Thyroid Tumor Board: The Pathologic Criteria of Poorly Differentiated Thyroid Cancer Can Be Difficult to Distinguish From Differentiated Thyroid Carcinoma

2017 ◽  
Vol 29 (6) ◽  
pp. 244-246
Author(s):  
Brice L. Hunt ◽  
Wendy Sacks
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Cancer ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Tumor ◽  
Tumor Board ◽  
Poorly Differentiated

scholarly journals Lenvatinib Administered via Nasogastric Tube in Poorly Differentiated Thyroid Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Eleonora Molinaro ◽  
David Viola ◽  
Nicola Viola ◽  
Pierpaolo Falcetta ◽  
Francesca Orsolini ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Gastric Tube ◽  
Kinase Inhibitors ◽  
Locally Advanced ◽  
Differentiated Thyroid Carcinoma ◽  
Cervical Esophagus ◽  
Extrinsic Compression ◽  
Poorly Differentiated ◽  
Iodine 131

Background. The tyrosine kinase inhibitors (TKIs) are indicated for the treatment of locally advanced or metastatic progressive thyroid carcinoma (CDT), refractory to radioactive iodine. The following report describes the efficacy of lenvatinib administered through a nose-gastric tube (SNG) in a patient affected with a poorly differentiated thyroid carcinoma (PDTC) which determined a stenosis of the esophagus. Material and Methods. A patient was followed up for papillary thyroid carcinoma follicular variant (T3NxMx), subjected to total thyroidectomy and treated with iodine-131 radio metabolic therapy. Two years after surgery, following the onset of dysphonia and dysphagia, patient was submitted to a computed tomography (CT) scan of the neck that showed the presence of a lesion of 6 × 2.5 × 3.5 cm, which determined trachea deviation and cervical esophagus compression. The biopsy indicated the presence of PDTC, triggering tracheal lumen reduction and sub-stenosis of the cervical esophagus for an ab-extrinsic compression. A nose-gastric tube (SNG) was placed and lenvatinib was started at a dose of 20 mg/day, administered via this probe after opening the capsules and diluting the drug in 10 ml of saline solution. Results. One month later, CT showed a significant cervical lesion reduction. Bronchoscopy confirmed tracheal infiltration, but the residual caliber was improved from 50% to 75%. At the esophagogastroduodenoscopy (EGDS), the sub stenosis of the cervical esophagus was no longer appreciated; however, a double perforation of the esophagus was found, without fistula. Conclusion. Lenvatinib therapy is effective also when administered via SNG. Our result is of particular relevance in the management of thyroid cancer patients, especially in the presence of subjects unable to swallow. Further studies are needed to validate the administration of lenvatinib by SNG, in order to extend the indications to this alternative administration way, beside the oral one.

scholarly journals Does Radioiodine Therapy in Patients with Differentiated Thyroid Cancer Increase the Frequency of Another Malignant Neoplasm?

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Renata Midori Hirosawa ◽  
Monica Marivo ◽  
Juliana de Moura Leite Luengo ◽  
Jose Vicente Tagliarini ◽  
Emanuel Cellice Castilho ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Cancer ◽  
Radioiodine Therapy ◽  
Clinical Laboratory ◽  
Malignant Neoplasm ◽  
Differentiated Thyroid Carcinoma ◽  
Cancer Type ◽  
Primary Malignancy ◽  
The Moment

Objectives. To compare the frequency of another primary malignancy in patients with differentiated thyroid carcinoma (DTC) who received radioiodine therapy or not (131I). Material and Methods. 168 cases of DTC patients were retrospectively evaluated as to the frequency of another neoplasia by comparing patients with and without it, taking into account clinical, laboratory, and therapeutic parameters. Results. Another primary malignancy occurred in 8.9% of patients. Of these, 53.3% showed the malignancy before 131I and 46.7% after it. By comparing both groups, the age at the moment of diagnosis of another neoplasia was 46.1 ± 20.2 years for the group before 131I therapy and of 69.4 ± 11.4 years for the group after it (P=0.02). Of the 148 patients treated with 131I, 4.7% developed another malignancy. The latter were older (61 ± 17 years) than those who did not show another cancer type (44.1 ± 14.2 years) (P<0.05). Conclusion. The frequency of another neoplasia found after 131I was similar to that found before 131I.

scholarly journals The Efficacy of Thyrotropin Suppression Therapy in Treatment of Differentiated Thyroid Cancer after Total Thyroidectomy

2015 ◽  
Vol 6 (2) ◽  
pp. 24-33
Author(s):  
Niveen A. Abo-Touk ◽  
Dalia H. Zayed
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Cancer ◽  
Tumour Size ◽  
Differentiated Thyroid Carcinoma ◽  
Tsh Suppression ◽  
Significant Difference ◽  
Tsh Suppression Therapy ◽  
Disease Free

AbstractBackground: The aim of this prospective study was to assess the effect of the TSH suppression on both disease-free and overall survivals in patients with nonmetastatic differentiated thyroid cancer (DTC) after total thyroidectomy.Patients & Methods: One hundred and forty eight patients with pathologically proved operable differentiated thyroid carcinoma were enrolled in this prospective study. Levothyroxin (L-T4) therapy was started in doses according to treatment groups. Patients were randomly assigned to receive either postoperative TSH suppression therapy in group I (76 patients) or nonsuppression therapy in group II (72 patients).Results: During the period of follow up with a median 54 months, the disease-free survival for patients without TSH suppression therapy did not reach statistically significant difference comparing with those for patients with the suppression therapy (p=0.09). However, the difference was statistically significant for high-risk patients (p=0.04). On comparing both groups there was no statistically significant difference with regard to overall survival (p=0.17). The age of the patients more than 45 years, tumour size more than 4 cm and high-risk group were significant independent predictors for thyroid carcinoma-related relapse in univariate analysis. However, tumour size was the only significant factor in multivariate analysis.Conclusion: Suppressive treatment with L-T4 therapy in patients with differentiated thyroid carcinoma should be individualised and balanced against the adverse effects. TSH suppression is indicated in patients with high-risk disease or recurrent tumour. Normalisation of serum TSH is preferred for long-term treatment of disease-free elderly patients with DTC and comorbidities.

scholarly journals MON-452 Poorly Differentiated Thyroid Carcinoma Metastatic to the Adrenal Gland

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Priyanka Mathias ◽  
Anjali Manavalan ◽  
Sandra Aleksic ◽  
Noah Bloomgarden ◽  
Ulrich Schubart
Keyword(s):  
Thyroid Cancer ◽  
Adrenal Gland ◽  
Thyroid Carcinoma ◽  
Distant Metastasis ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
Poorly Differentiated Thyroid Carcinoma ◽  
Poorly Differentiated ◽  
The Right ◽  
Post Therapy

Abstract Background: Poorly differentiated thyroid carcinoma (PDTC) constitutes 1-15% of all thyroid cancers.1 Invasive adrenal metastases secondary to PTDC are exceedingly rare. Clinical Case: A 64-year-old woman with a non-toxic multinodular goiter presented with right upper quadrant abdominal pain and distension for three months. CT imaging revealed a 13.5 cm right suprarenal retroperitoneal mass invading the liver and inferior vena cava (IVC), concerning for adrenocortical carcinoma. She underwent resection of the mass with en block right adrenalectomy, partial hepatectomy, and IVC resection. Pathology demonstrated metastatic thyroid cancer with necrosis of the adrenal gland and IVC. Immunohistochemical staining was positive for PAX8, TTF1, and thyroglobulin (Tg). Completion thyroidectomy revealed an encapsulated 2 cm focus of PDTC with Hurthle cell phenotype in the right thyroid lobe. The mitotic activity was 5/10 per HPF. There were focal areas of tumor necrosis, 3 foci of capsular invasion, and extensive angioinvasion. Surgical margins were free of tumor invasion. Eight resected lymph nodes were negative for malignancy (Stage T1bN0M1; AJCC 8, Stage IVb). Genetic testing was positive for somatic mutations of NRAS, TERT, PTEN, and GNAS with broad copy number loss on chromosome 22q conferring aggressive tumor behavior.3 MRI of the brain and spine ruled out additional metastases. A radioactive iodine (RAI) whole-body scan (WBS) showed residual uptake of 7.6% in the right thyroid bed and a focus of increased uptake at the right sternoclavicular joint. A therapeutic dose of 206 mCi of I-131 was administered. A post-therapy WBS demonstrated focal activity in the right thyroid bed, distal right clavicle, and lower lung lobes. Chest CT and MRI of the right shoulder revealed no structural evidence of metastases corresponding to radiotracer uptake. The stimulated Tg level prior to RAI was 323 ng/mL with a TSH of 66 uU/mL (0.4-4.6 uU/mL). Tg antibodies were undetectable. She was maintained on 150 mcg of levothyroxine with the goal of TSH suppression. Tg levels declined to 4.8 ng/mL at three months, and to 0.3 ng/mL eight months post-RAI. Discussion: PDTC is an aggressive thyroid cancer subtype with distant metastasis reported in 36-85% of cases.2 Distant metastasis is predictive of poorer outcomes, with patients three times more likely to die from the disease than those without metastatic disease.1 Adrenal metastasis of thyroid cancer is rare, and unlike in our patient, usually asymptomatic and frequently detected on a post-therapy scan. Despite a dramatic response to therapy, given the poorly differentiated features of the primary tumor, a whole-body PET-CT is warranted to evaluate for RAI refractory disease. References: 1. Ibrahimpasic T et al. J Clin Endocrinol Metab. 2014;99(4):1245-52. 2. Sanders EM Jr et al. World J Surg. 2007;31(5):934-45. 3. Cheng DT et al. J Mol Diagn. 2015;17(3):251-64.

Should Treatment of Highly Differentiated Thyroid Carcinoma Be Conservative?

1983 ◽  
Vol 22 (01) ◽  
pp. 20-23 ◽  
Author(s):  
B. Helpap ◽  
U. Koch ◽  
R. Janson ◽  
C. Baumgarten ◽  
C. Winkler ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Cancer ◽  
Radioiodine Therapy ◽  
Thyroid Tissue ◽  
Differentiated Thyroid Carcinoma ◽  
Therapeutic Concept ◽  
Regional Metastases ◽  
Node Metastases

On the basis of three selected cases (one with clinically occult follicular and two with metastatic papillary carcinoma) the necessity of a comprehensive therapeutic concept even in highly differentiated thyroid cancer is stressed. Thyroid tissue and regional metastases should be eliminated by surgery, followed by radioiodine therapy in any event. Radiation teletherapy should be reserved to patients with invasive tumor growth exceeding the organ capsule, with lymph node metastases, and with massive angioinvasive growth.

scholarly journals Bioinformatic analysis and identification of potential hallmarks in poorly differentiated thyroid cancer

2021 ◽  
Author(s):  
Xin Chen ◽  
Runsheng Ma ◽  
Hongqiang Li ◽  
Yifeng Tang ◽  
Detao Yin
Keyword(s):  
Thyroid Cancer ◽  
Malignant Transformation ◽  
Differentiated Thyroid Cancer ◽  
Anaplastic Thyroid Cancer ◽  
Bioinformatic Analysis ◽  
Thyroid Tumor ◽  
High Expression ◽  
Hub Genes ◽  
Expression Levels ◽  
Poorly Differentiated

Abstract Purpose: The accumulation of malignant tumor gene mutations makes differentiated thyroid cancer (DTC) gradually dedifferentiated to poorly differentiated thyroid cancer (PDTC) or anaplastic thyroid cancer (ATC). This study analyzed the gene expression profile in the process of dedifferentiation of thyroid cancer, aiming to explore the molecular mechanism of PDTC and ATC.Methods: Eight series from GEO database are collected for differentially expressed genes (DEGs) of DTC, PDTC and ATC. Then, GO analysis, KEGG pathway analysis, and functional path enrichment analyses are performed by MATESCAPE. Hub-genes are identified by using the method of MNC in protein interaction networks. Moreover, the expression of hub-genes and hub-gene related survival in thyroid cancers are analyzed by GEPIA2. Finally, the functional path enrichment pathways of PDTC are performed by GSEA Java.Results: There are obvious differences among DEGs of DTC, PDTC, and ATC, and 17 cross gene of DEGs were found. The DEGs in PDTC were mainly concentrated in regulation of cytoskeleton organization, cell division, positive regulation of kinase activity. While the DEGs in ATC were mainly in extracellular matrix organization, extracellular structure organization. Furthermore, 6 hub-genes were obtained in the development of PDTC by using Cytoscape: EGF, CCND1, DEPDC1, ANLN, HGF, BCL2L1. The high expression levels of the genes of EGF, DEPDC1, ANLN, HGF were associated with the poor survival of thyroid cancer. While the high expression levels of CCND1 and BCL2L1 were beneficial to the survival of patients with thyroid tumor. Finally, GSEA revealed that two gene sets are significantly enriched, including KEGG_THYROID_CANCER and KEGG_GLIOMA. And CCND1 and EGF have a core gene position in KEGG_GLIOMA.Conclusions: The molecular function (MF), biological processes (BP) and KEGG pathways have changed during the process of malignant transformation of thyroid cancer. Especially, the activation of EGF-EGFR pathway promotes the malignant transformation of thyroid tumor. Furthermore, six hub-genes, especially CCND1 and EGF, could become potential biomarkers of PDTC. This study can serve as a reference to understand the malignant transformation of thyroid cancer.

Derangement of p53 and MDM2 is involved in transformation of differentiated into anaplastic thyroid cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5556-5556 ◽  
Author(s):  
S. M. Wiseman ◽  
H. Masoudi ◽  
P. Niblock ◽  
D. Turbin ◽  
A. Rajput ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Tumor Progression ◽  
Anaplastic Thyroid Cancer ◽  
Differentiated Thyroid Carcinoma ◽  
Thyroid Tumor ◽  
Thyroid Tumors ◽  
P53 Overexpression ◽  
Anaplastic Transformation ◽  
Mdm2 Overexpression

5556 Background: Anaplastic thyroid cancer arises as a consequence of tumor progression, or transformation, from pre-existing differentiated thyroid cancer. Mutation of the p53 tumor-suppressor gene represents a common event in thyroid tumor progression. MDM2 encodes a protein that complexes with p53, downregulates its function, and leads to its degradation via a ubiquitin-proteasome pathway. The objective of this study was to evaluate the change in p53 and MDM2 expression in the transformation of differentiated to anaplastic thyroid carcinoma. Methods: Of 94 cases of anaplastic thyroid cancer diagnosed and treated in British Columbia Canada over a 20 year period (1984–2004) 32 cases (34%) had adequate tissue available for evaluation and 12 of these cases had associated foci of differentiated thyroid carcinoma. A tissue microarray was constructed from these 12 anaplastic thyroid tumors and their associated differentiated foci. Immunohistochemistry was utilized to evaluate expression of p53 and MDM2 by these tumors. Results: There was decreased expression of p53 and MDM2 by the anaplastic tumors when compared to the differentiated thyroid tumors from which they evolved. The expression of p53 and MDM2 was 17% and 8%, respectively, by the differentiated thyroid carcinoma, and 83% and 25%, respectively, by the anaplastic tumors. Evaluating the anaplastic cancers and the differentiated foci from which they evolved, p53 overexpression developed in 8 (67%) of tumors and MDM2 overexpression developed in 3 (25%) of tumors. All the anaplastic tumors that developed MDM2 overexpression also concurrently developed p53 overexpression. Conclusions: This report is the first to demonstrate derangement of p53, and its regulator, MDM2, is involved in the transformation of a subset of differentiated into anaplastic thyroid tumors. Isolated MDM2 overexpression does not appear to play an important role in anaplastic transformation of thyroid cancer. No significant financial relationships to disclose.

scholarly journals Cumulative doses of radioiodine in the treatment of differentiated thyroid carcinoma: knowing when to stop

2010 ◽  
Vol 54 (9) ◽  
pp. 807-812 ◽  
Author(s):  
Raul Martins-Filho ◽  
Laura S. Ward ◽  
Barbara J. Amorim ◽  
Allan O. Santos ◽  
Mariana C. L. de Lima ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Differentiated Thyroid Cancer ◽  
Progressive Disease ◽  
Treatment Strategies ◽  
Differentiated Thyroid Carcinoma ◽  
Tumor Node Metastasis ◽  
Node Metastasis ◽  
The Impact

OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and > 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs > 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.

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