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Objective To investigate the clinicopathological features,immunohistochemical characteristics,diagnosis,treatment and prognosis of intrathyroid thymic carcinoma.Methods Clinical data of 7 patients with intrathyroid thymic carcinoma were retrospectively reviewed.Histological examination and immunohistochemical staining were performed on the surgically resected tumors.The infection of Epstein-Barr virus(EBV)was detected by EBER in situ hybridization.Results The 7 patients included 5 males and 2 females.The age ranged from 40 to 71 years,with a median of 54 years.The tumors were located in the thyroid gland,with the maximum diameter ranging from 2.2 cm to 6.0 cm and the average maximum diameter of(4.0±1.2)cm.All the patients underwent thyroid gland resection and local lymph node dissection.After operation,all the cases were treated with radiotherapy and five of them additionally received chemotherapy.Six patients were followed up for 10-163 months,all of whom were still alive,including 2 patients with recurrence in situ,1 patient with homolateral cervical lymph node metastasis and the rest with no recurrence or metastasis.CK-pan,P63,CD5 and CD117 were expressed in all the cases,while TTF-1,TG,CT and PAX8 were negative.One case of them expressed SYN and CgA.Ki-67 proliferation index ranged from 10% to 90%.EBER in situ hybridization showed negative results in all 7 cases.Conclusions Intrathyroid thymic carcinoma is a relatively low-grade malignant tumor.The combination of immunohistochemical CD5,CD117 and monoclonal PAX8 is helpful in the diagnosis and differential diagnosis of intrathyroid thymic carcinoma.EBV may not be involved in the development of intrathyroid thymic carcinoma.Thyroid gland resection plus central lymph node dissection is an important treatment measure for intrathyroid thymic carcinoma.For patients with regional lymph node metastasis and obvious peripheral tissue invasion,postoperative radiotherapy with/without chemotherapy can effectively delay the disease progression.
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Child, Preschool , Female , Humans , Male , Epstein-Barr Virus Infections , Herpesvirus 4, Human , Neoplasm Recurrence, Local , Retrospective Studies , Thymoma , Thymus Neoplasms/therapyABSTRACT
Objective To investigate the ultrasonographic and clinical pathological features of intrathyroid thymic carcinoma( IT TC) . Methods T he ultrasonographic and clinical pathological features of 11 cases of pathologically confirmed intrathyroid thymic carcinoma were analyzed retrospectively . T he size , shape ,boundary ,internal echo ,calcification ,cystic change ,blood flow of the lesion and lymph nodes of the neck were recorded . T I‐RADS classification was performed on the lesion ,and the medical history ,clinical symptoms and treatment process of the patients were recorded . Results T he lesions of all 11 patients were solid and located in the lower pole or middle‐lower part of the thyroid ,8 cases were located in the right lobe of the thyroid gland ( 8/11 ,72 .7% ) ,and 3 cases were located in the left lobe ( 3/8 ,27 .3% ) . T he maximum diameter diameter of the lesions was ( 3 .55 ± 0 .51 ) cm . All the lesions were hypoechogenicity or marked hypoechogenicity and ill‐defined margin . T he internal echo of the lesions were heterogeneous . Ten lesions were characterized by striped hyperechogenicity interiorly on ultrasonograms . According to T I‐RADS classification ,2 cases were class 4a ,3 cases were class 4b ,2 cases were class 4c and 4 cases were class 5 . T here was no cystic component or calcifcation in all lesions ,and there was no taller‐than‐wide shape . T hree of 11 cases were accompanied by Hashimoto′s thyroiditis . Postoperative pathology showed that 5 cases had cervical lymph node metastasis ,5 had perithyroidal soft tissue in ltration ,of them , 3 cases had recurrent laryngeal nerve ,2 cases invaded the esophageal wall ,and 3 cases invaded the striated muscle of the neck . Immunohistochemistry showed that CD5 and CD117 of all lesions were positive . All patients underwent surgery ,and 3 of them underwent radiotherapy and chemotherapy after surgery . Conclusions There are common sonographic features of intrathyroid thymic carcinoma ,which are located at the lower pole or middle‐lower of the thyroid gland ,presenting a solid hypoechogenicity or marked hypoechogenicity ,with ill‐defined margin and striped hyperechogenicity interiorly on ultrasonograms . T hese sonographic features are helpful for the diagnosis of IT TC .
ABSTRACT
Objective: To investigate the clinicopathological features of intrathyroid thymic carcinoma. Methods: Clinical data of 5 patients with intrathyroid thymic carcinoma were retrospectively reviewed. Histological examination and immunohistochemical staining were performed on the surgically resected tumors. The infection of EB virus (EBV) was detected by in situ hybridization of EBV-encoded RNAs (EBER). BRAF V600E mutation was examined by amplification refractory mutation system. Results: There were 3 males and 2 females with age between 51 and 69 years (average of 60.8 years). All 5 cases were intrathyroid tumors. The tumors were 2.0-3.5 cm in diameter. All 5 cases showed positive staining for CK, CK19, P40, CD5, CD117, Bcl-2, and Ki-67 at protein level, and negative staining for other related differential diagnosis markers including 34βE12, TPO, TG, TTF1, SYN, EBV, and BRAF. In situ hybridization of EBER showed negative results and no BRAF V600E mutation was found. Conclusion: Intrathyroid thymic carcinoma is a low-grade malignant tumor. Expressions of CD5 and CD117 in tumor cells play a very important role in the differential diagnosis.