Primary Papillary Carcinoma Research Articles

No Correlation between PD-L1 and NIS Expression in Lymph Node Metastatic Papillary Thyroid Carcinoma.

Approximately 90% of thyroid cancers are differentiated thyroid cancers (DTCs), originating from follicular epithelial cells. Out of these, 90% are papillary thyroid cancer (PTC), and 10% are follicular thyroid cancer (FTC). The standard care procedure for PTC includes surgery, followed by radioiodine (RAI) ablation and thyroid-stimulating hormone (TSH) suppressive therapy. Globally, treating radioiodine-refractory DTC poses a challenge. During malignant transformation, thyroid epithelial cells often lose their ability to absorb radioiodine due to impaired membrane targeting or lack of NIS (sodium/iodide symporter) expression. Recent reports show an increase in PD-L1 (programmed death ligand 1) expression in thyroid cancer cells during dedifferentiation. However, no research exists wherein NIS and PD-L1 expression are analyzed together in thyroid cancer. Therefore, we aimed to investigate and correlate PD-L1 and NIS expression within primary tumor samples of lymph node metastatic PTC. We analyzed the expression of hNIS (human sodium/iodide symporter) and PD-L1 in primary tumor samples from metastatic PTC patients using immunohistochemistry. Immunohistochemistry analysis of PD-L1 and NIS was conducted in 89 and 86 PTC cases, respectively. Any subcellular NIS localization was counted as a positive result. PD-L1 expression was absent in 25 tumors, while 58 tumors displayed PD-L1 expression in 1-50% of their cells; in 6 tumors, over 50% of the cells tested positive for PD-L1. NIS immunohistochemistry was performed for 86 primary papillary carcinomas, with 51 out of 86 tumors showcasing NIS expression. Only in seven cases was NIS localized in the plasma membrane; in most tumors, NIS was primarily found in the intracytoplasmic membrane compartments. In the case of PD-L1 staining, cells showing linear membrane positivity of any intensity were counted as positive. The evaluation of NIS immunostaining was simpler: cells showing staining of any intensity of cytoplasmic or membranous fashion were counted as positive. The number of NIS positive cells can be further divided into cytoplasmic and membrane positive compartments. There was no observed correlation between PD-L1 and NIS expression. We can speculate that the manipulation of the PD-1/PD-L1 axis using anti-PD-L1 or anti-PD-1 antibodies could reinstate the functional expression of NIS. However, based on our study, the only conclusion that can be drawn is that there is no correlation between the percentage of NIS- or PD-L1-expressing tumor cells in the primary tumor of lymph node metastatic PTC.

Metastatic Papillary Thyroid Microcarcinoma Presenting as a Branchial Cleft Cyst in Young Female.

Though aetiology of lateral neck masses is complex, branchial cleft cyst is the second most common congenital lesions of the neck next only to thyroglossal duct cysts. Rarely ectopic thyroid tissue within a branchial cleft cyst may develop into primary papillary carcinoma, and even more rarely it may harbour metastases of primary thyroid papillary carcinoma. We report a rare case of lateral cystic neck mass in a 24-year-old female patient diagnosed as metastatic PTC. The patient was diagnosed after she underwent surgical excision of branchial cleft cyst. Later prospectively the patient underwent total thyroidectomy which revealed papillary thyroid micro invasive carcinoma.

Primary Papillary Colonic Adenocarcinoma With PDGFRA Mutation. A New Morphological Subtype? A Case Report and Review of Literature.

Classic colon carcinomas are defined as adenocarcinomas, characterized by groups of medium/large cells with basophilic and polymorphous nuclei and an eosinophilic elongated cytoplasm, that rearrange on glandular structures. Signs of poor prognosis include high tumor budding, lymphovascular and perineural invasion, poor differentiation, positive margins, and CDX2 loss. Less frequent colon carcinoma subtypes are: mucinous, medullary, signet-ring cell, squamous cell, small cell and undifferentiated carcinoma, among others. In the following case report, we present a 65-year-old woman with a T2N0Mx colon carcinoma with a remarkable papillary and follicular histological appearance. The immunohistochemical stains confirmed an intestinal origin (CDX2+) and excluded a thyroid, gynecological, and urological metastasis, with tumor cells negative for GATA3, PAX8, TTF-1, and thyroglobulin. There was no loss of mismatch repair proteins and p53 showed a wild-type staining. next generation sequencing showed a platelet-derivated growth factor receptor alpha (PDGFRA) mutation. To the best of our knowledge, there have been only two examples of primary papillary colon carcinoma reported in the literature, and neither of them with a PDGFRA mutation. We describe one tumor and discuss its pathological features.

CD4, CD20 and PD-L1 as Markers of Recurrence in Non-Muscle-Invasive Bladder Cancer

Introduction: A tumor microenvironment plays an important role in bladder cancer development and in treatment response. Purpose: The aim of the study was to assess how the components of the microenvironment affect tumor recurrence and to find the potential biomarkers for immunotherapy in NMIBC. Methods: The study group consisted of 55 patients with primary NMIBC. Immunohistochemistry was performed on sections of primary papillary urothelial carcinoma of the bladder. Cox proportional hazard multiple regression analysis was performed to characterize tumors with the highest probability of an unfavorable outcome. Results: Multivariate analysis confirmed that the CD4 (p = 0.001), CD20 (p = 0.008) and PD-L1 expressed on tumor cells (p = 0.01) were independently associated with the risk of recurrence of bladder cancer. Patients with weak CD4+ cell infiltration (<4.6%) and severe CD20+ infiltration (>10%) belong to the group with a lower risk of recurrence. The cancer in this group also frequently recurs after 12 months (p = 0.0005). Conclusions: The evaluation of CD4+ and CD20+ cells in the tumor microenvironment, in addition to PD-L1 on tumor cells, facilitates the determination of a group of patients with a low risk of recurrence.

Primary papillary carcinoma in a thyroglossal duct cyst: A case report

Background: Thyroglossal duct cyst(TDC)is the most common congenital disorder of the thyroid gland. Seventy five percent of midline neck masses in children are (TDC). Occurrence of malignancy in (TDC) is very rare event, and include 1% of all cases of (TDC). Here in this report, we describe a rare case of primary papillary carcinoma which arises in a (TDC). Case report: Our case is a 42-year-old woman who presented with a hard painless solid and cystic mass in front of the neck above of thyroid cartilage. After initial physical examination and ultrasonography, the mass identified. Radiologist performed a core needle biopsy of the cyst and mass which show a papillary cell carcinoma. The patient underwent near total thyroidectomy, excision of lymph node and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the specimen revealed a thyroglossal duct cyst which showed a primary invasive papillary carcinoma that infiltrated the cyst wall. The thyroid gland was normal, cervical lymph node was not involved. Conclusions: Primary papillary carcinoma of thyroglossal duct cyst is a rare disease which presents in patients with cystic midline neck masses. Surgery and radical excision is the optimal patient management with radioactive iodine therapy which improve the survival.

Bilateral primary papillary serous carcinoma of the fallopian tube – A rare case scenario

Bilateral primary fallopian tube carcinoma is a very rare case scenario. Approximately, its incidence is 0.02% of all the gynecological malignancy. A 40-year-old female patient visited the hospital with complaints of lower abdominal pain for 3 months. Ultrasound of the pelvis shows complex bilateral adnexal lesions with ORADS score 4 – intermediate risk. The serum CA-125 is elevated. The provisional diagnosis of bilateral pyosalpinx was made. The uterus with bilateral ovaries and fallopian tubes was removed. On histopathology, thus, the final diagnosis of primary bilateral papillary serous carcinoma of the fallopian tube was made. Bilateral primary fallopian tube carcinoma is a very rare case scenario. Intraoperative frozen study is to be done to diagnose this entity. The high degree of suspicion is required to diagnose a case of bilateral fallopian tube carcinoma as it is a very rare case scenario and usually confused for pyosalpinx.

PRIMARY PAPILLARY CARCINOMA IN A THYROGLOSSAL CYST:A CASE REPORT

Thyroglossaal cyst associated carcinoma is a rare and comprise 1% of all thyroid carcinoma.(1) We in this report present a case of primary papillary carcinoma arise in a thyroglossal duct cyst. A 36 year old male presented with cystic mass in front of neck,ultrasound scanning was suggestive of a complex cystic lesion and normal thyroid,FNAC showed Thyroglossal cyst with inammation.The Sistrunk procedure was performed and histopathology conrmed the diagnosis of Papillary carcinoma thyroid in thyroglossal cyst

Her-2 Expression Status in Different Histopathological Grades of Urothelial Carcinoma

Introduction: Urothelial carcinoma is the predominant histological sub-type and accounts for 90% of human urinary bladder cancers. It is among the ten common malignancies of adults in Pakistan. Her-2 receptor modifications including mutations have been previously evaluated as one of the major players in carcinogenesis of urinary bladder’s carcinoma arising from urothelium. The increase in expression of Her-2 receptor is seen in higher grade carcinomas along with muscle infiltration in comparison to tumors of lesser grade and not invading muscle layer. Aims and Objectives: To compare epidermal growth factor (Her-2) receptor expression status between high and low grade, infiltrative and non-infiltrating carcinoma of urinary bladder’s urothelium. Materials and Methods: 50 cases with diagnosis of primary papillary urothelial carcinoma with variable stages and grades, from both genders and different ages, were selected using convenience sampling for current cross sectional study. Routined protocols opted for immunohistochemical staining to observe Her-2 expression in urothelial cancer trans-urethral resection specimen. If more than 10 percent of cells with positive circumferential complete, and intense membrane staining for Her-2 were taken as positive as assessed semi-quantitatively by using immuno-reactive scoring system designated by ASCO/CAP guidelines. Results: Patients having ages ranging from 42 to 95 years including 37 males and 13 females were selected for current study. Her-2 immunostaining revealed, positivity in 27 (54%) patients. Results interpreted showed more number of cases having higher grade (p= 0.0006) and infiltration (p = 0.0001) with Her-2 positivity. Conclusions: The current study showed significant amount of Her-2 positivity in greater grade and carcinomas possessing muscle invasion as compared to tumors of lower grade and those not invading muscle wall. Key words: Her-2 receptor, Low grade urothelial carcinoma, Invasive papillary urothelial carcinoma

Papillary Thyroid Carcinoma in a Thyroglossal Cyst: A Case Report

Introduction: Thyroglossal duct cysts (TDC) are the most common anomaly occurring during thyroid development. Thyroid carcinoma can be seen in less than 1% of untreated thyroglossal duct cysts. The overall prognosis of primary papillary carcinoma in thyroglossal duct cyst is very good with a five year- survival rate of about 95%.

Bilateral kidney metastases from adenoid cystic carcinoma of lung: a case report and literature review

Adenoid cystic carcinoma (ACC) is a rare malignant tumor, usually arising from salivary glands and rarely found in other locations. ACC is characterized by asymptomatic course, slow growth pattern, perineural invasion and high incidence of late metastasis. Renal localization of metastasis is rare. Only 12 cases of renal metastasis were published and, to our best knowledge, no case of bilateral metastasis to the kidney has ever been reported. We present a case of a 58years old woman with bilateral renal metastasis from ACC of the right lung after fourteen years from lobectomy and radiotherapy for the primary presentation. The patient underwent bilateral robot-assisted partial nephrectomy in a two-stage approach. Despite its rare incidence and slow growth, ACC metastasis may simulate primary papillary renal carcinoma and occur many years after primary treatment. Therefore, lifelong follow-up, including abdominal imaging, is recommended.

Trends and Outcomes of Surgical Management of Primary Papillary Carcinoma in the Pediatric Population

BackgroundChildhood papillary thyroid cancer is more aggressive than carcinomas in adults. Current American Thyroid Association pediatric guidelines recommend a total or near-total thyroidectomy for all pediatric patients without gross evidence of lymph node metastases. Our objective is to analyze trends in the surgical management of pediatric papillary thyroid cancer and assess how well the guidelines are implemented. MethodsA retrospective cohort study of pediatric patients (ages 19 y and under) who underwent a thyroidectomy was conducted using the Surveillance, Epidemiology, and End Results database 2006-2017. Procedure type was classified as lobectomy or less and subtotal or total thyroidectomy. Descriptive statistics to illustrate patient and tumor characteristics as well as chi-square analysis to evaluate frequency of treatment with total thyroidectomies versus lobectomy or less were performed. Logistic regression analysis controlling for age, sex, size of tumor, rural versus urban institutions, and surgery year was conducted to identify factors predictive of procedure type. ResultsA total of 2271 children underwent surgical management of papillary thyroid cancer between 2006 and 2017. Most patients received a subtotal or total thyroidectomy as surgical management (n = 2,085, 91.8%). One hundred eighty-six patients (8.2%) received a lobectomy or less. The number of lobectomies or less increased with time, with 41 (6.6%) patients between 2006 and 2009, 98 (8.0%) between 2009 and 2015, and 47 (11.1%) between 2016 and 2017 (P = 0.03). Mortality rates were low (n = 15, 0.7%). On logistic regression analysis, later stages, larger sizes, and earlier operative years were predictive of a near-total or total thyroidectomy. ConclusionsDespite the American Thyroid Association Guidelines recommending a total thyroidectomy for pediatric well-differentiated thyroid cancer, the results of this study demonstrate that thyroid lobectomies are being performed in increasing frequency for smaller tumors in earlier stages of disease. Further investigation of whether this trend actually affects the outcomes in this patient cohort is needed.

Primary papillary serous carcinoma presenting as acute ovarian torsion in postmenopausal woman: a case report

A 51-year-old postmenopausal woman, with an uneventful past gynecologic history, was admitted to the present hospital with a diagnosis of severe pelvic pain due to a suspected ovarian torsion treated with different drugs intravenously without any improvement of symptoms. As a consequence of the increasing pelvic pain, a laparoscopic surgical treatment was decided: a left necrotic ovarian mass and pelvic peritoneal carcinomatosis were visualized and the procedure was converted from laparoscopy to laparotomy that confirmed a diagnosis of primary ovarian papillary serous carcinoma and permitted an adequate treatment. This is a rare case in literature of severe pelvic pain due to an acute ovarian torsion that permitted a prompt diagnosis and treatment of malignancy.

Intensity of Nuclear Staining for Ki-67, p53 and Survivin as a New Prognostic Factor in Non-muscle Invasive Bladder Cancer

The aim of the study was to determine the prognostic value of expression levels of biomarkers selected on the basis of the literature: p53, Ki-67, survivin, β-catenin, E-cadherin and N-cadherin in patients with non-muscle invasive bladder cancer. Immunohistochemistry was performed on sections of primary papillary carcinoma of the bladder removed during transurethral resection of the tumor in 134 patients. The expression of β-catenin and E-cadherin was found in all analyzed cases and N-cadherin expression was demonstrated in 3.73% of the tissues examined. The expression of the p53 protein was confirmed in 96.27% of tissues examined. The expression of the Ki-67 protein was demonstrated in all analyzed cases. Survivin expression was found in 95.52% of the study group. Multivariate analysis confirmed the relationship between the recurrence-free survival (RFS) and the intensity of the nuclear reaction for p53 (HR 1417, 95% CI 1.001–2.007, p = 0.049) and survivin (HR 1.451; 95% CI 1.078–1.955; p = 0.014), the expression level of the Ki-67 protein expressed by the TS index (HR 1.146, 95% CI 1.116–1.823, p = 0.005) and the use of adjuvant BCG therapy (HR 0.218, 95% CI 0.097–0.489, p = 0.0002). The evaluation of Ki-67 expression and the intensity of nuclear staining for survivin and p53 may provide additional information that will allow more accurate stratification of the risk of NMIBC recurrence after TURBT.

CHARACTERISTICS OF SUBCLONAL STRUCTURE IN THYROCYTE POPULATION IN RADIOIODINE-REFRACTORY METASTASES OF PAPILLARY THYROID CANCER

The aim of the study was cytological and immunocytochemical researches of thyrocyte populations in fine-needle aspiration smears of radioiodine-refractory metastases and their comparison with radioiodine-avid metastases and corresponding primary papillary carcinoma of the thyroid. Materials and Methods. The cytomorphological and immunocytochemical researches were conducted on the fine needle aspiration smears of 60 papillary thyroid carcinomas and 104 metastases, which were detected in the postoperative period. We applied the indirect immunoperoxidase technique using primary monoclonal mouse antibodies against leukocyte-common antigen, macrophage antigen, thyroglobulin, epithelial cell adhesion molecule, cytokeratines 7.8, polyclonal rabbit antibodies against calcitonin. Results. It was demonstrated, that radioiodine-avid metastases and corresponding primary papillary thyroid carcinoma smears had first type of cellular population with a relatively regular location of thyrocytes. Unlike them, radioiodine-refractory metastases smears had the second type of cellular population with irregularly location of thyrocytes among which showed up two cellular phenotypes. In our investigated smears some special cellular complexes were found – in 21 % of radioiodine-refractory metastases, 1 % in radioiodine-avid metastases and none of it in corresponding primary papillary thyroid. The cytological sign of cystic degeneration was found in 58 % of radioiodine-refractory metastases, but in radioiodine-avid metastases – was absent. Conclusion. The radioiodine-refractory metastases of papillary thyroid cancer demonstrated their distinction from radioiodine-uptake metastases with a presence of phenotypic heterogeneity. It is shown, that an appearance of certain cell subpopulations, special cellular complexes and cystic degeneration in fine-needle aspiration smears of radioiodine-refractory metastases, which in radioiodine-uptake metastases and corresponding primary papillary thyroid carcinomas were not found, can be used during the preoperative period to forecast the impossibility of radioiodine treatment.

SUN-601 Papillary Thyroid-like Carcinoma Of The Kidney

INTRODUCTION: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and usually associated with good prognosis. Typical sites for metastases include lymph nodes, lung and bone, while renal metastasis is rare. Here we present a case of primary papillary thyroid-like carcinoma of the kidney. Histologically and immunohistochemically, the tumor closely resembled PTC, but no abnormalities were found in the thyroid or cervical lymph nodes. CASE REPORT: 54-year-old Caucasian male non-smoker with history of GERD, and dyslipidemia was referred to ENT for evaluation of left tonsillar mass. PET CT showed hypermetabolic regions in the left base of tongue and lingual tonsil, and hypodensity in the lower pole of the left kidney. He underwent bilateral palatine tonsillectomy for invasive squamous cell carcinoma followed by adjuvant chemoradiation. MRI of the abdomen confirmed a 1.7cm left lower pole renal mass and he underwent laparoscopic partial nephrectomy. Pathological examination of the renal tumor was suggestive of papillary carcinoma of thyroid origin (immunohistochemical staining positive for TTF-1, PAX-8 and CK7, and negative for thyroglobulin, RCC, CK20 and racemase). Histologically, the tumor displayed nuclear inclusions, nuclear grooves and papillary architecture. RET oncogene amplification further supported the diagnosis of PTC. Neck ultrasound was negative for thyroid nodules or lymphadenopathy, and no residual hypermetabolic disease was seen on follow-up PET CT. Due to concern for metastatic PTC, the patient underwent total thyroidectomy with central lymph node dissection. Pathology showed only benign thyroid with lymphocytic thyroiditis. Post-thyroidectomy whole body scan showed no abnormal radiotracer uptake to suggest residual thyroid or disease. Serum thyroglobulin level remained undetectable with negative anti-TPO antibodies. DISCUSSION: This patient presented with an incidentally discovered renal tumor that histologically and immunohistochemically resembled PTC. Renal metastasis of PTC is very rare, with less than 20 cases reported, yet positive staining for TTF-1 is highly sensitive and specific for thyroid cells. The possible origins of the tumor include metastasis from an occult intra-thyroidal tumor, primary PTC that had undergone spontaneous resolution, or a primary renal tumor with thyroid-like characteristics. To our knowledge this is the second reported case of a primary papillary thyroid-like cancer of kidney.

Morphological features of radioiodine-resistance metastases of thyroid papillary carcinoma

An important problem in the diagnosis, treatment and prediction of papillary thyroid cancer is radioiodine-resistant metastases, early prediction of which is possible on the condition of determining their cytological and histological characteristics. The purpose of this work was to identify the histological and cytological characteristics of metastases of papillary thyroid carcinomas correlated with their iodine-accumulative capacity, on the basis of which it will be possible to predict the radio-resistance of papillary thyroid carcinomas. A cytological examination of punctates of 30 papillary carcinomas and 45 of their metastases identified in the postoperative period and analysis of the histological characteristics of 100 papillary carcinomas of the general population, 47 primary papillary carcinomas and their radio-resistant metastasis and 17 primary papillary carcinomas of patients with radioiodine-uptake metastases were conducted. Statistical analysis was performed via the non-parametric criterion χ2 in the package Statistica 11.0. It has been shown a statistically significant difference between presence of sign of follicular structures in the histological material of primary papillary canсer of patients with radioiodine-resistance metastases and between of primary papillary canсer of patients with radioiodine-uptake metastases and common population of papillary thyroid cancer. It has been shown a statistically significant difference between punctuates of radioiodine-resistance and radioiodine-uptake metastases in presence of such cytological characteristics as different subpopulations of thyrocytes. It has been shown that the cytological characteristics of radioiodine-resistant metastases differ from radioiodine-uptake metastases and primary papillary carcinomas by the presence of different subpopulations of thyrocytes, particular structures and oxyphilic changes. It is shown that such histological characteristics as lack of follicular structures in the material of primary papillary carcinomas correlate with radio-resistance and can be prognostic factors of its appearance.

Invasive primary papillary carcinoma in a thyroglossal duct cyst: A case report and review of the literature

PatientFemale, 46. Clinical procedureSistrunk's procedure, Total Thyroidectomy and excision of the cervical lymph nodes. BackgroundThyroglossal duct cyst is the commonest congenital anomaly of the thyroid gland. Occurrence of malignancy in a thyroglossal duct cyst is considered a rare condition, forming 1% of all cases of thyroglossal duct cyst. Here in the current report we presented a rare case of primary papillary carcinoma which arise in a thyroglossal duct cyst and a review of the literature. Case reportOur case is a 46-year-old female patient who presented with a painless cystic mass in front of the neck. After initial physical examination we have performed fine needle aspiration cytology (FNAC) of the cyst which revealed a papillary neoplasm. The patient underwent total thyroidectomy with excision of the cervical lymph nodes and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the specimen revealed a thyroglossal duct cyst which contains a primary invasive papillary carcinoma that infiltrated the cyst wall. The thyroid gland was normal, most of the cervical lymph node was positive for PTC. ConclusionsPrimary papillary carcinoma of thyroglossal duct cyst is a rare condition that should be considered in patients with cystic midline neck masses. Surgery and radical excision is the optimal patient management to improve survival.

Primary papillary carcinoma of a thyroglossal duct cyst: A rare case

The incidence of papillary cell carcinoma arising in a thyroglossal duct cyst (TDC) is rare and occurs in 1% of TDCs. Due to embryological remnants of thyroid tissue located in the TDC, the same malignant tumors that develop in the thyroid tissue can also develop in the TDC. The occurrence of carcinoma of TDC, even though rare and unexpected, should always be considered an option and histologically ruled out mainly on account of the atypical localization. We report a case of papillary carcinoma arising in a TDC, presenting with an anterior neck mass in a 28-year-old woman, who underwent a Sistrunk procedure for removal of the mass with total thyroidectomy and neck dissection. Fine-needle aspiration cytology did not contribute to the diagnosis. Based on the histopathologic findings, the patient received postoperative iodine-131 ablation treatment (120 mCi). This type of carcinoma usually has a good prognosis with an overall survival rate of 95.5% at 10 years. Carcinomas of TDC demonstrate lower frequency of regional lymph node metastasis in comparison with that arising in the thyroid gland proper and can be successfully managed with surgery and careful follow-up.

De novo papillary carcinoma in a thyroglossal duct cyst

Introduction Thyroglossal duct cysts (TGDC) account for 70% of congenital neck masses.Majority (70%) is diagnosed during childhood and only 7% in adulthood. Only 1% of thyroid carcinomas evolve from a TGDC. It’s essential to differentiate primary papillary carcinoma in a TGDC from a metastatic papillary carcinoma of thyroid. Objective A 23 year old girl presented with a painless lump over the anterior neck for one month. Examination revealed a non-tender firm midline neck lump just above the hyoid bone with no palpable thyroid nodules or cervical lymphadenopathy. Ultrasound revealed a suprahyoid TGDC and a sub-centimeter solitary thyroid nodule (STN) in right lobe with no cervical lymphadenopathy. FNAC of TGDC showed a benign cystic neoplasm. Ultrasound guided FNAC of the STN showed benign cells only. Thyroid functions were normal. A Sistrunk operation was performed. Histology revealed a papillary carcinoma (with CTF1 nuclear and CK19 positivity in cells lining the papillae). A Total Thyroidectomy was performed after an oncological consultation to exclude a possible primary focus in the STN and to facilitate adjuvant treatment. Histology of the STN was a papillomatous focus likely to be hyperplastic (CK19 negative) and rest of the thyroid normal Conclusion De novo papillary carcinoma in a TGDC is rare. The diagnosis in most cases is incidental after surgical resection. Total thyroidectomy would be indicated, if the carcinomatous component is > 1 cm or <1 cm but with enlarged cervical lymph nodes, tumour invasion of the cyst wall or an abnormal thyroid gland

Commentary on: “Comprehensive molecular characterization of papillary renal-cell carcinoma.” Cancer Genome Atlas Research Network.: N Engl J Med. 2016 Jan 14;374(2):135–45.

BackgroundPapillary renal-cell carcinoma, which accounts for 15%–20% of renal-cell carcinomas, is a heterogeneous disease that consists of various types of renal cancer, including tumors with indolent, multifocal presentation, and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal-cell carcinoma, and no effective forms of therapy for advanced disease exist. MethodsWe performed comprehensive molecular characterization of 161 primary papillary renal-cell carcinomas, using whole-exome sequencing, copy-number analysis, messenger RNA and microRNA sequencing, DNA-methylation analysis, and proteomic analysis. ResultsTypes 1 and 2 papillary renal-cell carcinomas were shown to be different types of renal cancer characterized by specific genetic alterations, with type 2 further classified into 3 individual subgroups on the basis of molecular differences associated with patient survival. Type 1 tumors were associated with MET alterations, whereas type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2-antioxidant response element (ARE) pathway. A CpG island methylator phenotype was observed in a distinct subgroup of type 2 papillary renal-cell carcinomas that was characterized by poor survival and mutation of the gene encoding fumarate hydratase. ConclusionsTypes 1 and 2 papillary renal-cell carcinomas were shown to be clinically and biologically distinct. Alterations in the MET pathway were associated with type 1, and activation of the NRF2-ARE pathway was associated with type 2; CDKN2A loss and CpG island methylator phenotype in type 2 conveyed a poor prognosis. Furthermore, type 2 papillary renal-cell carcinoma consisted of at least 3 subtypes based on molecular and phenotypic features. (Funded by the National Institutes of Health.)