Hürthle Cell Research Articles

American Thyroid Association guidelines for evaluation of thyroid nodule: Our experience of patients presenting to AKUH

Thyroid nodules are one of the frequently seen presentations in the clinic. Thyroid nodules are present in almost 5% of females and 1% males in iodine-sufficient regions [1]. On the other hand it can incidentally be found in as high as 67% of the patients on ultrasound neck. Among all the thyroid nodules, 5-15% come out to be malignant on final histopathology [1]. Thyroid carcinomas can be divided into Differentiated Thyroid Carcinomas (DTC) and undifferentiated carcinomas. The differentiated thyroid carcinomas include papillary, follicular and hurthle cell carcinomas [1]. Among all the thyroid carcinomas reported, 90% tend to be DTC. The undifferentiated group includes anaplastic thyroid cancers [1,2]. Over last 3 decades, the incidence of thyroid cancer is increasing worldwide [1,3]. An increase of almost 4 folds have been seen between 1988 and 2002 in incidence of papillary thyroid carcinoma [1].

A single-center multidisciplinary study analyzing thyroid nodule risk stratification by comparing the thyroid imaging reporting and data system (TI-RADS) and American thyroid association (ATA) risk of malignancy for thyroid nodules

ObjectivesThe thyroid imaging reporting and data system (TI-RADS) and 2015 American Thyroid Association (ATA) guidelines are two well-known risk stratification systems for classifying thyroid nodules based on cancer risk. This study aims to evaluate the diagnostic efficacy of these two systems in predicting malignancy in patients undergoing thyroid surgery. MethodsWe studied data on 120 individuals who were scheduled to undergo surgery for benign or malignant nodular diseases of the thyroid gland between October 2017 and October 2019. The TI-RADS category and ultrasound pattern based on ATA guidelines were assigned to dominant thyroid nodule categories by two experienced radiologists blinded to patients’ previous thyroid ultrasonography and fine-needle aspiration biopsy results. A pathologist with experience in thyroid diseases blinded to patients’ sonographic and clinical data reviewed the thyroidectomy specimens. ResultsA total of 120 patients, 88 women and 32 men, were included in our study. Final histopathological results were as follows: 50% (n=60) papillary thyroid carcinoma, 36.6% (n=44) benign nodular thyroid diseases, 4.1% (n=5) follicular adenoma, 2.5% (n=3) hurtle cell adenoma, 1.7% (n=2) follicular thyroid carcinoma, 1.7% (n=2) medullary thyroid carcinoma, 1.7% (n=2) hurtle cell carcinoma, and 1.7% (n=2) follicular tumor of uncertain malignancy potential. The sensitivity, specificity, positive predictive value, and negative predictive value for TI-RADS were 80%, 56%, 72%, and 67%, respectively, and that for ATA were 80%, 64%, 76%, and 69%, respectively. ConclusionThe TI-RADS and ATA showed similar rates of sensitivity, specificity, NPV, and PPV. Our observed risk of malignancy was higher than expected for the ACR TI-RADS 3–5 categories and the very low, low, and intermediate suspicion risk strata in the ATA guidelines. We found no difference between observed and expected malignancy risk for the ACR TI-RADS 2’s and ATA's high suspicion categories.

HuRthle cell tumors vs oncocytic variants of the follicular cell derived thyroid tumours: a comprehensive analysis based in transcriptome, proteome and cnv profiling

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

Complicated treatment with lenvatinib for hurthle cell carcinoma

Complicated treatment with lenvatinib for hurthle cell carcinoma

Prognostic factors and survival analysis of Hurthle cell carcinoma: A population-based study

BackgroundHurthle cell carcinoma is a rare type of differentiated thyroid cancer and historically associated with a worse prognosis. The aim of this study was to define the demographic and socioeconomic factors, tumor characteristics, and surgical treatment status associated with Hurthle cell carcinoma survival using the most recent population-level data. MethodsThe Surveillance, Epidemiology, and End Results database was queried for adult patients (>18 years of age) diagnosed with Hurthle cell carcinoma from 2000 to 2018. The demographic factors, socioeconomic factors, tumor characteristics, and extent of surgery data were collected as potential predictors. The outcomes of interest were 10-year overall and disease-specific survival, which were estimated using the Kaplan-Maier method. The associations between the potential predictors and survival were evaluated using the Cox proportional hazard model. ResultsIn total, 4,643 patients with Hurthle cell carcinoma were identified using the Surveillance, Epidemiology, and End Results database. The cohort was predominately White, had a mean age of 57.7 (±15.6), 69% female sex, and median follow-up was 90 months. The 10-year overall survival and Hurthle cell carcinoma-specific survival were 78.1% (95% confidence interval: 76.7%–79.5%) and 91.8% (95% confidence interval: 90.9%–92.9%), respectively. Younger age <55 years, female sex, White race, Hispanic ethnicity, higher household income, and lower tumor grade and stage were significantly associated with increased survival (P < .01). In the multivariate Cox proportional hazard model, all variables except race and ethnicity remained significantly associated with overall survival. Although patients who underwent thyroid surgery had improved survival compared to no surgery, the extent of surgery did not have any effect on their overall or disease-specific survival. ConclusionThis study highlighted the aggressive nature of Hurthle cell carcinoma and the effect of socioeconomic factors, such as household income, which may play a role in Hurthle cell carcinoma survivorship. Research is needed to understand the interplay of these factors and their role in predicting patient outcomes.

Diagnostic and prognostic significance of detecting mutations in the &lt;i&gt;BRAF, TERT, RAS, RET/PTC, PAX8/PPARG&lt;/i&gt; in the material of fine needle aspiration biopsy thyroid nodules in the IV cytological group (Bethesda, 2017)

Introduction. Fine needle aspiration biopsy followed by cytological examination is the gold standard in the diagnosis of thyroid nodules. However, up to one third of cases represent an indeterminate result (Bethesda Thyroid Classification, 2017) III—V). Among such cases, category IV is the most common and most difficult to interpret (Bethesda, 2017). The study objective is to determination of the diagnostic and prognostic significance of the molecular genetic study of the fine needle aspiration biopsy material in patients with thyroid nodules with the cytological category Bethesda, IV.Materials and methods. The study included surgical thyroid samples obtained from patients whose cytological examination revealed pathology of cytological category IV according to the Bethesda classification (2017). group 1 included surgical samples from 143 patients with thyroid lesions, and group 2 - cytological material from 45 patients. Determination of the BRAF V600E mutation, mutations in the RAS genes (KRAS, HRAS, NRAS) was carried out using allele-specific polymerase chain reaction, and the RET / PTC1, RET / PTC3 and PAX8 / PPARG translocations were determined using reverse transcription polymerase chain reaction. Sanger sequencing was used to detect mutations in the promoter region of the TERT gene.Results. In group 1, an overall prevalence of the studied mutations in thyroid cancer was 35.1 %: 8.8 % of cases were mutation BRAF V600E, 24.6 % - mutations in the RAS genes, 1.8 % - mutation C228T in the TERT gene. The C228T mutation in the TERT gene was found in 1 case of widely invasive Hurtle cell carcinoma. The prevalence of mutations in benign formations was 4.7 %. mutations in RAS genes were also found in them in group 1, mutation BRAF V600E was associated with the presence of extrathyroid invasion (p = 0.024), vascular invasion (p = 0.018), and lymph node metastases (p = 0.018). In group 2, using the genetic panel sensitivity and specificity were equal: 36.4 and 93.9 %, respectively. positive and negative predictive values were 66.7 and 81.6 %, respectively. No RET / PTC and PAX8 / PPARG translocations were found in groups 1 and 2.Conclusion. The investigated molecular genetic panel, having a high specificity for carcinomas, will make it possible to supplement the cytological diagnostics of material in the category Bethesda, IV. BRAF V600E was associated with an aggressive morphological pattern.

Ultrasound guided fine needle aspiration cytology (FNAC): an assessment of the diagnostic potential in histologically proven thyroid nodules.

Aim Results of ultrasound guided fine needle aspiration cytology (FNAC) as the compatibility of cytological findings with histopathological diagnoses (the "gold standard") in the diagnosis of nodular thyroid lesions are inconsistent. The aim of this prospective study was to determine the validity of FNAC, as well as the compatibility of findings with histopathological diagnoses. Methods The study included 92 patients who underwent FNAC and later surgery and histopathological assessment with a final diagnosis. Results FNAC showed 95% specificity, 78% sensitivity and 90% accuracy. The compatibility of the cytological and histopathological findings was good (Kappa coefficient of 0.756; 95% CI). The cytology results proved to be very good at predicting malignant histopathological findings, (OR=72.33; p<0.001). Also, the result of ROC analysis (AUC=0.866) confirmed FNAC as a very good method of distinguishing benign and malignant thyroid nodules. Conclusion The results confirmed the correctness of the algorithm in which, following clinical or ultrasound confirmation of nodular thyroid lesions with suspicious changes, FNAC is indicated. The FNAC results should guide a clinician to further diagnostic and therapeutic procedures. Certainly, in case of suspected follicular/ Hurthle cell lesions one should be vigilant and aware of the fact that in these cases malignancy is defined by the invasion of blood vessels and/or the capsule, which FNAC is unable to detect.

Probability of malignancy as determined by ThyroSeq v3 genomic classifier varies according to the subtype of atypia.

ThyroSeq assesses the probability of malignancy (POM) in thyroid fine-needle aspiration cytology specimens diagnosed as atypia of undetermined significance (AUS). The authors investigated whether defined AUS subcategories are associated with specific molecular alterations, the molecular-derived risk of malignancy (MDROM), and the risk of malignancy (ROM). Fine-needle aspiration cytology reports of AUS and corresponding results from the ThyroSeq version 3 genomic classifier results were retrieved and subcategorized as follicular cells with either cytologic atypia (FC-C), architectural atypia (FC-A), both cytologic and architectural atypia (FC-CA), or a predominance of Hurthle cells (PHC). The MDROM, ROM, and frequency of molecular alterations by subcategory were computed and analyzed, and p &lt; .05 was considered significant. The final analysis included 541 cases subdivided into 233 with FC-A, 104 with FC-C, 116 with FC-CA, and 88 with PHC. The benign call rate and positive call rate for the AUS category were 72% and 28%, respectively, which varied between AUS subcategories. The MDROM by subcategory was 15.9% FC-A, 20.5% FC-C, 33.8% FC-CA, and 14.4% PHC. Histologic follow-up was available for 155 (28%) AUS cases with a follow-up period ≥12 months. The 95% confidence intervals of the MDROMs overlapped with the ROMs. The highest MDROM and ROM were in the FC-CA subcategory. RAS mutations were present in all subcategories. BRAF V600E mutations and papillary thyroid carcinoma were most frequent in the FC-CA subcategory. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was significantly more frequent in the FC-C subcategory. The current results demonstrated that AUS subcategories are associated with specific genetic alterations, the MDROM, and the ROM. Molecular results and an awareness of various cancer probabilities within AUS subcategories can allow for a more tailored management.

The role of surgery in small differentiated thyroid cancer.

The incidence of small, differentiated thyroid cancer (DTC) cases has been increasing in the United States and the world mainly due to incidental detection because of widespread use of diagnostic modalities. While the option of active surveillance instead of surgical resection is getting more popular, there is still an open discussion about the best approach in these cases. The National Cancer Database was queried for patients diagnosed with non-metastatic small T1/N0 DTC between 2004 and 2016, who have known surgical status and Charlson comorbidity index of two or less. We evaluated the overall survival (OS) based on the surgery status using Kaplan-Meier estimates and multivariable cox regression analyses. A total of 98,501 patients with non-metastatic small DTC were included, within which 96,612 (98.1%) were treated with surgery, and 1889 (1.9%) were not treated with surgery or other ablative modalities. We found that patients who were treated with surgery had better OS compared to patients who were not treated with surgery (mean OS 171 months vs 134.1 months, P < 0.001, median OS was not reached). This difference was still statistically significant even after we used propensity score matching for age, gender, race, Charlson-Deyo score, tumor size, and histology. On multivariate analysis, surgery was associated with better OS (HR 0.218; 95% CI: 0.196-0.244; P < 0.001). Same trend was found in subgroup analysis when we split the cohort according to tumor size (<1 and ≥1 cm), histology (follicular, papillary and Hurthle cell carcinoma), and age (<55 years vs ≥55 years). Patients with non-metastatic small DTC who were treated with surgery had significant improvement in OS compared to patients who were not treated with surgery. Notwithstanding the limitations of the current analysis, these results call for caution prior to recommending routine surveillance for all patients with small DTC.

Cabozantinib versus placebo in patients (pts) with radioiodine-refractory (RAIR) differentiated thyroid cancer (DTC) who progressed after prior VEGFR-targeted therapy: Outcomes in prespecified subgroups based on histology subtypes.

6081 Background: DTC comprises multiple histology subtypes, the most common being papillary and follicular. Based on results of the phase 3 COSMIC-311 trial, the multikinase inhibitor cabozantinib was recently approved by FDA for the treatment of pts with RAIR DTC who progressed after prior VEGFR-targeted therapy (Brose et al. 2021). In an extended follow-up, median (m) progression-free survival (PFS) was 11 months (mo) for cabozantinib vs 1.9 mo for placebo (HR 0.22, 96% CI 0.15–0.32, P&lt;.0001) in the intent-to-treat (ITT) population (Capdevila et al. ESMO 2021. Abstr LBA67). Here we present outcomes for prespecified subgroups based on the baseline histology subtypes of papillary and follicular thyroid cancers. Methods: Pts were randomized 2:1 to cabozantinib (60 mg QD) or placebo. Placebo pts could cross over to open-label cabozantinib upon disease progression per blinded independent radiology committee (BIRC). Primary endpoints were PFS (ITT) and objective response rate (ORR, first 100 randomized pts), per RECIST v1.1 assessed by BIRC. Results: After a median follow-up of 10.1 mo, 258 pts (170 cabozantinib, 88 placebo) had been randomized (data cutoff 8 Feb 2021); 150 pts (96 cabozantinib, 54 placebo) had papillary thyroid cancer (PTC) and 113 pts (78 cabozantinib, 35 placebo) had follicular thyroid cancer (FTC), with the PTC and FTC subgroups each including 5 pts with both PTC and FTC. Sixty-three pts (̃56%) within the FTC subgroup had Hurthle cell and poorly differentiated variants. mPFS was 9.2 mo for cabozantinib vs 1.9 mo for placebo in the PTC subgroup (HR 0.27, 95% CI 0.17–0.43) and 11.2 mo vs 2.6 mo in the FTC subgroup (HR 0.18, 95% CI 0.10–0.31). The mPFS was 11.1 mo for cabozantinib and 1.9 mo for placebo for pts with Hurthle cell and poorly differentiated variants (HR 0.12, 95% CI 0.05–0.27). The ORR was 15% for cabozantinib vs 0% for placebo in the PTC subgroup and 8% vs 0% in the FTC subgroup. Median duration of cabozantinib exposure was 5.5 mo for the PTC subgroup and 7.3 mo for FTC. Grade 3/4 treatment-emergent adverse events (TEAE) in the cabozantinib arm occurred in 59% of pts in the PTC subgroup and 68% of pts in the FTC subgroup; discontinuations due to TEAE occurred in 17% and 15% of pts, respectively. Conclusions: In the extended follow-up, cabozantinib maintained superior efficacy vs placebo irrespective of histology subtype, including the aggressive Hurthle cell and poorly differentiated variants. The moderately higher rates of grade 3/4 TEAE in the FTC vs the PTC subgroup could be attributed to the longer median duration of exposure of cabozantinib in the FTC subgroup. Clinical trial information: NCT03690388.

Safety and efficacy of YBL-006, an anti-PD-1 monoclonal antibody in advanced solid tumors: A phase I study.

e14557 Background: YBL-006 is a fully human anti-programmed death-1 (PD-1) antibody under evaluating its safety and efficacy in phase I clinical trial. We have reported interim analysis of dose escalation cohort which showed a tolerable safety profile. Here, we present the updated clinical activity of YBL-006 in dose escalation and expansion cohorts. Methods: Dose escalation (0.5, 2, 5, 10 mg/kg) and dose expansion (flat doses of 200 mg every 2 weeks [Q2W] and 300 mg every 3 weeks [Q3W]) cohorts explored the safety, pharmacokinetics (PK) and objective response rate (ORR) in the patients with advanced solid tumors who failed or were ineligible to the standard of care. Adverse events (AEs) were graded using the CTCAE v5. ORR was assessed using the RECIST (v1.1). Lunit SCOPE IO, an H&amp;E analysis tool, was applied as an exploratory biomarker, and samples with “Immune inflamed phenotype” were defined as those with high intratumoral TIL density in ≥ 20% of the tumor microenvironment. The cut-off date for analysis was Jan 4th, 2022. Results: A total of 67 patients (safety set) with advanced solid tumors were enrolled in the study. Median follow-up duration of the safety set was 1.6 months (range 0.2-16.8). There was no dose-limiting toxicity during dose escalation phase. Most frequent AEs were grade 1 or 2; fatigue (19.4%), pruritus (10.4%), and fever (7.5%), and two hypothyroidism (3.0%), one pneumonitis (1.5%), and one cytokine-releasing syndrome (1.5%) were observed. One subject experienced grade 3 diarrhea in the safety set. PK study showed that half-life was 8.0 days, and mean Cmax and AUC0-inf were 4.15 x 104 ng/ml and 1.12 x 107 ng/ml*h for 200 mg dose, and 6.26 x 104 ng/ml and 1.53 x 107 ng/ml*h for 300 mg dose, respectively. A total of 52 patients were evaluable for efficacy. ORR was 15.4%, including 1 complete response (penile squamous cell carcinoma [SqCC]), and 7 partial responses (two gastric adenocarcinomas, anal SqCC, paranasal sinus SqCC, nasopharyngeal carcinoma, neuroendocrine carcinoma, and thyroid Hurthle cell carcinoma). Durable responses were seen in 2 patients for over 12 months. Median duration of response was 4.9 weeks (range 1-65). Among efficacy set, 32 samples were available for Lunit SCOPE IO. ORR was significantly higher in inflamed immune phenotype compared to non-inflamed samples (62.5% vs 8.3% p = 0.005). Conclusions: Interim analysis of phase I trial of YBL-006 shows a tolerable safety profile and clinical activity. Notable anti-tumor efficacy was observed in inflamed immune phenotype. Clinical trial information: NCT04450901.

Proposal of a molecular testing algorithm for differentiated thyroid cancer (DTC).

e18090 Background: In the growing era of precision medicine and tumor-agnostic therapies, the molecular testing of DTC is becoming mandatory to optimize diagnostic and therapeutical strategies. Even if the most frequent oncogenic events, occurring in a mutually exclusive manner, are BRAF V600E, followed by RAS, gene fusions mainly occurring in RET, NTRK1-3, and ALK genes have been also found. In this scenario, the definition of a molecular testing algorithm to be implemented for clinical practice is needed, in order to optimize resources and time for better clinical patient management. Methods: Gene mutations and gene fusions were evaluated on DNA and RNA extracted from cytologic or histologic samples. Mutations were tested using a lab-developed multi-gene panel able to analyze the hot-spot regions of 28 genes (total of 343 amplicons, 21.77 kb); gene fusions were tested using the Oncomine Focus assay panel. Results: Molecular characterization was performed on a total of 63 DTC (50 papillary thyroid carcinoma - PTC, 8 – follicular thyroid carcinoma - FTC, 5 – hurthle cell carcinoma - HCC) by the treating clinician for diagnostic, prognostic or clinical reasons. In 27 cases (42.8%) at least one DNA mutation was detected, 17 cases (26.9%) were positive for gene fusion rearrangement, in only 2 cases (3.1%) both DNA mutations and gene rearrangements were found and in the remaining 17 (26.9%) cases no DNA mutations or rearrangements were detected. Among mutated-subgroup, BRAF V600E mutation was the most common (14 of 63 cases – 22.2%), followed by RAS mut (9 cases – 14.2%: 4 NRAS, 3 HRAS, and 3 KRAS), both as single event in 7 and 4 cases respectively. Substitutions in TERT promoter region was found in 16 cases (25.3%), of which 14 as secondary event. Other mutations in TP53 (4 cases –6.3 %, of which 2 as single event), PIK3CA (1 case – 1.5%), AKT1(1 case – 1.5%), and RNF43 (1 case – 1.5%) were detected. Among riarranged subgroup, RET fusions and NTRK1-3 was found in 8 cases respectively (12.6%), while ALK fusion was found 1 case (1.5%). The concomitant mutational and fusion events found in 2 cases were the following: 1) HRAS and PAX8/PPARG; 2) PIK3CA/TP53/TERT and RET/CCDC6. Conclusions: As expected, BRAF and RAS mutations represent the most common genetic events in DTC and occur in a mutual exclusive manner. However, in about 30% of patients, mostly of young age, with papillary histology and lymph nodal involvement, a clinically actionable gene rearrangement has been found. Thus, we propose a two-step molecular testing algorithm with a first-level test to identify the most common mutations and a second-level test, including less common mutations and gene rearrangements, if the genes analyzed with the first level test are wild-type. The second-level test may be performed up-front in cases where there are clinicopathologic features suggestive of fusion gene TC gene or in clinically aggressive unconventional cases for which molecular therapy is being considered.

Phenotypic Appraisal of Collision Tumors of Thyroid – Initial Experience of a Rare Entity at a Cancer Centre in South India

Introduction: Collision tumours (CT) of the thyroid refer to the coexistence of two or more independent, histologically distinct malignant tumours. Though the presence of multifocal differentiated thyroid carcinomas is common, it is extremely rare for the thyroid to harbour more than one type of malignancy simultaneously. Methods: An extensive literature search of PubMed databases identified very few cases indicating the tumour rarity. To the best of our knowledge, this is the first documentation of a case series including various combinations of CT in the thyroid. Our main aim is to explore the phenotypic characteristics of CT in the thyroid with an aim of revealing unique features associated with this rare entity. Results: Of a total of 138 thyroid cancers treated during the eight-year period, five (3.62%) were diagnosed as CT. All were females with a median age of 50 years. Papillary Thyroid Carcinoma (PTC) was the major component (80%) in collision with medullary (MC), follicular, and hurthle cell carcinomas. Both cases with papillary microcarcinoma showed vascular emboli and patients with a combination of MC and PTC had nodal metastasis. 80% of patients had a survival of more than 2.5 years and are alive without disease at present. Our study showed features like female predominance and PTC as the most common component with good overall survival. Metastatic and survival rates were consistent with matched singleton pathology. Conclusion: Insight into the genomic and proteomic pathways of this entity is the need of the hour.

Expression of β-Catenin in Thyroid Neoplasms (Histopathological and Immunohistochemical Study)

Background: Thyroid cancer is the most common malignant tumor of the endocrine system accounting for more than 90% of all endocrine cancer and 63% of all endocrine cancer deaths. β-catenin is a multifunctional protein that plays a key role in Wnt (wingless type) pathway and influences the expression of different genes and their proliferation, thus making it a potential therapeutic target.&#x0D; Aim of Work: This work aimed to examine immunohistochemical expression of β-catenin in different cases of thyroid neoplasms and to correlate between β-catenin expression and clinicopathological features of these thyroid neoplasms.&#x0D; Methods: This retrospective study was conducted on sixty cases of archived, formalin fixed, paraffin embedded tissue blocks that included different histologic types of thyroid neoplasms. Immunohistochemistry using β-catenin monoclonal antibody was performed using a standard avidin-biotin-peroxidase system. β-catenin expression was quantified both at membranous and cytoplasmic level. Immunostaining scores were based on the staining intensity (I) and the percentage of positive cells (P). β-catenin final score (H score) resulted by summation of I and P (ranging from 0 to 7). Cases with H score between 1–3 were considered with low score and cases with H score between 4–7 were considered with high score.&#x0D; Results: Of the malignant thyroid neoplasms in the studied cases, 81% showed positive β-catenin expression with the majority (86%) of the benign thyroid cases showing positive expression. Both membranous and cytoplasmic staining were both assessed in which the majority of the negative and high positive membranous cases also showed the same interpretation for cytoplasmic β-catenin expression. Positive correlations were proved between β-catenin expression of diagnosed malignant cases, (pvalue =0.042) where all hurthle cell, follicular and medullary carcinoma cases, 87.5% of studied papillary carcinoma cases and 50% of poorly differentiated carcinoma cases showed β-catenin positivity while all anaplastic carcinoma cases were negative. Furthermore, statistically significant findings were seen in cases with absence of extrathyroid extension (P value= 0.045) especially those displaying β-Catenin cytoplasmic expression with extrathyroid extension of studied malignant cases showing a P value= (0.011) . No significant correlation was found between β-catenin expression and patients' pathological diagnosis, gender, extent of primary tumor (pT), lymph node metastasis, multifocality and co-existing pathology among studied malignant cases.&#x0D; Conclusion: The present study suggests the prognostic role of β-catenin and its possible usage to identify patients who may benefit from adjuvant β-catenin targeted mono- or combined therapy for tumors expressing this protein, especially for thyroid cases that cannot be removed surgically or that do not respond to traditional treatment options.&#x0D; &#x0D; Key Words: β-catenin, immunohistochemistry, malignant thyroid neoplasms, benign thyroid neoplasms.&#x0D;

Hurthle cell tumors of the thyroid gland: diagnostic and therapeutic features

Hurthle cell tumors of the thyroid gland: diagnostic and therapeutic features

Hurthle cell carcinoma of the thyroid gland: diagnostic, therapeutic and prognostic features

Hurthle cell carcinoma of the thyroid gland: diagnostic, therapeutic and prognostic features

Abstract #1183852: Hurthle cell carcinoma with bone metastasis

Hurthle cell thyroid cancer is usually classified as a type of Follicular thyroid cancer. It comprises about 3-5% of thyroid cancer cases. Hurthle cell thyroid cancers are known for their more aggressive tumor biology; metastases are observed in a minority of cases, and long-term survival can be expected.

Abstract #1168947: Thyroid bed lymphadenopathy after COVID-19 vaccine in a patient with history of thyroidectectomy due to Hurtle cell thyroid cancer

The primary treatment for differentiated thyroid cancer is surgical resection with or without postoperative radioactive iodine ablation with I-131, depending on the risk stratification. Despite the good prognosis, local recurrence and distant metastasis are not uncommon. Hence these patients need to be monitored closely with neck ultrasound, thyroglobulin, and thyroglobulin antibodies. Cases of LAD caused by the COVID-19 vaccine have been reported. Common LAD sites are the ipsilateral axilla and supraclavicular lymph nodes (LN) and, less commonly, the cervical LN.

Frequency of Hypocalcemia after Thyroid Surgery

Objective: The purpose of this study is to determine the prevalence of hypocalcemia among patients after thyroid surgery. Study Design: Descriptive study/ Cross-sectional Place and Duration: The study was conducted at the surgical department of Mayo Hospital, Lahore for the duration of eighteen months from July 2020 to December 2021. Methods: Fifty-five male and female subjects participated in this research. Patients ranged in age from 17 to 62 years. After obtaining written permission from the patient, demographic information such as age, sex, BMI, and tumors type was collected. Contralateral lobe cancer was also shown to be a problem. Before surgery and on the first post-operative day, the blood calcium levels of the patients were measured. Patients who received a full thyroidectomy were evaluated for signs of hypocalcemia. Analysis was performed using SPSS 22.0. Results: Among 55 patients, majority of the cases were females 30 (54.5%) were females and the rest were males 25 (45.5%). The patients mean age was 37.16±14.52 years and had mean BMI 24.45±6.62 kg/m2. Papillary cancer was the most common tumor found in 42 (76.4%) cases, followed by follicular cancer in 9 (16.4%) case and 4 (7.3%) cases had hurthle cell carcinoma. We found frequency of hypocalcemia in 14 (25.5%) cases. Among 14 patients of hypocalcemia 10 (71.4%) were females and 4 (38.6%) were males. Retrosternal of goiter found in 5 (35.7%) cases and no retrosternal extension found in 9 (64.3%) case. Post-operative other complications among all cases were seroma, transient hoarseness of voice and neck hematoma. Conclusion: In this study we found higher frequency of hypocalcemia in 25.5% cases after thyroid surgery. Majority of the cases were females and had no retrosternal extension. Except hypocalcemia other complications among all cases were seroma, transient hoarseness of voice and neck hematoma. Keywords: Thyroid Surgery, Tumors, Complications, Hypocalcemia

Outcomes and Trends of Treatments in High-Risk Differentiated Thyroid Cancer.

To analyze the variant-specific survival benefits and usage patterns of standardized treatment combinations of surgery (S), radioactive iodine ablation (RAI), and thyroid-stimulating hormone suppression therapy (THST) for high-risk differentiated thyroid cancer. Retrospective cohort study. National Cancer Database. The 2004-2017 National Cancer Database was queried for patients receiving definitive surgery for high-risk papillary, follicular, or Hurthle cell thyroid cancer. Cox proportional hazards and Kaplan-Meier analyses assessed for treatment-associated survival. Of 21,076 cases, 18,214 underwent survival analysis with a mean ± SD age of 50.6 ± 17.1 years (71.3% female). When compared with surgery alone, S + RAI was associated with reduced mortality in papillary (hazard ratio [HR], 0.574; P < .001) and follicular (HR, 0.489; P = .004) thyroid cancer. S + RAI + THST was associated with reduced mortality in papillary (HR, 0.514; P < .001), follicular (HR, 0.602; P = .016), and Hurthle cell (HR, 0.504; P = .021) thyroid cancer. In papillary thyroid cancer, S + RAI (91.3%), S + THST (89.2%), and S + RAI + THST (92.7%) were associated with higher 5-year overall survival rates than surgery (85.4%, all P < .001). Papillary thyroid cancer treatments involving THST were associated with higher 5-year overall survival rates than corresponding regimens without THST (all P < .001). In follicular thyroid cancer, S + RAI (73.9%) and S + RAI + THST (78.7%) were associated with higher 5-year overall survival rates than surgery (65.6%, all P < .05). In Hurthle cell thyroid cancer, S + RAI (66.5%) and S + RAI + THST (73.4%) were associated with higher 5-year overall survival rates than surgery (53.7%, all P < .05). On linear regression, THST usage increased by 77.5% (R2 = 0.944, P < .001), while RAI usage declined by 11.3% (R2 = 0.320, P = .035). High-risk differentiated thyroid cancer exhibited varying susceptibilities to different treatment combinations depending on histology, with greatest responses to regimens that included RAI. Physician practices have trended toward decreased RAI and increased THST usage.