Intermediate-risk thyroid carcinoma: indicators of a poor prognosis

ABSTRACT Objective: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy. Subjects and methods: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated. Results: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up. Conclusion: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

La densidad óptica nuclear como indicador diagnóstico en el carcinoma papilar de tiroides / Nuclear optical density as a diagnostic indicator in papillary thyroid carcinoma

Introducción: El carcinoma papilar de tiroides es la causa más frecuente de cáncer de naturaleza endocrina. Constituye la variante histológica de mejor pronóstico, sin embargo, en ocasiones es motivo de importantes dudas diagnósticas con otras variantes de evolución tórpida, lo que dificulta que un mayor número de pacientes se beneficie con un tratamiento individualizado y conservador. Por esta razón, se desarrollan estudios en los que cada vez más se añaden procedimientos morfométricos y densitométricos, los que permiten disminuir la subjetividad en el diagnóstico histopatológico. Objetivo: Determinar la densidad óptica nuclear en el carcinoma papilar de tiroides. Método: Se realizó un estudio morfométrico de serie de casos con 12 pacientes con carcinoma papilar de tiroides, atendidos en el Hospital Provincial Universitario Vladimir Ilich Lenin. Se seleccionaron 36 campos y se midieron 965 núcleos celulares, lo que constituyó la muestra del estudio. Se determinó la densidad óptica nuclear como indicador morfométrico del carcinoma papilar de tiroides. Resultados: El valor de la densidad óptica nuclear fue 1,14, considerado bajo. Conclusiones: Se determinó la densidad óptica nuclear del carcinoma papilar de tiroides en los casos estudiados, lo que puede contribuir a su diagnóstico histopatológico(AU)

Background: Papillary thyroid carcinoma is the most frequent cause of endocrine cancer. It is an histological variant with the best prognosis, however, sometimes it is a reason for significant diagnostic doubts with other variants of torpid evolution, which makes it difficult for a greater number of patients to benefit from an individualized and conservative treatment. For this reason, studies are developed in which more and more morphometric and densitometric procedures are added, which allow reducing the subjectivity in the histopathological diagnosis and could represent a tool of great value. Objective: To determine the nuclear optical density in papillary thyroid carcinoma. Method: A morphometric study of a series of cases was carried out with 12 patients with this histopathological diagnosis, attended at the Vladimir Ilich Lenin University Provincial Hospital. We chose 36 fields and 965 cell nuclei were measured, which constituted the study sample. Nuclear optical density was determined as a morphometric indicator of papillary thyroid carcinoma. Results: The value of nuclear optical density was 1, 14. It is considered low. Conclusion: Nuclear optical density of papillary thyroid carcinoma was determined in the studied cases that may contribute to histopathological diagnosis(AU)

Contribuição da análise de textura do núcleo celular para o diagnóstico diferencial de lesões foliculares da tireoide: comparação com marcadores imunoistoquímicos / Contribution of nuclear texture analysis for the differential diagnosis of follicular lesions of the thyroid: comparison to immunohistochemical markers

OBJETIVO E MÉTODOS: Com o propósito de investigar a contribuição do exame da cromatina nuclear no diagnóstico diferencial das lesões foliculares da glândula tireoide, foram estudadas 76 amostras previamente submetidas à análise de expressão proteica de HBME-1, CK-19 e galectina-3. RESULTADOS: HBME-1 confirmou-se como o mais sensível marcador imunoistoquímico de malignidade. Uma série de variáveis morfométricas, densitométricas e de textura foram úteis na distinção entre os diferentes tipos de lesão folicular. Entre essas variáveis, o r², parâmetro relacionado à granularidade do núcleo, apresentou a melhor acurácia, sensibilidade, especificidade, valor preditivo positivo e negativo, diferenciando lesões benignas de malignas. CONCLUSÃO: A morfometria analítica de imagem da cromatina nuclear pode acrescentar acurácia ao diagnóstico diferencial das lesões de padrão folicular.

OBJECTIVE AND METHODS: To investigate the utility of nuclear chromatin texture assessment in the differential diagnosis of follicular patterned lesions, by means of examining 76 samples previously submitted to the immunohistochemical protein analysis of HBME-1, CK-19 and galectina-3. RESULTS: HBME-1 confirmed to be the most sensitive marker of malignancy. A series of morphometric, densitometric and texture variables were useful in the discrimination of the different types of follicular lesions. Among these variables, r², a parameter related to the granularity of the nucleus presented the best accuracy, sensitivity, specificity and positive and negative predictive values, distinguishing benign from malignant lesions. CONCLUSION: The morphometric analysis of nuclear chromatin images may add accuracy to the differential diagnosis of follicular patterned lesions.

Carcinoma mucoepidermóide de tireóide: relato de caso e revisão da literatura / Mucoepidermoid carcinoma of the thyroid: a case report and literature review / Mucoepidermoid carcinoma of the thyroid: a case report and literature review

O carcinoma mucoepidermóide é um tipo de neoplasia encontrada geralmente nas glândulas salivares, mamas, pâncreas e trato digestivo. O acometimento primário da glândula tireóide é muito raro, apenas 33 casos na literatura. Embora a maioria dos casos de carcinoma mucoepidermóide de tireóide (CMET) tenha evolução favorável, o caso clínico relatado descreve uma paciente com tumor agressivo e, a partir deste relato, é apresentada revisão da literatura quanto aos aspectos clínico, histopatológico, imunohistoquímico e origem histogenética dessa neoplasia.

The mucoepidermoid carcinoma is a neoplasia that usually occurs at salivary glands, breast, pancreas and gastrointestinal tract. The primary occurrence on thyroid gland is rare and only 33 cases were previously published. Although the majority of cases of mucoepidermoid carcinoma of the thyroid (MECT) show a benign evolution, this paper describes a patient with an aggressive tumor. A literature review over clinical, histopathological, imunohistochemical features and histogenetic origin was discussed.

Papillary carcinoma in a thyroglossal duct: case report

CONTEXT: Thyroglossal duct cysts are the most common congenital cervical abnormality in childhood. Malignant lesions are rare in thyroglossal duct cysts (about 1 percent). OBJECTIVE: To report a case of papillary carcinoma in thyroglossal duct cysts. DESIGN: Case report. CASE REPORT: The patient was a 21-year-old female with a four-month history of an anterior midline neck mass but without other symptoms. The physical examination revealed a 4.0 cm diameter, smooth, painless, cystic nodule at the level of the hyoid bone. The thyroid gland was normal by palpation and no neck lymph nodes were found. Indirect laryngoscopy, fine-needle biopsy aspiration and cervical ultrasound were normal and compatible with the physical findings of a thyroglossal duct cyst. The patient underwent surgery with this diagnosis, under general anesthesia, and the mass was resected by the usual Sistrunk procedure. There were no local signs of invasion of the tissue surrounding the cyst or duct at surgery. The patient was discharged within 24 hours. Histopathological examination of the specimen showed a 3.5 x 3.0 x 3.0 cm thyroglossal cyst, partially filled by a solid 1.0 x 0.5 cm brownish tissue. Histological sections showed a papillary carcinoma in the thyroid tissue of a thyroglossal cyst, with normal thyroid tissue at the boundary of the carcinoma. There was no capsule invasion and the margins were negative. The follow-up of the patient consisted of head and neck examinations, ultrasonography of the surgical region and thyroid, and total body scintigraphy. The patient has been followed up for two years with no further evidence of disease

Cáncer tiroídeo tipo intermedio folicular-medular; una forma inhabitual, particular y agresiva: comunicación de tres casos / Mixed medullary and follicular carcinoma of the thyroid: report of three cases

Mixed medullary and follicular carcinomas of the thyroid shares secretory and immunohistochemical features of both follicular and parafollicular thyroidal cells. We report three women, aged 34, 63 and 61 old with this type of tumor. Its diagnosis must be bore in mind in patients with thyroidal tumors and a histological appearance of a medullary or undifferentiated carcinomas. An early diagnosis of a mixed medullary and follicular carcinomas of the thyroid is important, considering its special treatment and negative prognosis

Carcinoma mucoepidermoide esclerosante com eosinofilia primario da tireoide: relato de um caso e analise de literatura / Sclerosing mucoepidermoid carcinoma with primary eosinophilia of thyroid: case report and literature analysis

O carcinoma da glandula tireoide e uma neoplasia maligna de rara ocorrencia na pratica medica, perfazendo apenas 1 por cento de todos os canceres. O carcinoma mucoepidermoide da tireoide (CME) foi descrito pela primeira vez em 1977, com 32 relatos, ao nosso conhecimento na literatura, ate o momento. Esse trabalho objetiva relatar um novo caso dessa rarissima patologia assim como revisar a literatura. Um homem de 36 anos com diagnostico previo de anemia esferocitica e tireoidite de Hashimoto foi submetido a intervencao cirurgica para investigacao de nodulo em lobo direito devido a suspeita de neoplasia papilifera a puncao com agulha fina. Foi realizada tireoidectomia total apos verificacao de ausencia de acometimento...

unusual morphologic pattern of papillary carcinoma of the thyroid

We report a case of an unusual morphologic pattern of papillary carcinoma of the thyroid within a single large encapsulated nodule, consisting predominantly of microfollicles with bland nuclei to a transition of follicles lined by optically clear nuclei and ill-defined papillary structures

Carcinoma del conducto tirogloso / Thyroglossal duct carcinoma

Se presenta un caso de carcinoma del conducto tirogloso y se revisa la literatura. Este es un tumor inusual del cual pocas veces se sospecha en el preoperatorio. El examen microscópico es diagnóstico. Hasta la fecha, se han reportado 141 casos en la literatura, Desde el punto de vista histológico, el recubrimiento epitelial de los remanentes es variable, y tejido tiroideo se ha encontrado hasta en un 62% de los remanentes tiroglosos. La incidencia del carcinoma es mayor en la tercera década, y en mujeres 1,7:1. El tipo histopatológico más común es el edenocarcinoma papilar (79%). El origen primario del carcinoma tirogloso se confirma con esta. revisión. Hubo diferentes modalidades de tratamiento y no es posible determinar la mejor terapia, sin embargo, se hacen recomendaciones. La tasa de mortalidad es baja, y aparentemente sigue el mismo patrón de los carcinomas tiroideos