Late bone metastasis from an apparently benign oncocytic follicular thyroid tumor

Summary A man underwent total thyroidectomy for goiter when he was 62 years old. The pathology report informed on a 5.5 cm oncocytic follicular adenoma and a 3.5 mm papillary microcarcinoma. Due to the papillary tumor, he was treated with ablative radioiodine therapy and suppressive doses of levothyroxine. After uneventful follow-up for 9 years, increased levels of serum thyroglobulin were detected. Further imaging studies including a whole body scan (WBS) after an empirical dose of 200 mCi 131I were negative. Two years later, a 99mTc SestaMIBI WBS and a 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography showed a well-delimited focal uptake in the right femur. A bone biopsy of the lesion demonstrated metastasis of follicular thyroid carcinoma. Retrospective histological reexamination of available material from the primary oncocytic thyroid tumor failed to reveal definitive traits of malignancy. Learning points Oncocytic follicular thyroid tumors are a relatively uncommon variant of follicular thyroid neoplasms mostly composed of distinctive large oxyphilic cells (Hürthle cells). Criteria for the distinction between benign and malignant oncocytic neoplasms are not different from those used in the diagnosis of ordinary follicular tumors. Some cases of apparently benign oncocytic neoplasms have been found to develop malignant behavior. Search to rule out vascular and capsular invasion should be particularly exhaustive in histological assessment of oncocytic thyroid tumors. Even so, long-term surveillance remains appropriate for patients with large apparently benign oncocytic tumors.

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Optimization of Predictive Performance for the Therapeutic Response Using Iodine Scan-Corrected Serum Thyroglobulin in Patients with Differentiated Thyroid Carcinoma

Cancers ◽

10.3390/cancers12020262 ◽

2020 ◽

Vol 12 (2) ◽

pp. 262

Author(s):

Su Woong Yoo ◽

Md. Sunny Anam Chowdhury ◽

Subin Jeon ◽

Sae-Ryung Kang ◽

Sang-Geon Cho ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Thyroid Tissue ◽

Predictive Performance ◽

Response Prediction ◽

Differentiated Thyroid Carcinoma ◽

Whole Body ◽

Serum Thyroglobulin ◽

Focal Uptake ◽

Uptake Pattern ◽

Iodine Scan

We investigated whether the performance of serum thyroglobulin (Tg) for response prediction could be improved based on the iodine uptake pattern on the post-therapeutic I-131 whole body scan (RxWBS) and the degree of thyroid tissue damage with radioactive iodine (RAI) therapy. A total of 319 patients with differentiated thyroid carcinoma who underwent total thyroidectomy and RAI therapy were included. Based on the presence/absence of focal uptake at the anterior midline of the neck above the thyroidectomy bed on RxWBS, patients were classified into positive and negative uptake groups. Serum Tg was measured immediately before (D0Tg) and 7 days after RAI therapy (D7Tg). Patients were further categorized into favorable and unfavorable Tg groups based on the prediction of excellent response (ER) using scan-corrected Tg developed through the stepwise combination of D0Tg with ratio Tg (D7Tg/D0Tg). We investigated whether the predictive performance for ER improved with the application of scan-corrected Tg compared to the single Tg cutoff. The combined approach using scan-corrected Tg showed better predictive performance for ER than the single cutoff of D0Tg alone (p < 0.001). Therefore, scan-corrected Tg can be a promising biomarker to predict the therapeutic responses after RAI therapy.

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Tumors Metastatic to Thyroid Neoplasms: A Case Report and Review of the Literature

Pathology Research International ◽

10.4061/2011/238693 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Todd M. Stevens ◽

Alan T. Richards ◽

Chhanda Bewtra ◽

Poonam Sharma

Keyword(s):

Tumor Metastasis ◽

Follicular Adenoma ◽

Thyroid Neoplasms ◽

Thyroid Tumor ◽

Thyroid Neoplasm ◽

Papillary Thyroid ◽

Review Of The Literature ◽

Abrupt Transition ◽

Tumor To Tumor Metastasis ◽

Carcinoma Tumor

Metastasis into a thyroid neoplasm—tumor-to-tumor metastasis—is exceedingly rare. We describe the 28th documented case of a tumor metastatic to a thyroid neoplasm and review the literature on tumor-to-tumor metastasis involving a thyroid neoplasm as recipient. All cases showed a recipient thyroid neoplasm with an abrupt transition to a morphologically distinct neoplasm. Metastasis into primary thyroid neoplasm was synchronous in 33% of cases and metachronous in 67%. Follicular adenoma was the most common recipient thyroid neoplasm overall (16/28), and papillary thyroid carcinoma was the most common malignant recipient neoplasm (9/28). Of the 9 recipient papillary carcinomas, 6 were follicular variants. Renal cell carcinoma was the most common neoplasm to metastasize to a primary thyroid neoplasm (9/28), followed by lung (6/28), breast (5/28), and colon (3/28) carcinoma. Tumor-to-tumor metastasis should be considered whenever a dimorphic pattern is encountered in a thyroid tumor.

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Thyroid Follicular Adenoma with Tracheal Stenosis

Journal of Clinical Case Studies ◽

10.16966/2471-4925.231 ◽

2021 ◽

Vol 6 (4) ◽

Author(s):

Kusunoki T ◽

Wada R

Keyword(s):

Tracheal Stenosis ◽

Malignant Tumors ◽

Follicular Adenoma ◽

Thyroid Tumor ◽

Thyroid Tumors ◽

Thyroid Lymphoma ◽

Chronic Thyroiditis ◽

Preoperative Ct ◽

Malignant Lesions ◽

Benign Thyroid

Some cases of thyroid malignant tumors and thyroid lymphoma were reported to have caused tracheal stenosis and choking. Benign thyroid tumors with dyspnea due to tracheal stenosis are very rare. We experienced a benign thyroid tumor that caused tracheal stenosis and dyspnea. In the preoperative CT, there was tracheal stenosis due to enlarged bilateral thyroid lobes and the width of the stenotic lumen was 7mm. Subtotal thyroidectomy improved the dyspnea. Postoperative histopathologic examination confirmed follicular adenoma without malignant lesions or chronic thyroiditis. On postoperative CT, the tracheal stenosis had improved and the lumen had increased to 15mm. The above findings would suggest that it should be keep in mind that even benign thyroid tumors with tracheal stenosis of less than 7mm in the lumen have the possibility of causing dyspnea.

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Thyroid Neoplasms in a Colony of Beagle Dogs

Veterinary Pathology ◽

10.1177/030098588902600509 ◽

1989 ◽

Vol 26 (5) ◽

pp. 438-441 ◽

Cited By ~ 14

Author(s):

P. J. Haley ◽

F. F. Hahn ◽

B. A. Muggenburg ◽

W. C. Griffith

Keyword(s):

Malignant Tumors ◽

Thyroid Neoplasms ◽

Thyroid Tumor ◽

Benign Tumors ◽

Thyroid Tumors ◽

Beagle Dogs ◽

Tumor Bearing ◽

Clinical Diagnoses ◽

The Mean ◽

Epidemiologic Features

The histologic, clinicopathologic, and epidemiologic features of spontaneous thyroid neoplasms were evaluated in a control population of Beagle dogs. The mean age of thyroid tumor-bearing dogs (16.2 years) as significantly higher than non-tumor-bearing dogs (13.6 years). Thirteen benign and 18 malignant tumors were identified, with the incidence of both tumors increasing rapidly near the mean age of 16.2 years for tumorbearing dogs. The age-specific incidence of tumors was 1.1% per year at 8 to 12 years, increasing to 4.0% per year by 12 to 15 years and 67% over 17 years of age. Numbers of malignant tumors were greater than benign tumors at an earlier age. Approximately 44% of the malignant tumors metastasized but only 22% resulted in death of the dog. There was no difference in tumor incidence when compared according to sex, if total tumor numbers were considered or if tumors were separated into benign and malignant categories. The age at death of tumor-bearing dogs was not increased significantly by the surgical resection of the thyroid tumors. Of dogs with thyroid tumors, 15% had clinical diagnoses of hypothyroidism, and no dogs with thyroid tumors had diagnoses of hyperthyroidism.

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A Family With a Carotid Body Paraganglioma and Thyroid Neoplasias With a New SDHAF2 Germline Variant

Journal of the Endocrine Society ◽

10.1210/js.2018-00353 ◽

2019 ◽

Vol 3 (11) ◽

pp. 2151-2157

Author(s):

Katherine I Wolf ◽

Michelle F Jacobs ◽

Rohit Mehra ◽

Priya Begani ◽

Matthew S Davenport ◽

...

Keyword(s):

Succinate Dehydrogenase ◽

Carotid Body ◽

Follicular Adenoma ◽

Needle Aspiration ◽

Neck Mass ◽

Whole Body ◽

Whole Body Mri ◽

Pathogenic Variants ◽

Assembly Factor ◽

Associated Tumors

Abstract At least 30% of all pheochromocytomas (PCCs)/paragangliomas (PGLs) arise in patients with a germline predisposition syndrome. Variants in succinate dehydrogenase subunits A, B, C, and D (SDHA, SDHB, SDHC, and SDHD) are the most common pathogenic germline alterations. Few pathogenic variants have been reported in succinate dehydrogenase assembly factor 2 (SDHAF2). Here, we describe a 30-year-old female patient who presented with a left-sided neck mass, which was later characterized as a carotid body PGL. Genetic testing revealed a likely pathogenic SDHAF2 variant (c.347G>A;p.W116X). Two sisters carried the same pathologic variant, and screening protocols were recommended. Whole-body MRI revealed thyroid nodules; this testing was followed by fine-needle aspiration, which confirmed papillary thyroid carcinoma in one sister and a follicular adenoma in the other. The two sisters then underwent hemithyroidectomy and total thyroidectomy, respectively. Because evidence for pathogenic variants in SDHAF2 causing predisposition to PCC/PGL is limited, we discuss the challenges in mutational variant interpretation and decision making regarding screening for associated tumors.

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Thyroid tumors: Cytomorphology of medullary, clinically anaplastic, and miscellaneous thyroid neoplasms

Diagnostic Cytopathology ◽

10.1002/dc.2840060603 ◽

1990 ◽

Vol 6 (6) ◽

pp. 383-389 ◽

Cited By ~ 28

Author(s):

Arvind Kaur ◽

Gita Jayaram

Keyword(s):

Thyroid Neoplasms ◽

Thyroid Tumors

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A PCR-based expression signature of malignancy in follicular thyroid tumors

Endocrine Related Cancer ◽

10.1677/erc-06-0023 ◽

2007 ◽

Vol 14 (2) ◽

pp. 381-391 ◽

Cited By ~ 34

Author(s):

Theodoros Foukakis ◽

Arief Gusnanto ◽

Amy YM Au ◽

Anders Höög ◽

Weng-Onn Lui ◽

...

Keyword(s):

High Risk ◽

Gene Selection ◽

Thyroid Neoplasms ◽

Thyroid Tumors ◽

Large Tumor ◽

Term Outcome ◽

Long Term Outcome ◽

Expression Levels ◽

High Risk Disease ◽

Follicular Thyroid Tumors

The diagnosis of follicular thyroid carcinoma (FTC) in the absence of metastasis can only be established postoperatively. Moreover, high-risk FTCs are often not identifiable at the time of diagnosis. In this study, we aimed to identify transcriptional markers of malignancy and high-risk disease in follicular thyroid tumors. The expression levels of 26 potential markers of malignancy were determined in a panel of 75 follicular thyroid tumors by a TaqMan quantitative RT-PCR approach. Logistic regression analysis (LRA) was used for gene selection and generation of diagnostic and prognostic algorithms. An algorithm based on the expression levels of five genes (TERT, TFF3, PPARγ, CITED1, and EGR2) could effectively predict high-risk disease with a specificity of 98.5%. The metastatic potential could be predicted in all four cases with apparently benign or minimally invasive (MI) disease at the time of diagnosis, but poor long-term outcome. In addition, a second model was produced by implementing two genes (TERT and TFF3), which was able to distinguish adenomas from de facto carcinomas. When this model was tested in an independent series of atypical adenomas (AFTA) and MI-FTCs, 16 out of 17 AFTAs were classified as ‘benign’, while MI-FTCs with vascular invasion (sometimes referred to as ‘moderately invasive’) and/or large tumor size tended to classify in the ‘malignant’ group. The reported models can be the foundation for the development of reliable preoperative diagnostic and prognostic tests that can guide the therapeutic approach of follicular thyroid neoplasms with indeterminate cytology.

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Combined Treatment with Laser Ablation and Tyrosine-Kinase Inhibitor as a Novel Multimodality Approach to Locally Advanced Thyroid Cancer: a Case Report

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530321666210830093522 ◽

2021 ◽

Vol 21 ◽

Author(s):

Agnese Persichetti ◽

Salvatore Monti ◽

Carmela Coccaro ◽

Federica Presciuttini ◽

Maria Grazia Deiana ◽

...

Keyword(s):

Thyroid Cancer ◽

Laser Ablation ◽

Tyrosine Kinase ◽

Combined Treatment ◽

Locally Advanced ◽

Tumor Burden ◽

Whole Body ◽

Laser Source ◽

Thyroid Tumors ◽

Multimodality Approach

Background: Direct locoregional treatments were recently proposed for the local control of cervical and distant metastasis of thyroid cancer, but data on their use as part of a multimodality approach for primary thyroid tumors are poor. In this feasibility study, laser ablation (LTA) was successfully used for the initial debulking of unresectable radioiodine-refractory thyroid cancer in sequential therapy with tyrosine-kinase inhibitors (TKI). Clinical case: A 69-year-old woman underwent partial resection of papillary thyroid cancer with extensive tracheal infiltration. Post-treatment whole-body scan (131I, 8140 MBq) showed the absence of cervical thyroid uptake. The patient experienced a rapid increase in her cervical mass associated with dysphonia, dyspnea, and dysphagia. Due to a concomitant severe hypertensive state and cardiac failure, the patient was treated with LTA after a multidisciplinary consultation. After local anesthesia, two 300 nm optic fibers were inserted into the lesion through 21G spinal needles. Two illuminations with 4-watt output power and 3600 Joules energy delivery were performed with a diode-laser source. LTA resulted in rapid cancer debulking, and mass volume decreased from 23.9 to 7.5 mL resulting in significant improvement of pressure symptoms. Three months later, the patient was started on lenvatinib due to the initial regrowth of the tumor mass. The cervical tumor burden was controlled by TKI for 20 months when a rapid disease progression occurred, and the patient died. Discussion: Locally advanced, unresectable, and radioiodine-refractory thyroid tumors can be managed with a novel multimodality approach. The initial debulking with LTA of the locally aggressive disease results in rapid control of the tumor burden threatening patients’ life and is effectively followed by long-term control with TKI treatment. Conclusion: Based on this experience, sequential multimodality treatment with an initial locally directed laser ablation procedure followed by TKI therapy may be considered as a salvage option in patients with unresectable and rapidly progressive RR thyroid tumors.

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