Tall Cell Variant Of Papillary Carcinoma Research Articles

Follicular Carcinoma Thyroid with Focus of Squamous Cell Carcinoma - A Case Report

Collision tumors of the thyroid gland are a rare entity. Primary squamous cell carcinoma of the thyroid (PSCCT) is a malignant epithelial tumor, composed entirely of cells with squamous differentiation and accounting for less than 1% of all malignancies of the thyroid gland. PSCCT arises from other thyroid diseases such as Hashimoto’s thyroiditis, tall cell variant papillary carcinoma, follicular carcinoma, and anaplastic carcinoma1. We describe a patient with the combination of a well-differentiated squamous cell carcinoma and follicular carcinoma of the thyroid.

Molecular Profile and Clinical Outcomes in Differentiated Thyroid Cancer Patients Presenting with Bone Metastasis

Objective: Differentiated thyroid cancer patients uncommonly present with bone metastasis as the initial manifestation. Their molecular profile is largely unknown. The aim of this study was to evaluate the histopathology, molecular profiles, and response to radioactive iodine therapy in these patients. Methods: Eight patients presented with symptomatic bone metastasis from an unknown primary tumor. We identified these patients by performing a retrospective chart review. Pathology slides were reviewed and the molecular analysis of 112 thyroid cancer-related genes was performed on bone metastasis specimens using targeted next-generation sequencing. Results: These patients presented with long bone fractures, spinal cord compression, or intractable bone pain. Histopathologic analysis of the bone and thyroid tumor specimens revealed follicular variant of papillary carcinoma in 7 patients and tall cell variant papillary carcinoma in 1 patient. Primary tumor size ranged from 0.4 to 7.5 cm. All patients received high dose radioiodine therapy following thyroidectomy. Molecular analysis revealed telomerase reverse transcriptase (TERT) mutations in 7 (88%) tumors, 4 (50%) contained co-occurring TERT and RAS GTPase gene (RAS) mutations, 2 had isolated TERT mutations, and 1 had TERT and proto-oncogene B-Raf (BRAF) V600E mutations, respectively. Tumors carrying RAS, TERT, or a combination of these mutations were radioiodine-avid, with predictable tumor response and reduction in serum thyroglobulin levels. One patient with radioiodine-refractory disease harbored BRAF and TERT mutations. Conclusion: These results demonstrate that differentiated thyroid cancers presenting with bone metastasis independent of the primary tumor size have a high prevalence of TERT mutations, frequently coexisting with RAS mutations. This molecular signature may predict a favorable response to radioiodine therapy. Abbreviations: BRAF = proto-oncogene B-Raf; DNA = deoxyribonucleic acid; DTC = differentiated thyroid cancer; FV = follicular variant; PTC = papillary thyroid carcinoma; RAI = radioactive iodine; RAS = Ras GTPase gene; TERT = telomerase reverse transcriptase; TG = thyroglobulin.

Combined squamous cell carcinoma and follicular carcinoma of the thyroid.

Primary squamous cell carcinoma of the thyroid (PSCCT) is a malignant epithelial tumor, composed entirely of cells with squamous differentiation and accounting for fewer than 1% of all malignancies of the thyroid gland [1]. Because squamous cells are absent from the normal thyroid gland, the etiology of PSCCT remains unclear. Hypotheses include the differentiation of squamous cells derived from embryonic remnants of epithelial cells in the gland, squamous metaplastic changes in response to inflammatory diseases such as thyroiditis, and malignant neoplasms, such as papillary, follicular, or anaplastic carcinoma [2]. Occasionally, PSCCT arises from other thyroid diseases such as Hashimoto’s thyroiditis, tall cell variant papillary carcinoma, follicular carcinoma, and anaplastic carcinoma [3,4]. We describe a patient with the combination of a well-differentiated squamous cell carcinoma and follicular carcinoma of the thyroid. To our knowledge, this is the third report of a patient with primary squamous cell carcinoma plus follicular carcinoma of the thyroid in the English language literature [2,5].

Canine Detection of Metastatic Thyroid Cancer

Introduction: Current diagnostic procedures for thyroid cancer often yield uncertain results, leading to recurrent clinical procedures and often unwarranted surgery. Scent-trained dogs have been trained to find and alert on small concentrations of human fluids and tissues. We tested the hypothesis that a scent-trained dog could reliably detect metastatic thyroid cancer in patient urine and blood samples. Materials and Methods: The UAMS IRB and IACUC committees approved the protocol. Urine and blood samples were collected from patients after total thyroidectomy and treatment of papillary cancer. Metastatic cancer was clinically significant (≥1.0 cm) and documented by imaging and/or elevated thyroglobulin levels (1742±656 ng/mL [SE] without antibodies; range 2.2 to >5000). All cancer patients were treated after surgery with radioactive iodine ablation. Thyroidectomy patients without thyroid cancer were identified by the pathologic absence of cancer. Our dog (male, mixed breed rescue) was imprinted on pathologically verified papillary thyroid cancer tissue obtained during surgery. Imprinting was accomplished by conditioning and positive reinforcement (rewarding for directed behaviors), and discrimination training involved the random presentation of cancer and healthy samples. The dog was rewarded with verbal excitement and a treat for correct answers. Training was conducted with scent-cones devices and evolved to solidify the dog's unique ability to identify cancer and noncancer samples. Reliability testing was accomplished by the random presentation of urine or blood samples. Each testing session included the presentation of six to eight urine and/or blood samples. Samples contained only the subject code, and the handler was blinded to the sample status (cancer vs noncancer). A gloved handler presented samples to the dog by removing the top of each cryotube and placing it at the nose level. After sample presentation, the handler gave a generalized examination command, and the dog's response was verbalized to the study coordinator. When correct, the dog was rewarded with verbal excitement and an edible treat. Results: Imprinting and discrimination between metastatic and noncancerous patient samples were accomplished during the first session of training. Only samples from papillary cancer patients were examined. The dog's response was evaluated on both urine (n=35) and blood (n=31) samples. In 97.1% (34/35) of urine samples, the dog's alert matched the final diagnosis, resulting in a sensitivity of 91.7% (10/11) and specificity of 100.0% (24/24). In 96.8% (30/31) of blood samples, the dog's alert matched the final diagnosis, resulting in a sensitivity of 91.7% (11/12) and specificity of 100% (19/19). The false-negative urine and blood samples were from the same patient who had a diagnosis of tall cell variant papillary carcinoma. The dog was not imprinted on this tissue variant and the errant diagnosis points to the requirement for histologically specific imprinting. Due to random sample extraction and presentation, 15 urine samples were examined on multiple occasions, entailing three to six freeze-thaw cycles. The freeze-thaw cycle did not affect reliability assessments. Conclusions: A previously scent-trained dog can be quickly trained to detect metastatic thyroid cancer in a patient's blood and urine with a high degree of reliability. Current efforts focus on the dogs' prospective determination of cancer presence in thyroid nodules. Source of Work: The study was conducted at the UAMS and funded by internal sources. There are no conflicts of interest or obligations for any of the authors. There are no commercial associations with this work. Dr. Ferrando provided the previously scent-trained dog. Dr. Bodenner is the director of the UAMS Thyroid Cancer Clinic where patient samples were obtained. Dr. Stack is the thyroid surgeon who provided resected thyroid tissue and consulted for the study. Ms. Wilkerson functioned as a study coordinator and experimenter. Dr. Hinson performed data consolidation and interpretation and also functioned as a secondary study coordinator. Runtime of video: 8 mins 12 secs

Cytology of columnar-cell variant of papillary thyroid carcinoma

Columnar cell variant of papillary carcinoma (CCV-PC) thyroid is a rare and aggressive tumor composed of tall columnar cells that form papillae, glands and solid structures. This paper describes fine needle aspiration (FNA) cytologic features in a case of CCV-PC occurring in the right thyroid lobe of a 27-year-old female. Smears showed tall columnar cells in monolayered, three-dimensional, acinar and occasional papillary clusters. Nuclei were oval or elongated and monomorphic. Nuclear pseudo-stratification, resembling that seen in respiratory epithelial cells, was present in some of the cell clusters. Occasional cells showed squamous or Hurthle cell metaplasia. Nuclear grooves and intra-nuclear cytoplasmic inclusions were not seen. Sections of the right lobectomy specimen showed an well-encapsulated CCV-PC with capsular and vascular permeation. Tall cell variant of papillary carcinoma (TCV-PC) can be distinguished from CCV-PC by the oxyphilia of the tumor cells and the absence of nuclear pseudo-stratification. Colorectal and endometrial adenocarcinomas metastatic to the thyroid may be difficult to distinguish from CCV-PC. Diagn. Cytopathol. 2000;22:227–229. © 2000 Wiley-Liss, Inc.

Bcl-2 and Bax expression in thyroid tumours. An immunohistochemical and western blot analysis.

Bcl-2 and Bax proteins, which are involved in repressing and promoting programmed cell death, respectively, have been investigated immunohistochemically and by Western blot analysis in a series of thyroid tumours. Three immunostaining patterns were identified. Benign lesions and well-differentiated thyroid carcinomas displayed a profile similar to that of normal follicular epithelium, in which Bcl-2 immunostaining was predominant. Thyroid carcinomas associated with an aggressive behaviour, such as the tall-cell variant of papillary carcinoma and the poorly differentiated carcinomas, co-expressed both proteins. Finally, anaplastic carcinomas expressed only the Bax protein. Western blot analyses revealed that the anti-Bcl-2 antibody recognized two bands, of molecular weights 21 kDa and 25 kDa. This was only seen in the tall-cell papillary carcinomas and in the anaplastic carcinomas.