Invasive Follicular Carcinoma Research Articles

Catching the silent culprits: Prospective TERT promoter mutation screening for minimally invasive follicular and oncocytic thyroid carcinoma in clinical practice

Catching the silent culprits: Prospective TERT promoter mutation screening for minimally invasive follicular and oncocytic thyroid carcinoma in clinical practice

Preserving vocal cord function: Continuous intraoperative vagus nerve monitoring in total thyroidectomy

A 42-year-old female patient who underwent left hemithyroidectomy for a benign thyroid nodule, was referred for further management, as histology revealed a minimally invasive follicular carcinoma requiring completion thyroidectomy as recommended by Oncologists. She had developed unilateral vocal card palsy following the initial hemithyroidectomy. Pre operatively vocal cord function was evaluated by fibre optic laryngoscopy, which confirmed a left vocal cord palsy. During the completion thyroidectomy, continuous intraoperative nerve monitoring was done using an electrode attached to endotracheal tube. A delta electrode was attached to the Vagus nerve and continuous monitoring of the Vagus nerve was done while performing intermittent monitoring of the Recurrent Laryngeal nerve. Stimulation was performed using a current of 1–2 mA. According to the International Nerve monitoring Study Group (INMSG) guidelines initial amplitude value of at least 500 μV was considered as the normal value.According to INMSG guide lines, change of EMG signal curve amplitude below 100 μV was considered as loss of signal during the operation. Post-operative period of the patient was uneventful and the right vocal cord function was confirmed as normal by fibre optic endoscopic examination. Even though intraoperative nerve monitoring is a useful procedure for all the thyroidectomy surgeries it is documented to be more beneficial during revision surgeries, thyroid malignancies and pre-operative unilateral nerve palsy patients.

SAT549 False Alarm: Profoundly High Thyroglobulin Level Without Evidence Of Thyroid Malignancy

Abstract Disclosure: F.L. Thelmo: None. J. Watari: None. J.L. Miller: None. Thyroglobulin (TG) remains a clinical mainstay for monitoring of disease burden and recurrence in patients with differentiated thyroid cancer. TG levels are expected to be low to undetectable in patients who undergo total thyroidectomy and less than 30 ng/mL in patients who undergo thyroid lobectomy. We describe a case of a 52-year-old patient who underwent thyroid lobectomy for a 16 mm minimally invasive follicular thyroid carcinoma (single vessel angioinvasion) who was later found to have a TG level in excess of 2,000 despite no signs of metastatic disease. A 52-year-old male with past medical history of prediabetes and minimally invasive follicular thyroid cancer presented for follow-up after right lobectomy five years prior. The patient was lost to follow-up after his lobectomy. During work-up of paresthesias, a cervical spine MRI incidentally noted a 41 mm enhancing mass in the left thyroid lobe. The patient had a TSH of 1.1 mIU/L. A dedicated thyroid ultrasound was performed which found a left 2.9 cm TI-RADS 3 nodule which was biopsied and found to be benign (Bethesda II). TG level was obtained and found to be significantly elevated at 2,479.9 ng/mL with negative thyroglobulin antibodies. This was repeated twice with subsequent levels being 1,857.5 ng/mL and 2,555.1 ng/mL. TG antibodies remained undetectable throughout the clinical course. The patient had a CT chest, abdomen, and pelvis exam for which no signs of metastatic disease were detected. A skeletal survey was performed which showed no evidence of metastatic disease. The patient elected for a completion thyroidectomy to ensure there was no undetected malignancy. The patient underwent successful completion thyroidectomy. Surgical pathology showed benign nodular hyperplasia. The patient was started on replacement levothyroxine and one month later the TG level became undetectable. We would like to draw attention to this patient’s profoundly high TG levels which are normally associated with recurrence of thyroid malignancy or large goiter. After comprehensive evaluation this patient was found to have no underlying disease recurrence. A completion thyroidectomy showed no malignancy within remnant thyroid tissue or adjacent lymph nodes and repeat TG level was undetectable after completion showing that native thyroid tissue had significantly high TG production without underlying disease. We believe his remaining relatively normal thyroid lobe was a super producer of thyroglobulin. Despite TG being a sensitive marker for residual thyroid tissue and disease, the standard cut-off for lobectomy must be used with caution and may not apply to every patient. Presentation Date: Saturday, June 17, 2023

The histologic outcomes of indeterminate thyroid nodules with rat sarcoma mutations: A case series.

Molecular testing is an adjunct test for thyroid fine needle aspirations with indeterminate diagnoses, with certain mutations showing a greater risk of malignancy (ROM). Rat sarcoma (RAS) point mutations are the most common alterations in indeterminate thyroid nodules. While they can have a high ROM, they are also found in benign disease. This study describes the histologic outcomes of indeterminate nodules with RAS mutations. Bethesda III and IV thyroid nodules with ThyroSeq results showing RAS mutations (NRAS, KRAS, and HRAS) were identified between November 1, 2018 and February 28, 2023. Baseline patient characteristics, ThyroSeq results, and surgical diagnoses were collected. We identified 18 nodules with RAS mutations from 17 patients. Fourteen were NRAS (isolated NRAS in 6; NRAS with other abnormalities [NRAS+] in 8); one was isolated KRAS; and three were HRAS with other abnormalities (HRAS+). NRAS Q16R was the most common amino acid change. Twelve cases had follow-up. Two were malignant, a minimally invasive follicular carcinoma (NRAS+) and a papillary thyroid carcinoma, follicular variant (HRAS+). Three were noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), 2 HRAS+ and 1 NRAS+. Four were follicular adenomas, one being atypical (3 NRAS+ and one isolated NRAS). One was an oncocytic adenoma (isolated NRAS). Two were nodular hyperplasias (isolated NRAS and NRAS+, respectively). Twenty-eight percent of our RAS-mutated nodules were malignant or NIFTP. All three HRAS-mutated nodules were malignant or NIFTP. The three isolated RAS mutations with follow up were benign (adenomas or nodular hyperplasia). These findings were in line with the literature.

New Insights on the Importance of the Extent of Vascular Invasion in Widely Invasive Follicular Thyroid Carcinoma.

This study aimed to investigate the association between the extent of vascular invasion (VI) and the outcome of widely invasive follicular thyroid carcinoma (WI-FTC). The records of 107 patients with WI-FTC confirmed by surgical specimens from January 2005 to December 2016 were retrospectively reviewed. Among the 107 patients with WI-FTC, those with a VI of < 4 (n = 62) and ≥ 4 (n = 45) had a 10year cause-specific survival (CSS) rate of 97.7% and 89.4% (p = 0.008), respectively. Univariate analysis identified M1 (p = 0.001), and the number of VI of ≥ 4 as significant negative prognostic factors for CSS. Multivariate analysis identified M1 (hazard ratio [HR] = 9.366) as independent negative prognostic factor for CSS. Among the 72 patients with M0 WI-FTC, those with a VI of < 2 (n = 33) and ≥ 2 (n = 39) had a 10-year distant metastasis-free survival (DMFS) rate of 96.8% and 56.8% (p = 0.001), respectively. Univariate analysis identified age ≥ 55years (p = 0.011), presence of VI, the number of VI of ≥ 2, and resection margin status (p < 0.001) as significant negative prognostic factors for DMFS. Multivariate analysis identified the number of VI ≥ 2 (HR = 9.137), and resection margin status (HR = 5.853) as independent negative prognostic factors for DMFS. It may be unnecessary that WI-FTC with curative resection margin status and a VI of < 2, especially in capsular invasion only, routinely undergo completion thyroidectomy and postoperative ablation.

Widely invasive follicular thyroid carcinoma. A case report

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

TERT Promoter Mutation as a Prognostic Marker in Encapsulated Angioinvasive and Widely Invasive Follicular Thyroid Carcinomas

Clinical ThyroidologyVol. 35, No. 5 Thyroid CancerTERT Promoter Mutation as a Prognostic Marker in Encapsulated Angioinvasive and Widely Invasive Follicular Thyroid CarcinomasYasuhiro Ito and Takashi AkamizuYasuhiro Ito Department of Surgery, Kuma Hospital, Kobe, Hyogo, JapanSearch for more papers by this author and Takashi Akamizu Department of Internal Medicine, Kuma Hospital, Kobe, Hyogo, JapanSearch for more papers by this authorPublished Online:12 May 2023https://doi.org/10.1089/ct.2023;35.202-204AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 35Issue 5May 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Yasuhiro Ito and Takashi Akamizu.TERT Promoter Mutation as a Prognostic Marker in Encapsulated Angioinvasive and Widely Invasive Follicular Thyroid Carcinomas.Clinical Thyroidology.May 2023.202-204.http://doi.org/10.1089/ct.2023;35.202-204Published in Volume: 35 Issue 5: May 12, 2023PDF download

Thyroid follicular carcinomas: current state of the problem and long-term results of treatment

Thyroid follicular tumors remain a difficult category for both cytological and histological diagnosis, due to the lack of reliable cellular signs of malignancy. An important innovation of the 2022 classification is the appearance of a whole group of low‑risk thyroid neoplasms, which took an intermediate place between the groups of benign and malignant neoplasms. Despite the success of cytological diagnosis of thyroid neoplasms, there are unresolved issues related to the diagnosis of follicular neoplasias, which are considered a «gray zone» of cytological diagnosis.&#x0D; Objective — to perform a retrospective analysis of the long‑term results of diagnosis and surgical treatment of patients with thyroid follicular carcinoma.&#x0D; Materials and methods. The research material was the results of treatment of 113 patients who were operated on in the surgical clinic of the V.Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Sciences of Ukraine due to the thyroid follicular carcinoma. All patients had a pre‑operative cytological conclusion from the Institute's laboratory and were observed by specialists for at least five years (maximal term 35 years).&#x0D; Results. Bethesda group IV («follicular neoplasia») was established in 24.8% of cases. A cytological conclusion about a malignant process (Bethesda VI) or a suspicion of it (Bethesda V) was established in 27.4% (15% and 12.4%, respectively). In 41.6% of cases, the Bethesda II group («benign process») was determined, i.e., there were no doubts about the benign nature of the formation at all. According to the final pathological diagnosis, 8 cases were classified as widely invasive follicular carcinoma, 15 were classified as angioinvasive, and 90 were minimally invasive. The combination of signs of thyroid carcinoma with papillary carcinoma was indicated in 5 cases, 4 of them were present in the presence of minimally invasive carcinoma, in one case — widely invasive. In general, the obtained data indicated a favorable prognosis of minimally invasive follicular carcinomas and allowed to confirm the opinion that in general they do not require radioiodine therapy. The performance of definitive thyroidectomy concluded to be debatable.&#x0D; Conclusions. The obtained results have shown that thyroid cancer remains difficult to diagnose and predict, but in the most cases, it is effectively cured. In the past decades, the attitude towards all follicular carcinomas was more «aggressive», which needs to be revised in view of new data and corresponds to modern world trends.

Follicular Thyroid Carcinoma Presenting with A Hyperfunctioning Nodule in An Adolescent Girl

Background: Follicular thyroid carcinoma is rare in young patients and further diagnostic challenge is added when it presents as a hyperfunctioning thyroid nodule. Case report: We described a 14-year-old girl who presented with thyrotoxicosis and a large goitre associated with compressive symptoms. Thyroid scintigraphy demonstrated a solitary autonomous hyperfunctioning thyroid nodule. FNAC examination was not suggestive of malignancy. Thyrotoxicosis was controlled with carbimazole and a hemithyroidectomy was done. Histopathological examination revealed minimally invasive follicular thyroid carcinoma, following then, complete thyroidectomy was done. Discussion: This patient’s risk factors of malignancy were her age (young), gender (female), large nodule size, progressive growth, and compressive symptoms. This case illustrates the limitation of FNAC to ascertain malignancy in patients with large AFTN as the initial FNAC report was consistent with a benign lesion. Surgical resection without prior FNAC should be considered for cases with hyperfunctioning thyroid nodule which then would allow timely histologic analysis and accurate diagnosis. Conclusion: Autonomous functioning nodules in children and adolescents warrant careful evaluation to exclude malignancy. Our case illustrated the challenges to discriminate between malignant and benign lesions preoperatively for children and adolescents who present with AFNT.

Pros and cons of an aggressive initial treatment with surgery and radioiodine treatment in minimally invasive follicular thyroid carcinoma

BackgroundCurrently, surgery alone is the gold standard treatment for minimally invasive follicular thyroid cancer (mi-FTC).Case presentationA case of a mi-FTC diagnosed in 1994 was treated with total thyroidectomy and radioiodine (RAI) ablation, according to the therapeutic algorithm used at that time. Nevertheless, he had a recurrence with distant metastasis after 24 years from the initial treatment.ConclusionTotal thyroidectomy and RAI ablation might have delayed the development of distant metastasis but they were not sufficient to avoid disease recurrence. Certainly, remnant ablation simplified the follow-up and the monitoring of serum thyroglobulin allowed the early detection of the biochemical recurrence, but didn’t change the outcome of the disease. Moreover, because of this early detection the patient was exposed to useless biochemical and imaging examinations. The aim of this report is to discuss the pros and cons of an aggressive treatment of a patient with mi-FTC.

What is the contribution of tumor capsule thickness and tumor nucleus diameter to differential diagnosis in encapsulated variant thyroid papillary carcinomas?

Objective: Capsule thickness and papillary carcinoma nuclear features are common diagnostic criteria for invasive follicular variant papillary thyroid carcinoma (IEFVPTC), non-invasive follicular thyroid neoplasm with papillary nuclear features (NIFT-P), and encapsulated papillary thyroid carcinoma (E-PTC). Our goal in this study is to evaluate these two histomorphological criteria using computerized image analysis systems and to determine whether they can serve as auxiliary criteria for distinguishing these diagnostic groups. Materials and methods: 10 patients were selected from IEFVPTC, NIFT-P, and E-PTC diagnostic groups. Slides containing the largest tumor diameter were scanned and digitized. Using computerized image analysis systems, tumor capsule thickness was measured from 4 areas of 4 equal quadrants, and the average tumor capsule thickness (TCT) was determined. Furthermore, from these 4 equal quadrants, the nucleus diameter of 10 clearly distinguishable cells was measured to determine the average tumor cell nucleus diameter (ND). Results: TCT and ND histomorphological criteria were statistically significant among the diagnostic groups. For IFVPTC diagnosis, both TCT and ND were found to be significant diagnostic tools. We demonstrated that ND can easily be used as a diagnostic tool for NIFT-P, whereas more caution is required for TCT. Conclusion: Differentiating papillary nuclear feature-containing follicular variant thyroid papillary carcinomas is challenging. In this study with a limited number of patients, we demonstrated that the TCT and ND criteria can, to some extent, contribute to differential diagnosis between diagnostic groups. Future studies with larger patient groups and more advanced computerized image analysis programs will yield more promising results.

Psammomatous calcifications in thyroid oncocytic (Hürthle cell) follicular tumors

Concentric calcifications, also known as psammoma bodies, are a relatively frequent finding in certain types of tumors, particularly papillary thyroid carcinoma (PTC). In the thyroid, they have been assigned a significant role in the diagnosis of PTC and in distinguishing between these tumors and other types of thyroid neoplasms. Concentric calcifications have also less commonly been noted in other processes in the thyroid, such as in tumors characterized by cells containing abundant oxyphilic cytoplasm (i.e., Hürthle cells). We have studied 12 patients with oncocytic thyroid follicular tumors that contained scattered psammomatous calcifications that led to difficulties in diagnosis. The patients were 9 women and 3 men, aged 34 to 63 years. 10 cases corresponded to benign, non-invasive oncocytic tumors and 2 cases were minimally invasive follicular carcinomas of oncocytic (so called Hürthle cell) type. The psammomatous calcifications were randomly scattered throughout the lesions and were present as a focal, incidental finding in 8 cases and were diffuse in 4 cases. They were composed of concentrically laminated deposits of dense basophilic material closely resembling psammoma bodies, often associated with more homogeneous deposits of lightly eosinophilic material without concentric lamination that were interpreted as precipitated thyroglobulin. Seven patients with clinical follow-up, including one with minimally invasive carcinoma, were alive and well between 5 and 12 years after diagnosis. Concentric laminated calcifications may be encountered in oncocytic (Hürthle cell) follicular tumors and should not be interpreted as indicative of PTC in the context of oncocytic neoplasms of the thyroid.

PSAT382 Characterization of Ultrasound and Cytological Features Identifying Thyroid Nodules with Aggressive Behavior: From Histology to Clinic

Abstract Fine-Needle Aspiration Biopsy (FNAB) guides surgical treatment of thyroid nodules which, according to the Italian classification, are classified as TIR 1/1C, TIR 2, TIR 3A, TIR3B, TIR4 or TIR5, which correspond to Thy I, Thy II, Thy III, Thy IV, Thy V and Thy VI categories of the Bethesda System. TIR 3 identifies the follicular pattern, which is typical of both benign and malignant lesions. Surgery is usually recommended for TIR 3B, TIR 4 and TIR 5 nodules. The latest histopathological classifications of thyroid cancers have introduced significant changes. While the follicular (FV-PTC) and classical variants (CV-PTC) of papillary thyroid carcinoma and the minimally invasive follicular thyroid carcinoma (FTC) are characterized by a good prognosis and require a less aggressive treatment, the poorly differentiated thyroid carcinoma (PDTC), the anaplastic thyroid carcinoma (ATC), the tall cell (TC-PTC) and the solid variants (SV-PTC) and other variants have a worse prognosis. In addition, thyroid ultrasound often identifies thyroid nodules &amp;lt;1 cm, which are usually characterized by an indolent behavior and active surveillance may be advised. We retrospectively analyzed consecutive histopathological records of 1117 patients (for a total of 1668 nodules, of which 650 malignant) who underwent surgery in 2017, and who had previously undergone FNAB and thyroid ultrasound (available for 390 nodules), in order to characterize echographic and cytological features useful to identified aggressive variants among TIR4-5 nodules and malignant lesions among TIR3B nodules. Of the 566 PTC, 18.7% were TIR3A, 20.7% TIR 3B and 51.6% TIR4-5, while of 50 FTC 42.0% were TIR3A, 42.0% TIR3B and 6.0% TIR4-5. Of the 11 PDTC 54.5% had been diagnosed as TIR 3B. Of the 249 classic variant of PTC, 0.8% had resulted TIR3A, 14.1% TIR3B and 79.9% TIR4-5. Among 49 tall cell variant, none had resulted TIR3A, 2% had been diagnosed as TIR3B and 95.9% as TIR4-5. Of the 219 follicular variant of PTC 42.0% had resulted TIR3A, 39.7% TIR3B and 12,3% TIR4-5. Among 34 SV-PTC, 32.4% had been diagnosed as TIR3A, 41.2% TIR3B and 0.6% TIR4-5. Blurred margins were the only feature associated with malignancy (p=0.034) in TIR3B nodules. The coexistence of hypoechogenicity and blurred margins in absence of microcalcifications were more common in tall cell variant (7/28) compared to classic variant (10/120) of PTC (p= 0.021). A significant number of PDTC and SV-PTC were diagnosed as TIR3. Among TIR3B nodules, irregular margins correlate with malignancy. Coexistence of irregular margins with a hypoechoic pattern in absence of microcalcifications is helpful in identifying TIR4/TIR5 nodule which turn out TC-PTC. In conclusion, among TIR3B, TIR4 and TIR5 nodules, ultrasound helps to identify aggressive variants and therefore to choose the extent of surgical treatment and, when &amp;lt;1 cm, to confidently advise active surveillance. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma.

Encapsulated angioinvasive follicular thyroid carcinoma (EAFTC) is associated with an increased risk of distant metastasis and reduced survival compared to minimally invasive follicular thyroid carcinoma (MIFTC). There is controversy regarding the extent of surgery and adjuvant radioactive iodine therapy for angioinvasive follicular thyroid carcinoma when stratified by number of foci of angioinvasion. All follicular thyroid carcinoma cases from 1990-2018 were identified from a thyroid cancer database. Primary outcomes were distant metastasis-free survival (DMFS) and disease-specific survival (DSS) with factors of interest being age, gender, tumour size, treatment, foci of angioinvasion and histological subtype. A total of 292 cases were identified; 139 MIFTC, 141 EAFTC and 12 widely invasive follicular thyroid carcinoma (WIFTC). Over a follow-up period of 6.25years, DMFS was significantly reduced (p < 0.001) with 14.2% (EAFTC) and 50% of WIFTC developing metastasis. The risk of metastasis in EAFTC with ≥ 4 foci of angioinvasion was 31.7% (HR = 5.89, p = 0.004), 6.3% for EAFTC with < 4 foci of angioinvasion (HR = 1.74, p = 0.47), compared to 3.6% MIFTC. Age ≥ 50years (HR = 4.24, p = 0.005) and tumour size (HR = 1.27, p = 0.014) were significantly associated with increased risk of distant metastasis. DSS was reduced significantly (p < 0.001), with 7.8% EAFTC patients dying of disease. For EAFTC patients, DSS was 96.8% for < 4 foci and 82.6% for ≥ 4 foci of angioinvasion (p = 0.003). EAFTC is at increased risk of distant metastasis related to the extent of angioinvasion. Tumours with < 4 foci of angioinvasion should be considered for a total thyroidectomy, particularly in older patients.

Molecular Pathological Characteristics of Thyroid Follicular-Patterned Tumors Showing Nodule-in-Nodule Appearance with Poorly Differentiated Component.

Simple SummaryPoorly differentiated thyroid carcinoma (PDTC) is aggressive and is reportedly evoked by well-differentiated thyroid follicular-patterned tumors (TFTs). TFTs showing nodule-in-nodule (NN) appearance with PD component (PDc) but neither invasion nor metastasis are uncommon and are regarded as benign nodules despite their high-grade histological features. Our study aimed to preliminarily assess the potential role of PDc in NN in PDTC carcinogenesis using dual-color immunofluorescence of 53BP1 as a DNA damage response (DDR) molecule and the Ki-67, NRAS codon 61, and TERT-promoter (TERT-p) mutations. The prevalence of abnormal type 53BP1 expression and NRAS and TERT-p mutations in PDc was comparable to that of carcinomas. Because co-expression of 53BP1 and Ki-67 can be an indicator of altered DDR, the development of PDc in NN may be associated with DDR impairments after harboring NRAS and TERT-p mutations. Therefore, PDc in NN is potentially a precursor lesion associated with PDTC.Thyroid follicular-patterned tumors (TFTs) showing nodule-in-nodule (NN) appearance with poorly differentiated component (PDc) but neither invasion nor metastasis are diagnosed as benign nodules. Although PDc exhibits histologically aggressive features relative to the outer nodule (Out-N), its pathological significance remains unclear. TP53 binding protein-1 (53BP1) is a DNA damage response (DDR) molecule that rapidly localizes at DNA double-strand breaks. Using dual-color immunofluorescence with Ki-67, the profile of 53BP1 expression is shown to be significantly altered during diverse tumorigenesis. In this study, we aimed to elucidate the malignant potential of PDc at the molecular level. We analyzed the profile of 53BP1 expression and NRAS codon 61 and TERT-promoter (TERT-p) mutations in 16 cases of TFTs showing NN with PDc compared to 30 adenomatous goiters, 31 follicular adenomas, 15 minimally invasive follicular carcinomas (FCs), and 11 widely invasive FC cases. Our results revealed that the expression level of abnormal type 53BP1 and incidence of NRAS and TERT-p mutations in PDc were comparable to FCs, suggesting a malignant potential. Because co-expression of 53BP1 and Ki-67 can be an indicator of altered DDR, the development of PDc in NN may be associated with DDR impairments after harboring NRAS and TERT-p mutations.

Molecular testing in the diagnosis and management of thyroid malignancy: a feasibility study

Abstract Background NHS England’s reorganization of genomic testing has provided an opportunity to explore molecular testing as part of thyroid nodule diagnostics and the routine postoperative histology. Aim Routine molecular testing in an NHS service has not previously been explored. This study aims to evaluate whether (1) there is sufficient material to perform this on an FNAC in cytologically indeterminate nodules (2) what the yield is from indeterminate nodules (3) whether post-operative testing is feasible and (4) whether management is altered. Methods This in an ongoing feasibility study in a UK tertiary institution commenced in January 2021. Data until May in presented. Two groups are enrolled: those with indeterminate pre-operative cytology and those who have undergone thyroidectomy for malignancy. FNAC samples were sent for a routine panel including BRAFv600e, H-K-NRAS and histology for TP53, RET and NTRK in addition. Results Out of 30 patients with indeterminate cytology, molecular testing was requested in eight. The material was insufficient for added molecular testing in six and the panel of mutations tested was negative in two. Thirty-one patients underwent thyroidectomy for malignancy and 11 surgical specimens underwent molecular testing. Mutations were detected in 54.5%(n=6). BRAFv600e mutation was found in four specimens with PTC, whereas NRAS mutation was detected in one Hobnail variant of PTC and one minimal invasive follicular carcinoma. Conclusion Addition of molecular testing to preoperative cytology was shown to require a further FNAC in a majority of cases. In postoperative specimens, molecular testing is feasible but further follow-up is required to determine whether clinical management is altered.

Hemithyroidectomy vs. total thyroidectomy for minimally invasive follicular thyroid carcinoma: Quality of life and oncological outcomes

AbstractAimTo evaluate outcomes of patients following hemithyroidectomy (HT) vs. total thyroidectomy (TT) for minimally invasive follicular thyroid carcinomas (MI‐FTCs).Patients and MethodsThis is a retrospective analysis of 82 patients with unilateral MI‐FTC that was conducted for cases operated between April 2015 and April 2019. A total of 42 and 40 patients were included in the HT and TT groups, respectively. The main outcomes were survival, metastasis and recurrence rates; procedure‐related complications and quality of life (QoL) 1 year after thyroidectomy.ResultsMean follow‐up 36.3 ± 11.8 months; TT rendered significantly more complications. No recurrences, distant metastases or disease‐specific deaths were observed in either group. Overall survival in the HT vs. TT group was 40/42 (95.2%) vs. 37/40 (92.5%), with P = .570. QoL was better in 5/8 SF‐36v2 items in HT with no superiority for mean collective scores.ConclusionsHT has less morbidity and comparable survival, metastasis, recurrence and QoL with TT for MI‐FTC. HT might be considered as a first‐line option in the low‐risk subgroup of MI‐FTC; however, further research is needed to establish the ideal individualised approach.

Case report of delayed metastasis from thyroid micropapillary carcinoma to the deltoid muscle in a patient with thyroglobulin elevated negative iodine scintigraphy (TENIS)

Differentiated thyroid cancers are common but distant metastasis to the muscles is rare. We present a case of 64-year-old male who underwent thyroidectomy for a suspicious thyroid lesion. His histopathology was reported as widely invasive follicular carcinoma of the thyroid with a focus of micropapillary carcinoma (MPC). He underwent radioiodine ablation. On follow-up, he had a serial increase in thyroglobulin but a whole-body radioiodine scan failed to detect any lesion. An 18-fluorodeoxyglucose positron emission tomography (PET)-computed tomography scan picked up a lesion in the left deltoid muscle. An intraoperative ultrasound localization was done and the nonpalpable lesion was successfully removed surgically. The deltoid lesion was a delayed metastasis of a thyroid MPC. A rising thyroglobulin level in a patient with negative iodine scintigraphy warrants further evaluation with PET since rare distant metastasis may be present. A surgeon performing intraoperative ultrasound is useful in effectively identifying and removing occult lesions with small incisions.

Is there an indication for thyroidectomy in cases of minimally invasive follicular thyroid carcinoma?

Is there an indication for thyroidectomy in cases of minimally invasive follicular thyroid carcinoma?

Periostin expression and its supposed roles in benign and malignant thyroid nodules: an immunohistochemical study of 105 cases

BackgroundThyroid tumors are often difficult to histopathologically diagnose, particularly follicular adenoma (FA) and follicular carcinoma (FC). Papillary carcinoma (PAC) has several histological subtypes. Periostin (PON), which is a non-collagenous extracellular matrix molecule, has been implicated in tumor invasiveness. We herein aimed to elucidate the expression status and localization of PON in thyroid tumors.MethodWe collected 105 cases of thyroid nodules, which included cases of adenomatous goiter, FA, microcarcinoma (MIC), PAC, FC, poorly differentiated carcinoma (PDCa), and undifferentiated carcinoma (UCa), and immunohistochemically examined the PON expression patterns of these lesions.ResultsStromal PON deposition was detected in PAC and MIC, particularly in the solid/sclerosing subtype, whereas FA and FC showed weak deposition on the fibrous capsule. However, the invasive and/or extracapsular regions of microinvasive FC showed quite strong PON expression. Except for it, we could not find any significant histopathological differences between FA and FC. There were no other significant histopathological differences between FA and FC. Although PDCa showed a similar PON expression pattern to PAC, UCa exhibited stromal PON deposition in its invasive portions and cytoplasmic expression in its carcinoma cells. Although there was only one case of UCa, it showed strong PON immunopositivity. PAC and MIC showed similar patterns of stromal PON deposition, particularly at the invasive front.ConclusionsPON may play a role in the invasion of thyroid carcinomas, particularly PAC and UCa, whereas it may act as a barrier to the growth of tumor cells in FA and minimally invasive FC.