Malignant Thyroid Tumors Research Articles

Retracted: Meta-Analysis of Contrast Enhanced Ultrasound in Judging Benign and Malignant Thyroid Tumors.

[This retracts the article DOI: 10.1155/2021/2577113.].

An exploration of safety and feasibility of transoral vestibular endoscopy in the treatment of thyroid malignant tumors

Objective:To investigate the safety and feasibility of transoral vestibular endoscopy in the treatment of patients with thyroid malignant tumors. Methods:120 patients with thyroid cancer admitted to Xi 'an Central Hospital from January 2019 to December 2021 were selected and randomly divided into endoscopic surgery group（60 cases） and traditional open surgery group（60 cases）. The general operation conditions, postoperative complications and postoperative quality of life were compared between the two groups. Results:The intraoperative blood loss, indwelling drainage tube time and average length of hospital stay in the endoscopic surgery group were significantly lower than those in the traditional open surgery group （P<0.05）, while the operation time and number of lymph nodes dissected were significantly higher than those in the traditional open surgery group （P<0.05）. There was no significant differences in VAS score at 24h after surgery, white blood cell count, TgAb （+） and temporary hypothyroidism between the two groups at 24 h after operation （P >0.05）. The CRP, total drainage volume, TgAb and serum calcium in the endoscopic surgery group were higher than those in the traditional open surgery group, and the PTH and Tg were lower than those in the traditional open surgery group （P<0.05）.One case of hoarseness,2 cases of extremities numbness, 1 case of subcutaneous effusion and 2 cases of chin nerve injury occurred in the endoscopic surgery group, the total incidence of postoperative complications was 10.00%. Five cases of hoarseness, 11 cases of choking cough limbs numbness, 1 case of drinking water, 1 case of postoperative bleeding and 4 cases of subcutaneous effusion occurred in the traditional open surgery group, the total postoperative incidence of complications was 36.67%, the total incidence of complications in endoscopic surgery group was lower than that in traditional open surgery group （P<0.05）. The total scores of physiological status, social/family status, emotional status, functional status and quality of life in endoscopic surgery group were significantly lower than those in traditional open surgery group （P<0.05）. Conclusion:The application of oral vestibular endoscopy in the treatment of thyroid malignant tumors has the advantages of good surgical status and postoperative recovery, fewer postoperative complications.The patient was well tolerated,with positive safety，this technique has high clinical application value.

Cytokeratin 19 (CK19) expression by thyroid neoplasms in a Nigerian tertiary health centre.

despite the observed appreciable sensitivity and specificity of the use of CK19 in predicting thyroid malignancies, there is still a paucity of information about its uses in Nigeria. Current information across the world is also scarce. This study was to review the histopathological diagnosis of thyroid neoplasms seen in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile Ife, using cytokeratin 19 immunohistochemical marker. a retrospective study of fifty-six cases of thyroid neoplasm seen over a period of twenty years was conducted. The tissue samples were subjected to immunohistochemical staining for CK19 using monoclonal antibodies. The expression of the markers on the various thyroid neoplasms was assessed histologically. the expression of CK19 was significantly higher in malignant thyroid neoplasms compared to benign neoplasms (p<0.05). The sensitivity and specificity for cytokeratin 19 were 90.0% and 75.0% respectively. diffuse immunohistochemical expression of CK19 is a strong indicator of thyroid malignancy. This biomarker can help in the diagnosis of thyroid neoplasms especially those with incomplete or equivocal histomorphology features.

A Case of Carcinoma Showing Thymus-Like Differentiation (CASTLE)

Thyroid carcinoma showing thymus-like differentiation (CASTLE) is a rare histological type of malignant tumor of the thyroid gland and similar to thymic epithelial tumors. Thyroid CASTLE accounts for 0.075% of all malignant thyroid tumors, and preoperative diagnosis is difficult. We report the case of a 64-year-old woman with thyroid CASTLE. An elastic hard nodule was palpated on the right anterior neck. Blood tests showed no abnormalities, and thyroid function and parathyroid function were normal. Computed tomography showed an iso-absorbing nodular shadow measuring 16 mm located caudal to the right lobe of the thyroid gland. Neck echography showed a nodule with indistinct borders and slightly irregular margins on the caudal aspect of the right lobe of the thyroid gland. It was impossible to make a diagnosis, but since malignancy could not be ruled out, we decided to perform diagnostic and therapeutic surgery consisting of resection of the right lobe of the thyroid gland and ipsilateral lymph node dissection in the central region of the neck. A poorly differentiated 16-mm carcinoma was found at the inferior pole of the thyroid gland. Immunostaining was positive for CD5, and a diagnosis of thyroid CASTLE was made. If a tumor of the thyroid gland lacks the features of more common thyroid tumors such as papillary carcinoma or follicular tumor and is localized caudally to the inferior pole of the thyroid gland, thyroid CASTLE should be included in the differential diagnosis.

Clarion and Protuberant-Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is a malignant thyroid neoplasm exhibiting histological subtypes as classic papillary carcinoma, tall cell, micro-carcinoma, follicular, oxyphilic, diffuse sclerosing, cribriform morular, solid or insular variant. Tumefaction enunciates distinctive nuclear features as altered nuclear magnitude and outline, nuclear enlargement or elongation, nuclear overlapping, and ground glass nuclei. Genomic fusions of BRAF, RET, PPARG, NTRK1, NTRK3, ALK, LTK, MET, FGFR2 or THADA genes may be observed. Initial disease representation emerges as 67% singular thyroid nodules, 13% thyroid nodules combined with cervical lymph node metastasis and 20% neoplasms confined singularly to lymph nodes

Coexisting Molecular Alterations Increase the Risk of Malignancy in Thyroid Nodules with Copy Number Alterations.

Molecular mutations and alterations play a role in thyroid tumorigenesis. Different alterations are associated with different clinical and pathological characteristics. Copy number alterations (CNAs) are known to be present in some thyroid tumors; however, their idiosyncratic clinicopathological implications are not yet well elucidated. A retrospective chart review was performed to identify patients with CNAs on pre-operative molecular testing results who subsequently underwent surgical treatment between January 2016 and April 2022 at McGill University teaching hospitals. Of the 316 patients with thyroid nodules who opted for molecular testing with ThyroSeqV3 followed by surgery, 67 (21.2%) nodules were positive for CNAs, including 23 Bethesda III, 31 Bethesda IV, 12 Bethesda V and 1 Bethesda VI nodules. On surgical pathology, 29.9% were benign and 70.1% were malignant or non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Among those that were malignant/NIFTP, 17.02% were considered to be aggressive cancers. The presence of other molecular alterations was found to be an independent predictor of malignancy in multivariate analysis (OR = 5.087, 95% C.I. = 1.12-23.04, p = 0.035). No unique factor was correlated with aggressiveness; however, CNA-positive thyroid nodules that were associated with high-risk mutations such as BRAF V600E, TP53, NTRK1/3 fusion, or PTEN mutation with high allele frequency (AF) ended up being aggressive cancers. Most of the CNA-positive thyroid nodules resulted in follicular patterned tumors in 41 (65.2%) cases and oncocytic tumors in 20 (29.9%) cases. This study demonstrates that 70.1% of surgically resected thyroid nodules with CNAs were malignant/NIFTP. Most CNA-positive thyroid nodules were either oncocytic patterned tumors or follicular patterned tumors. Furthermore, CNA-positive thyroid nodules were more likely to be malignant if they were associated with other molecular alterations or mutations.

Thyroid gland cancer and insulin resistance: a modern view of the problem

Background. The impact of insulin resistance on the probability of increase in thyroid cancer risk has been drawing a lot of attention of researchers lately. This problem is far from being completely solved. Studying this interrelationship may influence the effectiveness of the treatment of the mentioned widespread pathology.&#x0D; Purpose – to review present literature sources on research of interrelationship between insulin resistance and thyroid cancer, and also possible mechanisms of this relationship.&#x0D; Materials and methods. Literature search was performed manually by the keywords (thyroid cancer, insulin resistance, IGF-1, IGF-2, abdominal obesity, increase in body mass index, metformin), and also literature sources from evidential data bases PubMed, Web of Science were reviewed. Metaanalyses, systematic reviews and cohort studies were also taken into account. 148 literature sources were studied in total. The sources, which had been published within the last 10 years, were preferably selected.&#x0D; Results. Insulin resistance is viewed as an important independent factor of development of numerous malignancies. The carcinogenic activity of insulin resistance is caused by the resistance itself, as well as by the metabolic disorders related to it. It has been established that excessive weight and obesity are to a great extent attributed to more aggressive clinical pathological signs of thyroid cancer. Recent research showed a larger volume of thyroid and higher risk of knot forming in patients with insulin resistance. Thus, thyroid cancer is one of the main factors of thyroid transformation. Therapeutic methods of eliminating metabolic syndrome and associated hormonal diseases for prevention and therapy of oncologic diseases are drawing ever-greater scientific interest. The anti-tumor features of metformin and its capability of retarding carcinogenesis are shown in the studies.&#x0D; Conclusions. The given literature analysis has proved that the problem of treating malignant thyroid tumors and their metastasis is caused not only by morphological, cellular and molecular-biological features of the tumor itself, but also by insufficient knowledge about the interrelationship between insulin resistance, abdominal obesity, increase in body mass index, high-calorie diet and reduction of consumption of polyunsaturated fats, harmful impact of environment with molecular changes, specific for thyroid cancer. It is confirmed by a significant increase in thyroid cancer rate, especially papillary histotype, alongside with an increase in obesity rate. The studying of possibilities of decreasing incidence and mortality rates of oncologic pathology when using medications, which stabilize insulin and contribute to a decrease in degree of hyperinsulinemia, one of which is metformin, generates profound interest

Primary Thyroid Lymphoma Diagnosed on Rapid Onsite and Cytology: A Rare Case Report.

Rapid on-site evaluation (ROSE) is an essential component of thyroid cytopathology, particularly important in thyroid lymphoma, anaplastic carcinoma, metastasis to avoid unnecessary surgery. Follicular epithelial neoplasms are the most common tumors arising from the thyroid, whereas primary thyroid lymphomas are uncommon, accounting for less than 5% of all thyroid malignancies. A 45-year-old male patient presented to our ENT outpatient department with swelling in the anterior neck for 3years duration. Non-aspirational needling was done along with rapid on-site evaluation using 1% aq. toluidine blue and was reported as Malignant thyroid neoplasm- possibility of Non-Hodgkin lymphoma (NHL). Cellblock sample also confirmed as B-cell NHL followed by Immunohistochemistry. Primary thyroid lymphomas (PTL) are uncommon malignant neoplasms. They represent < 5% of all thyroid malignancies and 1-2% of all extra-nodal lymphomas. If diagnosed cytologically, unnecessary surgery can be avoided in thyroid lymphoma. ROSE helps in the rapid diagnosis and sample adequacy. Cellblock can avoid the biopsy procedure used for confirmation and subtyping of lymphoma.

Papillary Thyroid Carcinoma With Breast and Bone Metastasis.

Papillary thyroid carcinoma is the most common thyroid malignant tumor and usually has a fine prognosis. The most common metastatic site is the cervical lymph node, and distant metastasis is rare. This report describes a female patient with papillary thyroid carcinoma who presented with multiple metastases in the cervical lymph nodes, breast, and spine. The patient's disease course lasted 11 years, and eventually metastatic cancer led to the patient's death. We also analyzed the survival rate and median survival time of papillary thyroid carcinoma with multiple organ metastases using data in the literature.

Intrathyroidal Thymic Carcinoma: A Retrospective Case Series Study.

Intrathyroidal thymic carcinoma (ITC) is a rare low-grade malignant thyroid tumor. There is neither sufficient understanding of this tumor nor its clinical treatment. This study is to explore the clinicopathological features, treatment, and prognosis of ITC and thereby provide a reference for the diagnosis and treatment of the disease. The clinical, pathological, therapeutic, and prognostic data of 13 patients with ITC were retrospectively analyzed. The case series comprised 7 males and 6 females, with an average age of 51.9 ± 10.1years. After surgical resection, all patients received post-operative neck radiotherapy at dosages of 60-66 Gy. Five patients with level VI lymph node metastasis additionally received 6 courses of cisplatin chemotherapy. All patients were followed-up for 21-132months (median = 66months), and all of them survived without recurrence or metastasis. The diagnosis of ITC depends mainly on pathological and immunohistochemical results, particularly CD5 positive staining. Surgical resection is the preferred primary treatment modality which can be supplemented with radiotherapy and chemotherapy to reduce the risk of recurrence and metastasis.

Neutrophil to Lymphocyte Ratio as a Predictive Factor in Iraqi Patients with Thyroid Cancer

Thyroid cancer is one of the fastest growing malignancies in recent years, with an increase of 14.51% per year. It has been shown that there is an association between some biomarkers and the progression of thyroid cancer. In this study, we aim to assess the Neutrophil to Lymphocyte Ratio (NLR) levels and Thyroid function test (TSH, T3, T4) in patients with thyroid cancer. In the current study, (145) participants were divided into 3 groups: G1: (60 malignant thyroid gland patients, G2: (35 benign thyroid gland patients), and G3: (50 healthy control individuals as a control group). The patients attended to AL-Amal oncology Hospital in Baghdad and Imam Sadiq Hospital in Babylon province, Iraq during the period from November 2021 to February 2022. Depending on hematology analyzer the level of NLR and by Mini Vida's the TSH, T3, T4 were estimated in the studied groups. The results showed that the highest number and percentage of malignant thyroid tumors 21 (35%) was among the age group (50-≥ 60) years, while the lowest number and percentage of malignant tumors 10 (16.7%) was among the age groups (20-29) and (30-39) years. The results also demonstrated that the number and percentage of female patients with malignant thyroid tumors was 43 (71.7%) and males 17 (28.3%). A highly significant increase (P&lt;0.01) in the levels of both NLR and TSH was observed in patients with malignant thyroid cancer when compared with their levels in the control group and benign tumor groups. The current study revealed that the age group (50-≥ 60) years and female patients were most affected by thyroid cancer and both NLR and TSH levels were highly increased in thyroid cancer patients. when compared with healthy group.

Effects of different types of radiation therapy on cardiac-specific death in patients with thyroid malignancy.

Radiation therapy (RT) is one of the common and widely used treatment method for thyroid tumors. Considering that the thyroid is located close to the heart, the radiation generated during the treatment of thyroid tumors may have an adverse greater impact on the heart. This study is to explore the influencing factors, especially additional effects of RT, on cardiac-specific death among patients with malignant thyroid tumors. Collecting information from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database using SEER*Stat. Patients with malignant thyroid tumors were searched, whether receiving RT or not. Ultimately, 201, 346 eligible patients were included. Propensity Score Matching (PSM) was used to minimize bias of baseline characteristics by adjusting for confounding factors. COX (proportional hazards) and fine-gray (competing risk) model regression analysis were used to explore the effects of various influencing factors on cardiac-specific death. The present analysis showed that, compared with non-RT, RT based upon radioactive implants and beam radiation were associated with lower risk of cardiac-specific death in patients with thyroid malignancy, beam radiation therapy may had a similar effect. Besides, the remaining RT methods did not significantly increase the risk of cardiac-specific death. In addition, Asian or Pacific Islander ethnicity, female sex, marital status, combined summary stage (localized, regional, and distant), high-income, and later year of diagnosis were associated with lower risk of cardiac-specific death. While older age of diagnosis, African ethnicity, non-Hispanic ancestry, and derived AJCC stage (IV) were risk factors for cardiac-specific death. These results help to identify the factors influencing cardiac-specific death among patients with thyroid malignancies. Furthermore, it may helps to improve the clinical application of RT without too much concern about adverse cardiac effects.

Features of diagnostics and treatment of malignant thyroid neoplasms

Objective. To analyze diagnostics and treatment of 50 patients operated for thyroid cancer (TC), to assess the information content of classification according to the TIRADS and BETHESDA systems in comparison with the final morphological study of the removed thyroid preparations.&#x0D; Materials and methods. Patients were divided into 3 groups. The first group 32 (64 %) patients with a verified thyroid cancer before surgery according to the results of fine needle aspiration puncture biopsy and a confirmed diagnosis after surgery. The second group, 4 (8 %) persons, included patients with a verified thyroid cancer before surgery, but a negative final morphological study. The third group, 14 (28 %) patients with an unverified thyroid cancer before surgery, but a confirmed diagnosis of thyroid cancer according to the results of a final morphological study. To compare the compliance of the TIRADS system with the BETHESDA system, the Kappa index was used.&#x0D; Results. The highest compliance, 100 %, was found between TIRADS 5 and BETHESDA 5, with a Kappa index of 1.&#x0D; Conclusions. Comparison of the results of preoperative and final morphological studies showed that the use of TIRADS and BETHESDA classifications is an informative method in diagnostics of thyroid cancer only in 48 % of cases.

CRABP2 Is Associated With Thyroid Cancer Recurrence and Promotes Invasion via the Integrin/FAK/AKT Pathway.

Cellular retinoic acid-binding protein 2 (CRABP2) participates in retinoid partitioning between different nuclear receptors. Recently, we identified that CRABP2 is one of the progression-associated genes in thyroid cancer. To explore the prognostic and functional significance of CRABP2, immunohistochemical analysis was performed in thyroid tissues and neoplasms. Overexpression of CRABP2 was observed in malignant thyroid neoplasms but not in benign thyroid lesions. CRABP2 expression was an independent predictive factor for recurrence-free survival in patients with differentiated thyroid cancer. Knockdown of CRABP2 reduced the sensitivity of thyroid cancer cells to retinoic acid. Importantly, CRABP2 expression in thyroid cancer cells was associated with epithelial-mesenchymal transition properties, including anoikis resistance, migration, and invasion capacity. Furthermore, invasion promoted by CRABP2 was mediated at least partly by the integrin/focal adhesion kinase/AKT pathway. In summary, CRABP2 expression is upregulated in thyroid cancer with adverse prognostic implications. The invasion-stimulating effects appear independent of canonical retinoic acid signaling and may serve as a potential therapeutic target.

Aberrant Expression of Thymosin Beta-4 Correlates With Advanced Disease and BRAF V600E Mutation in Thyroid Cancer.

Thymosin beta-4 (TMSB4X) was recently identified as a differentially expressed gene between malignant and non-malignant thyroid cells via single-cell RNA sequencing. In the present study, we aimed to study the immunostaining pattern of TMSB4X in benign and malignant thyroid neoplasms. Immunohistochemical analysis revealed that normal thyroid tissue or benign thyroid disorders exhibited undetectable immunoreactivity against TMSB4X except for positive staining of inflammatory infiltrates and stromal cells associated with autoimmune thyroid disease. By contrast, overexpression of TMSB4X was observed in a variety of thyroid malignancies, including papillary, follicular, poorly differentiated, and undifferentiated thyroid cancer. Among 141 patients with differentiated thyroid cancer, higher TMSB4X expression was associated with papillary tumor type, extrathyroidal extension, lymph node metastasis, and BRAF V600E mutation. The results were consistent with those from the public transcriptomic datasets. In summary, TMSB4X expression was aberrantly increased in various types of thyroid cancer, and higher TMSB4X expression was correlated with advanced disease characteristics. Thymosin beta-4 may be a novel downstream effector of the BRAF V600E mutation.

The properties and health hazards from early nuclear weapon fallout: The Castle Bravo incident revisited

Early fallout is defined as the fallback to the earth’s surface of radioactive particles shortly after a nuclear detonation (often arbitrarily defined within 24 h). At the difference of wide spreading global fallout, early fallout mainly consists of larger particles that are often visible. The initial mixture is rich in short- and very short-lived radionuclides associated with a very high initial activity that decreases rapidly (in 7 h, the dose rate is reduced by 90%). The main danger of early fallout results from external irradiation by highly penetrating gamma-radiation that may cause acute radiation sickness. Only in the case of the thyroid, internal irradiation by the incorporation of radioiodine may prevail. The bombings of Hiroshima and Nagasaki are examples of airbursts with many fatalities by prompt effects (blast, burns, and initial ionizing radiations), but they produced little fallout. The nuclear test code-named Castle Bravo on the Marshall Islands (1954) did not have casualties by its blast, thermal or initial radiation effects, but the inhabitants of the nearby islands and the crew of a Japanese fisherboat (Lucky Dragon) were affected by large amounts of fallout. For the inhabitants of the Rongelap Atoll, the average dose from external irradiation was assessed at 1.6 Gy. From a clinical point of view, based on hematological data using the METREPOL classification system, the acute radiation syndrome can be categorized as mild (H1). Blood transfusions were not required, and antibiotics were not administered for prophylaxis or therapy of infections related to irradiation. The equivalent dose received by the thyroid resulted mainly from internal irradiation with 7.6 Gy. The major late effects were thyroid abnormalities, including thyroid failure, nodules, and malignant tumors. The 23 Japanese crewmen seem to have been irradiated by higher doses (2.9 Gy). Compared to the hematological data of the Rongelap victims, the evolution pattern over time is quite similar. Still, the absolute values of the cell counts are lower, and on average, the acute radiation syndrome can be categorized as rather moderate (H2). Considering the individual cases, data show a large interindividual variability, and the clinical severity category ranges from “no alterations” (H0) to severe (H3). Victims were treated with repeated blood transfusions and antibiotics. Several of them developed jaundice, and one of them died six months after the incident showing symptoms compatible with subacute liver failure. A radiochemical organ analysis revealed that only the bones were clearly contaminated with fission products. In the 1990s, many surviving crewmen were diagnosed with hepatitis C, incurred probably from blood transfusions that were often contaminated at the time, and died from hepatocellular carcinomas. Thyroid dysfunctions were not reported. The Castle Bravo case permits to study the health hazards resulting from early fallout independently from the prompt effects of a nuclear detonation. The prevailing external irradiation was confirmed, except for the thyroid with a higher dose resulting from radioiodine incorporation mainly caused by ingestion. As shown for the Japanese fishermen, the risks incurred by medical treatments must be carefully weighed against the benefits of the therapeutic intervention. The cause of death of the only short-term fatality is not fully elucidated, but is consistent with liver failure due to transfusion hepatitis rather than radiation effects.

Machine learning for identifying benign and malignant of thyroid tumors: A retrospective study of 2,423 patients.

Thyroid tumors, one of the common tumors in the endocrine system, while the discrimination between benign and malignant thyroid tumors remains insufficient. The aim of this study is to construct a diagnostic model of benign and malignant thyroid tumors, in order to provide an emerging auxiliary diagnostic method for patients with thyroid tumors. The patients were selected from the Chongqing General Hospital (Chongqing, China) from July 2020 to September 2021. And peripheral blood, BRAFV600E gene, and demographic indicators were selected, including sex, age, BRAFV600E gene, lymphocyte count (Lymph#), neutrophil count (Neu#), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), platelets count (PLT), red blood cell distribution width—coefficient of variation (RDW–CV), alkaline phosphatase (ALP), and parathyroid hormone (PTH). First, feature selection was executed by univariate analysis combined with least absolute shrinkage and selection operator (LASSO) analysis. Afterward, we used machine learning algorithms to establish three types of models. The first model contains all predictors, the second model contains indicators after feature selection, and the third model contains patient peripheral blood indicators. The four machine learning algorithms include extreme gradient boosting (XGBoost), random forest (RF), light gradient boosting machine (LightGBM), and adaptive boosting (AdaBoost) which were used to build predictive models. A grid search algorithm was used to find the optimal parameters of the machine learning algorithms. A series of indicators, such as the area under the curve (AUC), were intended to determine the model performance. A total of 2,042 patients met the criteria and were enrolled in this study, and 12 variables were included. Sex, age, Lymph#, PLR, RDW, and BRAFV600E were identified as statistically significant indicators by univariate and LASSO analysis. Among the model we constructed, RF, XGBoost, LightGBM and AdaBoost with the AUC of 0.874 (95% CI, 0.841–0.906), 0.868 (95% CI, 0.834–0.901), 0.861 (95% CI, 0.826–0.895), and 0.837 (95% CI, 0.802–0.873) in the first model. With the AUC of 0.853 (95% CI, 0.818–0.888), 0.853 (95% CI, 0.818–0.889), 0.837 (95% CI, 0.800–0.873), and 0.832 (95% CI, 0.797–0.867) in the second model. With the AUC of 0.698 (95% CI, 0.651–0.745), 0.688 (95% CI, 0.639–0.736), 0.693 (95% CI, 0.645–0.741), and 0.666 (95% CI, 0.618–0.714) in the third model. Compared with the existing models, our study proposes a model incorporating novel biomarkers which could be a powerful and promising tool for predicting benign and malignant thyroid tumors.

Novel hybrid approach based on combination of textural features and clinical parameters for reliable prediction of thyroid malignancy

The dramatic increase in thyroid cancer, particularly among the younger population demands development of an automated decision support system for timely and reliable prognosis of the disease so as to facilitate improved chances of recovery in the subjects. While numerous methods are already reported by the researchers for the detection of Thyroid malignancy, the most crucial parameter of Thyroid Malignancy Index (TMI) has received very less attention. TMI is of paramount importance in diagnosis and treatment of the patients having malignant thyroid and its consideration is therefore inevitable. This research aims to develop an automated and a reliable decision support system for detection of thyroid malignancy. The proposed hybrid approach incorporates a novel combination of texture features and clinically observable parameters to initially identify a malignant thyroid tumor using support vector machines and further predicts its TMI value, thus exhibiting a performance like a trained radiologist. Publically available database comprising of 99 cases and 134 ultrasound images are used to validate the superiority of the proposed approach. Apt consideration and reliable prediction of the TMI in this research makes the designed approach novel and marks a mega leap towards its practical deployment in the clinical environment.

Thyroid Oncocytic (Hürthle Cell) Nodules With Longitudinal Nuclear Grooves: Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of 15 Cases.

Thyroid nodules with longitudinal nuclear grooves have been widely regarded as synonymous with papillary thyroid carcinoma (PTC). To study a series of cases of thyroid nodules that exhibited oncocytic (Hürthle cell) features and contained longitudinal nuclear grooves yet failed to display aggressive behavior or the full features of papillary thyroid carcinoma. The clinicopathologic, immunohistochemical, and molecular genetic features of 15 patients with these features were studied. Next-generation sequencing was performed to examine 161 genes for oncogenic driver alterations associated with thyroid neoplasia. The lesions occurred in 11 women and 4 men aged 27 to 80 years and measured 0.2 to 2.3 cm in diameter (mean, 1.1 cm). The tumors were well circumscribed and noninvasive and showed a proliferation of large cells with abundant granular cytoplasm and centrally placed nuclei displaying scattered longitudinal nuclear grooves. Immunohistochemical stains were negative for HBME-1, galectin-3, and CK19 in all cases. NRAS pQ61R was detected in 6 cases, KRAS p.Q61E in 1 case, and AKT2 p.E17K in 1 case. None of the genetic changes classically associated with conventional PTC or with high-grade thyroid malignant neoplasms were identified. Clinical follow-up in 9 patients showed no evidence of recurrence or metastases between 2 and 13 years (mean, 5.7 years). Longitudinal nuclear grooves can be occasionally encountered in oncocytic (Hürthle cell) tumors and should not lead to a diagnosis of PTC in the absence of other features supporting that diagnosis.

A preliminary study on the establishment of trachea respiratory passage invaded by thyroid malignant tumor

Objective: To investigate the establishment of trachea respiratory passage invided by advanced thyroid malignant tumor. Methods: Review of 14 cases with the establishment of trachea respiratory passage invided by advanced thyroid cancer was conducted who were treated at the Department of Otorhinolaryngology Head and Neck Surgery, Zhongda Hospital Southeast University between 2016 and 2020. There were 5 males and 9 females, aged from 24-79 years old. Shin grade was as follows，5 cases with Ⅱ grade, 6 with Ⅲ grade, and 3 with Ⅳ grade. Based on the conditions of tracheal compression and tumor extent, three types of managements were used: patients with the narrowest tracheal diameter>5 mm (8 cases with dyspnea Ⅰ-Ⅱ, Shin grade Ⅱ-Ⅲ) were applied with local surface anesthesia and conscious endotracheal intubation after sedation and analgesia; patients with the narrowest tracheal diameter with 4-5 mm (3 cases with dyspnea Ⅱ, Shin grade Ⅳ) needed tracheotomy with local anesthesia by supplying oxygen with a mask; patients with the narrowest tracheal diameter<4 mm (3 cases with dyspnea Ⅲ, Shin grade Ⅲ) needed tracheotomy with extracorporeal circulation. Results: Respiratory passages for general anesthesia were safely established in all 14 patients, of whom 12 cases with differentiated thyroid carcinoma were treated with surgery, and 2 cases with undifferentiated thyroid carcinoma and B-cell lymphoma was treated with tracheotomy and then treated with chemotherapy in the Oncology or Hematology Department. All patients were followed-up for 2-22 months and survived without tumors, but one patient with undifferentiated carcinoma survived for 3 months. Conclusion: Respiratory passage can be established quickly and safe in advanced thyroid malignant tumor. This provides a necessary safety for patients who are needed surgical treatment and also an opportunity for patients undergoing other treatments.