Synchronous Thyroid Research Articles

Aggressive Synchronous Papillary and Likely Follicular Thyroid Carcinomas in a Patient with Graves’ Disease

We report a case of an uncommonly aggressive presentation of the rare entity of synchronous papillary (PTC) and follicular thyroid carcinomas (FTC) in a 67-year-old woman initially presenting with thyrotoxicosis from Graves’ disease. She was found to have two thyroid nodules with extensive intra-cardiac tumour thrombus, symptomatic left pelvis bony metastasis with pathological fracture, pulmonary metastases and mediastinal lymph node metastases. Further investigations suggested a diagnosis of synchronous papillary and metastatic follicular thyroid cancer. Treatment with radical surgery followed by adjuvant therapeutic radioiodine ablation was proposed, but the patient declined all forms of cancer-specific therapy and was elected solely for a palliative approach to treatment. We discuss the diagnostic considerations in arriving at the diagnosis of synchronous thyroid malignancy – in this case the clear features of PTC and the strong probability of FTC due to invasiveness and metastatic follicular lesions. This case underscores potential limitations of the ACR TI-RADS system, notably with certain ultrasonographic features suggesting malignancy that might not be adequately captured. Notably, the aggressive presentation of DTC in this case may be contributed by the concurrent presence of Graves’ Disease, suggesting heightened vigilance when assessing potential thyroid malignancies in such patients.

Synchronous papillary and follicular thyroid carcinomas: the first retrospective cohort study and literature review.

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) contribute to more than 95% of thyroid malignancies. However, synchronous PTC and FTC are less common; it is most commonly discovered incidentally as synchronous malignancies during operation, which adds difficulties to intraoperative decision-making and postoperative treatment. Therefore, we analyzed the clinicopathological characteristics and prognosis of patients with PTC and FTC in our center. We conducted a search of single PTC, single FTC, and synchronous PTC/FTC patients who received initial surgery treatment at Fudan University Shanghai Cancer Center from 2006 to 2018 and collected paraffin-embedded samples of synchronous patients. Clinicopathological characteristics were collected from the electronic medical record system. Follow-up was performed through telephone contact or medical records. Exome sequencing was performed by ThyroLead panel. Total of 42 synchronous PTC/FTC patients, 244 single FTC patients, and 2,959 single PTC patients were included. It showed a similarity between the clinicopathological features of synchronous thyroid cancer patients and single PTC patients, with a greater proportion of females, higher probabilities of lymph node metastasis, and higher rate of concurrence of Hashimoto's disease. The disease-free survival (DFS) curve indicated a worse prognosis of the synchronous group and single PTC group compared to the single FTC group, who had a propensity for neck lymph node recurrence; however, logistic multivariate regression analysis did not find any factor related to recurrence in the synchronous group. After re-checking pathology, DNA extraction, and quality control, genetic alteration information of 62 samples including primary tumors and metastatic lymph nodes from 35 synchronous cancer patients was displayed. In total, 81 mutations and 1 fusion gene were identified, including mutations related to outcomes and targeted therapy. Besides, some rare mutations in thyroid cancer were found in these patients. To conclude, synchronous PTC/FTC tend to be incidentally discovered during or after operation, behaving more like single PTC. The prognosis of synchronous patients is worse than that of single FTC patients and supplemental cervical lymph node dissection, total thyroidectomy, and postoperative radioiodine therapy should be taken into consideration after diagnosis. The next-generation sequencing (NGS) showed a unique molecular feature of synchronous patients with some rare mutations.

Development and Validation of a Nomogram for Prognosis Prediction in Patients with Synchronous Primary Thyroid and Breast Cancer Based on SEER Database

This study aimed to develop prognostic prediction models for patients diagnosed with synchronous thyroid and breast cancer (TBC). Utilizing the SEER database, key predictive factors were identified, including T stage of thyroid cancer, T stage of breast cancer, M stage of breast cancer, patient age, thyroid cancer surgery type, and isotope therapy. A nomogram predicting 5-year and 10-year survival rates was constructed and validated, exhibiting strong performance (C-statistic: 0.79 in the development cohort (95% CI: 0.74-0.84), and 0.82 in the validation cohort (95% CI: 0.77-0.89)). The area under the Receiver Operator Characteristic (ROC) curve ranged from 0.798 to 0.883 for both cohorts. Calibration and decision curve analyses further affirmed the model’s clinical utility. Stratifying patients into high-risk and low-risk groups using the nomogram revealed significant differences in survival rates (P < 0.0001). The successful development and validation of this nomogram for predicting 5-year and 10-year survival rates in patients with synchronous TBC hold promise for similar patient populations, contributing significantly to cancer research.

Prevalence of Papillary Thyroid Carcinoma is Significantly Higher in Graves Disease with Synchronous Thyroid Nodules.

The association between autoimmunity-related tissue injury and thyroid cancer development remains an area of interest. Evidence suggests that patients with Graves disease (GD) may have an elevated risk for differentiated thyroid cancer. Multicenter studies are needed to gain insight into the correlates of papillary thyroid carcinoma (PTC) identified in this particular group of patients. This study aimed to investigate the prevalence of PTC and synchronous thyroid nodules in thyroidectomy specimens from GD patients in an endemic goiter region. A retrospective review of institutional pathology records at two tertiary care centers identified 237 surgically treated patients with GD. Patients were categorized as having nodular Graves disease (N-GD) if synchronous nodular thyroid was identified by ultrasonography, while those without synchronous thyroid nodules were categorized as non-nodular or simple Graves disease (S-GD). The prevalence of PTC, histopathological correlates, and demographic characteristics were recorded and compared between groups N-GD and S-GD. One hundred thirty-one and 106 patients were assigned to N-GD and S-GD, respectively. The mean age was significantly higher in N-GD (mean 45.52 years) compared to S-GD (mean 35.18 years) (p < 0.001). The overall frequency of PTC was 36.3% (86/237) in the entire cohort. PTC was identified in 48.1% (63/131) of N-GD and 21.7% (23/106) of S-GD (p < 0.001). Subcentimeter tumors constituted the majority of cases in both groups (76.2% in N-GD and 82.6% in S-GD) (p > 0.05). The group of S-GD was enriched in BRAF-like PTCs, whereas N-GD had equal distribution for RAS- and BRAF-like tumors. This study underscores that the majority of PTCs encountered in GD were enriched in low-risk subcentimeter PTCs with a prevalence that varies depending on the presence of underlying nodular thyroid tissue.

Large, Slowly Growing, Benign Thyroid Nodules Frequently Coexist With Synchronous Thyroid Cancers.

Thyroid nodules' size should not be the sole criterion for thyroidectomy; however, many patients undergo surgery for large or slowly growing nodules. We evaluated risk for clinically significant thyroid cancer in patients with large or slowly growing nodules. We reviewed data from 2 prospectively collected databases of patients undergoing thyroidectomies in tertiary referral centers in the USA and Greece over 14 consecutive years. We collected data on the preoperative surgical indication, FNA cytology, and surgical pathology. We included subjects operated solely for large or growing thyroid nodules, without any known or presumed thyroid cancer or high risk for malignancy, family history of thyroid cancer, or prior radiation exposure. We reviewed 5523 consecutive cases (USA: 2711; Greece: 2812). After excluding 3059 subjects, we included 2464 subjects in the present analysis. Overall, 533 thyroid cancers were identified (21.3%): 372 (69.8%) microcarcinomas (<1 cm) and 161 (30.2%) macrocarcinomas (≥1 cm). The histology was consistent with papillary cancer (n = 503), follicular cancer (n = 12), Hürthle cell cancer (n = 9), medullary cancer (n = 5), and mixed histology cancers n = 4. Only 47 (1.9%) of our subjects had any form of thyroid cancer in the nodule that originally led to surgery. The cancers were multifocal in 165 subjects; had extrathyroidal extension in 61, capsular invasion in 80, lymph node involvement in 35, and bone metastasis in 2 subjects. The risk of synchronous, clinically important thyroid cancers is small, but not null in patients with large or slow growing thyroid nodules. Therefore, more precise preoperative evaluation is needed to separate the patients who would clearly benefit from thyroid surgery from the vast majority of those who do not need to be operated.

Tumors colliding in thyroid: A case report

The synchronous presence of two histologically distinct and morphologically independent primary malignancies within the same organ is termed as collision tumor. However, these tumors are rare and many theories like stem cell theory, hostage theory, collision theory are proposed to explain their occurrence. The most frequently encountered collision tumor in the thyroid gland is of papillary carcinoma and medullary carcinoma. We report an extremely rare case of 41 year old female with papillary and follicular collision tumor. The diagnosis of synchronous thyroid malignancy was made on histopathology of the excised tissue.

159 - Solitary synchronous thyroid metastasis in a patient with a primary squamous cell carcinoma of the lung

159 - Solitary synchronous thyroid metastasis in a patient with a primary squamous cell carcinoma of the lung

Synchronous thyroid gland metastases from breast cancer. Case reports

Background. Breast cancer is the leading cause of death in women. Distant metastases in different organs, including the thyroid gland, are still an urgent problem. Distant metastases are very rare in clinical practice. Nevertheless, the accumulated clinical and surgical experience in treatment has shown that breast cancer is the second most common primary tumor, leading to thyroid gland metastases, after kidney cancer.&#x0D; Aim. Present the clinical observations of synchronous thyroid gland metastases from breast cancer.&#x0D; Materials and methods. We observed two patients, aged 55 and 72 years, suffering from metastatic breast cancer with simultaneous metastases to the thyroid gland, to the cervical and mediastinal lymph nodes, to the lungs, to the ovaries and to the bones.&#x0D; Results. A 55-year-old woman with a left sided neck mass and hoarseness has been suffering from the metastatic breast cancer with simultaneous metastases to the thyroid gland, to the cervical lymph nodes, to the lungs, to the ovaries and to the bones. The biopsy of the primary tumor has been performed. The tumor has the structure of invasive ductal carcinoma, G2, luminal A subtype, HER2-negative type in histological and immunohistochemical analysis. The spread of the tumor has been determined by positron emission tomography/computed tomography (PET/CT). Metastases from breast cancer have been cytologically proven during thin needle biopsy. A 72-year-old woman with a mass in the region of thyroid gland has been suffering from breast cancer with metastases to the thyroid gland, to the mediastinal and cervical lymph nodes, to the bones, and to determine this process PET/CT, the thyroid fine needle aspiration biopsy and core biopsy of primary tumor have been applied. The histological variant was represented by invasive ductal cancer, G2, luminal A subtype, HER-2 negative type. Taking into account the spread of the process, the patients were given polychemotherapy, targeted therapy and hormone therapy. There is no disease progression for 6 months.&#x0D; Conclusion. Synchronous thyroid gland metastases in case of primary breast tumors are rare. In such cases, PET/CT is the important diagnostic method. The main therapeutic option in this case is systemic therapy, including chemotherapy, targeted and hormone therapy, the nature of the agent depends on the biological variant of the tumor.

Synchronous thyroid cancer on the edge: Incidentalomas of 18F-FDG PET/CT in clinical practice.

The objective of this study was to discuss the outcomes of the oncology patients whose PET/CT scans show incidental focal thyroid 18F-FDG uptake. This retrospective analysis examined 2575 18F-FDG PET/CT scans from 1803 patients with no known thyroid cancer history. The survival rates were analyzed for patients with and without cytopathological evaluation. Increased metabolic activity of the thyroid was detected in 96 patients. Of those, 72 were diagnosed with a focal uptake of 18F-FDG and 24 subjects had a diffuse uptake. All 72 patients with a focal uptake were referred for ultrasound (US) and fine-needle aspiration cytology (FNAC). Of those patients, 44 were admitted for US and 16 underwent FNAC. The mean SUVmax was 16.0 ± 7.97 for patients with malignant lesions and 3.24 ± 0.88 for patients with benign lesions (p = 0.023). The mortality rate was higher in the patients who were not evaluated with FNAC. Patients with incidental focally increased thyroid 18F-FDG accumulation on PET/CT are known to have a high risk of malignancy. These patients require additional diagnostic procedures to distinguish the underlying pathology. However, the clinical condition of these patients will be the primary concern when performing these procedures.

Mystery Case of Parathyroid Carcinoma Masquerading as a Thyroid Nodule

Introduction: Parathyroid carcinoma is a rare malignancy with a prevalence of 0.005%. Patients typically present with symptoms of hypercalcemia and elevated parathyroid hormone (PTH) levels. Non-functional parathyroid carcinoma presenting with neck pain and normal calcium is a unique and challenging entity. We describe a challenging case of normocalcemic parathyroid carcinoma presenting as neck pain. Case Description: A 59-year old woman with a history of asthma, type 2 diabetes, and tobacco use presented with neck pain and swelling worsening over months. On physical exam, she was noted to have right-sided thyroid mass. CT scan of the neck showed an enlarged thyroid gland with a 1.6 cm nodule with evidence of the trachea’s compression. Subsequent thyroid US revealed a 2.1 cm dominant solid, hypoechoic nodule in the right thyroid lobe. Initial testing revealed normal calcium levels; however, PTH level was not available. FNA of the nodule was non-diagnostic with subsequent repeat FNA interpreted as benign mass. Due to suspicious imaging features and significant neck discomfort, she underwent right hemithyroidectomy. During the surgery, the nodule was noted to be invasive with evidence of extrathyroidal extension. Postoperatively calcium was 8.9 mg/dl (8.6–10.4 mg/dl), ionized calcium 4.7 mg/dl (4.8–5.6mg/dl), PTH 48 pg/mL (14–64 pg/ml), and vitamin D25OH 48 ng/dL (30-100ng/dl). TSH was mildly elevated at 4.59 uIU/ml (0.27–4.2 uIU/ml) with free T4 of 1.09 ng/dl (0.93–1.70ng/dl). The preliminary pathology report described follicular thyroid carcinoma; however, immunostains failed to confirm primary thyroid cancer. The lesion was negative for TTF-1, PAX8, TG, CEA, calcitonin, chromogranin, and synaptophysin. The tumor was strongly positive for GATA3, PTH and positive in nuclear staining for parafibroma. The specimen was evaluated by two pathologists who favored the diagnosis of parathyroid carcinoma. A separate incidental microscopic 4mm papillary thyroid carcinoma (PTC) was found and tested positive for BRAF mutation. Genetic testing for CDC73 was negative. PET scan showed increased uptake in the right thyroid bed. Given microscopic PTC and mildly elevated TSH, she was started on levothyroxine. The patient recovered successfully after the surgery with the resolution of symptoms. She was evaluated by an oncologist, and adjuvant radiation therapy was recommended. Conclusion: Non-functional parathyroid carcinoma is a unique entity, and its diagnosis may be delayed given an atypical presentation and normal endocrine function. Differentiation between nonfunctioning parathyroid carcinoma, parathyroid adenoma, and thyroid disease based on location and proximity to the thyroid may be challenging. Although concomitant thyroid disease is not uncommon, synchronous thyroid cancer is very rare.

Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

BackgroundParathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review.Case presentationWe herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma.ConclusionsOur experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.

Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer

BackgroundDifferentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common.Case PresentationA 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease.ConclusionDespite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.

A synchronous papillary and follicular thyroid carcinoma presenting as a large toxic nodule in a female adolescent

Case presentationWe report for the first time a synchronous papillary and follicular thyroid carcinoma in a 12-year-old girl presenting with a large (5 cm diameter) left thyroid nodule, an increased left and right upper pole technetium tracer uptake at scintigraphy and hyperthyroidism. The uptake at the right lobe was explained by the crossing of the left nodule to the right site of the neck at Computed Tomography (CT) scanning.BackgroundAlthough thyroid nodules are less common in children than in adults, there is more vigilance required in children because of the higher risk of malignancy. According to literature, about 5% of the thyroid nodules in adults are malignant versus 20–26% in children. The characteristics of 9 other pediatric cases with a differentiated thyroid carcinoma presenting with a toxic nodule, which have been reported during the last 20 years, are summarized. A nodular size of more than 3.5 cm and female predominance was a common finding.ConclusionsThe presence of hyperthyroidism in association with a hyperfunctioning thyroid nodule does not rule out thyroid cancer and warrants careful evaluation, even in the absence of cervical lymph node invasion.

MON-510 Patients with Large Multinodular Goiters Operated for Presumed Benign - Large or Growing Thyroid Nodules, Have a High Likelihood of Significant Synchronous Thyroid Cancers

Introduction: Despite the current state of evidence suggesting that thyroid nodules’ size should not be the sole criterion for the decision to undergo thyroidectomy, many patients are still operated for large, or growing nodules. In order to ascertain whether this is a justifiable approach, we performed the present study. Methods/ Subjects: We reviewed the data from two prospectively collected databases of patients undergoing thyroid surgery in two tertiary referral centers, one in the USA (A) and the other one in Greece (B) over 14 consecutive years. We collected data on the preoperative surgical indication, FNA cytology and surgical pathology. We included subjects with multinodular goiters, operated solely for large or growing thyroid nodules, who did not have any known or presumed thyroid cancer, or indications of high risk for malignancy (FNA suspicious for thyroid cancer, follicular neoplasm, suspicious for follicular neoplasm, FLUS/AUS, cellular specimen), family history of thyroid cancer or prior neck radiation exposure. Results: We reviewed 5523 consecutive cases of thyroid surgery (A:2711, B:2812). After excluding n=3059 subjects, we included n=2464 subjects in the present analysis. Overall 535 thyroid cancers were identified (21.7%): 349 (65.2%) were microcarcinomas (<1cm), 161 (30.0%) were macrocarcinomas (≥1cm) and 25 of undetermined size. The histology was consistent with papillary cancer (PTC) n=500, follicular cancer (FTC) n=14, Hurthle cell cancer (HCC) n=9, medullary cancer (MTC) n=4, thyroid lymphoma n=1 and mixed histology cancers n=4. In n=68 (2.75%) cases, a thyroid cancer was found in the large or growing thyroid nodule, which was the original indication for surgery. The cancers were multifocal in n=165 subjects; there was extrathyroidal extension in n=61, capsular invasion was present in n=80, lymph node involvement in n=35 and bone metastasis in n=2 subjects. Conclusions: Although the likelihood of identifying a clinically relevant thyroid cancer in a large or growing nodule, in the absence of risk enhancing features, is low; the risk of synchronous, clinically important, thyroid cancers is high in patients with large multinodular goiters. Therefore, more precise screening strategies are urgently needed to identify the patients, who would clearly benefit from thyroid surgery and protect those who do not need to be operated on.

Incidental versus clinical diagnosis of papillary thyroid microcarcinoma. Long-term prognosis

IntroductionThe incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent years, especially in patients operated on for presumably benign thyroid disease. The aim of this study was to analyze the differences between PTMC incidentally diagnosed and PTMC clinically diagnosed, as well as its long-term prognosis. Material and methodsThe study population consisted of patients with a histological diagnosis of PTMC. Patients with previous thyroid surgery, other synchronous thyroid or extrathyroid malignancies and an ectopic location of PTMC were excluded. Two groups were compared: patients with PTMC incidentally diagnosed (group 1) and patients with PTMC clinically diagnosed (group 2). A multivariate analysis of differentiating factors was performed. ResultsPTMC clinically diagnosed had a high frequency of hypothyroidism (4,6% vs. 18,9%; p = 0,004), extrathyroidal extension (5,7% vs. 17,6%; p = 0,018), metastatic lymph nodes (1,1% vs. 18,9%; p < 0,001) and lymphocytic thyroiditis (5,7% vs. 27%; p < 0,001). In the multivariate analysis, metastatic lymph nodes (OR 22,011, IC95% 2,621-184,829; p = 0,004) and lymphocytic thyroiditis (OR 4,949, IC95% 1,602-15,288; p = 0,005) were associated with the clinical diagnosis of PTMC. During a mean follow-up of 119,8 ± 65,1 months, one recurrence was detected in group 2 (0 vs. 1,4%; p = 0,460). No patient died due to the disease. ConclusionsPTMC clinically diagnosed, although it has more aggressive histopathological characteristics (extrathyroidal extension and metastatic lymph nodes), presents a long-term prognosis similar to the PTMC incidentally diagnosed. The presence of metastatic lymph nodes and lymphocytic thyroiditis were independent factors associated with PTMC clinically diagnosed.

Ultrasound Assessment of Synchronous Thyroid Nodules in Patients With Papillary Thyroid Cancer: A Nodule-by-nodule Analysis Between Ultrasound and Pathology.

The purpose of this study was to evaluate the diagnostic value of preoperative ultrasound (US) in the assessment of synchronous thyroid nodules in patients with papillary thyroid cancer (PTC) for determination of surgical extent. A total of 210 consecutive patients who were surgically diagnosed with PTC were included in this study. Synchronous nodules, divided into probably benign and suspicious nodules based on US findings, were correlated with pathologic results using a nodule-by-nodule analysis. Among the 302 synchronous nodules in 129 patients, 83 (27.5%) synchronous nodules in 73 patients were diagnosed as malignant after surgery. Ipsilateral probably benign nodules on US were more likely to be malignant than contralateral probably benign nodules (ipsilateral, 10.6%; contralateral, 2.0%, p=0.015). The presence of suspicious contralateral nodules on US and the number of synchronous nodules were significant factors related to contralateral cancer (p<0.001 and 0.030). For evaluation of synchronous nodules in PTC patients, US assessment for synchronous nodules can be applied for preserving the contralateral lobe.

High Genetic Diversity and No Evidence of Clonal Relation in Synchronous Thyroid Carcinomas Associated with Hashimoto's Thyroiditis: A Next-Generation Sequencing Analysis.

The close association between pre-existing Hashimoto’s thyroiditis and thyroid cancer is well established. The simultaneous occurrence of multiple neoplastic foci within the same organ suggests a common genotoxic effect potentially contributing to carcinogenesis, the nature of which is still not clear. Next-generation sequencing (NGS) provides a potent tool to demonstrate and compare the mutational profile of the independent neoplastic foci. Our collection of 47 cases with thyroid carcinoma and Hashimoto’s thyroiditis included 14 with at least two tumorous foci. Detailed histological analysis highlighted differences in histomorphology, immunoprofile, and biological characteristics. Further, a 67-gene NGS panel was applied to demonstrate the mutational diversity of the synchronic tumors. Significant differences could be detected with a wide spectrum of pathogenic gene variants involved (ranging between 5 and 18, cutoff >5.0 variant allele frequencies (VAF)). Identical gene variants represented in both synchronous tumors of the same thyroid gland were found in only two cases (BRAF and JAK3 genes). An additional set of major driver mutations was identified at variable allele frequencies in a highly individual setup suggesting a clear clonal independence. The different BRAF statuses in coincident thyroid carcinoma foci within the same organ outline a special challenge for molecular follow-up and therapeutic decision-making.

Diagnóstico incidental versus clínico del microcarcinoma papilar de tiroides. Pronóstico a largo plazo

IntroductionThe incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent years, especially in patients operated on for presumably benign thyroid disease. The aim of this study was to analyze the differences between PTMC incidentally diagnosed and PTMC clinically diagnosed, as well as its long-term prognosis. Material and methodsThe study population consisted of patients with a histological diagnosis of PTMC. Patients with previous thyroid surgery, other synchronous thyroid or extrathyroid malignancies and an ectopic location of PTMC were excluded. Two groups were compared: patients with PTMC incidentally diagnosed (group 1) and patients with PTMC clinically diagnosed (group 2). A multivariate analysis of differentiating factors was performed. ResultsPTMC clinically diagnosed had a high frequency of hypothyroidism (4.6% vs. 18.9%; P=.004), extrathyroidal extension (5.7% vs. 17.6%; P=.018), metastatic lymph nodes (1.1% vs. 18.9%; P<.001) and lymphocytic thyroiditis (5.7% vs. 27%; P<.001). In the multivariate analysis, metastatic lymph nodes (OR: 22.011, IC 95%: 2.621-184.829; P=.004) and lymphocytic thyroiditis (OR: 4.949; IC 95%: 1.602-15.288; P=.005) were associated with the clinical diagnosis of PTMC. During a mean follow-up of 119.8±65.1 months, one recurrence was detected in group 2 (0% vs. 1,4%; P=.460). No patient died due to the disease. ConclusionsPTMC clinically diagnosed, although it has more aggressive histopathological characteristics (extrathyroidal extension and metastatic lymph nodes), presents a long-term prognosis similar to the PTMC incidentally diagnosed. The presence of metastatic lymph nodes and lymphocytic thyroiditis were independent factors associated with PTMC clinically diagnosed.

Synchronous Hodgkin Lymphoma and Papillary Thyroid Carcinoma: The Importance of Positron Emission Tomography/Computed Tomography (PET/CT)

We report a 50-year-old male with synchronous Hodgkin lymphoma (HL) and papillary thyroid carcinoma (PTC). The patient was diagnosed as having HL of the nodular sclerosis type on excisional biopsy of an enlarged right scalene node in March 2018. After further examinations including bone marrow biopsy and positron emission tomography/computed tomography (PET/CT) with 2-[18F]-fluoro-2-deoxy-D-glucose (18F-FDG), he was classified as having stage IVA HL with bone marrow involvement. The patient’s medical history was unremarkable for any chronic disease or previous throid disease. He had no history of irradiation to head and neck, nor had any regular medications. Her mother had a diagnosis of breast carcinoma.

Synchronous thyroid disease in patients with primary hyperparathyroidism

Synchronous thyroid disease in patients with primary hyperparathyroidism