Atrophic kidney-like lesion: A rare benign entity and mimicker of thyroid follicular-like carcinoma of kidney

Atrophic kidney like lesion (AKLL) is a recently described benign entity with only 14 cases reported so far. Genitourinary Pathology Society proposed inclusion of AKLL as a provisional entity in 2021. It mimics thyroid follicular-like carcinoma of kidney as it has a follicular architecture. We report a case of an 18-year-old female with detection of renal mass, while the patient was being investigated for abdominal pain. Mediastinal nodes were also enlarged with detection of necrotizing granulomas on biopsy. Histology revealed a tumor enveloped by a thick capsule with smooth muscle fibers, varying sized follicles, interspersed atrophic tubules, and calcifications. Immunohistochemically, the “cystic follicles” show WT1 +/PAX8 -/CK7-phenotype, while atrophic tubules present between “cystic follicles” harbor WT1 -/PAX8 +/CK7 + phenotype. Morphological diagnosis and differential diagnosis will be discussed.

A STUDY OF THE CLINICAL, RADIOLOGICAL, CYTOLOGICAL AND HISTOPATHOLOGICAL CORRELATION OF SOLITARY THYROID NODULE

Background: Solitary thyroid lesions are a common presentation in the surgical OPD. The signi?cance of solitary nodule is its malignant potential. Thyroid nodule is an elusive clinical problem. Surgeons and Physicians are often required to make a diagnostic or management decision in its treatment. To study the Aim and Objectives: correlation between Clinical, Radiological, Cytological and Histopathological ?nding in patients who presented with “solitary thyroid nodule”. A prospective observational study, Ramakrishna Mission Materials and Methods:Study design: Study area: Seva Pratishthan Hospital, Kolkata, July 2019 to June 2022(3 years), 40 patients, Inclusion criteria: Study period: Sample size: Patients presenting with solitary thyroid nodule, Patients with multinodular goitre, patients with carcinoma Exclusion criteria: thyroid with distant metastasis, paediatric patients and those unwilling. Thorough history, clinical examination, Methodology: investigation (FNAC/USG/Isotope Scan, TSH), appropriate surgical intervention and HPE of excised specimen was done. Results: In our study of 40 cases, 28(70.0%) were colloid goiter, 7(17.5%) were papillary carcinoma, 2(5%) were follicular adenoma, 1(2.5%) was follicular carcinoma, 1(2.5%) was adenomatoid hyperplasia and 1(2.5%) was Hashimoto thyroiditis. 28(70%) cases underwent hemithyroidectomy, 11(27.5%) underwent total thyroidectomy and 1(2.5%) underwent hemithyroidectomy followed by revision total thyroidectomy. 2 cases of papillary carcinoma with enlarged neck nodes underwent total thyroidectomy with neck node dissection. Solitary nodule is most common in woman and in third Conclusion: and fourth decade of life, more common in the right lobe. USG and FNAC are common modalities of investigations with high speci?city and sensitivity. Isotope scan is only indicated to con?rm the toxic nodule. Malignancy reported in my study was 20%. Early diagnosis and prompt treatment will cure the disease since carcinoma thyroid is more curable amongst all cancers.

Research progress of ultrasound based in diagnosis follicular thyroid carcinoma / 国际生物医学工程杂志

Follicular thyroid carcinoma(FTC) is a differentiated thyroid carcinoma originated from thyroid follicular cells. The sensitivity and specificity of ultrasound classification and scoring systems in diagnosis of follicular carcinoma are insufficient. Ultrasound guided fine needle aspiration(US-FNA) can screen but cannot diagnose FTC. Core needle biology(CNB) can reduce repeated FNA and unnecessary operations, and improve the diagnostic accuracy of FN patients, but CNB still has many controversies. Ultrasound guided FNA combined with gene detection (such as RAS) can significantly improve the diagnostic accuracy of follicular neoplasm. In recent years, artificial intelligence assisted diagnosis has shown high specificity in distinguishing FTC from follicular thyroid adenoma (FTA), which is conducive to the standardized treatment of thyroid follicular neoplasm. In this paper, the research progress of ultrasound based in diagnosis of FTC was reviewed.

Accuracy of fine needle aspiration cytology and thyroid imaging reporting and data system to predict the nature of nodular goiter and its comparison with postoperative histology

Background: Aim of the study was to find accuracy of pre-operative fine needle aspiration cytology (FNAC) and thyroid imaging reporting and data system (TIRADS) in predicting the nature of nodular goitre and confirming it with post-operative biopsy. Objective of the study was to assess the sensitivity and specificity of FNAC compared with post-operative biopsy and to assess the sensitivity and specificity of TIRADS compared with post-operative biopsy.Methods: This retrospective study was carried out at tertiary hospital, King George Hospital, Visakhapatnam over a period of 1 year from march 2018 to march 2019. Sensitivity and specificity are calculated based on formulae.Results: Sample size calculated with 90% confidence interval for population of vizag is 96, a sample of 100 patients were taken in this study. Of the 100 cases, 16 had thyroid carcinoma. 15 of them were papillary carcinoma and 1 follicular carcinoma. 8 cases matched with cytology report after post op biopsy and 8 we mismatched with cytology report after post op biopsy. The incidence of malignancy in clinically and cytologically benign goitre is 8.69. In our study sensitivity of FNAC is 50%, specificity is 100% and accuracy of test is 92% and TIRADS has a sensitivity of 100% and specificity of 72.62% and an accuracy of 77%.Conclusions: The current study has showed the disparity we see in thyroid neoplasms in FNAC test and TIRADS, which were proved to be different diagnosis in clinical and histopathology, so even if cytology is benign, we can’t rule out malignancy. FNAC and TIRADS combined have more sensitivity and specificity than individual tests.

Histopathological Spectrum of Thyroid Lesions- A Two Years Study

In clinical practice, thyroid nodules are very common, with wide disparity in incidence and histopathological pattern related to age, sex, dietary and environmental factors and are usually associated with a wide spectrum of diseases extending from functionally and immunologically mediated enlargement to neoplastic lesions. Thyroid cancer is the commonest endocrine cancer accounting for 92% of all the endocrine malignancies even though it is a relatively rare malignancy. The aim of this study was to estimate the frequency, age group, sex distribution, and various histopathological spectrum of lesions in the thyroid.METHODSThe present study is a hospital based retrospective two-year study and was conducted in the Department of Pathology, Azeezia Medical College, Meeyannor, Kollam, Kerala. Tissue samples for H&E sections were fixed in 10% formalin and subjected to routine paraffin embedded processing after which this was then stained with Haematoxylin and Eosin. Various histopathological spectrum of lesions in the thyroid were observed and classified as benign and malignant on the basis of World Health Organization histological classification of the thyroid tumours.RESULTSOut of total cases of 476 thyroid lesions, maximum number of lesions were seen in patients in the age group of 41-50 years. Most common clinical symptom was midline neck swelling. Out of 476 cases, 419 cases (88.1%) were diagnosed as non-neoplastic and remaining 57 cases (11.9%) as neoplastic. The most common non-neoplastic lesion was multi-nodular goiter (MNG) (55.4%), followed by lymphocytic thyroiditis (17.6%), Hashimoto thyroiditis (9%), and adenomatous goiter (5.6%). The common benign lesion was follicular adenoma seen in 17 (29.8%) cases. Papillary carcinoma was the commonest malignant tumour seen in 33 cases, 66.6% of all malignant lesions which we encountered in our study.CONCLUSIONSIn our study, majority of thyroid diseases showed a female predominance with most of them occurring in the age group of 41-50 years and most common thyroid lesions were non-neoplastic. Proper diagnostic tools, including clinical history, ultrasonography and proper pathological examination are required for the identification of thyroid malignancy. Diagnosis by histopathological examination is important for the prompt diagnosis and treatment of neoplastic lesions.

Advances in the pathogenesis, diagnosis and treatment of thyroid follicular carcinoma / 医学研究生学报

Thyroid follicular carcinoma (FTC) is one of the highly differentiated malignant tumors second only to papillary thyroid carcinoma (PTC). Its occurrence is mainly caused by the abnormal differentiation of thyroid follicular epithelial cells. Lymph node metastasis around FTC is rare, but distant tissue metastasis is more common. At present, there are few studies on the pathogenesis of FTC. The clinical diagnosis and treatment of FTC are mainly focused on imaging examination, fine needle aspiration and so on. Surgical resection is the main clinical treatment, with unfavourable prognosis. In this paper, the epidemiology, pathogenesis, diagnosis and treatment of FTC were summarized, and the research progress of FTC was reviewed.

Accuracy of FNAC for Diagnosis of Malignancy in Long Standing Multinodular Goiter and Histopathological Correlation

FNAC is widely accepted as the most accurate, sensitive,specific and cost affective diagnostic procedure in theassessment of thyroid nodules and helps to select people preoperative for surgery. The purpose of this study was toevaluate the accuracy of FNAC for diagnosis of malignancy inlong standing multinodular goiter and histopathological corelation. I evaluated the cytological and histological results of105 patients, who were underwent pre-operative FNAC andsubsequent surgery followed by post-operative histopathology.The cytological diagnosis was classified as- benign, suspiciousand malignant. The definitive cytological study showed benignlesion 92, suspicious 2 and malignant 11 among 105 patients.Post-operative histopathology study showed malignant lesion 9and 96 were benign, among the malignant lesion- 4 werefollicular variant of p. carcinoma and 4 were direct papillarycarcinoma. Benign lesions were distributed as 94 multinodulargoiter and 2 follicular adenoma. In FNAC- eleven patients werefound to be malignant but on post-operative histopathologyexamination confirmed 8 of them as malignant and 3 of themwere benign, 2 follicular adenoma and 1 multinodular goiter. 94patients were found to be benign in FNAC but post-operativehistopathology examination confirmed 93 as multinodular goiterand 1 papillary carcinoma. So total number of malignancyfound in post-operative histology is (8+1)= 9. Rest of them 96were benign. So there is discrepancy between 2 cases. So mystudy revealed a cytological and histological discrepancy in 2patient out of 105 patients due to either diagnostic or samplingerror.

Expression of CK19, CD56, and Galectin-3 Tumor Markers in Different Types of Thyroid Carcinoma

Background: Thyroid disorders represent a major problem in Saudi Arabia, particularly in the northern part of the country. The objective of the current study was to investigate the immunohistochemical expression of CK19, CD56, and Gal-3 in a series of Saudi patients with thyroid carcinoma in Northern Saudi Arabia (Hail) region. Methodology: This is a retrospective study, investigated 50 formalin-fixed paraffin wax tissue blocks with a confirmed diagnosis of thyroid carcinoma from Northern Saudi Arabia. Immunohistochemistry demonstration was for CK19, CD56, and Gal-3 markers applying Avidin-Biotin method. Results: Out of the 50 patients, 45(90%) were females and 5(10%) were males, aged 13-70 years old with a mean age of 43 years. CK19 was positively expressed in 74% of the thyroid carcinoma. Positive CD56 expression was demonstrated in 45.7%, 58.3%, and 100% of the papillary, follicular and undifferentiated thyroid carcinomas, correspondingly. Positive Galectin-3 expression was demonstrated in 71.4%, 58.3%, and 100% of the papillary, follicular and undifferentiated thyroid carcinomas, correspondingly. Conclusion: Papillary thyroid carcinoma is the most common thyroid cancer in Northern Saudi Arabia. Females represent more than 90% of the cases of the thyroid carcinoma in Northern Saudi Arabia. CK19, CD56, and Gal-3 are useful for the assessment of thyroid carcinoma.

An Unusal Presentation of Follicular Carcinoma of Thyroid

Although the incidence of thyroid carcinoma hasincreased in recent years, metastatic spread to the skullis rare. Here we report a case of an occult follicularthyroid carcinoma. A 65 year old female patientpresented with a large swelling of 20 × 20 cm over thefrontal and parietal regions for 2 years. MagneticResoning Imaging (MRI) showed well definedlobulated mass in bilateral frontal and parietal regionswith cystic and solid components. Incisional biopsy ofthe mass was done and was reported as metastaticfollicular carcinoma with transformation to anaplasticvariant. In view of this report the patient underwenttotal thyroidectomy, the biopsy report confirmed thediagnosis of follicular carcinoma. Surgery is the maintreatment for resectable metastatic differentiated131 thyroid carcinoma, followed by I ablation andthyroid stimulating hormone suppression withlevothyroxine

Preoperative serum thyroglobulin in prediction of follicular thyroid tumors / 中华内分泌外科杂志

Objective To analyze whether preoperative serum thyroglobulin (Tg) can be the indicator for predicting malignancy in follicular thyroid tumors (FTC).Methods A retrospective analysis was done for 125 patients with FTC who had been diagnosed by pathology in our hospital.The patients were grouped into benign group and malignant group.Sex,age,tumor size and preoperative serum Tg concentration were analyzed.Results There were 62 patients in benign group (23 male and 39 female).The mean age was 49 years old,ranging from 19 to 78 years,and the mean diameter of tumors was (3.4±1.374) cm,ranging from 0.1 to 5.5 cm.There were 63 patients in malignant group (13 male and 50 female).The mean age was 46 years old,ranging from 15 to 79 years,and the mean diameter of tumors was (3.14±1.143) cm,ranging from 0.3 to 7 cm.The mean preoperative serum Tg concentration was (299.73± 495.02) ng/ml in malignant group and(48.20 ±43.68)ng/ml in the benign group.Through comparing the two groups,we found age and tumors diameter had no statistical difference between the two groups (P＞0.05),while sex and Tg had statistical difference (P＜0.05).When the cutoff of Tg was 100 ng/ml,the sensitivity and specificity for the diagnosis of malignancy was 48.7％ and 90％ respectively.Conclusions Tg can be used as auxiliary diagnosis index of thyroid FTC.High preoperative Tg levels should be highly suspected the possibility of FTC.

Ultrasound Evaluation of Thyroid Lesions

This study was done at Santhiram general hospital. 57 patients with thyroid swelling were examined with ultrasound and followed up with FNAC. Findings were analyzed which showed that 14 were cystic, 27 solid and 16 were mixed lesions; 93% of cystic lesions were benign (Table 2). Among solid lesions 83% were benign rest malignant. Among mixed lesions 87.75% benign and only 12.25% were malignant (Table 3). Ninty two per cent of goiter showed calicification papillary; carcinoma case showed calicification. Hypoechoic hallow showed 88% benign lesions and 12% of malignant lesions; hence US has a definete role in charecterising thyroid lesions. It is being cheap and readily available. The characterisation of perilesion halo is whether irregular or smooth which helps in differentiating benign and malignant nature of lesion. It helps in FNAC for exact localisation.

Struma ovarii con un foco de micro-carcinoma papilar variante folicular de tiroides: reporte de caso y revisión de la literatura / Struma ovarii with follicular variant of papillary thyroid carcinoma: report of one case

Struma ovarii is an ovarian teratoma composed mainly of thyroid tissue, which can occasionally develop a malignant thyroid tumor. We report a 61 years old female consulting for a metrorrhagia in whom an ovarian cyst was discovered. The patient was subjected to a hysterectomy and bilateral oophorectomy. The pathological study of the surgical piece revealed a focus of papillary thyroid carcinoma, follicular variety in a right struma ovarii. Three months after surgery, an abdominal CAT scan did not show any abnormality.

Metastatic Follicular Thyroid Carcinoma in Cervical Spine: A Case Report / 대한내분비외과학회지

Differentiated thyroid cancers are rarely associated with distant metastases and have 10-year survival rates higher than 80%; however, the prognosis deteriorates significantly if metastasis occurs. Bone is the second most common site of metastasis after the lungs in cases of thyroid cancer. Here we describe a case in which a 57-year-old female patient had extremely severe pain on the posterior neck. After magnetic resonance imaging, 18F-FDG PET CT and ultrasonography guided biopsy, right papillary thyroid carcinoma with cervical spine metastasis was suspected; therefore, she underwent surgery for removal of thyroid carcinoma and seventh cervical spine metastasis. Pathologic diagnosis was confirmed as left thyroid follicular carcinoma with seventh cervical spine metastasis and synchronous right thyroid papillary carcinoma. The patient then underwent an additional spinal tumor removal operation, I131 treatment and external radiation therapy. Complete removal of the cervical spine tumor could not be achieved due to intra-operative bleeding and the need to prevent damage to the spinal cord. Following treatment, the patient reported great relief from severe neck pain. This is a rare presentation of follicular thyroid carcinoma with cervical spine metastasis in Korea.

Role of pro-angiogenic marker galectin-3 in follicular neoplasms of thyroid.

The role of pro-angiogenic marker galectin-3 (GAL-3) was examined in differential diagnosis of follicular neoplasms of thyroid into histological subsets of follicular adenoma (FA), follicular carcinoma (FC) and follicular variant of papillary thyroid carcinoma (FVPTC). The study included 22 cases from January 2006 to June 2011 comprising of FA (n = 12), FC (n = 3) and FVPTC (n = 7). Immunohistochemical evaluation of GAL-3 was performed on representative histologic sections from the resected thyroid specimens. The proportion of stained cells and intensity of staining in tumor blood vessels were evaluated. GAL-3 expression showed that angiogenesis was prominent in malignancy (FC and FVPTC) and negative in non-neoplastic thyroid parenchyma and benign condition (FA). GAL-3 expression was found to differentiate benign from malignant follicular neoplasms. Focal and diffuse positivity for GAL-3 was found to be associated with FC and FVPTC respectively, thus GAL-3 can be used as a immunohistochemical marker in the differential diagnosis of follicular neoplasms of thyroid based on the type of expression. Limitation of this study was relatively less number of cases studied; however, this data need to be corroborated in larger cohort.

Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature

A 35-year-old woman was determined to have an ovarian cyst and underwent a right ovarian cystectomy at 10 weeks of gestation. A histopathological examination revealed follicular carcinoma arising in a teratoma. No evidence of metastasis was found after delivery. She underwent a total thyroidectomy, followed by radioactive iodine (RAI) therapy. However, her serum thyroglobulin level increased to 1,437 ng/ml (normal range: 0-52 ng/ml) after 10 months. Radioiodine scintigraphy and abdominal computed tomography revealed liver metastasis and peritoneal seeding. She underwent debulking surgery of the liver, right salpinx, and peritoneal seeding nodules. A pathological examination showed metastatic follicular carcinoma with focal poorly differentiated features. Adjuvant RAI therapy was restarted, and her serum thyroglobulin levels returned to normal. In conclusion, metastatic lesions were successfully treated with a combination of debulking surgery and RAI therapy. Close medical follow-up monitoring serum thyroglobulin levels is mandatory in such patients.

A Case of Minimal Invasive Follicular Carcinoma in Childhood / 대한이비인후과학회지

Minimally invasive follicular carcinoma is exceedingly rare in children and should be included in the differential diagnosis of thyroid mass. A 2-year-old child visited the hospital with a left neck mass. Ultrasonography showed a 3.5 cm-sized well-defined hypoechoic mass in the left lobe of thyroid gland and fine needle aspiration cytology revealed multiple benign follicular cells and a cluster of giant cell. He underwent left lobectomy and the subsequent histopathologic diagnosis confirmed the minimally invasive follicular carcinoma. He has been followed up for 12 months without any evidence of recurrence.

Perfil dos pacientes com câncer diferenciado de tireoide em acompanhamentono ambulatório de Endocrinologia do Hospital Universitário de Florianópolis

Objetivo: O objetivo da pesquisa foi determinar o perfil clínico epidemiológico dos pacientes com câncer diferenciado de tireoide atendidos no Hospital Universitário de Florianópolis (HU-UFSC). Métodos: Tratou-se de estudo descritivo, realizado através da análise de prontuários. Incluídos pacientes com diagnóstico de câncer diferenciado de tireoide, em acompanhamento no Serviço de Endocrinologia de Hospital Universitário em consulta de setembro de 2009 a fevereiro de 2010. Considerou-se: idade ao diagnóstico, sexo, história familiar de câncer de tireoide, citologia pré-operatória (PAAF), histologia, tamanho tumoral,tipo de tireoidectomia; dose de I131, PCI (pesquisa de corpo inteiro), diagnóstico de hipoparatireoidismo póscirúrgico, níveis de tireoglobulina, anticorpo anti-tireoglobulina e TSH. Resultados: Foram avaliados 50 pacientes, sendo 92% mulheres. A média de idade foi de 48,5 anos. A prevalência de carcinoma papilífero e folicular foi de 92% e 8%, respectivamente. Hipoparatireoidismo ocorreu em 20% dos pacientes, sendo 8% permanente. Detectou-se evidência de doença ativa em 24% dos pacientes. Conclusões: Em nosso meio, o câncer de tireoide diferenciado é mais frequente em mulheres, sendo o papilífero o mais comum. O hipoparatireoidismo pós-cirúrgico definitivo é uma complicação importante encontrada em 8% dos casos.

Objective: The research aimed to determine the clinical and epidemiological profile in patients with differentiated thyroid cancer assisted at the University Hospital (HU-UFSC). Methods: The study was descriptive study by analysis of medical records. Included patients with differentiated thyroid cancer and followed at the Endocrinology Service of University Hospital from September 2009 to February 2010. Was considered: age at diagnosis, sex, family history of thyroid cancer, preoperative thyroid aspiration cytology, histology, tumor size, type of thyroidectomy, the dose of I131, whole body scan, post-surgical hypoparathyroidism, thyroglobulin, antithyroglobulin antibodies and TSH level. Results: We evaluated 50 patients, 92% women. The mean age was 48.5 years. The prevalence of papillary and follicular carcinoma was 92% and 8% respectively. Hypoparathyroidism occurred in 20% of patients, 8%permanent. Was detected evidence of active disease in 24% of patients. Conclusions: In our research, differentiated thyroid cancer is more common in women, with the papillary the most common. The post-surgical hypoparathyroidism is an important complication found in 8% of cases.

Meningioma with metastasis from follicular carcinoma thyroid.

A 45-year-old female presented with loss of vision in the left eye, numbness on left half of face and left-sided hemicrania for two months. On the basis of radiological investigations, provisional diagnosis of basal meningioma was made. Tissue sent for histopathological evaluation revealed a dual tumor-meningioma with metastasis from follicular carcinoma, thyroid. To the best of authors' knowledge, this is the first report of a tumor metastasizing to another tumor, where a follicular carcinoma thyroid metastasized to meningioma.

A Case of Follicular Thyroid Carcinoma with Metastasis to the Sternum / 대한이비인후과학회지

Metastasis to the sternum from follicular thyroid carcinoma is very rare. Because of a resistance to radioactive iodine therapy, skeletal metastases from differentiated thyroid cancer are difficult to treat. The surgical resection of skeletal metastatic lesion can be a valuable complement to radioactive iodine therapy and it can offer cure with prolonged survival. We recently experienced a case of follicular thyroid carcinoma with metastasis to the sternum in a 60-year-old woman, who presented with anterior chest wall mass and pain. We present this case with a review of the literature.

Clinical Menifestation and Anaylsis of Thyroid Follicular Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy after papillary thyroid carcinoma. We performed this study to obtain further understanding and more supporting ideas for the diagnosis and treatment of thyroid follicular carcinoma. SUBJECTS AND METHOD: Over a 12-year period, 126 patients surgically treated for FTC with an average follow-up of 57.5 months were retrospectively studied. RESULTS: Eighteen (14.3%) patients had distant metastasis at presentation and completion thyroidectomy was performed for 58 patients (46%) after partial thyroidectomy. This implies how difficult it is to diagnosis this type of cancer at the preoperative or intra-operative stage of treatment. Fine-needle aspiration cytology has been shown to be an ineffective method for the diagnosis of FTC. Five patients developed recurrent distant metastasis 6 month after their initial treatment and 3 patients died of persistent distant metastatic disease. The 10-year overall survival rate were 97.6%, and 10-year disease free survival rate was 82.5%. The patients with minimally invasive follicular carcinoma (n=92) and low risk group according to AMES classification, stage IV in TNM classification had more favorable prognosis. But the results showed no statistically significant difference. CONCLUSION: Several staging systems can be applied specifically to patients with FTC. The distinction of FTC in minimally invasive and widely invasive carcinoma, analysis of prognostic factor (recurrence, local invasion, distant metastasis, age, tumor size) is important in identifying low risk patients for a more conservative treatment.