Metastasis Of Follicular Thyroid Carcinoma Research Articles

Atypical metastasis of follicular thyroid carcinoma

Atypical metastasis of follicular thyroid carcinoma

Large Skull Metastasis in Follicular Thyroid Carcinoma: A Comprehensive Case Presentation and Systematic Review.

Skull metastases from follicular thyroid carcinoma (FTC) are infrequent but clinically significant, often presenting with localized pain, neurologic deficits, and cranial nerve dysfunction. Early detection and accurate diagnosis pose challenges due to their asymptomatic nature in some cases. A systematic literature review, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identified and analyzed 15 relevant studies focusing on large skull metastases in FTC. Data extraction and synthesis included clinical presentation, diagnostic methods, treatment strategies, and patient outcomes. The systematic review encompassed 20 patients with secondary skull metastases from FTC, offering insights into the clinical diversity of this rare condition. Clinical presentations varied, with localized pain (70% of cases) and headaches being predominant symptoms. Imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), played a pivotal role in diagnosis. Surgical resection was considered in select cases, achieving complete or near-complete tumor removal in 30 to 50% of patients. Radiotherapy, including external beam radiation therapy (EBRT) and stereotactic radiosurgery (SRS), provided local control and symptom relief in 70 to 80% of cases. Systemic therapies, such as tyrosine kinase inhibitors (TKIs), showed promise in disease stabilization or regression (45% of patients). Prognosis remained poor, with a median overall survival of 6 to 12 months, reflecting an advanced and aggressive disease state. Managing secondary skull metastases from FTC requires a comprehensive approach, including surgical intervention, radiotherapy, and potential systemic therapies. The rarity of these metastases underscores the need for further research to establish standardized treatment guidelines, explore molecular profiling, and investigate immunotherapy and combination therapies, offering hope for improved outcomes in this challenging clinical scenario.

Bilateral choroidal metastasis of follicular thyroid carcinoma 7 years after total thyroidectomy: a case report

Bilateral choroidal metastasis of follicular thyroid carcinoma 7 years after total thyroidectomy: a case report

Cytodiagnosis of Metastatic Thyroid Follicular Carcinoma in Left Iliac Bone with Occult Primary: A Case Report

Bone metastasis of Follicular Thyroid Carcinoma (FTC) is an aggressive complication. Typically, follicular carcinoma remains confined to the thyroid gland, with distant metastasis occurring in 4-15% of cases. The lungs are the most frequent site of metastasis, followed by bone (2-13%). A peculiar clinical manifestation of FTC observed is the metastasis with the primary still remaining clinically occult. Solitary bone metastases are exceedingly rare and can easily be misdiagnosed as primary bone tumours on clinicoradiological assessment. This causes delays in the diagnosis and management. In these cases, the cytomorphology of cells on diagnostic Fine Needle Aspiration (FNA) was found to be useful in suggesting the primary origin of FTC. Distant bone metastases from follicular carcinoma on histopathological examination from biopsy specimens have been reported in the literature. The cytodiagnosis and cytomorphology of metastatic FTC by Fine Needle Aspiration Cytology (FNAC) are seldomly described in the literature. Involvement of the iliac bone in the metastasis of FTC is uncommon. The FNAC of such a bony lesion helps immensely not only in the diagnosis of the metastasis but also in suggesting the primary malignancy. Authors, hereby report a clinicopathological profile of one such rare case of a 74-year-old female with cytodiagnosis of FTC with no clinical thyroid swelling. The cytodiagnosis made from the primary lytic lesion involving the left iliac bone led to the retrospective radiological and histopathological work-up of the thyroid gland, confirming the occult primary carcinoma of the thyroid gland. The present case highlights the rare presentation and cytomorphological details of metastatic thyroid follicular carcinoma.

Sternal Metastasis in Follicular Thyroid Carcinoma: An Atypical Presentation

Follicular Thyroid Carcinoma (FTC), the second most common type of thyroid cancer, accounts for 10-20% of thyroid cancers, primarily affecting individuals over 40, and it tends to spread hematogenously to various organs. It often metastasizes to the lungs (49%) and bones (7-28%), including the spine, pelvis, skull, long bones, and rarely, the sternum. Metastatic FTC carries a poor prognosis, with a 3-21% ten-year survival rate when bone metastases are present. Sternal metastasis from thyroid carcinoma is exceptionally rare and significantly impacts prognosis. In this article, we present an unusual case of a 65-year-old patient who presented with a year-long compressive goiter. Examination revealed a firm, painless nodular goiter and a sternal mass. Tests showed a low TSH, normal T4, and thyroid nodules. Following thyroidectomy, a 7cm vesicular thyroid carcinoma was diagnosed. Sternal metastasis was confirmed through biopsy. The patient underwent sternal mass excision, responded well, and was referred for radioactive iodine therapy. Treatment options for metastases in FTC include surgery, radioactive iodine therapy and radiation. Surgical removal of metastases is crucial in such cases, as it can enhance the effectiveness of subsequent treatments and improve patient outcomes. This comprehensive management approach can offer a better quality of life and extended survival for patients facing this uncommon but challenging situation.

Follicular Thyroid Carcinoma Metastasis to the Skull and Brain: Case Series with Literature Review

Distant metastasis is more common in follicular thyroid carcinomas (FTC) than papillary thyroid carcinomas (PTC), as vascular invasion is often characteristic of FTC. Lung, bone, brain, liver, bladder, and skin are potential sites of distant metastases. On the other hand, lymph node involvement is much less common (8–10%) in cases of FTC compared to PTC. The therapy of patients may be significantly impacted by learning more about the epidemiological features of thyroid metastases at uncommon sites. In our experience, metastases in uncommon sites do not always indicate a poor prognosis for differentiated thyroid carcinoma (DTC), which might be due to the disease patterns. Every year, around 5% new FTC patients are registered, treated with radioiodine, and followed up in the thyroid division of National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Four FTC patients (F=3, M=1) with skull bone and brain metastases are discussed in this case series. All of them were post thyroidectomized and were referred to NINMAS for radioiodine ablation therapy (RAIT). Two of them had skull and brain metastases, third patient had extensive skull, facial bone and pubic bone invasion, whereas, fourth patient had multiple skull metastases. Bangladesh J. Nuclear Med. 25(2): 128-137, 2022

Unusual spread of the follicular thyroid carcinoma, metastases to liver and pancreas

We report a multimetastatic follicular thyroid carcinoma(FTC) with match lesions between 18F-FDG PET/CT and post-treatment 131I imaging. The patient had a history of thoracic vertebra corpectomy surgery and liver tru-cut biopsy; both resulted in metastases of FTC. After total thyroidectomy surgery, the patient was referred to the 18F-FDG PET/CT to investigate other possible metastatic foci. 18F-FDG PET/CT showed increased FDG uptakes on a cervical lymph node, bones, lung, liver, and pancreas. After treatment of 131I, post-treatment iodine scintigraphy demonstrated iodine uptakes in the same areas as the 18F-FDG PET/CT scan and at the thyroid bed. All the matched lesions were concluded as a spread of the FTC. Here we describe an infrequent differentiated thyroid carcinoma case with metastases to the liver and pancreas. This case report also highlights the importance of 18F-FDG PET/CT in determining the extent of thyroid cancer.

Expanding the Spectrum of BRAF Non-V600E Mutations in Thyroid Nodules: Evidence-Based Data from a Tertiary Referral Centre.

The BRAF p.V600E mutation represents the most specific marker for papillary thyroid carcinoma and is potentially related to aggressive behavior and persistent disease. BRAF alterations other than the p.V600E are less common in thyroid carcinoma and represent an alternative mechanism of BRAF activation with unclear clinical significance. The study aims to describe the frequency and clinicopathologic characteristics of BRAF non-V600E mutations in a large cohort (1654 samples) of thyroid lesions characterized by next-generation sequencing. BRAF mutations have been found in 20.3% (337/1654) of thyroid nodules, including classic (p.V600E) mutation in 19.2% (317/1654) of samples and non-V600E variants in 1.1% of cases (19/1654). BRAF non-V600E alterations include 5 cases harboring p.K601E, 2 harboring p.V600K substitutions, 2 with a p.K601G variant, and 10 cases with other BRAF non-V600E alterations. BRAF non-V600E mutations have been reported in one case of follicular adenoma, three cases of conventional papillary thyroid carcinoma, eight cases of follicular variant of papillary carcinomas, one case of columnar cell variant papillary thyroid carcinoma, one case of oncocytic follicular carcinoma, and two bone metastasis of follicular thyroid carcinoma. We confirm that BRAF non-V600E mutations are uncommon and typically found in indolent follicular-patterned tumors. Indeed, we show that BRAF non-V600E mutations can be found in tumors with metastatic potential. However, in both aggressive cases, the BRAF mutations were concomitant with other molecular alterations, such as TERT promoter mutation.

Clinical detection of "extremely low-risk" follicular thyroid carcinoma: A population-based study of 7304 patients.

BackgroundPrevious studies have not been consistent in the risk of metastasis in follicular thyroid carcinoma (FTC). Therefore, we conducted a large population study to stratify the risk of distant metastasis in FTC patients using only clinical parameters.MethodsWe extracted FTC patients from The Surveillance, Epidemiology, and End Results (SEER) database and divided them into training and validation cohorts.ResultsThe two cohorts consisted of 4913 and 2391 patients, respectively. We developed a nomogram and risk table based on a logistic regression model using algorithm‐selected variables. Receiver Operating Characteristic (ROC) analyses showed high discriminatory power in the training and validation cohorts (Area under the curve [AUC] of 0.85 and 0.84, respectively). Extremely low, low, intermediate, and high‐risk groups had 0.3%, 1%, 3.5%, and 16.7% risk of distant metastasis, respectively.ConclusionsOur risk scoring table can separates patients into four risk groups and efficiently detect patients with almost no risk of metastasis.

Mandibular metastasis of follicular thyroid carcinoma

Metastasis is one of the major complications of malignant tumors that leads to morbidity and mortality. Metastatic tumors to the oral cavity are very rare, and true incidence is still unknown. However, they are of great clinical significance as they can represent as the first and the only manifestation of dissemination in most of the cases. The most common sources of metastasis in the oral cavity are the breast, kidney, lung, prostate and Gastrointestinal tract (GIT). Thyroid carcinoma though is the most common type of endocrinal malignancy but rarely metastasizes to the oral region. Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer after papillary thyroid carcinoma. It affects the jawbones more often than the soft tissues. To our knowledge, till present, literature has reported 44 cases of metastatic FTC to jawbones with mandibular predominance. With the increasing incidence of these tumors during the past few years, it has become of great concern to diagnose them at an early stage so that further complications can be eradicated. Here, we present a rare case of metastatic FTC occurring in the mandible of a 55 year old male along with a systematic review of the literature.

A rare case of follicular thyroid carcinoma metastasis to the sacral region: A case report with literature review.

IntroductionFollicular thyroid carcinoma (FTC) is the second most common thyroid cancer subtype after papillary thyroid cancer (PTC), and it accounts for approximately 10% of all thyroid cancers, the incidence of distant metastasis in FTC has been reported to be 6–20%, bones and lungs are the most frequent sites of distant metastases. Most occult thyroid carcinomas are papillary carcinoma.Case presentationWe describe an extremely rare case of a 74-year-old woman who had a history of right thyroid lobectomy 20 years ago, was referred to our hospital for metastatic thyroid follicular carcinoma to the sacral region confirmed by the biopsy of the sacral mass. The patient was treated by analgesic radiotherapy, surgical totalisation of thyroidectomy, and Radioactive Iodine, with thyroid replacement by levothyroxine. In the follow up we noticed a significant symptom reduction leading to a much better quality of life.ConclusionIncreasing importance should be given to rare metastases in DTP patients. Early detection will help in the early diagnosis and treatment of the disease, thereby improving the patient's survival rate and quality of life.

Machine learning algorithms are comparable to conventional regression models in predicting distant metastasis of follicular thyroid carcinoma.

Distant metastasis often indicates a poor prognosis, so early screening and diagnosis play a significant role. Our study aims to construct and verify a predictive model based on machine learning (ML) algorithms that can estimate the risk of distant metastasis of newly diagnosed follicular thyroid carcinoma (FTC). This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. A total of 5809 FTC patients were included in the data analysis. Among them, there were 214 (3.68%) cases with distant metastasis. Univariate and multivariate logistic regression (LR) analyses were used to determine independent risk factors. Seven commonly used ML algorithms were applied for predictive model construction. We used the area under the receiver-operating characteristic (AUROC) curve to select the best ML algorithm. The optimal model was trained through 10-fold cross-validation and visualized by SHapley Additive exPlanations (SHAP). Finally, we compared it with the traditional LR method. In terms of predicting distant metastasis, the AUROCs of the seven ML algorithms were 0.746-0.836 in the test set. Among them, the Extreme Gradient Boosting (XGBoost) had the best prediction performance, with an AUROC of 0.836 (95% confidence interval [CI]: 0.775-0.897). After 10-fold cross-validation, its predictive power could reach the best [AUROC: 0.855(95% CI: 0.803-0.906)], which was slightly higher than the classic binary LR model [AUROC: 0.845 (95% CI: 0.818-0.873)]. The XGBoost approach was comparable to the conventional LR method for predicting the risk of distant metastasis for FTC.

Chronic thyroiditis in lateral ectopic thyroid mimicking cervical metastasis of thyroid cancer.

SummaryWe present the case of a 45-year-old Caucasian woman who attended the Endocrinology Unit for a left cervical mass discovered during follow-up for autoimmune chronic thyroiditis. The ultrasound-guided fine-needle aspiration biopsy of the lesion was consistent with a metastasis of follicular thyroid carcinoma. The sonographic neck evaluation revealed no thyroid nodules but three markedly hypoechoic and highly vascularized areas, with irregular margins and hyperechoic spots. In the clinical suspicion of primary thyroid neoplasm, ultrasound-guided fine-needle aspiration biopsy of two of the three areas was performed, but both cytological reports were non-diagnostic, revealing only colloid and blood. Subsequently, the patient underwent surgical removal of the cervical mass, with the intra-operatory consultation with frozen section examination suggesting follicular-like neoplasia. For this reason, thyroidectomy with both central and lateral neck dissection was performed. Surprisingly, the final histologic examination revealed chronic thyroiditis in the thyroid specimen and no evidence of metastasis in the left neck mass. Consequently, the pathological revision of the frozen section assessment led to the final diagnosis of chronic thyroiditis on the lateral ectopic thyroid. This case represents an uncommon example of lateral ectopic thyroid tissue with coexisting normally located thyroid tissue both affected by chronic thyroiditis.Learning pointsEctopic thyroid must be considered in the diagnostic work-up of lateral neck mass.Even if rare, ectopic thyroid tissue can be found lateral to the carotid sheath and with coexisting normally located thyroid tissue.As the orthotopic tissue, lateral ectopic thyroid tissue can be affected by chronic thyroiditis, which may complicate the diagnosis both on ultrasound and cytology.

Radiomics Based on Thyroid Ultrasound Can Predict Distant Metastasis of Follicular Thyroid Carcinoma

We aimed to evaluate whether radiomics analysis based on gray-scale ultrasound (US) can predict distant metastasis of follicular thyroid cancer (FTC). We retrospectively included 35 consecutive FTCs with distant metastases and 134 FTCs without distant metastasis. We extracted a total of 60 radiomics features derived from the first order, shape, gray-level cooccurrence matrix, and gray-level size zone matrix features using US imaging. A radiomics signature was generated using the least absolute shrinkage and selection operator and was used to train a support vector machine (SVM) classifier in five-fold cross-validation. The SVM classifier showed an area under the curve (AUC) of 0.90 on average on the test folds. Age, size, widely invasive histology, extrathyroidal extension, lymph node metastases on pathology, nodule-in-nodule appearance, marked hypoechogenicity, and rim calcification on the US were significantly more frequent among FTCs with distant metastasis compared to those without metastasis (p < 0.05). Radiomics signature and widely invasive histology were significantly associated with distant metastasis on multivariate analysis (p < 0.01 and p = 0.003). The classifier using the results of the multivariate analysis showed an AUC of 0.93. The radiomics signature from thyroid ultrasound is an independent biomarker for noninvasively predicting distant metastasis of FTC.

MON-451 An Unusual Case of Follicular Thyroid Cancer with Pulmonary Metastasis and Concurrent Hyperthyroidism

Introduction: Follicular Thyroid Cancer (FTC) accounts for approximately 12 % of all thyroid cancers and is the second most common cause of differentiated thyroid cancer. However, coexisting hyperthyroidism and thyroid malignancy is considered a rare event and is thought to have a prevalence of 0.21–9.0 %. We describe a compelling case of metastatic FTC initially presenting with subclinical hyperthyroidism progressing to overt hyperthyroidism.Clinical Case: An 88-year-old man with a history of prostate cancer, previous tobacco dependence, and hypertension initially presented with complaints of a chronic non-productive cough associated with unintentional weight loss and fatigue. Initial imaging included a chest CT that showed several bilateral pulmonary nodules suspicious for metastatic disease, as well as an enlarged left-sided thyroid mass, which extended from the inferior pole into the mediastinum. FDG PET/CT showed avid disease identified in the lung. CT-guided lung biopsy was performed, and histopathology revealed FTC. Thyroid function tests (TFTs) revealed a Tg level of 1427 (0.00–33.70), TgAb <1.0 (< 13.6), TSH 0.05 (0.40–4.50), FT4 1.1 (0.8–1.8) and FT3 3.4 (2.3–4.2). Biochemical testing was consistent with subclinical hyperthyroidism. Neck ultrasound showed bilateral thyroid nodules, the largest located on the left mid-pole measuring 3.4 x 3.2 x 3.7 cm. He underwent a whole-body I-131 diagnostic scan, which showed intense uptake of the radionuclide within the thyroid gland, more evident on the left, but additional metastatic lesions elsewhere in the visualized body were not possible. TFTs were repeated, which showed a TSH of 0.01, FT4 of 2.0, and FT3 of 6.4. He was subsequently started on methimazole daily and eventually became euthyroid. Due to advanced age, significant mediastinal extension, and lung metastasis, the patient was not a candidate for surgical resection and treatment with a targeted tyrosine kinase inhibitor. He ultimately opted for an observational approach.Conclusion: Although metastatic FTC carries a poor prognosis, concurrent hyperthyroidism is thought to be associated with a more aggressive disease course and higher mortality compared to differentiated thyroid cancers in euthyroid patients.Sources: 1. Pazaitou-Panayiotou, K., Perros, P., Boudina, M., Siardos, G., Drimonitis, A., Patakiouta, F., & Vainas, I. (2008). Mortality from thyroid cancer in patients with hyperthyroidism: the Theagenion Cancer Hospital experience, European Journal of Endocrinology, 159(6), 799–803.2. Benjamin Momo Kadia, Christian Akem Dimala, Ndemazie Nkafu Bechem, Desmond Aroke. BMC Res Notes. 2016; 9: 369.3. Parameswaran R, Shulin Hu J, Min En N, Tan WB, Yuan NK. Patterns of metastasis in follicular thyroid carcinoma and the difference between early and delayed presentation. Ann R Coll Surg Engl. 2017;99(2):151–154.

Solitary Renal Metastasis of Follicular Thyroid Carcinoma with Cervical Nodal Deposits

Solitary Renal Metastasis of Follicular Thyroid Carcinoma with Cervical Nodal Deposits

Temporal Bone Metastasis of Follicular Thyroid Carcinoma in an Asymptomatic Patient: A Rare Case

Introduction: Thyroid carcinomas are classified according to their histological subtypes, namely: papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), medullar y carcinoma, undifferentiated carcinoma and poorly differentiated carcinoma. PTC usually spread to the lymph node which can be the presenting complaint, whereas FTC tends to have distant metastasis owing to its propensity of hematogenous spread. Differentiated thyroid carcinomas (DTC) such as papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) have a better prognosis compare to medullary and undifferentiated types. FTC constitutes around 10 to 25% of thyroid malignancies. Despite of its rarity compared to PTC, FTC tends to have distant metastases to lungs and bones. Usually long bones such as femur are more affected. Metastases to the skull and skull base are rare with only few reported cases. We report a case of temporal bone metastasis in an asymptomatic follicular thyroid carcinoma, which was detected on Iodine-131 (131I) scan and characterized on single-photon emission computed tomography/ computed tomography (SPECT/CT) scan.Conclusion: Temporal bone is a rare metastatic site of FTC. Early detection and prompt treatment play a vital role in patients’ survival and reducing the metastatic risk. In post total thyroidectomy patients, post ablation 131I whole body scan with SPECT/CT and serum thyroglobulin correlation is essential in detection of distant metastasis in asymptomatic patients.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 42

Role of phospho\u2013ezrin in differentiating thyroid carcinoma

Comprehensive theory explaining the relationship between estrogen (E2) and ezrin in metastasis of thyroid cancer remains non-elicited. In vitro results revealed that E2 could stimulate the expression and phosphorylation of ezrin in a time and dose dependent manner. Our data clearly showed that E2 enhanced the migration and invasion of cells, which was reversed by the transfection of cells with ezrin specific siRNA. Further, we observed that Phosphoinositide 3-kinase (PI3K) ROCK-2 are among the kinases responsible for E2 induced phosphorylation of ezrin. Clinical validation of ezrin/phospho-ezrin revealed that phospho-ezrin was intensely expressed in follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FVPTC), while it was completely absent in follicular adenoma (FA) lesions in which the differentiation of the follicular neoplasms remains subtle. When histology of different carcinomas is correlated with benign FA with respect to phospho-ezrin, we observed that the marker was highly significant (p = 0.0001). 100% sensitivity, specificity and diagnostic accuracy of the above marker in the histological association of FTC, FVPTC with FA, enables us to suggest phospho-ezrin as a diagnostic marker to differentiate the follicular neoplasms. These data are the first to suggest the dynamic regulation of ezrin phosphorylation during metastasis in FTC.

Multiple Cutaneous Metastasis of Follicular Thyroid Carcinoma in the Scalp and Upper Extremities

Multiple Cutaneous Metastasis of Follicular Thyroid Carcinoma in the Scalp and Upper Extremities

Risk Factors for Distant Metastasis in Follicular Thyroid Carcinoma in Korea

Risk Factors for Distant Metastasis in Follicular Thyroid Carcinoma in Korea