Thyroid-like follicular carcinoma of kidney: case presentation and literature review

Published in August 2021

Radiofrequency ablation for symptomatic, non-functioning, thyroid nodules: a single center learning curve

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-centre team. Methods: Retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least one year. Primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) > 50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR > 50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 ml (range 2.0–58.0 ml). A 6-month VRR > 50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in five. Lobectomy revealed a follicular carcinoma (T2N0M0) in two patients. In one patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR > 50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR < 50% and in those with regrowth to exclude underlying malignancy.

Analysis of vascularization in thyroid gland nodes with superb microvascular imaging (SMI) and CD34 expression histology: a pilot study

Background The Doppler sonography technique known as "superb microvascular imaging" (SMI) is advancing sonographic micro vascularization imaging in various disciplines. In this study, we aimed to determine whether SMI could reliably reproduce the blood flow in thyroid nodes and whether malignancy could be diagnosed, based on vascularization properties. Immunhistochemical staining by CD34 and SMI where used to determine the vascularization of nodes in terms of quantified vascularization parameters gained by computational evaluation. Methods We used image analysis programs to investigate whether the quantitative value for vascularization strength in the thyroid node, measured with SMI, was correlated with the actual degree of vascularization, determined microscopically. We included 16 patients that underwent thyroid resections. We prepared thyroid gland tissue slices for immunohistochemistry and labelled endothelial cells with CD34 to visualize blood vessels microscopically. We used image analysis programs, ImageJ, to quantify SMI Doppler sonographic measurements and CellProfiler to quantify CD34 expression in histological sections. We evaluated the numeric values for diagnostic value in node differentiation. Furthermore, we compared these values to check for correlations. Results Among the 16 nodes studied, three harboured malignant tumours (18.75%): two papillary and one follicular carcinoma. Among the 13 benign lesions (81.25%), four harboured follicular adenomas. Malignant and benign nodes were not significantly different in sonographic (0.88 ± 0.89 vs. 1.13 ± 0.19; p = 0.2790) or immunohistochemical measurements of vascularization strength (0.05 ± 0.05 vs. 0.08 ± 0.06; p = 0.2260). Conclusion We found a positive, significant correlation (r = 0.55588; p = 0.0254) between SMI (quantitative values for vascularization strength) and immunohistochemistry (CD34 staining) evaluations of thyroid nodes.

Isolated Metastasis of the Ascending Ramus of the Mandible of Thyroid Follicular Carcinoma: A Case Report and Literature Review

Objectives: The mandibular metastatic spread of carcinoma from the thyroid gland is exceedingly rare. In August 2020, we treated a 69-year-old woman exhibiting thyroid follicular carcinoma metastasis to the ascending ramus region of the mandible showing evidence of detailed radiological and pathological features. Methods: We present a case report of thyroid carcinoma that metastasized to the ascending ramus region of the mandible at 21 years after partial thyroidectomy. We also present relevant information in a literature review of 35 articles, consisting of 43 cases (including our case) of thyroid carcinomas with jaw bone metastasis. We statistically analyzed the demographical and clinical results in terms of age, sex, type of primary cancer, site and time of metastasis, treatment, and outcome.Results: Unlike most of the other cases, in our case, the thyroid cancer had metastasized to the ascending ramus region of the mandible, which made the diagnosis relatively difficult. The patient underwent partial mandibular resection, thyroidectomy, and iodine-131 treatment. The patient was followed up regularly, and no new symptoms were observed at seven months after post-treatment.Conclusions: Surgery is the most common treatment for thyroid metastases of the mandible. Clinicians should ask thyroid cancer patients for follow-up to monitor whether any new complications have occurred. Patients must undergo complete examination of the maxillofacial bone for up to 40 years or more. Otolaryngologists and stomatologists should pay extra attention to patients with thyroid cancer or nodules to avoid misdiagnosis or missing the recognition of thyroid metastatic cancer.

The Correlation of age and gender with prevalence of histopathological patterns of thyroid diseases among Iraqi patients

Objectives: The aim of this study was to investigate the prevalence of histopathological patterns of thyroid lesions and their relation to age and gender in patients underwent total or near total and partial thyroidectomy. Methods: 430 biopsy blocks examined for patients who had undergone total or near total and partial thyroidectomy for both non-neoplastic and neoplastic thyroid lesions, between January 2018 to December 2020 at Surgical Department, Medical city, Baghdad, Iraq. Results: Out of 430 thyroidectomy specimens, 275 (64%) cases of non-neoplastic lesions, and 155 (36%) cases of neoplastic lesions were present. There were 63 males and 367 females with a male to female ratio of 1:5.6. The age ranged in males from 12 to 83 years with a mean age of 47.5 years and the age ranged in females from 10-68 years with a mean age of 39 years. In non-neoplastic lesions, the predominant lesion was the nodular hyperplasia with 233 (84.7%) cases followed by Hashimoto thyroiditis with 24 (8.7%) . In neoplastic lesions, papillary carcinoma was the commonest lesion with 98 (63.2%) cases followed by follicular carcinoma with 11 (7%) cases. Conclusion : Nodular colloid goiter was the most common non –neoplastic lesion with female predominance . Papillary carcinoma was the most frequent thyroid cancer accounting for 84.4% of thyroid cancers. with micropapillary variant making 44.89 % with most cases occurring in the third and forth decade.There appears to be a slightly increased trend of papillary carcinoma diagnosis. The present study highlights the necessity for time to time assessment of neoplastic lesions in young and middle-aged female for initial detection.

Periostin expression and its supposed roles in benign and malignant thyroid nodules: an immunohistochemical study of 105 cases

Background Thyroid tumors are often difficult to histopathologically diagnose, particularly follicular adenoma (FA) and follicular carcinoma (FC). Papillary carcinoma (PAC) has several histological subtypes. Periostin (PON), which is a non-collagenous extracellular matrix molecule, has been implicated in tumor invasiveness. We herein aimed to elucidate the expression status and localization of PON in thyroid tumors. Method We collected 105 cases of thyroid nodules, which included cases of adenomatous goiter, FA, microcarcinoma (MIC), PAC, FC, poorly differentiated carcinoma (PDCa), and undifferentiated carcinoma (UCa), and immunohistochemically examined the PON expression patterns of these lesions. Results Stromal PON deposition was detected in PAC and MIC, particularly in the solid/sclerosing subtype, whereas FA and FC showed weak deposition on the fibrous capsule. However, the invasive and/or extracapsular regions of microinvasive FC showed quite strong PON expression. Except for it, we could not find any significant histopathological differences between FA and FC. There were no other significant histopathological differences between FA and FC. Although PDCa showed a similar PON expression pattern to PAC, UCa exhibited stromal PON deposition in its invasive portions and cytoplasmic expression in its carcinoma cells. Although there was only one case of UCa, it showed strong PON immunopositivity. PAC and MIC showed similar patterns of stromal PON deposition, particularly at the invasive front. Conclusions PON may play a role in the invasion of thyroid carcinomas, particularly PAC and UCa, whereas it may act as a barrier to the growth of tumor cells in FA and minimally invasive FC.

The Potential Diagnostic Utility of TROP-2 & C-Kit in Thyroid Neoplasms

Background: Thyroid nodules are common finding, only 5% of nodules are malignant and the vast majority is non-neoplastic lesions or benign neoplasms. Thyroid cancer incidence is increasing faster than any other cancer types, thus representing one of the most common and clinically worrying malignant tumors of the endocrine system. Trophoblast antigen 2 (TROP2) is a transmembrane receptor glycoprotein encoded by the tumor-associated calcium signal transducer 2(Tacstd2) gene, which is located on chromosome 1p32. Although the biological function of TROP2 is unclear, accumulating evidence has demonstrated that its expression is elevated in various malignant tissues, whereas in human normal tissues relatively low or no TROP2 expression is observed. C-Kit is a type III receptor tyrosine kinase. C-Kit expression and signaling have been well characterized in several tumors, including gastrointestinal stromal tumors (GISTs). However, few studies have investigated c-Kit in the thyroid gland or in thyroid malignancies. The aim of this study was to investigate the diagnostic utility of TROP-2 on a large set of neoplastic thyroid lesions & to investigate the utility of TROP-2 & c-Kit markers to distinguish between benign and malignant thyroid neoplasms on Paraffin blocks. Methods: Immunohistochemistry for TROP2 and c-Kit was carried out on 85 different thyroid lesions (40 benign, 7 borderline and 38 malignant). Results: Malignant thyroid lesions were found to have negative expression of c-Kit in contrast to 80% of benign thyroid neoplasms. TROP2 was strong positive in 87.5% of papillary thyroid carcinomas (PTC), but there was no TROP2 expression in benign thyroid neoplasms, non-invasive follicular thyroid neoplasm with papillary like nuclear features, follicular carcinoma, anaplastic and poorly differentiated thyroid carcinoma. Conclusions: TROP2 is a good diagnostic tool for PTCs to differentiate between PTCs & other lesions with papillary like nuclear features as NIFTP, c-Kit is a good diagnostic tool for follicular adenoma & to differentiate between follicular adenoma & follicular carcinoma.