Multifocal Papillary Thyroid Carcinoma Research Articles

The BRAF V600E Mutation and Clinicopathological Changes Among Patients With Hashimoto thyroiditis, Papillary Thyroid Carcinoma With Hashimoto Thyroiditis, and Nodular Goiter.

The study aimed to investigate the BRAF V600E mutation and clinicopathological changes among patients with Hashimoto thyroiditis (HT), papillary thyroid carcinoma (PTC) with Hashimoto thyroiditis (HT), or nodular goiter (NG). A total of 87 patients with the BRAF V600E mutation who were diagnosed with HT (including with hyperplasia dysplasia), PTC with HT, and PTC with NG were enrolled. Clinical data, concentrations of antithyroglobulin antibodies (TGAb) and thyroid microsomal antibodies (TMAb) in the serum thyroid-function levels, and the result presence of the BRAF V600E mutation were retrospectively analyzed. There were significant differences in the BRAF V600E mutation rates between the HT and PTC with HT groups (P <0.05) and the HT and PTC with NG groups (P <0.05), whereas no significant difference was found between the PTC with HT and PTC with NG groups. There was no difference in incidences of PTC between HT with elevated TGAb and TMAb group and those with baseline levels. The incidence of multifocal PTC was higher in the PTC with HT group; however, the difference was not significant. Our findings documented that BRAF mutation distinguished between the benign HT and the malignant PTC groups. The serum levels of TGAb and TMAb autoantibodies did not directly correlate with PTC in the background of HT. HT and NG may similarly contribute to the pathogenesis of PTC.

Ultrasound and clinical factors predicting central lymph node metastases in patients with unilateral multifocal papillary thyroid carcinoma.

This retrospective study involving a large dataset of unilateral multifocal papillary thyroid carcinoma (UM-PTC) sought to identify factors that predict central lymph node metastases (CLNM) in patients. We identified a cohort of 158 patients who underwent cervical ultrasonography followed by UM-PTC diagnosis based on postoperative pathology. The relationship between CLNM and UM-PTC clinical ultrasound features was evaluated using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of total tumor diameter (TTD) to predict CLNM. Among the 158 UM-PTC patients, the incidence of CLNM was 29.7% (47/158). Univariate and multivariate analyses revealed that a number of similarity of sonographic features (NSSF) ≥4 (odds ratio [OR]=11.335, 95% confidence interval [CI]: 3.95-32.50, p=0.000), microcalcifications (OR=3.54, 95% CI: 1.30-9.70, p=0.014), a TTD of ≥2cm (OR=4.48, 95% CI: 1.62-12.34, p=0.004), number of nodules ≥3 (OR=13.17, 95% CI: 3.24-53.52, p=0.000), and Lateral cervical lymph node metastasis (LLNM) (OR=5.57, 95% CI: 1.59-19.48, p=0.007) were independently associated with CLNM in UM-PTC. ROC curve analysis revealed that the TTD cut-off of 1.795cm had a sensitivity of 0.723 and a specificity of 0.676 for predicting CLNM. Patients with UM-PTC are at high risk of CLNM. NSSF ≥4, microcalcifications, TTD of ≥2cm, LLNM, and a number of nodules ≥3 were independently associated with CLNM. Our data show that ultrasound may guide surgical decisions in the treatment of UM-PTC.

Trends of the prevalence rate of central lymph node metastasis and multifocality in patients with low-risk papillary thyroid carcinoma after delayed thyroid surgery.

Active surveillance has been an option for patients with low-risk papillary thyroid carcinoma (PTC). However, whether delayed surgery leads to an increased risk of local tumor metastasis remain unclear. We sought to investigate the impact of observation time on central lymph node metastasis (CLNM) and multifocal disease in patients with low-risk PTC. Patients who were diagnosed with asymptomatic low-risk PTC, and with a pathological maximum tumor size ≤1.5 cm by were included. The patients were classified into observation group and immediate surgery group, and subgroup analyses were conducted by observation time period. The prevalence of CLNM, lymph node (LN) involved >5, multifocal PTC and bilateral multifocal PTC were considered as outcome variables. The changing trend and risk ratio of prevalence over observation time were evaluated by Mann-Kendall trend test and Logistics regression. Overall, 3,427 and 1,860 patients were classified to the observation group and immediate surgery group, respectively. Trend tests showed that decreasing trends both on the prevalence of CLNM and LN involved >5 over the observation time, but the difference was not statistically significant, and the prevalence of multifocal PTC and bilateral multifocal PTC showed the significant decreasing trends. After adjustment, multivariate analysis showed no statistically significant difference between observed and immediate surgery groups in the four outcome variables. In patients with subclinical asymptomatic low-risk PTC, observation did not result in an increased incidence of local metastatic disease, nor did the increased surgery extent in patients with delayed surgery compared to immediate surgery. These findings can strengthen the confidence in the active surveillance management for both doctors and patients.

Microwave Ablation versus Surgical Resection for US-detected Multifocal T1N0M0 Papillary Thyroid Carcinoma: A 10-Center Study.

Background Microwave ablation (MWA) is currently under preliminary investigation for the treatment of multifocal papillary thyroid carcinoma (PTC) and has shown promising treatment efficacy. Compared with surgical resection (SR), MWA is minimally invasive and could preserve thyroid function. However, a comparative analysis between MWA and SR is warranted to draw definitive conclusions. Purpose To compare MWA and SR for preoperative US-detected T1N0M0 multifocal PTC in terms of overall and 1-, 3-, and 5-year progression-free survival rates and complication rates. Materials and Methods In this retrospective study, 775 patients with preoperative US-detected T1N0M0 multifocal PTC treated with MWA or SR across 10 centers between May 2015 and December 2021 were included. Propensity score matching (PSM) was performed for patients in the MWA and SR groups, followed by comparisons between the two groups. The primary outcomes were overall and 1-, 3-, and 5-year progression-free survival (PFS) rates and complication rates. Results After PSM, 229 patients (median age, 44 years [IQR 36.5-50.5 years]; 179 female) in the MWA group and 453 patients (median age, 45 years [IQR 37-53 years]; 367 female) in the SR group were observed for a median of 20 months (range, 12-74 months) and 26 months (range, 12-64 months), respectively. MWA resulted in less blood loss, shorter incision length, and shorter procedure and hospitalization durations (all P < .001). There was no evidence of differences in overall and 1-, 3-, or 5-year PFS rates (all P > .05) between MWA and SR (5-year rate, 77.2% vs 83.1%; P = .36) groups. Permanent hoarseness (2.2%, P = .05) and hypoparathyroidism (4.0%, P = .005) were encountered only in the SR group. Conclusion There was no evidence of a significant difference in PFS rates between MWA and SR for US-detected multifocal T1N0M0 PTC, and MWA resulted in fewer complications. Therefore, MWA is a feasible option for selected patients with multifocal T1N0M0 PTC. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.

Primary diffuse large B cell lymphoma (DLBCL) of thyroid with concurrent multifocal papillary thyroid carcinoma in a background of Hashimoto’s thyroiditis

Primary diffuse large B cell lymphoma (DLBCL) of thyroid with concurrent multifocal papillary thyroid carcinoma in a background of Hashimoto’s thyroiditis

The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas

(1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs ≤ 10 mm, TTDs &gt; 10 mm, TTDs ≤ 20 mm, and TTDs &gt; 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of &gt;10 mm and unifocal PTCs with a primary tumor diameter (PTD) of &gt;10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD &gt; 10 mm were found to be significant risk factors for LNM, and PNI, TTD &gt; 10 mm, TTD &gt; 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD &gt; 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD &gt; 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD &gt; 10 mm along with unifocal PTCs with PTD &gt; 10 mm may be more useful in terms of clinical management of the disease.

Metastatic papillary thyroid carcinoma masquerading as lymphangioma: A rare case report and review of literature

ABSTRACT Papillary thyroid carcinoma coexisting with lymphangioma is a rare presentation of a cystic neck mass. Here, we report a case of papillary thyroid carcinoma masquerading as lymphangioma in the neck clinically and radiologically. Our patient was a 31-year-old man who presented with swelling on the left side of the neck for four months. A detailed history and investigation are summarized, and a review of published literature on similar cases is obtained. The initial computed tomography (CT) scan reported it as lymphangioma, and the fine-needle aspiration cytology (FNAC) reported it as a cystic lesion. However, the excision biopsy showed a picture of metastatic papillary carcinoma of the thyroid with cystic changes and associated lymphangioma. The patient finally underwent total thyroidectomy, which again revealed multifocal papillary thyroid carcinoma with capsular invasion and lymph node metastasis on histopathological examination (HPE). Primary occult carcinoma of the thyroid with metastatic deposits presenting as lymphangioma is a very rare presentation of a cystic neck mass, and very few cases have been reported in the English language literature.

Metastases to lymph nodes from monofocal and multifocal papillary thyroid malignant tumors in patients with autoimmune thyroiditis

The aim of this work was to study the risk factors for metastasis to the central and lateral neck lymph nodes in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), especially in patients with Hashimoto’s thyroiditis (TH).Methods: A retrospective analysis of 763 patients after thyroidectomy with bilateral central lymphadenectomy (CLE) was performed at the interterritorial Center for Endocrine Surgery in Krasnodar during the period from October 2011 to October 2021. All patients had official histological diagnoses of TH. To identify risk factors for metastasis (Mts) to the lymph nodes of the neck, a multifactorial logistic regression analysis was performed.Results: In our study, 277 patients with SCLC and TC showed relatively low rates of Mts to the central lymph nodes (CLU) compared with patients with SCLC without TC (37.2 % vs. 54.7 %, P 140 IU / ml was established as the most sensitive and specific level for predicting MPCT based on the study. Antibodies to AT-TPO, age, tumor size, and multifocal tumor shape demonstrated the ability to predict Mts in the central nervous system in patients with PCT on the background of TC with a probability of 81.1 % based on a multidimensional model. TH was associated with an increased prevalence of multifocal tumor with invasion of the gland capsule.Conclusions: TH detection demonstrated the reduced risk of metastases to the CLN in patients with PCT and MPCT and indicated a potential protective effect. We found that the prognostic model is applicable for predicting a multifocal tumor and metastasis to the central nervous system in patients with PCT and TH.

Total thyroidectomy versus unilateral lobectomy for unilateral multifocal papillary thyroid carcinoma: systematic review and meta‑analysis.

The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the efficacies of total thyroidectomy and lobectomy in patients with unilateral multifocal papillary thyroid carcinoma. A literature search of the PubMed/Medline, Embase, Web of Science, Cochrane Library, Wan Fang, and Zhi Wang databases for relevant studies, published from inception to October 31, 2022, was performed. Two researchers independently extracted data from the included studies. Lymph node metastasis, vocal fold paralysis, parathyroid injury, postoperative recurrence, and disease-free survival were evaluated. The meta-analysis included 7 studies comprising 1540 patients, of whom 496 and 1044 underwent lobectomy and total thyroidectomy, respectively. Compared with lobectomy, total thyroidectomy resulted in more vocal cord paralysis (odds ratio [OR] 0.35 [95% confidence interval (CI) 0.13 to 0.96]; P = 0.04) and parathyroid injury (OR 0.11 [95% CI 0.03-0.39]; P = 0.001) but with better disease-free survival (OR 0.21 [95% CI 0.09-0.49]; P = 0.000), although vocal cord paralysis and parathyroid injury, in large part, resolved within 1year after surgery. In addition, there was no difference in postoperative lymph nodes metastasis (OR 0.74 [95% CI 0.13-4.21]; P = 0.737) and postoperative recurrence (OR 2.37 [95% CI 0.42-13.38]; P = 0.33). Excluding studies that deviated from the general trend, total thyroidectomy was beneficial in reducing recurrence. Compared with lobectomy, total thyroidectomy was beneficial in reducing recurrence and disease-free survival and may be considered a more optimal approach for unilateral multifocal papillary thyroid carcinoma.

Multifocality as an adverse histopathological factor in papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is characterized by various clinical and pathomorphological features, such as metastases to the locoregional lymph nodes and radioiodine resistance. It could also be diagnosed as a microcarcinoma coexisting with other benign thyroid pathologies or as multifocal growth. Of these, multifocality in PTC is considered an unfavourable pathomorphological feature. However, the research findings are controversial. Objective — to investigate and evaluate the clinical and pathohistological features of multifocal PTC (mPTC) in comparison with unifocal (single nodule) PTC. Materials and methods. Among the patients who underwent operative treatment at the clinical bases of the Department of Surgery, Institute of Biology, and Medicine at Taras Shevchenko National University of Kyiv, 91 were diagnosed with PTC and were included in the study. Results. Out of the 91 patients, 31 (34%) had mPTC and 60 (66%) had PTC. Bilateral mPTC was diagnosed in 23 (74%) patients, which is in line with other studies. It is also worth mentioning, that 5 (16%) patients were diagnosed with multifocal growth only at the stage of histopathology section, without preoperative or intraoperative evidence of multifocality. A significantly higher frequency of locoregional metastasis was found in the mPTC group in 17 (55%) patients as compared to 18 (30%) patients with PTC (p=0.025). Lateral neck dissection was performed in 13 (42%) patients with mPTC, and in 13 (22%) patients with PTC (р=0.0525). Frozen section pathology was performed in 17 (24 patients with mPTC, and in 4 (10%) patients with PTC (р &gt;0,05). Conclusions. A higher frequency of locoregional metastasis and a higher propensity for performing a lateral neck dissection are both indicators of a higher biological aggressiveness of the carcinoma in PTC multifocal growth.

Bilaterality as a Risk Factor for Recurrence in Papillary Thyroid Carcinoma.

Previous studies suggested that the multifocality of papillary thyroid carcinoma (PTC) would increase the risk of recurrence; however, the impact of its bilaterality remains unclear. Between 2011 and 2018, 1258 patients with PTC underwent total thyroidectomy at Ewha University Medical Center. The 5-year recurrence-free survival rate was 95.7% in patients with bilateral PTC, while those with unilateral multifocal PTC and a unifocal tumor showed a 5-year event-free survival rate of 97.0% and 97.8%, respectively (p = 0.004). A multivariable Cox proportional hazards model indicated that bilaterality (HR 2.550, 95% CI 1.354-4.800), male sex (HR 2.010, 95% CI 1.007-4.013), and tumor size (HR 1.748, 95% CI 1.316-2.323) were associated with recurrence, although unilateral multifocality did not increase the risk of recurrence (HR 1.211, 95% CI 0.348-4.213). In conclusion, bilaterality was associated with aggressive features, including tumor size and microscopic ETE. Moreover, bilaterality was an independent predictor of recurrence in patients with PTC. Patients with bilateral PTC might require careful treatment and follow-up approaches.

Related factors of high-volume lymph node metastasis in multifocal papillary thyroid carcinoma

Objective: To explore the related factors of high-volume lymph node metastasis (HVM) in multifocality papillary thyroid carcinoma (MPTC). Methods: The clinical and pathological data of multifocality papillary thyroid carcinoma (MPTMC, d≤10 mm) and MPTC (d>10 mm) collected from Hangzhou First People's Hospital from January 2010 to March 2023 were retrospectively analyzed. Univariate and multivariate logistic regression analysis were used to analyze the relevant factors of HVM. Results: Among 566 cases of MPTMC and 381 cases of MPTC, there were 72 males and 494 females in MPTMC, 106 males and 275 females in MPTC, respectively. The median age of the patients was 47 (39, 54) and 47 (34, 56) years, respectively, and the incidence of HVM was 4.6% (26/566) and 21.5% (82/381), respectively (χ2=64.588, P<0.001). Univariate analysis showed that in patients with MPTMC and MPTC, the incidence of HVM in males was higher than that in females [15.3% (11/72) vs 3.0% (15/494) (χ2=21.487, P<0.001) in MPTMC, 33.2% (35/106) vs 17.1% (47/275) (χ2=11.492, P=0.001) in MPTC]. The age of the HVM group was lower than that of the non-HVM group [41 (33, 50) vs 48 (39, 54) years (Z=-2.128, P=0.033) in MPTMC, 38 (29, 48) vs 48 (36, 57) years (Z=-4.987, P<0.001) in MPTC]. The maximum diameter of tumors in the HVM group were higher than those in the non-HVM group [7.0 (5.0, 10.0) mm vs 6.0 (5.0, 8.0) mm (Z=-2.558, P=0.011) in MPTMC, 17.5 (13.0, 25.0) mm vs 15.0 (12.0, 20.0) mm (Z=-2.871, P=0.004) in MPTC]. Multivariate logistic regression analysis showed that larger tumor size (OR=3.027, 2.378; 95%CI: 1.287-7.117, 1.404-4.030; P=0.011, 0.001), male (OR=5.398, 1.909; 95%CI: 2.284-12.758, 1.113-3.274; P<0.001, P=0.019), and younger age (OR=3.889, 3.136; 95%CI: 1.686-8.969, 1.837-5.355; P=0.001, P<0.001) were all risk factors for the occurrence of HVM in MPTMC and MPTC. Conclusion: The proportion of HVM in MPTC patients was higher than that in MPTMC, and larger maximum diameter, male gender and younger age are related factors for HVM in MPTMC and MPTC.

SAT575 Can We Miss Diagnosis Of Tall Cell Variant Papillary Thyroid Carcinoma?

Abstract Disclosure: J. Huynh: None. A. Makawi: None. G. Elshimy: None. Introduction Large thyroid nodules have a high rate of evolving into malignancy. Fine needle aspiration biopsy (FNAB) is a key diagnostic tool with a caveat of a high false-negative rate for cancer detection ranging from 0.7 to 13%. Key to maximizing the odds of a successful FNAB are the utilization of ultrasound (US) guidance, visualization of the needle tip, preprocedural consideration of the size of the target nodule, and expertise of the cytopathologist. Case presentation 40-year-old African American female who presented to endocrinology clinic given concern for a large left-side thyroid nodule with tracheal deviation seen on a CT scan of the chest. The US revealed a large left hypoechoic, spongiform nodule &amp;gt;5cm with grade 2 vascularity with no calcification measuring 5.1 x 4.3 cm. The thyroid labs were within normal range and she denied any compressive symptoms. FNAB of the nodule showed benign colloid. Given the large size of the nodule, we recommended surgical resection but the patient declined and preferred conservative management. Five months later, she started to experience dysphagia with positional neck pain and shortness of breath. Due to the progression of the compressive signs, the patient opted for left thyroidectomy which revealed multifocal papillary thyroid carcinoma (PTC) tall cell variant (TCV) with the largest foci of 1.7 cm with extrathyroidal extension and vascular invasion. She then underwent completion thyroidectomy followed by postoperative radioactive iodine ablation later on as the second surgery pathology was also consistent with PTC with metastasis to the lymph nodes. She was treated with levothyroxine with the goal to suppress TSH. Postoperatively, the patient is being monitored with biochemical testing and imaging for recurrence given the aggressive nature of her disease. Discussion There is a positive correlation between nodule size and false negative results (FNR). FNR for malignancy is known to be higher in nodules larger than 4cm. Patients with large thyroid nodules causing compressive signs should undergo resection regardless of the FNAB result. This patient had a benign FNAB initially which was misleading as the pathology of thyroidectomy was consistent with TCV PTC, a more aggressive variant. TCV PTC usually presents in larger nodules and with a higher rate of extrathyroidal extension and metastasis compared to classic. The prognosis is poorer with TCV, even without an extranodal extension. This patient received appropriate treatment with total thyroidectomy, THR therapy, sequential imaging, and biochemical testing for recurrence. A key takeaway here is that FNABs may not always reflect accurate histology of the whole lesion with larger nodules having a higher tendency for inadequate sampling. Key to successful biopsy and reducing FNAB false-negative results is an experienced radiologist, a cytopathologist familiar with these tumors, and US guidance. Presentation: Saturday, June 17, 2023

The value of total tumor diameter in unilateral multifocal papillary thyroid carcinoma: a propensity score matching analysis.

Tumor multifocality is frequently observed in papillary thyroid carcinoma (PTC). However, the maximum tumor diameter (MTD), currently utilized in various staging schemes, might not accurately indicate the level of aggressiveness exhibited by multifocal tumors. We aimed to investigate the relationship between total tumor diameter (TTD) and clinicopathological features of papillary thyroid carcinoma. Retrospective data analysis was done on 1936 individuals who underwent complete thyroidectomy for PTC. Patients were classified into subgroups according to unilateral multifocality, central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). The relationships of clinicopathological features among these groups were analyzed. Unilateral multifocality was observed in 117 patients. The clinicopathological features of the unilateral multifocal PTC were similar to the unifocal PTC with approximate TTD. The unilateral multifocality played no independent role in CLNM and LLNM. Moreover, the efficiency of TTD in predicting CLNM and LLNM was significantly higher than that of MTD. In the case of unilateral multifocal PTC, TTD is a more accurate indicator of the biological characteristics of the tumor than MTD.

Prognostic Value of Tumor Multifocality in Pediatric Papillary Thyroid Carcinoma: A Real-Life Multicentric Study.

To investigate the association of multifocality with clinical outcomes in pediatric papillary thyroid cancer. Multicenter retrospective study of prospectively collected data. Tertiary referral center. This study included patients 18 years or younger who underwent total thyroidectomy and radioiodine ablation for papillary thyroid carcinoma (PTC) between 2005 and 2020 at 3 tertiary adult and pediatric hospitals in China. For disease-free survival (DFS), events were defined as persistent and/or recurrent diseases. The primary outcome was the association of tumor multifocality and DFS, assessed using Cox proportional hazards regression models. One hundred and seventy-three patients (median age 16 years [range, 5-18 years]) were recruited. Multifocal diseases were seen in 59 patients (34.1%). After a median follow-up of 57 (range, 12-193 months) months, 63 (36.4%) patients had persistent diseases. There was a significant association between tumor multifocality and decreased DFS on univariable analysis (hazard ratio [HR] = 1.90, p = .01), yet it was nonsignificant after multivariate adjustment (HR = 1.20, p = .55). In a subgroup analysis of 132 pediatric patients with clinically M0 PTC, neither unadjusted HR (2.21, p = .06) nor adjusted HR (1.70, p = .27) of multifocal PTC was significantly higher in comparison to unifocal PTC. In this highly selective surgical pediatric patient cohort with PTC, tumor multifocality was not an independent risk factor for decreased DFS.

Multifokal Papiller Tiroid Karsinomlu Hastalarda Total Tiroidektominin Sonuçları ve Patolojik Özellikleri

Aim: The incidence of thyroid cancer has increased dramatically in recent decades. Multifocality is considered a poor prognostic factor for papillary thyroid carcinoma (PTC). Patients with multifocal PTC (MPTC) are at high risk for local recurrence, as well as lymphatic and distal metastases. This study examined the features and outcomes of MPTC. Material and Methods: This retrospective study was conducted on 300 patients with PTC. Patients were classified into a multifocal group and a unifocal group. The pathological features of the PTC and the patients’ outcomes were analyzed and compared. Results: The multifocal group included 146 patients (48.7%), while the unifocal group included 154 patients (51.3%). The occurrence of multifocality was higher in females than in males (Odds ratio, OR: 2.37, 95% confidence interval, CI: 1.20-4.67, p=0.015). Tumor size of &amp;gt;1 cm in the multifocal group was larger than in the unifocal group (2.5 and 2.2 cm, respectively, p=0.021). Moreover, in multifocal group higher moderate risk of recurrence was detected than in the unifocal group (OR: 1.63, 95% CI: 1.01-2.60, p=0.044). At follow-up after treatment, MPTC patients had higher lymph node metastasis (OR: 2.89, 95% CI: 1.23-6.80, p=0.014). In addition, significantly higher thyroglobulin plasma levels (p=0.026) and disease recurrence (OR: 2.41, 95% CI: 1.05-5.52, p=0.037) were found in the multifocal group compared to the unifocal group. Conclusion: Patients with MPTC had a higher risk of disease recurrence, and multifocality was concluded to be an independent prognostic factor for overall disease recurrence.

Synchronous thyroid cancer and malignant struma ovarii: concordant mutations and microRNA profile, discordant loss of heterozygosity loci

BackgroundStruma ovarii is an unusual ovarian teratoma containing predominantly thyroid tissue. Less than 10% of cases undergo malignant transformation in the thyroid tissue and are considered malignant struma ovarii (MSO). MSO have been reported with concurrent thyroid lesions, but molecular data is lacking.Case presentationA 42-year-old female developed MSO and synchronous multifocal subcentimeter papillary thyroid carcinoma (PTC). The patient underwent a salpingo-oophrectomy, thyroidectomy, and low-dose radioactive iodine ablation. Both the thyroid subcentimeter PTC and MSO were positive for BRAF V600E mutation, and microRNA expression profiles were similar across all tumor deposits. However, only the malignant component demonstrated extensive loss of heterozygosity (LOH) involving multiple tumor suppressor gene (TSG) chromosomal loci.ConclusionsWe present the first reported case of MSO with synchronous multifocal subcentimeter PTC in the thyroid containing concordant BRAF V600E mutations and resulting with discordant LOH findings. This data suggests that loss of expression in tumor suppressor gene(s) may be an important contributor to phenotypic expression of malignancy.

Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

A preoperative method is desired to discriminate benign from malignant thyroid nodules. This retrospective study evaluated the diagnostic performance of BRAF (B-Raf proto-oncogene) mutation (BRAFV600E ) positivity and fine-needle aspiration cytology (FNAC) relative to intraoperative frozen section pathology. Patients underwent preoperative FNAC of thyroid nodules. Cytology specimens were classified according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), and analyzed for BRAFV600E using an amplification-refractory mutation system (ARMS). Thyroid tissue was surgically removed and frozen sections processed for histology. The sensitivities and specificities of each analysis were compared, alone and in combination. Among 346 patients, 333/358 FNACs (93%) showed malignant nodules; 322 (93%) patients received a pathological diagnosis of papillary thyroid carcinoma (PTC). The sensitivity and specificity of BSRTC VI for malignancy was the highest among the BSRTC categories. Compared with FNAC, the BRAFV600E analysis had significantly higher sensitivity and specificity. The diagnostic efficacy of frozen section pathology was significantly higher than that of either BSRTC category or BRAFV600E analysis alone. Combining methods variably improved diagnostic performance. BRAFV600E was not associated with capsule infiltration, neurovascular infiltration, mono- or multifocal PTC, lymph node metastasis, or clinical stage. The diagnostic performance of preoperative BRAFV600E determination was better than that of the BSRTC-FNAC category; combining both improved sensitivity and specificity. Patients with positive malignancy scores from both should be recommended for surgery; those with negative scores require close monitoring. Surgical treatment should include comprehensive intraoperative frozen section assessment. BRAF mutations cannot indicate aggressive treatment.

Can total tumor diameter be the most powerful predictor of recurrence in patients with multifocal papillary thyroid carcinoma?

Can total tumor diameter be the most powerful predictor of recurrence in patients with multifocal papillary thyroid carcinoma?

Incidental Papillary Microcarcinoma and Papillary Thyroid Carcinoma in Multinodular Goiter.

This study aimed to examine the incidence of incidental papillary microcarcinoma (PMC) and papillary thyroid carcinoma (PTC) in patients with benign multinodular goiter (MNG) and to compare their relationship with some prognostic factors from a new perspective. Bilateral total thyroidectomy (BTT) was used to evaluate the data of 716 patients who underwent a surgery for MNG. The prognostic data for these tumors and the relationship between patients with bilateral and multifocal tumors were evaluated using statistical tests. Papillary carcinomas were detected in 201 patients, PMC in 134 of them, and PTCs in 67. Bilaterality was more common in patients with PTCs than in those with PMC. The incidence of bilaterality in male patients with PTC was statistically more common. The presence of intra-tumoral lymphocytes was higher in multifocal PTC cases than in unifocal PTC cases. The results revealed that the number of PMC s was high in incidental tumors, and patients with PTC with male sex, bilaterality, multifocality, and tumor capsule invasion were associated with poor prognosis.