NEOPLASIA FOLICULAR E CARCINOMA PAPILÍFERO EM UMA MESMA TIREOIDE: UM RELATO DE CASO

RESUMO Neoplasias malignas da tireóide correspondem ao tipo mais comum de câncer endócrino. Dentre os diferentes subtipos histológicos, os mais comuns são os carcinomas papilares, seguidos dos carcinomas foliculares. A ocorrência de “tumores de colisão” na tireoide é rara, e a associação aumenta os riscos de metastatização linfática e hematogênica. A condução de “tumores de colisão” na tireoide é geralmente complexa e a literatura sobre esses casos é escassa, sendo usualmente guiada pelo subtipo mais agressivo. O tratamento cirúrgico com terapia adjuvante guiado pela histologia e pelo estado do paciente é a recomendação. Relatamos o caso de uma paciente com queixa de nódulos tireoidianos palpáveis associado a pigarro recorrente há 1 mês, e que ao exame físico apresentava múltiplos nódulos em toda a topografia da tireoide, com aumento difuso da glândula. O estudo anatomopatológico evidenciou um “tumor de colisão” em tireoide, que apresentou-se histologicamente como carcinoma folicular e papilar. Palavras-chave: Tireoide; carcinoma; tumor de colisão. ABSTRACT Malignant thyroid neoplasms are the most common type of endocrine cancer. Among the different histological subtypes, the most common are papillary carcinomas, followed by follicular carcinomas. The occurrence of thyroid “collision tumors” is rare, and the association increases the risks of lymphatic and hematogenous metastatization. The conduction of “collision tumors” in the thyroid is generally complex and the literature on these cases is scarce and usually guided by the more aggressive subtype. Surgical treatment with adjuvant therapy guided by histology and patient status is the recommendation. We report the case of a patient complaining of palpable thyroid nodules associated with recurrent throat clearing for 1 month, and on physical examination presented multiple nodules throughout the thyroid topography, with diffuse enlargement of the gland. The anatomopathological study showed a “collision tumor” in the thyroid, which presented histologically as follicular and papillary carcinoma. Key-words: Thyroid; carcinoma; collision tumor.

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The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

Oncopediatrics ◽

10.15690/onco.v5i1.1862 ◽

2018 ◽

Vol 5 (1) ◽

pp. 13-23

Author(s):

Nikolai S. Grachev ◽

Elena V. Feoktistova ◽

Igor N. Vorozhtsov ◽

Natalia V. Babaskina ◽

Ekaterina Yu. Iaremenko ◽

...

Keyword(s):

Thyroid Cancer ◽

Predictive Value ◽

Thyroid Nodules ◽

Pediatric Patients ◽

Thyroid Neoplasms ◽

Diagnostic Methods ◽

Diagnostic Approach ◽

First Line ◽

Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

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Raman Spectroscopy Discloses Altered Molecular Profile in Thyroid Adenomas

Diagnostics ◽

10.3390/diagnostics11010043 ◽

2020 ◽

Vol 11 (1) ◽

pp. 43

Author(s):

Armida Sodo ◽

Martina Verri ◽

Andrea Palermo ◽

Anda Mihaela Naciu ◽

Marialuisa Sponziello ◽

...

Keyword(s):

Raman Spectroscopy ◽

Thyroid Nodules ◽

Thyroid Neoplasms ◽

Molecular Profile ◽

Molecular Fingerprint ◽

Extensive Evaluation ◽

Associated Proteins ◽

Thyroid Adenomas ◽

Malignant Lesions ◽

Nuclear Features

Follicular patterned nodules are sometimes complex to be classified due to ambiguous nuclear features and/or questionable capsular or vascular invasion. In this setting, there is a poor inter-observer concordance even among expert pathologists. Raman spectroscopy was recently used to separate benign and malignant thyroid nodules based on their molecular fingerprint; anyway, some histologically proved follicular adenomas were clustered as having a characteristic profile of malignant lesions. In this study, we analyzed five follicular thyroid adenomas with a malignant spectroscopic profile compared to five follicular adenomas with a benign Raman spectrum in order to assess possible molecular differences between the two groups. Morphological, immunohistochemical, and molecular analyses evidenced expression of malignancy-associated proteins in four out of five malignant clustered adenomas. The remaining malignant clustered adenoma showed a TSHR mutation previously associated with autonomously functioning follicular carcinomas. In conclusion, thyroid follicular adenomas are a group of morphologically benign neoplasms that may have altered the mutational or expression profile; cases of adenomas with altered immunophenotype are recognized as showing a profile associated with malignancy by Raman spectroscopy. This correlation warrants a more extensive evaluation and suggests a potential predictive value of spectroscopic assessment in recognizing characteristics associated with tumor progression in follicular thyroid neoplasms.

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Analysis of Malignant Thyroid Neoplasms with a Striking Rise of Papillary Microcarcinoma in an Endemic Goiter Region

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-017-1156-8 ◽

2017 ◽

Vol 71 (S1) ◽

pp. 121-130 ◽

Cited By ~ 2

Author(s):

Alka Mary Mathai ◽

K. Preetha ◽

S. Valsala Devi ◽

Sam Vicliph ◽

Raja Pradeep ◽

...

Keyword(s):

Endemic Goiter ◽

Thyroid Neoplasms ◽

Papillary Microcarcinoma ◽

Malignant Thyroid Neoplasms

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Urothelial and Prostate Carcinoma Metastasizing to the Same Lymph Node

Archives of Pathology & Laboratory Medicine ◽

10.5858/2001-125-1354-uapcmt ◽

2001 ◽

Vol 125 (10) ◽

pp. 1354-1357 ◽

Cited By ~ 3

Author(s):

Kerith Overstreet ◽

Parviz Haghighi

Keyword(s):

Lymph Node ◽

Urothelial Carcinoma ◽

Internal Control ◽

Specific Antigen ◽

Collision Tumor ◽

Second Primary ◽

Gleason Grade ◽

Primary Tumors ◽

Collision Tumors ◽

Immunohistochemical Stains

Abstract We report herein a case of a collision tumor composed of high-grade urothelial carcinoma and a Gleason grade 3+4 prostate adenocarcinoma metastasizing to the same lymph node. After the patient underwent cystoprostatectomy for known urothelial carcinoma, he was incidentally discovered to have a second primary prostate tumor. Lymph node examination revealed that one node appeared to have metastatic foci from both primary tumors. The presence of 2 tumor types colliding in the same lymph node was confirmed using immunohistochemical stains, including monoclonal carcinoembryonic antigen, prostate-specific antigen, prostatic acid phosphatase, cytokeratins 7 and 20, and CD57. We also stained both primary tumors with the same panel as an internal control. Although 2 similar collision tumors have been reported in the literature in the past, neither used a battery of immunohistochemical stains to definitively distinguish one tumor from the other. Herein, we review the literature on urothelial and prostate collision tumors and some of the special stains used to distinguish them.

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Prostatic Adenocarcinoma Metastatic to Pleomorphic Liposarcoma, a “Collision Phenomenon”: Report of a Case with Review of Pelvic Collision Tumors

Pathology Research International ◽

10.4061/2011/173541 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7

Author(s):

Somak Roy ◽

Ronald L. Hrebinko ◽

Kathleen M. Cieply ◽

Anil V. Parwani ◽

Uma N. M. Rao

Keyword(s):

Pelvic Mass ◽

Collision Tumor ◽

The Body ◽

Pathological Examination ◽

Prior History ◽

Pelvic Cavity ◽

Collision Tumors ◽

History Of ◽

Conclusive Diagnosis

“Collision tumor” is an uncommon phenomenon characterized by coexistence of two completely distinct and independent tumors at the same site. Collision tumors have been reported in different sites in the body; however, these are particularly uncommon in the pelvic cavity. A 70-year-old man, with prior history of urothelial and prostate cancer, presented with a large pelvic mass detected on imaging studies. Pathological examination revealed a large liposarcoma with prostatic carcinoma embedded in it. Immunohistochemistry and florescence in situ hybridization studies were performed to reach to a conclusive diagnosis. To the best of our knowledge, this is the second case reported till date. We present the challenges encountered in the diagnosis of this case and review of pelvic collision tumors.

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Diagnostic Value of CK19, HBME-1 and TROP2 Biomarkers in Identification of Different Types of Thyroid Follicular Neoplasms

ACTA MEDICA IRANICA ◽

10.18502/acta.v59i1.5397 ◽

2021 ◽

Author(s):

Shohreh Vojuhi ◽

Masoud Mohebbi ◽

Zohreh Mousavi ◽

Mohammadali Yaghoubi ◽

Reza Ziaolhagh

Keyword(s):

Positive Predictive Value ◽

Papillary Carcinoma ◽

Predictive Value ◽

Thyroid Nodules ◽

Follicular Adenoma ◽

Thyroid Neoplasms ◽

Diagnostic Value ◽

Cross Sectional ◽

Predictive Values ◽

Different Types

Thyroid malignancies are found in 7% to 15% of all thyroid nodules. Immunohistochemical markers, including CK19, HBME-1and TROP2, have shown an effective role in identifying these malignancies. Hence, due to the lack of appropriate diagnostic tests for the identification of thyroid neoplasms, in this study, we aimed to determine the diagnostic value of these biomarkers in the identification of different types of follicular thyroid neoplasms. In this cross-sectional study, paraffin-embedded tissue blocks from the surgical resection of patients with thyroid nodules, referring to Imam Reza and Razavi Hospitals of Mashhad in 2017, were studied. Sensitivity, specificity, and positive and negative predictive values of these biomarkers for the identification of different types of follicular thyroid neoplasms were also studied. 129 patients with a mean age of 44.65±12.59 years participated in this study, of whom 101 (78.29%) were women. The most common type of follicular thyroid neoplasm was papillary carcinoma (60.47%). The highest sensitivity (94.87%) and positive predictive value (68.51%) in the detection of follicular neoplasms was observed by CK19 in papillary carcinoma. The sensitivity and positive predictive value of TROP2 in the detection of papillary neoplasms was 93.58% and 75.25%, respectively. In addition, HBME-1 had the highest specificity (72.54 %) and positive predictive value (81.57%) in identifying this neoplasm. The results of this study showed that CK19, HBME-1, and TROP2 had high diagnostic value in the detection of papillary thyroid neoplasms. Although these biomarkers had low diagnostic value in identifying follicular adenoma and carcinoma, given the high negative predictive value, they can be considered as powerful markers in identifying negative cases.

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Role of biomarkers in predicting the occurrence of thyroid neoplasms in radiation-exposed children

Endocrine Related Cancer ◽

10.1530/erc-17-0408 ◽

2018 ◽

Vol 25 (4) ◽

pp. 481-491

Author(s):

Joseph M Shulan ◽

Leonid Vydro ◽

Arthur B Schneider ◽

Dan V Mihailescu

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Subsequent Development ◽

Thyroid Neoplasms ◽

Childhood Cancer Survivors ◽

Malignant Neoplasms ◽

Increased Risk ◽

Need To Evaluate

With increasing numbers of childhood cancer survivors who were treated with radiation, there is a need to evaluate potential biomarkers that could signal an increased risk of developing thyroid cancer. We aimed to examine the relationships between thyrotropin and thyroglobulin levels and the risk of developing thyroid nodules and cancer in a cohort of radiation-exposed children. 764 subjects who were irradiated in the neck area as children were examined and followed for up to 25 years. All subjects underwent a clinical examination, measurements of thyrotropin, thyroglobulin levels and thyroid imaging. At baseline, 216 subjects had thyroid nodules and 548 did not. Of those with nodules, 176 underwent surgery with 55 confirmed thyroid cancers. During the follow-up, 147 subjects developed thyroid nodules including 22 with thyroid cancer. Thyroglobulin levels were higher in subjects with prevalent thyroid nodules (26.1 ng/mL vs 9.37 ng/mL; P < 0.001) and in those who had an initial normal examination but later developed thyroid nodules (11.2 ng/mL vs 8.87 ng/mL; P = 0.017). There was no relationship between baseline thyrotropin levels and the prevalent presence or absence of thyroid nodules, whether a prevalent neoplasm was benign or malignant, subsequent development of thyroid nodules during follow-up or whether an incident nodule was benign or malignant. In conclusion, in radiation-exposed children, higher thyroglobulin levels indicated an increased risk of developing thyroid nodules but did not differentiate between benign and malignant neoplasms. There was no association between the baseline TSH level and the risk of developing thyroid nodules or cancer.

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A noteworthy collision tumor: Merkel cell carcinoma and squamous cell carcinoma in the setting of a patient status post richter transformation case report

Otolaryngology Case Reports ◽

10.1016/j.xocr.2020.100242 ◽

2020 ◽

Vol 17 ◽

pp. 100242

Author(s):

Travis Smith ◽

Benjamin Gillette ◽

Bing Yi

Keyword(s):

Squamous Cell Carcinoma ◽

Case Report ◽

Cell Carcinoma ◽

Merkel Cell Carcinoma ◽

Squamous Cell ◽

Collision Tumor ◽

Merkel Cell ◽

Patient Status

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Ultrasonography Classification of the American Thyroid Association for Predicting Malignancy in Thyroid Nodules >1cm with Indeterminate Cytology: A Prospective Study

Hormone and Metabolic Research ◽

10.1055/a-0655-3016 ◽

2018 ◽

Vol 50 (08) ◽

pp. 597-601 ◽

Cited By ~ 8

Author(s):

Tiara Rocha ◽

Pedro Rosario ◽

Alexandre Silva ◽

Maurício Nunes ◽

Tulio Silva ◽

...

Keyword(s):

Prospective Study ◽

Thyroid Nodules ◽

Thyroid Neoplasms ◽

Needle Aspiration ◽

American Thyroid Association ◽

Molecular Tests ◽

Indeterminate Cytology ◽

A Prospective Study ◽

Doppler Analysis

AbstractThe objective of this prospective study was to evaluate the ultrasonography classification of the American Thyroid Association (ATA) for predicting malignancy in thyroid nodules >1 cm with indication for fine-needle aspiration (FNA) whose cytology was indeterminate. Additionally, the combination of the ATA classification with Doppler analysis was evaluated. All patients with thyroid nodules >1 cm were eligible. Each nodule was assigned to one of the ATA categories. Exclusively or predominantly intranodular vascularity was considered suspicious. One hundred and thirty-seven patients with 143 nodules underwent FNA and those with indeterminate cytology (Bethesda category III or IV) were selected. All patients were referred for surgery. Among the 143 nodules evaluated, 92 were benign, 33 were malignant, 13 were noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and 5 were tumors of uncertain malignant potential (TUMP). The rate of malignancy, including NIFTP and TUMP in this definition, was 80%, 42.8%, 13%, 10%, and 23% for nodules with a high suspicion, intermediate suspicion, low suspicion, very low suspicion, and undefined ultrasonographic pattern, respectively. Considering NIFPT and TUMP as benign, these rates were 72%, 22.4%, 4.3%, 0%, and 15.4%, respectively. The addition of Doppler analysis did not significantly improve the prediction of malignancy obtained with the ATA classification alone. The results of this prospective study show the usefulness of the ATA ultrasonographic classification for predicting malignancy specifically in thyroid nodules >1 cm with indeterminate cytology. The ATA category of the nodule should influence the decision for follow-up, molecular tests, or surgery.

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