Malignant Thyroid Research Articles

Survival Analysis of Anaplastic Thyroid Carcinoma With Various Therapeutic Modalities: Twenty-Seven Years' Experience in a Single Cancer Center.

Anaplastic thyroid carcinoma (ATC) is the most aggressive thyroid gland malignancy. Several consensuses support the concept of multimodal therapy that combines surgery, radiation, chemotherapy, and targeted therapy. However, patient's comorbidity, poor performance status, and metastasis often make it impossible for patients to undergo multimodal therapy. Therefore, this study aimed to evaluate the survival analysis of ATC patients with different therapeutic modalities. This study was a retrospective cohort study using data from the Cancer Registry in our institution. All patients with ATC who visited Prof Ngoerah Hospital between 1998 and 2024 were included in this study. Data regarding the survival duration of patients who received treatment modalities, and clinical data were analyzed using SPSS 20.0 with Kaplan-Meier and log-rank tests. Forty-two subjects with ATC were included in the analysis, of which 57.1% were female, with a mean age of 62.57 ± 13.42 years old. The median survival is 27.5 days. This study found no association between survival time and clinical characteristics of the patients (P > 0.05). This study found that patients who received combination therapy such as surgery + chemotherapy/radiotherapy (RT) had a longer survival time (64 days), compared to other patients who received surgery only (26 days), chemotherapy/RT only (49 days), or patients who died before receiving any therapy (19 days). However, the log-rank test showed that it was not statistically different (P > 0.05). ATC survival rates have remained low, and aggressive strategies are still needed to improve the prognosis.

Prevalence of extracolonic malignancies in patients with familial adenomatous polyposis.

103 Background: Familial adenomatous polyposis (FAP) is an autosomal-dominant inherited colorectal cancer syndrome resulting from mutations in the adenomatous polyposis coli ( APC ) gene. Patients with FAP have nearly 100% lifetime risk of colorectal cancer, typically managed with prophylactic colectomies. As patient survival has improved, the incidence of extracolonic tumors, including thyroid malignancies and desmoid tumors, has increased. However, limited research exists on the prevalence of extracolonic malignancies in FAP patients. Methods: We prospectively enrolled 219 patients with FAP in the Hereditary Gastrointestinal Cancers Cohort at the MD Anderson Cancer Center between December 2015 and July 2024. Inclusion criteria included either a clinical or molecular diagnosis of FAP. Data on demographics, cancer history (including cancers diagnosed both prior to and during the study period), BMI, tobacco use, medications, endoscopy results, thyroid ultrasound findings, and abdominal/pelvic CT results were collected. Screening for thyroid and desmoid tumors was provider-dependent, with additional screenings as deemed appropriate. Descriptive and inferential statistics were used to identify associations between demographic and clinical factors and the prevalence of extracolonic malignancies. Results: Among 219 patients, 20.5% developed desmoid tumors, 18.7% developed colorectal cancer, and 6.8% developed well-differentiated thyroid cancer (6.4% papillary thyroid cancer, 0.4% follicular thyroid cancer). Prophylactic colorectal surgery was performed in 151 patients (68.9%). Per chart review, benign thyroid disease and hypothyroidism were present in 21% and 11.4% of patients, respectively. Female sex was significantly associated with hypothyroidism (p=0.007) and thyroid cancer (p=0.009). BMI > 30 was also linked to increased thyroid cancer risk (p=0.046). Desmoid tumors were found in 20.5% of patients, most commonly in the abdominal wall. Female sex, BMI > 30, and history of colorectal surgery were significantly associated with desmoid tumor development (p=0.004, 0.0064, 0.0038). Conclusions: FAP patients exhibit a higher prevalence of benign thyroid disease, thyroid cancer, and desmoid tumors compared to the general population. Given these findings, adherence to existing surveillance guidelines, such as those outlined by the National Comprehensive Cancer Network (NCCN), is essential. Our findings further support the importance of these established surveillance strategies in the management of FAP patients.

Cribriform morular thyroid carcinoma: a case report of a rare thyroid malignancy

Cribriform morular thyroid carcinoma: a case report of a rare thyroid malignancy

Immune cells in thyroid adenoma and carcinoma: uncovering a hidden value of assessing tumor-host interplay and its potential application in thyroid cytopathology

IntroductionAlthough the role of tumor immune microenvironment (TIME) in thyroid cancer is well established, little data exists about the differences in immune cell presence in thyroid adenomas and carcinomas. We assume that immune cell density could be an additional diagnostic criterion for differentiating benign and malignant tumors in thyroid aspirates.AimThe current study compared the immune contexture of thyroid adenoma (TA) and thyroid carcinoma (TC) in histological and cytological specimens of III-V categories.Materials and methodsThis pilot study included 72 cases (36 of TA and 36 of TC) with verified histological diagnosis and pre-operative cytology corresponding to categories III, IV and V according to the Bethesda system for reporting thyroid cytology. The number of CD8+, CD68+ and CD163+ cells was assessed in histological samples of TA and TC with further comparison to cytological specimens. Besides, the expression of STAT6 and SMAD4 as potential regulators of TIME was evaluated in the study.ResultsTC demonstrated an immune-rich profile representing abundant tumor-associated CD8+ lymphocytes, CD68 and CD163+ macrophages. In contrast, TA represented mostly a low immune cell infiltration. The higher immunogenicity of TC was accompanied by the more profound expression of STAT6 and SMAD4 in tumor cells. The number of immune cells in cytological specimens correlated with CD8+ (r = 0.693; p < 0.001) and CD163+ cells (r = 0.559; p < 0.001) in histological samples, reflecting the differences in the tumor immune microenvironment between benign and malignant thyroid neoplasms.ConclusionTC demonstrated high immunogenicity compared to TA, which correlated to the number of immune cells in cytological specimens. The number of immune cells in thyroid cytology samples could be an additional criterion in cytological diagnostics for III-V Bethesda categories. Further investigations are needed to validate the findings of the study.

Current and Emerging Radiotracers and Technologies for Detection of Advanced Differentiated Thyroid Cancer: A Narrative Review

Differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancers, differs significantly in pathology compared to other thyroid malignancies such as medullary thyroid cancer (MTC), anaplastic thyroid cancer (ATC), and Hurthle cell carcinoma [...]

P-59 A CASE REPORT: A RARE CASE OF PAPILLARY THYROID CARCINOMA WITH BRAIN METASTASIS WITHOUT LOCAL RECURRENCE

Abstract Introduction Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy and generally has an excellent prognosis. However, distant metastases, particularly to the brain, are rare and associated with poor outcomes. This case report presents a 67-year-old female patient with a history of PTC, who developed brain metastasis in the follow-up. Clinical Case A 67-year-old female patient presented four years ago with a rapidly growing 4 cm mass, extending from the right thyroid gland to the right jugular vein. Fine-needle aspiration biopsy (FNAB) of the lesion was reported as suspicious for follicular neoplasm. Ultrasound imaging revealed pathological lymphadenopathy in the bilateral cervical chains. The patient underwent total thyroidectomy and bilateral neck dissection. Pathology confirmed the diagnosis of the follicular variant of papillary thyroid carcinoma (PTC), with extrathyroidal extension into muscle and adipose tissue, as well as lymph node metastases. After surgery, while the patient's TSH level was 68.6 µIU/ml, her thyroglobulin (Tg) level was 1.02 ng/ml, with negative anti-Tg antibodies. The patient received 150 mCi of radioactive iodine (RAI) approximately 3 months after surgery. One year after RAI therapy, a whole-body iodine scan showed no evidence of residual disease or metastasis. Follow-up Tg levels of the patient remained around 0.04 ng/ml. 3.5 years after surgery, there was a slight increase in thyroglobulin levels (0.26 ng/ml), although no recurrent disease was detected on ultrasound of the thyroid bed. The patient was planned to be under close surveillance but she did not come to visits regularly. The patient subsequently presented with complaints of imbalance and brain MRI revealed a mass lesion measuring 46x43x55 mm in the frontal region. The mass was surgically resected, and the pathology confirmed metastatic papillary thyroid carcinoma (PTC). A postoperative whole-body iodine scan was negative for metastatic disease. At that time, the TSH level was 0.5 µIU/ml, and thyroglobulin (Tg) was 0.04 ng/ml. Cranial radiotherapy was planned for the patient. Conclusion Approximately 10% of patients with PTC develop distant metastases, most commonly to the lungs and bones. Brain metastasis from PTC is extremely rare, occurring in less than 1% of cases. Due to its rarity, brain metastasis from PTC is not typically considered in the differential diagnosis for patients presenting with new neurological symptoms, potentially delaying diagnosis. Despite aggressive treatment, the prognosis for patients with PTC and brain metastasis remains poor, with a median survival of approximately 17 months. This case highlights the importance of considering the possibility of brain metastasis in high-risk PTC patients who present with neurological symptoms despite the lack of significant elevation in thyroglobulin (Tg) levels or evidence of recurrence on neck ultrasound.

Primary Thyroid Lymphoma: A Case Report

Background. Primary thyroid lymphoma (PTL) is a rare thyroid gland malignancy. In addition to airway compression symptoms and signs, which are the most common clinical findings, PTL may present with hypothyroidism or B symptoms of lymphoma, including night sweats, weight loss, and fever. Hashimoto thyroiditis is considered a significant risk factor and the most important underlying cause of PTL. Treatment options for PTL include chemotherapy, radiotherapy, and surgery. In this study, we present a patient who exhibited airway compression symptoms and was treated via total thyroidectomy. Case Report. A 62-year-old woman presented with complaints of weakness and fatigue lasting for approximately four years. The thyroid gland appeared enlarged on inspection and firm on palpation. The patient was diagnosed with hypothyroidism, characterized by elevated autoimmune antibody levels. Ultrasound imaging revealed thyroid enlargement with parenchymal heterogeneity. Despite achieving euthyroidism through thyroid hormone replacement therapy, thyroid enlargement and ultrasound features persisted during follow-up, accompanied by ongoing complaints of neck pain and redness. On magnetic resonance imaging, the thyroid gland appeared markedly enlarged with abnormal superior and inferior extensions. Due to the rapid, diffuse growth of the goitre, the patient underwent bilateral total thyroidectomy. She was discharged on the first postoperative day after an uneventful recovery. In her postoperative first-week follow-up, she reported no complaints and was doing well. Following the histopathological diagnosis of B-cell marginal zone lymphoma, the patient was referred to the Department of Hematology, and a close follow-up was arranged. At her postoperative ninth-month follow-up, she remains asymptomatic and recurrence-free. Conclusions. Thyroid lymphoma can present with rapid growth in the thyroid gland. In addition to chemotherapy and radiotherapy, surgery may be indicated in cases with symptoms and signs of airway compression.

Natural History and Long Term Follow-Up of Incidental Thyroid Nodules on Computed Tomography Imaging.

incidental thyroid nodules (ITNs) are found in up to 25% of CT scans. Increased use of cross-sectional imaging has contributed to the increased incidence of thyroid cancer worldwide. ITNs pose a management dilemma since nodule malignancy rate is 5-15% but most cancers are indolent and prognosis in differentiated thyroid cancer is excellent. Study aims are to determine prevalence of ITNs ≥1 cm on CT scans, evaluate reporting practices, assess for emergence of clinically evident thyroid cancer during 13-year follow-up and assess interim nodule growth and clinical outcomes in nodules that were further investigated. direct image review of 1499 consecutive CT scans that included the thyroid, performed during January 2009 in a large NHS health board was performed. Clinical data up to January 2022 was analysed in 150 patients with at least one ITN > =1cm. ITN prevalence was 11% with mean patient age 70 years and mean nodule diameter 17.5 mm. 30% of ITNs were mentioned in the CT report. During the follow-up period 11% proceeded to thyroid ultrasound, 5% fine needle aspiration and 2% diagnostic hemithyroidectomy with no thyroid malignancy found. 120 patients (80%) were deceased by the study endpoint, none from thyroid malignancy. No patients presented with clinically evident thyroid malignancy during follow-up. None of150 ITN cases developed clinically evident thyroid malignancy in a 13-year follow-up period with 80% of patients deceased by the study endpoint from non-thyroid causes. This would suggest that ITNs detected on CT do not require further investigation unless malignant appearances or significant clinical concern for thyroid malignancy.

Multicenter Retrospective Analysis of Pediatric Differentiated Thyroid Carcinoma: Treatment Practices and Outcomes Prior to Pediatric American Thyroid Association Guidelines Implementation.

Differentiated thyroid carcinoma (DTC) is the most common pediatric thyroid malignancy, with papillary thyroid carcinoma (PTC) representing 90% of the cases. In 2015, the American Thyroid Association (ATA) developed management guidelines for pediatric DTC. Patients less than 21years of age diagnosed with DTC between 2000 and 2015 at Texas Children's Hospital, Seattle Children's Hospital, Children's Healthcare of Atlanta, Children's Hospital Colorado, and Nationwide Children's Hospital were retrospectively analyzed to evaluate treatment practices before the implementation of the ATA guidelines. We included 216 pediatric patients with DTC. A majority were female (76%) with a median age at diagnosis of 14.8years. Neck swelling (56%) and palpable nodules (49%) were common presenting symptoms. Diagnostic evaluations typically included thyroid ultrasound, with common features being microcalcifications (47.7%) and hypoechogenicity (39.0%). Fine-needle aspiration cytology confirmed diagnosis in 50.5%. The majority of patients underwent total thyroidectomy (78.7%) and lymph node dissection (75.5%). ATA risk stratification was low, intermediate, and high risk in 111 (51.4%), 29 (13.4%), and 76 patients (35.2%), respectively. Upfront radioactive iodine (RAI) was administered in 83%. At 1-year follow-up, 46% were disease-free (66% low risk, 59% intermediate risk, and 13% high risk). The 5-year progression-free survival for low, intermediate, and high risk were 86%, 53%, and 43%, respectively. The disease-related overall survival was 100%. Prior to the introduction of the ATA guidelines, a majority of patients underwent total thyroidectomy with lymph node dissection followed by RAI. Selective use of RAI for low-risk disease as recommended in the current guidelines may be appropriate.

The Landmark Series: Testing in Thyroid Nodule Fine Needle Aspiration Cytology.

There has been remarkable growth in our understanding of the biologic behavior and molecular signature of thyroid malignancies, which has led to the introduction, application, and evolution of molecular testing of thyroid nodule FNA cytology. Next-generation sequencing molecular testing is an important, well-validated diagnostic tool for management of cytologically indeterminate thyroid nodules. It reduces unnecessary thyroid surgery for benign disease, avoiding associated surgical risks for the patient and reducing healthcare expenses. This article reviews the development and implementation of thyroid nodule cytologic classification and subsequent testing and how it has improved the diagnostic considerations in thyroid nodule and thyroid cancer management algorithms. The use of molecular testing as a prognostic tool is evolving and although the data are limited, they suggest a promising role in prognostication for oncologic outcomes. However, future studies are needed to further evaluate this.

The value of non-punctate echogenic foci in the ultrasonic diagnosis of thyroid nodules.

To evaluate the diagnostic value of different subtypes of non-punctate echogenic foci in thyroid malignancy. Retrospective research of 342 thyroid nodules with calcification was performed. The echogenic foci were divided into punctate echogenic foci (type I) and non-punctate echogenic foci (type II), and type II were further divided into four subtypes: macrocalcification (type IIa), continuous peripheral calcification (type IIb), discontinuous peripheral calcification (type IIc) and isolated calcification (type IId). Postoperative histopathological results were used as the gold standard to evaluate the correlation between non-punctate echogenic foci subtypes and thyroid malignancy. The malignant risk of nodules with echogenic foci was type I (82.1%) > type IIa (66.2%) > type IIc (52.9%) > type IId (16.7%) > type IIb (13.9%), P < 0.001. Type I and type IIa echogenic foci were independent risk factors for thyroid cancer (OR = 16.593, 7.785). Solid, hypoechogenicity/marked hypoechogenicity and a single lesion in a unilateral thyroid lobe were independently associated with malignant thyroid nodules with macrocalcification(OR = 6.825, 40.042, 5.201). Irregular margins and uneven calcification thickness were independent factors for malignant thyroid nodules with peripheral calcification (OR = 5.676, 2.750). Type IIa echogenic foci could independently predict thyroid malignancy. The diagnostic value of non-punctate echogenic foci depended on the differentiated combination of ultrasound characteristics. Type IIa nodules with solid composition, irregular margins, and a single lesion in a unilateral thyroid lobe implied a higher risk of malignancy; peripheral calcified nodules with irregular margins and uneven calcification thickness suggested an increased risk of malignancy.

Elevated Risk of Thyroid Malignancy in Biological Males Taking Estrogen Hormone Therapy.

The role of estrogen in developing thyroid malignancy is poorly understood. Epidemiological studies have shown exogenous estrogen is associated with increased risk in females. Still, no studies to date have investigated this association among biological males undergoing estrogen hormone therapy. Retrospective cohort study. TriNetX Research Network. Biologically male patients prescribed estrogen with at least 5 years of follow-up were queried from the database. Rates of diagnosis of malignant neoplasm of the thyroid gland within 5 years of estrogen hormone therapy prescription were determined, and statistics were conducted within the TriNetX platform. We identified 6394 biologically male patients from 65 health care organizations prescribed estrogen hormone treatment. The average age was 44.4 years. When balanced for demographic factors as well as known risk factors for thyroid malignancy, the estrogen treatment cohort had a 0.64% risk for diagnosis of thyroid malignancy within 5 years, compared to a 0.27% risk among patients not taking estrogen (relative risk: 2.35, 95% confidence interval: 1.34-4.15, P = .002). We found a higher risk of developing thyroid cancer in biologically male patients prescribed estrogen hormone therapy. This is the first association found between estrogen and thyroid malignancy in this group.

View on various clinical determinants of thyroid neoplasms based on their histopathological patterns

Background. Most thyroid cancers are differentiated, either follicular or papillary, and respond effectively to radioactive iodine therapy. Aim of study. To investigate the histopathological types of thyroid cancer and their relationship to certain demographic and clinical characteristics. Methods. A retrospective observational study with an analytic component was conducted over six months (May to November 2023). It included 120 patients diagnosed with thyroid cancer, selected from oncology department records. The following information was collected: age, gender, occupation, smoking status, family history of thyroid malignancy, tumor stage according to the 7th edition of the American Joint Committee on Cancer Staging, thyroid status, clinical presentation, ultrasound details, and histopathological report. Results. In this study, 68.3% of cases presented as goiter, and lymphadenopathy was observed in 18.3%. The most prevalent histological type was papillary carcinoma. Of the papillary cases, 80.6% were staged as T1, compared to 23.5% of follicular carcinoma cases. In papillary carcinoma, 38.9% had a tumor size &lt; 1 cm³, while 76.5% of follicular carcinoma cases had a tumor size &gt; 2 cm³. Lymphadenopathy was seen in 47.1% of follicular carcinoma cases, compared to 11.1% in papillary carcinoma cases. Regarding clinical presentation, goiter was found in 72.2% of papillary cases compared to 17.6% of follicular cases, with these differences being statistically significant. Conclusion. Thyroid cancer is more common in younger age groups and in females. The papillary form accounts for the majority of cases, suggesting that iodine deficiency is not a significant factor for most patients. Histopathological features may help predict the degree of lymph node metastasis.

Unveiling the Malignancy Risk of Surgically Treated Bethesda III Thyroid Nodules: A 10-Year Retrospective Study Comparing Fine-Needle Aspiration Cytology (FNAC) and Histopathology.

Introduction Thyroid malignancy remains a significant global health concern, making the accurate differentiation between benign and malignant thyroid nodules crucial for optimal patient management. Fine-needle aspiration cytology (FNAC) is the gold-standard preoperative diagnostic tool, and The Bethesda System for Reporting Thyroid Cytopathology provides a standardized framework for interpretation. This 10-year retrospective study evaluated the malignancy risk in surgically treated patients with thyroid nodules classified as Bethesda Category III by comparing FNAC findings with histopathological outcomes. Materials and methods This observational retrospective study included patients with thyroid nodules classified as Bethesda Category III treated surgically at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) Lahore between January 2014 and January 2024. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, US). Results A total of 44 patients were included in the study, with a mean age of 50.59 years. The majority were female 36 (81.8%) with8 (18.2%)males. All patients underwent surgery, with 23 (52.3%) undergoing total thyroidectomy and 21 (47.7%) undergoing lobectomy. Final histopathological analysis revealed benign findings in 27 (61.4%) cases and malignancy in 17 (38.6%). Conclusion In our study, benign adenomatous nodules and papillary thyroid carcinoma had equal prevalence. The malignancy rate in Bethesda Category III nodules was 38.6%, higher than the previously reported range of 10% to 30%. This elevated risk may reflect the specialized cancer center setting in which the study was conducted, aligning with similar findings from other cancer centers. These results suggest that Bethesda Category III may carry a higher malignancy risk, warranting reconsideration of current management guidelines.

Accuracy of ultrasound TIRADS classification for the differentiation between benign and malignant thyroid lesions taking Bethesda classification as gold standard

AbstractBackgroundThe TIRADS classification system is commonly used in ultrasound imaging to evaluate the risk of malignancy in thyroid nodules, but there is still debate about its accuracy. The BSRTC categorizes FNA biopsy results to determine the likelihood of malignancy in thyroid nodules, and this remains the gold standard for diagnosis.MethodologyThis is a cross-sectional study design conducted in the Radiology Department of Chughtai Lab Head Office in Lahore. This study assessed 154 patients with thyroid nodules. The ultrasound equipment used for the study is the Toshiba Applio 500 model, while the equipment for FNAC included topical anesthesia, 21-gauge 10 CC syringes, glass slides, cell block, and the Olympus CX23 microscope. The sampling technique employed is the consecutive sampling technique.ResultsOut of 154 patients, the mean age was 42.0 ± 13.6 years. Majority were female (89%) while 11% are male. The P-value of &lt;0.0001 suggests a statistically significant association between TIRADS and Bethesda categories. The findings suggested that ultrasonography is a highly reliable and effective method for diagnosis, with a superior degree of sensitivity and specificity in addition to invasive cytology tests. Results from the ROC curve analysis showed an impressive area under the curve of 0.972. The sonographic features show significant associations with TIRADS categories (P-value &lt;0.0001). The association between TIRADS suspiciousness and Bethesda diagnosis is statistically significant (P-value &lt;0.0001). Benign nodules were most commonly classified as not suspicious (56.5%), followed by mildly suspicious (9.7%), while malignant nodules were primarily classified as highly suspicious (11.0%). Notably, no malignant nodules were categorized as benign.ConclusionHealthcare professionals may consider utilizing TIRADS as a first-line imaging method and then BETHESDA if needed to provide patients with the most accurate results and minimize unwanted interventional exposure. Combining these two scoring methods appears to yield the most precise outcomes for identifying and distinguishing benign from malignant nodules, which is critical for arriving at a definitive diagnosis in individuals with thyroid malignancies.

Undifferentiated (Anaplastic) Thyroid Carcinoma: Exploring the Coexistence of Differentiated and Dedifferentiated Anaplastic Elements—Critical Insights from a Case Series and Review of Literature

AbstractUndifferentiated (anaplastic) thyroid carcinoma (ATC) is a rare thyroid malignancy, constituting &lt;2% of all thyroid carcinomas. It is an aggressive tumor, manifesting as a rapidly growing neck mass with compressive symptoms. Given that ATC often arises from dedifferentiation of well-differentiated thyroid carcinoma (WDTC), it is also possible that WDTC and ATC elements coexist, necessitating a clear distinction between WDTC with anaplastic transformation and pure ATC, due to significant differences in prognosis and treatment. Emphasizing the significance of cytological evaluation, particularly with the assistance of fine-needle aspiration, we present three cases that underscore the importance of timely detection for achieving precise diagnoses and guiding subsequent management decisions.

Spinal metastases in primary thyroid malignancies: Single center experience of 44 cases.

Patients with differentiated thyroid carcinoma have a 10year survival rate of more than 95%. However, the existence of spinal metastases significantly reduces overall survival. In this study, we review the epidemiology and outcomes of patients with thyroid malignancies with spinal metastases. A retrospective analysis was conducted on 44 patients with thyroid malignancy and spinal metastases treated at our institution from 2008 to 2021, evaluating the outcome parameters by analyzing demographic, clinical and radiological profiles. The median age upon presentation was 58years (range - 35 to 80years). 54.5% had single-level involvement. The thoracic spine exhibited the highest incidence of involvement, followed by the transitional zones and lumbar spine. The most common presenting features were spinal and radicular pain followed by myelopathy. In 77.3% of cases, the pathology was identified as the follicular variant of papillary thyroid carcinoma. A total of 81.8% of patients underwent total thyroidectomy, with 84% receiving iodine ablation and 61.3% undergoing locoregional radiotherapy. Surgical intervention for spinal metastases was performed in 18 individuals (40.9%). There was significant improvement in the postoperative Visual Analog Scale (VAS) score in the operated group (p-value of 0.000). Overall, no significant difference was observed in the OS and PFS between the operated and non-operated groups except for the subset of patients who underwent postoperative radiation therapy (p-value of 0.013). Vertebral metastasectomy in primary thyroid malignancies is associated with significant pain relief. Patients who receive postoperative radiotherapy perform better than patients who either undergo metastasectomy or radiation therapy.

Спорадическая медуллярная карцинома щитовидной железы в детском возрасте: клиническое наблюдение

Medullary thyroid carcinoma (MTC) is one of the rarest tumors of the neuroendocrine system occurring in childhood. MTC represents approximately 4% to 8% of all thyroid malignancies in children with an incidence of 0.03 per 100,000 pediatric population per annum. As a rule, MCT in childhood is presented as part of hereditary syndromes (MEN2A, MEN2B) whereas the prevalence of the sporadic form has not been sufficiently studied as well as its molecular and genetic features. Authors represent the Russia’s first clinical case of sporadic MTC in a 16 years old child. The girl at the age of 14 y/o was examined by an endocrinologist at the place of residence due to the absence of menarche. According to the results of a comprehensive examination, a mass measuring of up to 27 mm was detected in the left lobe of the thyroid gland. Cytological examination revealed a picture suspicious for C-cell carcinoma. The basal calcitonin level was 2160 pg/ml (with 0 to 4.8 pg/ml as a norm). The patient had then underwent thyroidectomy with central lymphadenectomy as a result of histological and immunohistochemical studies of medullary thyroid carcinoma pT2N0 MxLV0Pn0. According to the results of molecular genetic study of peripheral blood, neither germinal pathogenic nor opportunistic mutations in RET gene were detected. Full-exome sequencing of DNA isolated from tumour tissue revealed as pathogenic/conditional pathogenic mutations RET p.M918T, CHEK2 p. R29X, VRK1 p.H119R and ARSE p. G422R. After 3.5 years of follow-up, the patient had a complete structural and biochemical remission of the disease.

Primary Thyroid Diffuse Large B-Cell Lymphoma: A Case Report.

Primary thyroid lymphoma is rare. Hashimoto's disease is usually found as a risk factor. Among thyroid lymphoma, diffuse large B-cell lymphoma (DLBCL) is the most aggressive and frequent one. A 56-year-old man with a medical history of Hashimoto's disease presented with a neck mass and dysphonia. A computed tomography scan revealed a large thyroid mass. Fine-needle aspiration cytology (FNAC) was consistent with lymphoma, confirmed by a core needle as a DLBCL. The patient was transferred to the Department of Hematology and Oncology for chemotherapy with good results. Primary thyroid lymphoma accounts for less than 5% of all thyroid gland malignancies and less than 2% of extranodal lymphomas. It frequently affects women in the sixth or seventh decade. Hashimoto's disease is a major risk factor. DLBCL is the most common histological subtype with aggressive evolution. Radiology and FNAC are not usually very precise and a biopsy is needed. Treatment includes surgery, radiotherapy, chemotherapy, and targeted therapy.

Adiposity is associated with a higher number of thyroid nodules and worse fine-needle aspiration outcomes.

Adiposity may be associated with thyroid nodularity. However, its impact on the number of nodules and the risk of malignancy is unclear. To evaluate the impact of adiposity on thyroid nodules using body mass index (BMI), ultrasonographic (US) data and cytological data. A retrospective cohort study of 310 patients with thyroid nodules was performed. Patients were categorized based on their BMI, and grayscale US data and fine-needle aspiration cytology results were evaluated. Patients with BMI ≥ 25 kg/m2 were found to have a higher number of thyroid nodules compared to those with BMI < 25 kg/m2 (4.25 ± 2.42 vs 3.66 ± 1.93) (P value = 0.05). Patients with BMI ≥ 25 kg/m2 had more suspicious and malignant cytology than those with BMI < 25 kg/m2 (P value = 0.029). Patients with BMI ≥ 25 kg/m2 had more nodules with intermediate and high suspicion sonographic patterns. However, this did not reach statistical significance. Overweight and obese patients have a trend for more thyroid nodules and have a higher risk of being diagnosed with thyroid malignancy.