Follicular Type Research Articles

SAT535 ANKRD26-RET Fusion Positive Metastatic Papillary Thyroid Carcinoma - Advanced Presentation of a Rare Mutation

Abstract Disclosure: H. Hashmi: None. A. Ankireddypalli: None. L. Burmeister: None. A. Nelson: None. K. Amin: None. Background: While rearranged during transfection (RET) protooncogene mutations have been commonly associated with thyroid malignancy, ankyrin repeat domain containing protein 26 (ANKRD26) has been primarily linked to hematologic malignancy. Exon 29 of ANKRD26 (Chromosome [Chr] 10p12.1) has been shown to fuse with exon 12 of RET (Chr 10q11.21), resulting in a genetic fusion mutation ANKRD26:RET. This is a rare genetic mutation in papillary thyroid cancer with only one previously reported case. We report the first case in the US of this novel genetic mutation with a unique clinical presentation. Clinical Presentation: A 48-year-old, male patient presented with lower back pain radiating to the lower extremities of one year duration. MRI lumbar spine revealed an irregular mass lesion in the L1 vertebral body with extraosseous soft tissue extension, L1 compression fracture and extension into the T12 body. CT CAP revealed a 4.8 x 3.6 cm, heterogenous right thyroid lobe with tracheal compression and sub centimeter pulmonary nodules in the left lower and right middle lobes. Biopsy of the L1 paravertebral mass was diagnostic for metastatic thyroid carcinoma of a follicular pattern. Molecular testing with a next generation sequencing fusion profile assay was positive for ANKRD26:RET gene rearrangement. Thyroid ultrasound was notable for a solid, hypoechoic, 3.2 x 3.1 x 2.9 cm right lobe nodule with echogenic foci and level 4 lymph nodes with loss of reniform shape and fatty hilum. FNA of the nodule and right level 4 lymph node was suspicious for follicular neoplasm. The patient was admitted for acute cord compression necessitating extensive laminectomy, vertebral reconstruction and resection of the L1 paraspinal tumor. Pathology was positive for metastatic, follicular variant, papillary thyroid carcinoma. Total thyroidectomy, central and right modified radical neck dissection was performed. Pathology demonstrated a 4.2 cm papillary carcinoma, follicular type with tall cell variant; confined to the thyroid. Extensive angioinvasion (≥ 4 vessels) and lymphatic invasion was present. 10/32 positive lymph nodes. TNM grading was T3aN1bM1. Summary: The only other case of ANKRD26-RET fusion positive papillary thyroid cancer in the literature was reported by Staubitz et al in Germany in 2019. They reported a case of a 78-year-old male with follicular variant papillary thyroid carcinoma (pT3,pN0,M0). To our knowledge, our case is the second worldwide and the first to be reported in the United States of this rare fusion protein positive thyroid cancer. Such an aggressive presentation with distant osseous metastases has to our knowledge not been previously described. Conclusion: The clinical and therapeutic implications of this rare genetic mutation are not currently well elucidated. We present this case with the intent to expand the existing literature and increase recognition of this rare genetic mutation. Presentation Date: Saturday, June 17, 2023

An Immune-Related Gene Prognostic Prediction Risk Model for Neoadjuvant Chemoradiotherapy in Rectal Cancer Using Artificial Intelligence

To develop and validate an immune-related gene prognostic model (IRGPM) that can predict disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC) who received neoadjuvant chemoradiotherapy and to clarify the immune characteristics of patients with different prognostic risks. In this study, we obtained transcriptomic and clinical data from the Gene Expression Omnibus (GEO) database and rectal cancer database of West China Hospital. Genes in the RNA immune-oncology panel were extracted. Elastic net was used to identify the immune-related genes that significantly affected the DFS of patients. A prognostic risk model (IRGPM) for rectal cancer was constructed with the random forest method. The prognostic risk score was calculated by the model, and the patients were divided into high- and low-risk groups according to the median risk score. Immune characteristics were analyzed and compared between the high- and low-risk groups. A total of 407 LARC samples were used in this study. A 20-gene signature was identified by elastic net and was found to be significantly correlated with DFS. The IRGPM was constructed on the basis of the 20 immune-related genes. Kaplan‒Meier survival analysis showed poorer 5-year DFS in the high-risk group than in the low-risk group, and the receiver operating characteristic (ROC) curve suggested good model prediction (areas under the curve (AUCs) of 0.87, 0.94, 0.95 at 1, 3, and 5 years, respectively). The model was validated in the GSE190826 cohort (AUCs of 0.79, 0.64, and 0.63 at 1, 3, and 5 years, respectively) and the cohort from our institution (AUCs of 0.64, 0.66, and 0. 64 at 1, 3, and 5 years, respectively). The differentially expressed genes between the high- and low-risk groups were enriched in cytokine‒cytokine receptor interactions. The patients in the low-risk group had higher immune scores than the patients in the high-risk group. Subsequently, we found that activated B cells, activated CD8 T cells, central memory CD8 T cells, macrophages, T follicular helper cells and type 2 helper cells were more abundant in the low-risk group. Moreover, we compared the expression of immune checkpoints and found that the low-risk group had a higher PDCD1 expression level. The IRGPM, which was constructed based on the random forest and elastic net methods, is a promising method to distinguish DFS in LARC patients treated with a standard strategy. The low-risk group identified by IRGPM was characterized by the activation of adaptive immunity in tumor microenvironment.

Equine maternal aging affects the metabolomic profile of oocytes and follicular cells during different maturation time points.

Introduction: Oocyte quality and fertility decline with advanced maternal age. During maturation within the ovarian follicle, the oocyte relies on the associated somatic cells, specifically cumulus and granulosa cells, to acquire essential components for developmental capacity. Methods: A nontargeted metabolomics approach was used to investigate the effects of mare age on different cell types within the dominant, follicular-phase follicle at three time points during maturation. Metabolomic analyses from single oocytes and associated cumulus and granulosa cells allowed correlations of metabolite abundance among cell types. Results and Discussion: Overall, many of the age-related changes in metabolite abundance point to Impaired mitochondrial metabolic function and oxidative stress in oocytes and follicular cells. Supporting findings include a higher abundance of glutamic acid and triglycerides and lower abundance of ceramides in oocytes and somatic follicular cells from old than young mares. Lower abundance of alanine in all follicular cell types from old mares, suggests limited anaerobic energy metabolism. The results also indicate impaired transfer of carbohydrate and free fatty acid substrates from cumulus cells to the oocytes of old mares, potentially related to disruption of transzonal projections between the cell types. The identification of age-associated alterations in the abundance of specific metabolites and their correlations among cells contribute to our understanding of follicular dysfunction with maternal aging.

Clinicopathologic Profile and Surgical Modalities in Mandibular Ameloblastoma: A Descriptive Study.

Ameloblastoma is a benign neoplasm composed of epithelial tissue with invasive and infiltrative behavior at the local level and a high recurrence rate, with various histopathologic patterns and clinical forms. Approximately 85% of conventional ameloblastomas occur in the mandible, most often in the body, angle, and ascending ramus area. The treatment modalities include both conservative and radical treatments. Postoperative follow-up is most important in the treatment of ameloblastoma. To describe the clinicopathologic profile of mandibular ameloblastoma in patients undergoing different surgical modalities. The primary objective was to describe the clinicopathologic profile and surgical management of mandibular ameloblastoma in patients aged ≥18 years, who had reported to a tertiary dental care center for follow-up during the study period. The secondary objective was to describe the distribution of comorbidities associated with different surgical modalities and reconstructive methods. A total of 34 patients with mandibular ameloblastoma who underwent various surgical modalities between 2011 and 2021 were studied. Information was collected using a predesigned proforma and statistically analyzed. Thirty-four review cases of ameloblastoma were included in the study. The patients were analyzed concerning age, sex, site, size, clinical presentation, radiographic pattern, histopathologic subtype, type of surgery, and associated comorbidities. Most cases of mandibular ameloblastoma involve the age of 16 to 55 years. The mean age of occurrence was found to be 35.5±13.2. A female preponderance, a tumor size range of 2 to 4cm, a multicystic variant, involvement of the mandibular body in the premolar-molar area, root resorption, cortical perforation, and a follicular type of histopathologic pattern were the common presentations. Isolated anterior tumors restricted to the incisor/canine region were not found. The common surgical modalities undertaken were conservative methods such as enucleation, and chemical cauterization, and radical methods such as marginal mandibulectomy and segmental resection. Reconstruction using a titanium plate or free fibular graft was performed in the indicated cases. The common comorbidities included difficulty in chewing and loss of facial contour. Recurrence after surgical treatment was rare. Only 9% of cases developed a recurrence within 5 years. No recurrence was noted in cases treated with radical treatment, whereas 50% of cases treated with conservative methods showed recurrence. The age of occurrence, site, and size of the tumor, cortical perforation, root resorption, histopathologic type, and radiographic patterns are widely considered factors in devising a treatment plan for mandibular ameloblastoma. However, there may be rare instances where these tumors behave differently regardless of their innocuous clinicopathologic presentation. Surgical procedures such as segmental resection and marginal mandibulectomy were found to be promising for the eradication of the tumor, and prevention of recurrences and metastasis. However, conservative measures such as enucleation and chemical cauterization were fraught with an increased risk of tumor recurrence and metastasis. Future studies with a larger sample size should focus on the clinicopathologic characteristics of ameloblastoma to elucidate its varied behavior and develop newer and advanced treatment modalities that would provide better surgical and postsurgical outcomes in affected patients.

Clinicopathological profile and management of thyroid carcinoma: a Sub-Saharan country experience

BackgroundIn Sudan, there is limited knowledge on the epidemiology, clinical characteristics and pathological patterns of thyroid cancer. To address this shortcoming, we studied the clinical, pathological and treatment patterns of thyroid cancer at the National Cancer Institute ‒ University of Gezira (NCI-UG), Sudan.MethodsWe performed a retrospective health facility–based study of patients with thyroid cancer who were treated at NCI–UG from January 2009 to December 2017.ResultsA total of 139 patients with thyroid cancer were identified during the study period. Tumors were more common among women (69%). Goiter was the main presenting symptom (85%). The most common type of thyroid cancer was follicular carcinoma (41%), followed by papillary carcinoma (24%), then anaplastic carcinoma (20%). The mean age of the women was 56.3 years (SD ± 14.7), compared to 52.5 years (SD ± 16.6) for the men. The frequencies of stage I, II, III, and IV were 17%, 22%, 16%, and 45%, respectively. Different types of thyroidectomies were performed in 79% of the cases, lobectomy in 4%, and no surgery in 17%. Only 28% of the cases received radioactive iodine. Palliative chemotherapy and radiotherapy were prescribed to 17% and 37% of the cases, respectively.ConclusionThyroid cancer is more prevalent among women and most patients present at later stages. The dominance of follicular type suggests that the majority of this population is iodine-deficient.

A rare entity of adenomatoid odontogenic tumor involving anterior mandibular region- A case report

An adenomatoid odontogenic tumour (AOT) is a unique and somewhat uncommon odontogenic tumour that only arises from odontogenic epithelium and makes up between 2 and 7% of all odontogenic tumours and cysts. The lesion is categorised into three variants, the most common of which is the follicular type, which frequently presents as a dentigerous cyst clinically because it surrounds an impacted tooth. Because of the lesion's well-known ability to take on various clinical and histopathological appearances, it has been given the term "master of disguise". We report a case of AOT involving mandible in a 15-year-old male who reported to our department with a chief complaint of painless swelling in his mandibular region.

Pathological studies on spontaneous urinary bladder lesions in Indian buffaloes

The present investigation describes the spontaneous pathological lesions in urinary bladders (n = 177) of slaughtered buffaloes collected from Northern India. Gross examination revealed congestion, haemorrhages, oedematous changes and thickening of mucosa. Microscopically, epithelial abnormalities, inflammatory and neoplastic conditions were noticed. Epithelial abnormalities included epithelial hyperplasia, von Brunn’s nests, cystitis cystica and cystitis glandularis. Inflammatory conditions such as congestion, haemorrhages and cystitis were noticed. Cystitis was classified as lymphocytic, plasmo-lymphocytic, follicular and interstitial types. However, only single case of haemangiosarcoma was observed. Polymerase chain reaction revealed the presence of DNA of only BPV-1 in one sample out of 21, while one sample showed the presence of DNA of both BPV-1 and BPV-2. On immunohistochemistry, Ki-67 expression was observed only in haemangiosarcoma and one case of plasmo-lymphocytic cystitis with immunostaining restricted to nuclei. COX-2 immunostaining was observed in one case each of flat hyperplasia, von Brunn’s nest, haemangiosarcoma and two cases of plasmo-lymphocytic cystitis. Among epithelial abnormalities, COX-2 immunostaining was restricted to epithelial component of the lesions, and it was diffused cytoplasmic type with occasional perinuclear staining particularly in the cytoplasmic membrane. However, in haemangiosarcoma the COX-2 immunoreactivity was noticed in epithelial as well as connective tissue stroma. In conclusion, it may be stated that urinary bladders of slaughtered buffaloes showed a number of epithelial abnormalities, inflammatory conditions and occasionally neoplasms. Further studies to explore the infectious as well as non-infectious etiologies should be undertaken.

`PATTERN OF HISTOLOGIC VARIANTS OF AMELOBLASTOMA IN A SECONDARY HEALTH CARE FACILITY IN LAGOS STATE: A 5-YEAR RETROSPECTIVE STUDY.

Background: Ameloblastoma is a benign epithelial odontogenic neoplasm which is common amongst the Yoruba ethinc group. The various histologic types have been elucidated.
 Aim: This study aimed to assess the prevalent histologic types of ameloblastoma in a Lagos secondary health care facility.
 Methodology: A 5-year retrospective review of histopathologically diagnosed slides were retrieved. Data extracted include the age, gender, location, ethnicity and histologic variants were analysed by SPSS version 26. Percentages, ratio, mean, standard deviation and crude odd ratio were determined, and p-value ⩽ 0.05 is considered significant.
 Result: A total of seventy-seven histopathologically diagnosed ameloblastoma slides were retrieved. Males were more affected than females in ratio 1.2:1 with the mean age 33.61±13.3. Ameloblastoma was commonest in the third decade of life and more in the mandible than maxilla. Yoruba ethnic group was most affected. The commonest histologic type was the unicystic type with intraluminal subtype accounting for the largest proportion. There was significant association between histologic types and gender (p= 0.037). Crude odd ratio revealed the odds in the unicystic type between male and female {p=0.041; CI=95%, OR=2.649(1.042-6.733)} and in the follicular between male and female {p=0.013; CI=95%, OR=3.855(1.321-11.288)}.
 Conclusion: The unicystic histologic type of ameloblastoma was the commonest, occurring more in females and this was followed by the follicular histologic type which occurred more in males in this Lagos State secondary health care facility.

P-219 Single-follicle spatial proteomics of the whole ovary by MALDI mass spectrometry imaging: towards the identification of protein-markers of the follicle's quality

Abstract Study question Can we improve our knowledge of the single-follicle proteome signature by MALDI mass spectrometry imaging? Summary answer We identified follicle-type proteins that function during follicle growth (NUMA1, TPM2), GV-to-MII transition (SFPQ, ACTBL, MARCS, NUCL), ovulation (GELS, CO1A2) and preimplantation development (TIF1B, KHDC3). What is known already The acquisition of oocytes developmental competence occurs through a bidirectional exchange of molecular information between the oocyte, the companion follicle cells, the stroma, and the vascular network. This reciprocal relationship is still poorly understood and particularly scarce is our knowledge of the proteins that are playing a regulative role during folliculogenesis. Matrix-assisted laser desorption/ionisation mass spectrometry imaging (MALDI-MSI) is a powerful tool that allows the study of the proteomic landscape of small morphological structures inside a tissue, but in the field of reproduction has been only used to analyse rodent spermatogenesis. Study design, size, duration Nano-scale liquid chromatography-electrospray ionisation-tandem mass spectrometry (nLC-ESI-MS/MS) was combined with MALDI-MSI to identify the proteomic landscape and to map the changes occurring throughout folliculogenesis. We performed single-follicle spatial proteomics on all the follicles, from the secondary to the fully-grown preovulatory, present in histological serial sections of an entire prepubertal 25-day-old mouse ovary. Cross-referencing our results with those obtained by previous proteomics and transcriptomics analyses allowed to strengthen their significance. Participants/materials, setting, methods A single 25-day-old mouse ovary was fixed in 10% formalin, dehydrated, embedded in paraffin, and sectioned to obtain 133 6-μm serial sections. After paraffin removal, trypsin digestion and matrix deposition, mass spectra were acquired using a rapifleX MALDI Tissuetyper™ (Bruker) with a raster sampling of 20 μm in both x and y axes. Then, tryptic peptides were extracted from sections and analysed with nLC-ESI-MS/MS using a Dionex-UltiMate-3000 LC-nano-system coupled with an Impact HD™ UHR-QqToF (Bruker). Main results and the role of chance This study proposes a spatial proteomics workflow to investigate the proteome of a whole prepubertal 25-day-old mouse ovary, preserving the spatial relationship of the peptides in this complex histological context. A total of 401 proteins were identified by nLC-ESI-MS/MS, 69 with a known function in ovary biology. Enrichment analysis highlighted significant KEGG and Reactome pathways, with apoptosis, developmental biology, PI3K-Akt, epigenetic regulation of gene expression, and extracellular matrix organisation being well represented. Then, correlating these data with the spatial information provided by MALDI-MSI on 276 follicles highlighted 94 proteins that were detected throughout the secondary to the pre-ovulatory transition. Of these, 37 proteins showed a gradual quantitative change during follicle differentiation, comprising 10 with a known role in follicle growth (NUMA1, TPM2), oocyte GV-to-MII transition (SFPQ, ACTBL, MARCS, NUCL), ovulation (GELS, CO1A2) and preimplantation development (TIF1B, KHDC3). The proteome landscape identified includes molecules of known function in the ovary, but also those whose specific role is emerging. Altogether, this work demonstrates the utility of performing spatial proteomics in the context of the ovary and offers sound bases for more in-depth investigations that aim to further unravel its spatial proteome. Limitations, reasons for caution A limitation of MALDI-MSI is its 20 µm/pixel resolution which 1) leads to the acquisition of spectra comprising follicular and extra-follicular tissue, particularly with small follicles (15-30µm in diameter); and 2) does not distinguish among the different follicular cell types, thus precluding its application for single-cell in situ proteomics. Wider implications of the findings MALDI-MSI is a potent technology to study the proteome of ovary specimens, but it could also be used for the analysis of their lipidic or metabolic profiles. Our pipelline aim to identify protein-markers of the follicle's quality and, in turn, of the oocyte's developmental competence. Trial registration number not appplicable

Study of Ki67 in odontogenic benign tumors

The aim of the present study was to investigate the Ki67 expression level and to measure the cell proliferation index (Ki67) in odontogenic benign tumors.This was an analytical cross-sectional study of odontogenic benign tumors. The sampling was non-probabilistic with an exhaustive recruitment including all biopsy or surgical excision specimen of odontogenic benign tumors. Ki67 immunohistochemistry was performed on histological sections of paraffin-fixed tissues of 3µ thickness with the Ki67 (MM1) monoclonal antibody. The studied variables were sociodemographic, clinical and histopathological. The data have been analysed with SPSS 20.0 software.: Ameloblastoma represented 50.9% of cases and cemento-osseous dysplasia 36.4%. Among the 28 ameloblastoma cases, the 15 (53.6%) were plexiform type, the 7 (25%) follicular type and the 6 (21.4%) unicystic type. The percentage of Ki67 labelled cells was less than 1% in 74.6% (n=41) of the tumors and was equal to 5% in 12.7% (n=7) of cases. A Ki67 law labelling was found in 87.3% (n=48) of tumours and a negative labelling in 12.7% (n=7) of cases. The odontogenic benign tumors had a weak Ki67 expression level and a low epithelial cell proliferation index. The Ki67 could not therefore be used as a predictive biomarker of tumor cell proliferation and the risk of recurrence in odontogenic benign tumors.

Retrospective study on the predictive survival variables and therapeutic response in differentiated thyroid cancer

Introduction: The most established endocrine problems are thyroid cancer. Differentiated thyroid cancers (DTCs) usually come in papillary and follicular forms [1]. Thyroid cancers are now more time-honored than ever, accounting for 1% of all cancer instances recognized yearly [2]. Follicular kinds have a better impact than aggressive anaplastic types, while follicular types have a higher outlook than papillary types. Objective: How long-term survival for patients with unique thyroid carcinomas is predicted to be? Age, sex, bulk size, participation of lymph nodes, far away organ metastasis, surgical intervention, and differentiation Methods: At the medical institution of Zagazig University, the surgical department, 123 patients obtained thyroid surgical process for differentiated carcinoma between 2018 and 2022. (96 for papillary sort most cancers and 27 for follicular kind cancer). Post-operative mortality, histopathology findings (multifocality and differentiation), local and distal lymphatic invasion, Results: Follow-up At the surgical branch of the Zagzig University, ninety-six sufferers with papillary cancer underwent surgery; the typical patient age was once 43.7 /-16.0 years, and the male to girl ratio used to be 1:7. The 5-year mortality price after follow-up used to be 90.9% for papillary forms and 84.0% for follicular types, respectively. The average follow-up period was once 4.6 /- 4.9 years. Twenty-seven instances (average age: 49.5 /- 15.9 years, males: 7, females: 20, male to girl ratio: 0.35%) underwent follicular carcinoma surgery. Conclusions: Age type of pathological character of thyroid tumor affecting the survival of patients

The tumor immune microenvironment of nasopharyngeal carcinoma after gemcitabine plus cisplatin treatment.

Gemcitabine plus cisplatin (GP) chemotherapy is the standard of care for nasopharyngeal carcinoma (NPC). However, the mechanisms underpinning its clinical activity are unclear. Here, using single-cell RNA sequencing and T cell and B cell receptor sequencing of matched, treatment-naive and post-GP chemotherapy NPC samples (n = 15 pairs), we show that GP chemotherapy activated an innate-like B cell (ILB)-dominant antitumor immune response. DNA fragments induced by chemotherapy activated the STING type-I-interferon-dependent pathway to increase major histocompatibility complex class I expression in cancer cells, and simultaneously induced ILB via Toll-like receptor 9 signaling. ILB further expanded follicular helper and helper type 1 T cells via the ICOSL-ICOS axis and subsequently enhanced cytotoxic T cells in tertiary lymphoid organ-like structures after chemotherapy that were deficient for germinal centers. ILB frequency was positively associated with overall and disease-free survival in a phase 3 trial of patients with NPC receiving GP chemotherapy ( NCT01872962 , n = 139). It also served as a predictor for favorable outcomes in patients with NPC treated with GP and immunotherapy combined treatment (n = 380). Collectively, our study provides a high-resolution map of the tumor immune microenvironment after GP chemotherapy and uncovers a role for B cell-centered antitumor immunity. We also identify and validate ILB as a potential biomarker for GP-based treatment in NPC, which could improve patient management.

The effect of radioactive iodine (RAI) on disease-specific survival in differentiated thyroid cancer (DTC): A study of 96,557 patients.

e18095 Background: The use of RAI in the treatment of DTC of various stages and risk levels is widespread. However, its efficacy continues to be a subject of debate, particularly with regard to low-risk patients. Some studies have found significant differences in RAI's ability to decrease recurrence and distant metastasis, while others have not. Thus, we conducted this study to evaluate the effect of RAI on disease-specific survival (DSS) in patients with DTC without distant metastasis. Methods: Data were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database between the years 2000 and 2018. Patients who have distant metastatic, tumor size ≥200 mm, receiving chemotherapy or any type of radiation other than RAI were excluded. Only patients with total thyroidectomy as surgical procedure were included. These patients were classified into three groups based on their histology: classical papillary thyroid carcinoma (C-PTC), follicular type variant carcinoma (FV-PTC), and follicular thyroid cancer (FTC). T-tests and chi-square tests were employed to compare variables, while the Cox proportional hazards model was utilized to assess the effect of RAI on DSS, presenting adjusted hazard ratios and confidence intervals. Results: The study population consisted of 96,557 patients, with 59,460 classified as having C-PTC, 31,583 as FV-PTC, and 5,489 as FTC. Most patients were female (78.6%), and the mean age was 45.8 years. 80.5% of the patients were white. The mean tumor size was 19.4 mm, with FTC tumors having a larger mean size of 34.8 mm. About a third of cases had an extrathyroidal extension. FV-PTC had the most favorable survival outcome with a 5-year DSS of 97.9%, followed by C-PTC (97.1%) and then FTC (96.9%). RAI was administered to 61.2% of FTC cases, 53.2% of C-PTC cases, and 52.1% of FV-PTC cases. In both FV-PTC and C-PTC, patients who received RAI had significantly better long-term survival than those who underwent surgery alone. The multivariable analysis confirmed that RAI had a more favorable prognosis in FV-PTC (HR = 0.68, 95%CI: 0.61 to 0.77, p<0.001) and C-PTC (HR = 0.60, 95%CI: 0.54 to 0.67, p<0.001), but did not result in improved DSS in FTC (HR = 0.87, 95%CI: 0.70 to 1.09, p = 0.226). There was a survival difference between the three histological subtypes in the overall cohort (p<0.001), even after matching baseline characteristics (p = 0.019). Conclusions: Our results showed that RAI administration was statistically associated with improved long-term DSS outcomes in FV-PTC and C-PTC histological subtypes, but not in FTC. However, a careful interpretation of these results is needed as the survival benefit was less than 3% in all cohorts, it might be clinically insignificant. This study was the first to examine all histological types of DTC using a large sample size. There is a need for a randomized trial to confirm the efficacy of RAI in FTC treatment.

Collision Tumors of the Thyroid

"Collision tumors, rare neoplasms underlying two distinct histological types of carcinomas (with different origins) separated by normal tissue, are described in many organs including the thyroid gland, but to a lesser extent. We aim to overview the current published data concerning collision tumors of the thyroid (CTT). This is a narrative review considering papers published on PubMed through a search starting from the terms “collision” and “thyroid”. Inclusion criteria are full-length articles, the English language, the timeline from inception to December 2022, and original studies with different levels of statistical evidence. We followed the main types of thyroid carcinomas: differentiated thyroid carcinoma of papillary and follicular type, anaplastic/ undifferentiated/poorly differentiated carcinoma, respectively medullary thyroid carcinoma. We identified 92 papers based on the mentioned key words criteria. We excluded 54 papers (reviews or non-thyroid CTT or other topics outside our purpose). We included in the final analysis 38 papers: 34 case reports (1 patient per paper), 2 case series (2 individuals per each article), one case series of 3 subjects, and a single study of retrospective type (including 21 subjects) – a total of 62 patients on published cases which represents the largest study on published cases to our knowledge (according to our methodology) "

Ameloblastoma of the jaws in adult: A retrospective review of local recurrent lesions based on the resection margin in the adjacent apparent healthy tissues

BackgroundThe surgical treatment of ameloblastoma of the jaws remains contentious due to the variable recurrence rate amongst its variants, the tumor's local invasive behavior, and the lack of consensus among surgeons concerning the extent of resection in the contiguous healthy tissues. ObjectiveTo determine the recurrence rate of ameloblastoma and its association with the resection margins. Materials and methodsThis is a retrospective cohort study of the medical records of patients who underwent surgical resection of the jaws as the primary modality of treatment for ameloblastoma. Clinical data over the 26 years were analyzed for age, gender, site of the lesion, size, radiographic appearance, histopathological sub-type, and the incidence of recurrence post-treatment. Descriptive and bivariate statistics were computed. ResultsA retrospective audit of 234 cases was included in the study that was typical (solid/multicystic) ameloblastoma. The age of patients ranged from 20 to 66 years with a mean age of 33.4 ± 9.6 years, and a male-to-female ratio of 1.2: 1 (P = 0.52). The follicular and plexiform types accounted for the majority of histopathological variants (89.8%; P = 0.000). Overall, 6.8% of cases relapsed after the initial primary surgery. The rate of recurrence was high with a resection margin of 1.0 or 1.5 cm than 2.0 cm (P = 0.001). No case of recurrence was seen with a resection margin of 2.5 cm margin. ConclusionA low recurrence rate of 6.8% was noted in our series of cases. A wide 2.5 cm resection margin is recommended in the adjacent healthy tissues.

Residual sinonasal ameloblastoma

Ameloblastoma is the most common odontogenic tumour of the mandible. This disease can occur in the maxilla, but it is very rare. This tumour originates from the epithelium involved in the process of tooth formation, but the trigger for neoplastic transformation in the epithelium still is not known with certainty. Ameloblastoma is defined as a locally aggressive benign tumour with a high probability of recurrence. These tumours have several variations in histopathological appearance, but the types most often seen are the follicular and plexiform types. In most cases, ameloblastoma is locally invasive, usually asymptomatic and slow growing. It has been reported that a 45-year-old female patient with residual sinonasal ameloblastoma had a lateral rhinotomy performed using the Weber-Ferguson approach with good surgical results. Sinonasal ameloblastoma is a rare case with a high recurrence rate after surgery. Ameloblastoma can be diagnosed based on anamnesis, physical examination, and supporting examinations consisting of a CT scan and histopathology. Surgery is the standard treatment for ameloblastoma. A wide excision should be performed with 2 cm of normal bone removed from around the tumour margin to prevent the re-occurrence.

Hot Thyroid Nodule Revealing a Papillary Microcarcinoma: A Case Report

Introduction: Autonomously hyperfunctioning thyroid nodules, also known as "hot nodules", are defined by increased uptake of radiotracers compared to the surrounding thyroid parenchyma on scintigraphy. It has been believed that hot nodules have a low rate of malignancy, while an increasing number of thyroid carcinoma cases are being diagnosed in patients with hyperthyroidism. Case Presentation: A. J, a 50-year-old patient. She presented with signs of hyperthyroidism. Laboratory tests showed peripheral hyperthyroidism with an inhibited TSH of 0.03 μIU/ml and T4L of 37 pmol/L. The scintigraphy revealed a focus of hyper fixation almost completely affecting the right lobe which corresponded to a hot nodule most likely pre-extincted in the remaining parenchyma. The patient was initiated on synthetic antithyroid medication and, after achieving euthyroidism, she was referred to surgery. Right loboishmectomy was performed. The histological study revealed a 0.5 cm intralobular non-encapsulated microcarcinoma papillary on a background of thyroid dystrophy. Discussion: The initial evaluation of a thyroid nodule begins is the measurement of serum TSH and the performance of a thyroid ultrasound, followed by a thyroid radionuclide scan if the TSH is subnormal. Malignant nodules are usually non-functioning. The prevalence of malignancy associated with a hot nodule range between 1-10.3%. In many cases, thyroid cancer is not known preoperatively but is found incidentally during the postoperative histological examination of the thyroid. Most of these malignancies were of papillary carcinoma and less often follicular or Hurthle histological types, and they are small in size, and the majority are microcarcinomas. Conclusion: Further evaluation and characterization of the association between a hot thyroid nodule and malignancy are needed. In the case of our patient, the discovery of papillary carcinoma was incidental and was made during the postoperative histological examination .......

Integrated analysis of transcription factor-mRNA-miRNA regulatory network related to immune characteristics in medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC), a thyroid C cell-derived malignancy, is poorly differentiated and more aggressive than papillary, follicular and oncocytic types of thyroid cancer. The current therapeutic options are limited, with a third of population suffering resistance. The differential gene expression pattern among thyroid cancer subtypes remains unclear. This study intended to explore the exclusive gene profile of MTC and construct a comprehensive regulatory network via integrated analysis, to uncover the potential key biomarkers. Multiple datasets of thyroid and other neuroendocrine tumors were obtained from GEO and TCGA databases. Differentially expressed genes (DEGs) specific in MTC were identified to construct a transcription factor (TF)-mRNA-miRNA network. The impact of the TF-mRNA-miRNA network on tumor immune characteristics and patient survival was further explored by single-sample GSEA (ssGSEA) and ESTIMATE algorithms, as well as univariate combined with multivariate analyses. RT-qPCR, cell viability and apoptosis assays were performed for in vitro validation. We identified 81 genes upregulated and 22 downregulated in MTC but not in other types of thyroid tumor compared to the normal thyroid tissue. According to the L1000CDS2 database, potential targeting drugs were found to reverse the expressions of DEGs, with panobinostat (S1030) validated effective for tumor repression in MTC by in vitro experiments. The 103 DEGs exclusively seen in MTC were involved in signal release, muscle contraction, pathways of neurodegeneration diseases, neurotransmitter activity and related amino acid metabolism, and cAMP pathway. Based on the identified 15 hub genes, a TF-mRNA-miRNA linear network, as well as REST-cored coherent feed-forward loop networks, namely REST-KIF5C-miR-223 and REST-CDK5R2-miR-130a were constructed via online prediction and validation by public datasets and our cohort. Hub-gene, TF and miRNA scores in the TF-mRNA-miRNA network were related to immune score, immune cell infiltration and immunotherapeutic molecules in MTC as well as in neuroendocrine tumor of lung and neuroblastoma. Additionally, a high hub-gene score or a low miRNA score indicated good prognoses of neuroendocrine tumors. The present study uncovers underlying molecular mechanisms and potential immunotherapy-related targets for the pathogenesis and drug discovery of MTC.

An Unusual Presentation of “Two-Thirds Tumor” in the Mandible – A Diagnostic Quandary with a Review of the Literature

An adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of the oral cavity commonly found in the maxillary anterior region and is associated with impacted canines in young females. It rarely occurs in the mandibular region with no impacted or missing teeth. A 21-year-old female reported to the clinic with swelling on the right side of the face for the past six months with no history of pain. Radiographic features such as unilocular radiolucency with thinning of the cortical borders and considerable buccal cortical expansion, as well as some evidence of radiopaque specks were noted. Histopathological examination revealed cells with hyperchromatic nuclei, rosette-like structures with focal areas of calcified mass, and concentric rings resembling Liesegang rings, suggestive of AOT. The tumor was treated surgically by enucleation and cauterization. Although follicular type is a common variant, the tumor presented in this case was of extrafollicular type noted in the mandibular canine and premolar regions of a young female patient with no related impacted tooth.

Potential links between COVID-19 and periodontitis: a bioinformatic analysis based on GEO datasets

Background2019 Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 pandemic has already had a serious influence on human existence, causing a huge public health concern for countries all around the world. Because SARS-CoV-2 infection can be spread by contact with the oral cavity, the link between oral illness and COVID-19 is gaining traction. Through bioinformatics approaches, we explored the possible molecular mechanisms linking the COVID-19 and periodontitis to provide the basis and direction for future research.MethodsTranscriptomic data from blood samples of patients with COVID-19 and periodontitis was downloaded from the Gene Expression Omnibus database. The shared differentially expressed genes were identified. The analysis of Gene Ontology, Kyoto Encyclopedia of Genesand Genomes pathway, and protein–protein interaction network was conducted for the shared differentially expressed genes. Top 5 hub genes were selected through Maximal Clique Centrality algorithm. Then mRNA-miRNA network of the hub genes was established based on miRDB database, miRTarbase database and Targetscan database. The Least absolute shrinkage and selection operator regression analysis was used to discover possible biomarkers, which were then investigated in relation to immune-related genes.ResultsFifty-six shared genes were identified through differential expression analysis in COVID-19 and periodontitis. The function of these genes was enriched in regulation of hormone secretion, regulation of secretion by cell. Myozenin 2 was identified through Least absolute shrinkage and selection operator regression Analysis, which was down-regulated in both COVID-19 and periodontitis. There was a positive correlation between Myozenin 2 and the biomarker of activated B cell, memory B cell, effector memory CD4 T cell, Type 17 helper cell, T follicular helper cell and Type 2 helper cell.ConclusionBy bioinformatics analysis, Myozenin 2 is predicted to correlate to the pathogenesis and immune infiltrating of COVID-19 and periodontitis. However, more clinical and experimental researches are needed to validate the function of Myozenin 2.