, benign follicular nodule, and Hashimoto's thyroiditis, respectively. In the normal thyroid tissue, the rate of loss of CD56 expression was 1.6%. Classical, follicular, diffuse sclerosing, tall cell, and encapsulated variants of papillary thyroid carcinoma showed an 88.4%, 75.3%, 97.2%, 91.7%, and 91.7% loss of CD56 expression, respectively. In the comparison between the follicular variant of papillary thyroid carcinoma and follicular adenoma, the pooled sensitivity and specificity of CD56 immunohistochemistry was 0.82 (95% confidence interval (CI) 0.70, 0.90) and 0.94 (95% CI 0.83, 0.99), respectively. The diagnostic odds ratio and the area under curve on summary receiver operating characteristic curve was 51.43 (95% CI 5.83, 453.88) and 0.9387, respectively. Collectively, these results indicate that the rate of loss of CD56 immunohistochemistry expression was significantly higher in malignant tumors, such as papillary thyroid carcinoma and follicular carcinoma, than in follicular adenoma, benign follicular nodule, and Hashimoto's thyroiditis. As such, CD56 immunohistochemistry can be useful in differentiating follicular variant papillary thyroid carcinoma from follicular adenoma.

Carney complex: a case with thyroid follicular adenoma without a PRKAR1A mutation

BackgroundCarney complex (CNC) is a very rare disease. Although thyroid lesions are included in the diagnostic criteria for CNC, they are an infrequent occurrence.Case presentationThe patient was a 69-year-old woman who had undergone the removal of a left atrial myxoma 10 years earlier, at the age of 59. At the time of the operation, thyroid ultrasonography (US) revealed multiple hypoechoic nodules. Thyroid scintigraphy revealed an increased uptake of 99mTc in these lesions, which was consistent with toxic multinodular goiter, and she was diagnosed with CNC. Genetic studies showed no mutation in the PRKAR1A (protein kinase A regulatory subunit 1-α) gene. From then on, she received annual brain magnetic resonance imaging (MRI), abdominal computed tomography (CT), and thyroid US examinations. Her follicular thyroid nodules gradually increased in number and size. Although aspiration cytology samples from the thyroid nodules diagnosed them as class III, thyroid cancer could not be ruled out. The patient underwent a partial thyroidectomy, and the pathological diagnosis was multiple follicular adenomas.ConclusionCareful and frequent evaluation of the thyroid gland should be required for CNC patients due to the potential for carcinoma to develop in the context of a variety of follicular thyroid lesions.