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1.
Rev. Ciênc. Méd. Biol. (Impr.) ; 20(3): 480-484, dez 20, 2021. fig
Article in Portuguese | LILACS | ID: biblio-1354354

ABSTRACT

Introdução: o gene TERT codifica a subunidade catalítica da telomerase responsável pelo alongamento dos telômeros no final dos cromossomos. Mutações na região promotora do gene TERT resultam em superexpressão da subunidade catalítica e promovem aumento da atividade da telomerase, fatos que levam ao aumento da incidência do câncer. No carcinoma anaplásico da tireoide, essas mutações são preditores de pior prognóstico e estão associadas a comportamento clínico agressivo, incluindo alta frequência de recidivas, metástases a distância e morte específica pela doença. Objetivo: relatar o caso de uma paciente idosa portadora de carcinoma anaplásico da tireoide, cujo teste de sequenciamento genético revelou a mutação do promotor TERT C228T. Caso clínico: mulher idosa, 66 anos, diagnosticada inicialmente com nódulo tireoidiano, o qual cresceu rapidamente em um curto período de tempo. Diante da suspeita de neoplasia maligna, a paciente foi submetida a tireoidectomia total, com realização de esvaziamento cervical. Os estudos anatomopatológico e imuno-histoquímico do tumor confirmaram o carcinoma. Estudos moleculares realizados a partir da tecnologia do sequenciamento de nova geração negaram a presença de fusões gênicas, porém detectaram a mutação TERT C228T. Discussão: a identificação da mutação no promotor TERT C288T reforça a hipótese de que mutações TERT são frequentes em tumores tireoidianos mais agressivos, como é o caso do carcinoma anaplásico da tireoide. Conclusão: os dados apresentados neste estudo reforçam a premissa de que mutações no promotor TERT são preditores de pior prognóstico e de comportamento clínico mais agressivo.


Introduction: the TERT gene encodes the catalytic telomerase subunit responsible for elongating telomeres at the end of chromosomes. Mutations in the promoter region of the TERT gene result in overexpression of the catalytic subunit and promote increased telomerase activity, facts that lead to an increased incidence of cancer. In anaplastic thyroid carcinoma, these mutations are predictors of worse prognosis and are associated with aggressive clinical behavior, including a high frequency of relapses, distant metastases, and diseasespecific death. Objective: to report the case of an elderly patient with anaplastic thyroid carcinoma, whose gene sequencing test revealed a TERT C228T promoter mutation. Case report: Elderly woman, 66 years old, initially diagnosed with a thyroid nodule, which grew rapidly in a short period of time. Given the suspicion of malignant neoplasm, the patient underwent total thyroidectomy, with neck dissection. The anatomopathological and immunohistochemical studies of the tumor confirmed the carcinoma. Molecular studies performed using next-generation sequencing technology denied the presence of gene fusions, but detected the TERT C228T mutation. Discussion: identification of the mutation in the TERT C288T promoter reinforces the hypothesis that TERT mutations are frequent in more aggressive thyroid tumors, such as anaplastic thyroid carcinoma. Conclusion: data presented in this study reinforce the premise that mutations in the TERT promoter are predictors of worse prognosis and more aggressive clinical behavior.


Subject(s)
Humans , Female , Aged , Thyroidectomy , Telomerase , Thyroid Carcinoma, Anaplastic , Mutation , Genes
2.
Medicina (B.Aires) ; 81(4): 637-640, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346517

ABSTRACT

Resumen Las neoplasias cardíacas son entidades poco frecuentes en la práctica clínica cardiológica y dentro de éstas, la afectación metastásica es 20 a 40 veces más frecuente que la forma primaria, corres pondiendo al 95% de todos los tumores cardíacos; no obstante, debido a las características clínicas y oncológicas del tumor primario, los tumores cardíacos metastásicos son habitualmente subdiagnosticados. En este trabajo se presentan dos casos de pacientes con carcinoma anaplásico de tiroides, una mujer de 69 años con metástasis en ventrículo derecho y un varón de 61 años con metástasis en aurícula derecha. Ambos pacientes fallecieron durante la internación y a uno de ellos se le realizó autopsia.


Abstract Cardiac neoplasms are rare entities in the clinical practice. Cardiac metastatic involvement is 20 to 40 times more frequent than the primary form, representing 95% of all cardiac tumors; however, they are frequently underdiagnosed because of their clinical and oncologic features. In this report, we present two cases of cardiac metastasis from primary anaplastic thyroid carcinoma: a 69-years-old woman with right ventricular metastasis and a 61-years-old man with right atrial metastasis. Both patients died during their hospitalization and one of them underwent an autopsy.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Skin Neoplasms , Thyroid Neoplasms , Thyroid Carcinoma, Anaplastic , Heart Neoplasms/diagnostic imaging , Melanoma
3.
Arch. endocrinol. metab. (Online) ; 65(2): 242-247, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1248808

ABSTRACT

SUMMARY Anaplastic thyroid carcinoma is the rarest tumor of the thyroid gland, representing less than 2% of clinically recognized thyroid cancers. Typically, it has an extremely rapid onset, fatal outcomes in most cases, and a median overall survival of 3 to 10 months despite aggressive multidisciplinary management. The presence of targetable mutations in anaplastic thyroid carcinoma patients is an opportunity for treatment when conventional therapeutics approaches are not effective, a frequent situation in the majority of patients. We present our experience in the management of a patient with unresectable anaplastic thyroid cancer who had a remarkable and rapid response to treatment with dabrafenib and trametinib during the COVID-19 pandemic. After four weeks of dabrafenib 150 mg twice daily plus trametinib 2 mg daily, he showed a dramatic reduction of the cervical mass around 90%. Nearly eight weeks under treatment with dabrafenib plus trametinib, the patient remains with minimal locoregional disease without distant metastases.


Subject(s)
Humans , Male , Thyroid Neoplasms/drug therapy , Thyroid Carcinoma, Anaplastic/genetics , Thyroid Carcinoma, Anaplastic/drug therapy , COVID-19 , Oximes , Pyridones , Pyrimidinones , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Proto-Oncogene Proteins B-raf/genetics , Pandemics , SARS-CoV-2 , Imidazoles , Mutation
4.
Autops. Case Rep ; 11: e2021255, 2021. graf
Article in English | LILACS | ID: biblio-1153189

ABSTRACT

Undifferentiated or anaplastic thyroid carcinoma (ATC) is rare and one of the most aggressive human malignancies. The tumor is usually voluminous and fast-growing and mostly affects older women. The most common sites of distant metastases are the lungs, brain, and bones. Herein, we describe the case of a 66-year-old woman with a history of bilateral breast carcinoma and ATC, who presented with an acute abdomen and subsequently died. At autopsy, an isolated metastasis of ATC in the small intestine leading to bowel perforation was found. Moreover, there was adenocarcinoma in the descending colon. The review of extra-abdominal malignancies metastasizing to bowel and coincidence of breast and thyroid carcinoma is included.


Subject(s)
Humans , Female , Aged , Breast Neoplasms , Thyroid Carcinoma, Anaplastic , Intestinal Perforation/etiology , Neoplasm Metastasis , Autopsy , Fatal Outcome , Intestine, Small/injuries
5.
Rev. Ciênc. Méd. Biol. (Impr.) ; 19(4): 625-630, dez 30, 2020. fig
Article in Portuguese | LILACS | ID: biblio-1355249

ABSTRACT

Introdução: o Carcinoma Anaplásico de Tireoide (CAT) está entre as mais letais malignidades humanas, sendo a taxa de sobrevida estimada em 10-20% em 01 ano e menor que 5% em 10 anos. Diante da raridade do CAT e desfecho consideravelmente desfavorável da doença, este relato discute as modalidades terapêuticas utilizadas no tratamento do CAT e as características da doença possivelmente relacionadas a um melhor desfecho clínico. Objetivo: relatar o caso de um paciente idoso portador de CAT com resposta completa loco-regional após tratamento combinado com cirurgia e radioterapia (RT) adjuvante. Neste estudo, a literatura a respeito das características da patologia da neoplasia indiferenciada da tireoide e modalidades de tratamento no controle oncológico desta doença é revisada e discutida. Caso clínico: trata-se de um paciente masculino de 88 anos submetido a Tireoidectomia Total (TT) cujo estudo imuno-histoquímico evidenciou neoplasia maligna indiferenciada da tireoide. O paciente realizou tratamento adjuvante com RT na dose total de 66 Gy em leito operatório. Em tempo de seguimento de 18 meses, o paciente encontra-se vivo sem doença detectável em atividade. Conclusão: neste relato, descreveu-se um raro caso de uma evolução favorável de um paciente idoso portador de CAT com longa sobrevida livre de doença quando comparada ao prognóstico reservado dessa neoplasia. Este relato destaca a importância de uma terapia multimodal no manejo desta doença.


Backgroud: anaplastic thyroid cancer (ATC) ranks among the most lethal of all human malignancies, and the estimated survival rate ranges from 10 to 20% in 01 year and is less than 5% in 10 years. In view of the rarity of ATC and considerably unfavorable outcome of the disease, this report makes it possible to discuss the therapeutic modalities in the treatment of the ATC and the features of the disease possibly related to a better clinical outcome. Objective: the objective of the present study is to report the case of an elderly patient with ATC with locoregional complete response after combined treatment with surgery and adjuvant radiotherapy (RT.) In this study, the literature regarding the pathological features of the undifferentiated thyroid cancer and treatment modalities on oncologic outcome is reviewed and discussed. Case presentation: this is a case of a 88 year old male patient, who underwent total thyroidectomy (TT) for thyroid cancer treatment whose cytological analysis was compatible with anaplastic thyroid cancer. The immunohistochemical study showed undifferentiated malignancy of the thyroid. The patient underwent adjuvant treatment with RT at the total dose of 66 Gy in operative bed. In a follow-up period of 18 months, the patient is alive with no detectable disease in activity. Conclusions: in this report, is described a rare case of a favorable evolution of an elderly patient with ATC relatively long disease-free survival compared to the reserved prognosis of this neoplasm. This case underlines the importance of a multimodal therapy in the management of this disease.


Subject(s)
Humans , Male , Aged, 80 and over , Radiotherapy , Thyroidectomy , Thyroid Carcinoma, Anaplastic , General Surgery
6.
Oncol. (Guayaquil) ; 30(3): 215-228, Diciembre 30, 2020.
Article in Spanish | LILACS | ID: biblio-1145724

ABSTRACT

Introducción: El manejo inicial del cáncer diferenciado de tiroides (CDT) usualmente comprende la cirugía que puede acompañarse según el riesgo de recurrencia de la administración del yodo radioactivo (I-131); sin embargo, existe un pequeño grupo de pacientes que se catalogan como refractarios al I131, lo cual incide directamente en su pronóstico y expectativa de vida, siendo necesario evaluar opciones locales de tratamiento antes de avanzar a las terapias sistémicas y en estas condiciones la radioterapia (RTP) representa una opción local con fines de tratamiento primario o paliativo Métodos:Se realizó un estudio epidemiológico, descriptivo, retrospectivo, de centro único, que involucra a 49 pacientes con CDT e indicación de radioterapia. Resultados:En el 80% de los casos la edad fue mayor de 45 años, con predominio 74% en el sexo femenino, todos con diagnóstico de CDT sometidos a cirugía, 88%con variante no agresiva, 57% con un tamaño tumoral entre 1 a 4cm, 71% con extensión extratiroidea, 71% con metástasis ganglionares cervicales, 45% estadio TNM I y el 71% con alto riesgo de recurrencia. El 96% recibió I-131, con necesidad de reintervenciones quirúrgicas hasta por 5 o más ocasiones (8%). Recibieron RTP 57%con fines curativos y 43% paliativos. La técnica de radioterapia utilizada en el 69% de los pacientes fue IMRT/VMAT, y la dosis más frecuentemente empleada fue ≥ 60Gy en región cervical (61%). De los 49 pacientes, el 90% tiene respuesta estructural incompleta y 12% falleció por CDT. Conclusiones:La radioterapia debe considerarse en enfermedad avanzada localmente con extensión extratiroidea, enfermedad residual macroscópica y tumor irresecable o recurrente que falla a la terapia convencional del CDT. Palabras clave:Neoplasias de la Tiroides, Carcinoma Anaplásico de Tiroides, Tiroidectomía, Recurrencia Local de Neoplasia, recurrencia, /radioterapia


Introduction:The initial management of differentiated thyroid cancer (DTC) usually includes surgery that can be accompanied according to the risk of recurrence of the administration of radioactive iodine (I-131). However, there is a small group of patients who are classified as refractory to I-131, which directly affects their prognosis and life expectancy, making it necessary to evaluate local treatment options before advancing to systemic therapies and, in these conditions, radiotherapy (RTP) represents a local option for primary or palliative treatment purposes. Methods:An epidemiological, descriptive, retrospective, single-center study was carried out, involving 49 patients with DTC and indication for radiotherapy. Results:In 80% of the cases the age was over 45 years, with a 74% predominance in the female sex, all with a diagnosis of DTC undergoing surgery, 88% with a non-aggressive variant, 57% with a tumor size between 1 at 4cm, 71% with extrathyroid extension, 71% with cervical lymph node metastases, 45% TNM stage I, and 71% with a high risk of recurrence. 96% received I-131, requiring reoperations for up to 5 or more occasions (8%). 57% received RTP for curative purposes and 43% palliative. The radiotherapy techniqueused in 69% of the patients was IMRT / VMAT, and the most frequently used dose was ≥60Gy in the cervical region (61%). Of the 49 patients, 90% had an incomplete structural response and 12% died from DTC. Conclusions:Radiation therapy should be consideredin locally advanced disease with extrathyroid extension, macroscopic residual disease and unresectable or recurrent tumor that fails conventional therapy for DTC. Keywords:Thyroid Neoplasms; Thyroid Carcinoma,Anaplastic;Thyroidectomy;Neoplasm Recurrence, Local;/radiotherapy


Subject(s)
Humans , Thyroidectomy , Thyroid Neoplasms , Thyroid Carcinoma, Anaplastic , Radiotherapy , Recurrence , Neoplasm Recurrence, Local
7.
Article in English | WPRIM | ID: wpr-816633

ABSTRACT

The increased incidence of thyroid cancer is a worldwide phenomenon; however, the issue of overdiagnosis has been most prominent in South Korea. The age-standardized mortality rate of thyroid cancer in Korea steeply increased from 1985 to 2004 (from 0.17 per 100,000 to 0.85 per 100,000), and then decreased until 2015 to 0.42 per 100,000, suggesting that early detection reduced mortality. However, early detection of thyroid cancer may be cost-ineffective, considering its very high prevalence and indolent course. Therefore, risk stratification and tailored management are vitally important, but many prognostic markers can only be evaluated postoperatively. Discovery of preoperative marker(s), especially for small cancers, is the most important unmet clinical need for thyroid cancer. Herein, we discuss some such factors that we recently discovered. Another unmet clinical need is better treatment of radioiodine-refractory (RAIR) differentiated thyroid cancer (DTC) and undifferentiated cancers. Although sorafenib and lenvatinib are available, better drugs are needed. We found that phosphoglycerate dehydrogenase, a critical enzyme for serine biosynthesis, could be a novel therapeutic target, and that the lymphocyte-to-monocyte ratio is a prognostic marker of survival in patients with anaplastic thyroid carcinoma or RAIR DTC. Deeper insights are needed into tumor-host interactions in thyroid cancer to improve treatment.


Subject(s)
Humans , Incidence , Korea , Medical Overuse , Mortality , Phosphoglycerate Dehydrogenase , Prevalence , Prognosis , Serine , Thyroid Carcinoma, Anaplastic , Thyroid Gland , Thyroid Neoplasms
8.
Article in English | WPRIM | ID: wpr-816630

ABSTRACT

Anaplastic thyroid cancer (ATC) is a lethal human cancer with a 5-year survival rate of less than 10%. Recently, its genomic and transcriptomic characteristics have been extensively elucidated over 5 years owing to advance in high throughput sequencing. These efforts have extended molecular understandings into the progression mechanisms and therapeutic vulnerabilities of aggressive thyroid cancers. In this review, we provide an overview of genomic and transcriptomic alterations in ATC and poorly-differentiated thyroid cancer, which are distinguished from differentiated thyroid cancers. Clinically relevant genomic alterations and deregulated signaling pathways will be able to shed light on more effective prevention and stratified therapeutic interventions for affected patients.


Subject(s)
Genome , High-Throughput Nucleotide Sequencing , Humans , Survival Rate , Thyroid Carcinoma, Anaplastic , Thyroid Gland , Thyroid Neoplasms , Transcriptome
9.
Article in French | AIM, AIM | ID: biblio-1264038

ABSTRACT

INTRODUCTION : Les tumeurs oncocytaires (TO) de la thyroïde regroupent les adénomes et les carcinomes. La distinction entre malignité et bénignité constitue une difficulté de taille sur le plan histologique. De cet aspect découlent des contraintes dans l'attitude thérapeutique à adopter. L'objectif du travail était de déterminer les particularités cliniques, pathologiques et pronostiques des TO de la thyroïde et dégager les facteurs prédictifs de malignité. MÉTHODES : Etude descriptive, rétrospective portant sur 35 cas de TO de la thyroïde opérés entre 2007 et 2015. Les prélèvements ont été étudiés au service d'anatomopathologie. Une étude statistique a été réalisée à la recherche des facteurs prédictifs de mali¬gnité.RÉSULTATS : L'âge moyen des patients était de 53 ans. Le sex-ratio a été de 0,09. Le traitement était chirurgical dans tous les cas. L'examen anatomopathologique définitif a confirmé le diagnostic de 26 adénomes oncocytaires, six carcinomes papillaires on-cocytaires et trois carcinomes vésiculaires oncocytaires. La taille moyenne de la tumeur était de 38,1 mm (10-120). Une irathérapie post-opératoire a été proposée pour les carcinomes. En analyse univariée, les facteurs prédictifs de malignité étaient : l'âge supé¬rieur à 55 ans, la consistance dure, les limites floues, la double vascularisation anarchique, le caractère hypoéchogène du nodule, les microcalcifications, la colloïde sombre et dense, la capsule épaisse et la thyroïdite associée. En analyse multivariée, aucun de ces facteurs n'était prédictif de malignité.CONCLUSION : Les tumeurs oncocytaires de la thyroïde représentent une entité anatomo-clinique distincte. La détermination des facteurs prédictifs de malignité est essentielle pour adapter la prise en charge thérapeutique


Subject(s)
Adenoma , General Surgery , Histology , Thyroid Carcinoma, Anaplastic , Tunisia
10.
Article in English | WPRIM | ID: wpr-763693

ABSTRACT

BACKGROUND: We previously reported the frequent neurofibromatosis 2 (NF2) gene mutations in anaplastic thyroid cancers in association with the BRAF V600E mutation. We aimed to investigate the role of NF2 in thyroid cancer with BRAF mutation. METHODS: To identify the function of NF2 in thyroid cancers, we investigated the changes in cell proliferation, colon formation, migration and invasion of thyroid cancer cells (8505C, BHT101, and KTC-1) with BRAF V600E mutation after overexpression and knock-down of NF2. We also examined how cell proliferation changed when NF2 was mutagenized. Human NF2 expression in papillary thyroid carcinoma (PTC) was analyzed using the The Cancer Genome Atlas (TCGA) data. RESULTS: First, NF2 was overexpressed in 8505C and KTC-1 cells. Compared to control, NF2 overexpressed group of both thyroid cancer cells showed significant inhibition in cell proliferation and colony formation. These results were also confirmed by cell migration and invasion assay. After knock-down of NF2 in 8505C cells, there were no significant changes in cell proliferation and colony formation, compared with the control group. However, after mutagenized S288* and Q470* sites of NF2 gene, the cell proliferation increased compared to NF2 overexpression group. In the analysis of TCGA data, the mRNA expression of NF2 was significantly decreased in PTCs with lateral cervical lymph node (LN) metastasis compared with PTCs without LN metastasis. CONCLUSION: Our study suggests that NF2 might play a role as a tumor suppressor in thyroid cancer with BRAF mutation. More studies are needed to elucidate the mechanism how NF2 acts in thyroid cancer with BRAF mutation.


Subject(s)
Cell Movement , Cell Proliferation , Colon , Genes, Neurofibromatosis 2 , Genes, Tumor Suppressor , Genome , Humans , Lymph Nodes , Neoplasm Metastasis , Neurofibromatosis 2 , RNA, Messenger , Thyroid Carcinoma, Anaplastic , Thyroid Gland , Thyroid Neoplasms
11.
Article in English | WPRIM | ID: wpr-787536

ABSTRACT

BACKGROUND/OBJECTIVES: Although anaplastic thyroid carcinoma (ATC) is rare, it is one of the deadliest forms of thyroid cancer. The fatality rate for ATC is high, and the survival rate at one year after diagnosis is <20%. The present study aimed to investigate the anti-tumor activities of paclitaxel, radiation, and tyrosine kinase inhibitor (TKI) combined therapy in anaplastic thyroid cancer cells both in vitro and in vivo and explore its effects on apoptotic cell death pathways.MATERIALS #SPCHAR_X0026; METHODS: ATC cell line was exposed to TKI, lenvatinib in the presence or absence of paclitaxel with radiation, and cell viability was determined by MTT assay. Effects of the combined treatment on cell cycle and intracellular signaling pathways were assessed by flow cytometry and western blot analysis. The ATC cell line xenograft model was used to examine the anti-tumor activity in vivo.RESULTS: Our data revealed that the combined administration of paclitaxel, TKI, and radiation decreased cell viability in ATC cells, and also significantly increased apoptotic cell death in these cells, as demonstrated by the cleavage of caspase-3 and DNA fragmentation. This combination therapy reduced anti-apoptotic factor levels in ATC cells, while significantly decreasing tumor volume and increasing survival in ATC xenografts.CONCLUSION: These results indicate that administering the combination of paclitaxel, TKI, and radiation therapy may exert significant anticancer effects in preclinical models, potentially suggesting a new clinical approach for treating patients with ATC.


Subject(s)
Blotting, Western , Caspase 3 , Cell Cycle , Cell Death , Cell Line , Cell Survival , Diagnosis , DNA Fragmentation , Flow Cytometry , Heterografts , Humans , In Vitro Techniques , Paclitaxel , Protein-Tyrosine Kinases , Survival Rate , Thyroid Carcinoma, Anaplastic , Thyroid Neoplasms , Tumor Burden
12.
Article in Chinese | WPRIM | ID: wpr-687780

ABSTRACT

<p><b>OBJECTIVE</b>To identify hub genes and key pathways associated with anaplastic thyroid carcinoma (ATC), and to explore possible intervention strategy.</p><p><b>METHODS</b>The differentially expressed genes (DEGs) in ATC were identified by Gene Expression Omnibus (GEO) combined with using R language; the pathway enrichment of DEGs were performed by using Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO). The protein-protein interaction (PPI) network of DEGs was constructed by STRING database and visualized by Cytoscape. Furthermore, the hub genes and key nodes were calculated by MCODE. Finally, the drug repurposing was performed by L1000CDS.</p><p><b>RESULTS</b>A total of 2087 DEGs were identified. The DEGs were clustered based on functions and pathways with significant enrichment analysis, among which PI3K-Akt signaling pathway, p53 signaling pathway, inflammatory response, extracellular matrix organization were significantly upregulated. The PPI network was constructed and the most significant three modules and nine genes were filtered. Twenty-two potential compounds were repurposed for ATC treatment.</p><p><b>CONCLUSIONS</b>Using integrated bioinformatics analysis, we have identified hub genes and key pathways in ATC, and provide novel strategy for the treatment of ATC.</p>


Subject(s)
Computational Biology , Drug Repositioning , Gene Expression Profiling , Humans , Phosphatidylinositol 3-Kinases , Protein Interaction Maps , Thyroid Carcinoma, Anaplastic , Thyroid Neoplasms
13.
Radiation Oncology Journal ; : 103-113, 2018.
Article in English | WPRIM | ID: wpr-741943

ABSTRACT

PURPOSE: Anaplastic thyroid cancer (ATC) is a rare tumor with a lethal clinical course despite aggressive multimodal therapy. Intensity-modulated radiotherapy (IMRT) may achieve a good therapeutic outcome in ATC patients, and the role of IMRT should be assessed. We retrospectively reviewed outcomes for ATC treated with three-dimensional conformal radiotherapy (3D-CRT) or IMRT to determine the optimal treatment option and explore the role of radiotherapy (RT). MATERIALS AND METHODS: Between December 2000 and December 2015, 41 patients with pathologically proven ATC received RT with a sufficient dose of ≥40 Gy. Among them, 21 patients (51%) underwent surgery before RT. Twenty-eight patients received IMRT, and 13 received 3D-CRT. Overall survival (OS) and progression-free survival (PFS), patterns of failure, and toxicity were examined. RESULTS: The median follow-up time for survivors was 38.0 months. The median and 1-year OS and PFS rates were 7.2 months and 29%, 4.5 months and 15%, respectively. Surgery significantly improved the prognosis (median OS: 10.7 vs. 3.9 months, p = 0.001; median PFS: 5.9 vs. 2.5 months, p = 0.007). IMRT showed significantly better PFS and OS than 3D-CRT, even in multivariate analysis (OS: hazard ratio [HR] = 0.30, p = 0.005; PFS: HR = 0.33, p = 0.005). Significantly higher radiation dose could be delivered with IMRT than 3D-CRT (EQD210 66 vs. 60 Gy, p = 0.005). Only 2 patients had grade III dermatitis after IMRT. No other severe toxicity ≥grade III occurred. CONCLUSION: Patients with ATC showed better prognosis through multimodal treatment. Furthermore, IMRT could achieve favorable survival rates by safely delivering higher dose than 3D-CRT.


Subject(s)
Combined Modality Therapy , Dermatitis , Disease-Free Survival , Follow-Up Studies , Humans , Multivariate Analysis , Prognosis , Radiotherapy , Radiotherapy, Conformal , Radiotherapy, Intensity-Modulated , Retrospective Studies , Survival Rate , Survivors , Thyroid Carcinoma, Anaplastic
14.
Article in English | WPRIM | ID: wpr-787008

ABSTRACT

Thyroid carcinoma is the most common neoplasm of endocrine malignancies. Differentiated thyroid carcinoma (DTC) constitutes 90% of the thyroid carcinomas, rest being medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC). Distant metastases occur in up to 10% of patients with DTC. Metastases to axillary lymph nodes (ALN) are very rare. As per literature, only 25 cases have been reported. We report an unusual case of 47-year-old male with Hürthle cell carcinoma of the thyroid presenting with a solitary axillary lymph node metastasis 17 years after thyroidectomy, along with review of literature.


Subject(s)
Humans , Lymph Nodes , Male , Middle Aged , Neoplasm Metastasis , Positron Emission Tomography Computed Tomography , Recurrence , Thyroid Carcinoma, Anaplastic , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy
15.
Article in English | WPRIM | ID: wpr-713166

ABSTRACT

BACKGROUND: Anaplastic thyroid cancer (ATC) is one of the most lethal human malignancies. Docetaxel, a microtubule stabilizer, is a common chemotherapeutic agent used to treat various metastatic cancers. However, prolonged use results in various side effects and drug resistance. Flavonoids, such as baicalein, are accepted chemotherapeutic and dietary chemopreventive agents with many advantages, such as greater accessibility, affordability, and lower toxicity, compared with traditional chemotherapy agents. In this study, we evaluated whether baicalein enhances the effects of docetaxel on apoptosis and metastasis in 8505c ATC cells. METHODS: The 8505c cells were treated with baicalein or docetaxel individually and in combination. Cell viability was measured by MTT (thiazolyl blue tetrazolium bromide) assay, and apoptosis was detected by fluorescence microscopy of Hoechst-stained cells. The expression of apoptotic (Bax and caspase-3), anti-apoptotic (Bcl-2), angiogenic (vascular endothelial growth factor [VEGF], transforming growth factor β [TGF-β], E-cadherin, and N-cadherin), and signaling (extracellular signal-regulated kinase [ERK] mitogen activated protein kinase [MAPK], Akt, and mammalian target of rapamycin [mTOR]) proteins was determined by Western blot analysis. RESULTS: The combination of baicalein (50 or 100 µM) and docetaxel (10 nM) significantly inhibited proliferation and induced apoptosis compared with monotherapies. The combination treatment significantly inhibited the expression of Bax, caspase-3, VEGF, TGF-β1, E-cadherin, N-cadherin, and mTOR, but decreased the expression of Bcl-2 and significantly decreased the phosphorylation of ERK and Akt. CONCLUSION: The combination of baicalein and docetaxel effectively induced apoptosis and inhibited metastasis in 8505c cells through downregulation of apoptotic and angiogenic protein expression and blocking of the ERK and Akt/mTOR pathways in 8505c cells. These results suggest that baicalein enhances the anticancer effects of docetaxel in ATC.


Subject(s)
Apoptosis , Blotting, Western , Cadherins , Caspase 3 , Cell Survival , Down-Regulation , Drug Resistance , Drug Therapy , Endothelial Growth Factors , Flavonoids , Humans , Microscopy, Fluorescence , Microtubules , Neoplasm Metastasis , Phosphorylation , Phosphotransferases , Protein Kinases , Sirolimus , Thyroid Carcinoma, Anaplastic , Transforming Growth Factors , Vascular Endothelial Growth Factor A
16.
Rev. Soc. Bras. Clín. Méd ; 15(4): 259-263, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-877086

ABSTRACT

A hipercalcemia deve ser considerada no diagnóstico diferencial de alterações neuropsiquiátricas agudas. Em 90% dos casos, a etiologia corresponde a hiperparatireoidismo primário ou neoplasias. Valores séricos superiores a 14mg/dL e sintomáticos são frequentemente tradutores de causa maligna. O carcinoma anaplásico da tireoide consiste em um tumor indiferenciado, com progressão rápida e prognóstico reservado, que evolui, em alguns casos, a partir de lesões tireóideas preexistentes, benignas ou malignas (desdiferenciação). Embora a apresentação clínica mais frequente destes tumores consista no desenvolvimento de massa cervical, eles podem ser diagnosticados no esclarecimento etiológico de metástases ou síndromes paraneoplásicos. A hipercalcemia, associada à neoplasia, pode ocorrer em contexto de metástases ósseas, com libertação de citocinas, ou por mecanismo humoral, mediada pela proteína relacionada ao hormônio hormônio paratireóideo (PTHrP). Os autores descrevem o caso de uma mulher de 85 anos, com antecedentes de bócio multinodular benigno, internada para esclarecimento etiológico de hipercalcemia grave, com manifestações neuropsiquiátricas, diagnosticando-se, após avaliação, carcinoma anaplásico da tireoide. O caso foi abordado em reunião multidisciplinar, optando-se por limitação terapêutica a cuidados paliativos. A doente faleceu 3 meses após o diagnóstico.(AU)


Hypercalcaemia should be considered in the differential diagnosis of acute neuropsychiatric disorders. In 90% of the cases, the etiology corresponds to primary hyperparathyroidism or neoplasms. Serum values above 14mg/dL and symptomatic are often indicative of a malignant cause. The anaplastic thyroid carcinoma consists of an undifferentiated tumor, with rapid progression and poor prognosis, which in some cases progresses from pre-existing benign or malignant thyroid diseases (dedifferentiation). Although the most frequent clinical presentation of these tumors consists of the development of a cervical mass, they can be diagnosed in the etiological clarification of metastases or paraneoplastic syndromes. Neoplasm-associated hypercalcaemia may occur in the context of bone metastasis, with release of cytokines, or through a humoral mechanism, mediated by the parathyroid hormone (PTHrP)-related protein. The authors describe the case of an 85-year-old woman with a history of multinodular benign goiter, hospitalized for etiological elucidation of severe hypercalcaemia with neuropsychiatric manifestations, with a final diagnosis of anaplastic thyroid carcinoma, after the diagnostic evaluation. The case was approached in a multidisciplinary meeting, and the therapeutic limitation to palliative care was chosen. The patient died 3 months after the diagnosis.(AU)


Subject(s)
Humans , Female , Aged, 80 and over , Thyroid Neoplasms/diagnosis , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroid Carcinoma, Anaplastic/etiology , Hypercalcemia/etiology , Diagnosis, Differential
17.
Rev. chil. endocrinol. diabetes ; 10(4): 157-159, oct. 2017. ilus
Article in Spanish | LILACS | ID: biblio-999054

ABSTRACT

Anaplastic thyroid cancer is an uncommon malignant tumor, usually fatal, primarily affecting older adults and doesn't have effective systemic therapy. The median survival is less than 6 months from diagnosis. Brain metastases are low frequency and reach 18 percent. We present the case of a patient with papillary carcinoma of the thyroid who takes an aggressive form, becoming anaplastic carcinoma, with involvement of the central nervous system (CNS) manifested by paralysis of the cranial nerve IV, which is rare clinical condition.


Subject(s)
Humans , Thyroid Neoplasms/diagnosis , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroidectomy , Biopsy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Thyroid Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Fatal Outcome , Cavernous Sinus Thrombosis/etiology , Thyroid Carcinoma, Anaplastic/surgery , Thyroid Carcinoma, Anaplastic/pathology , Thyroid Carcinoma, Anaplastic/diagnostic imaging
18.
Rev. chil. endocrinol. diabetes ; 10(2): 45-48, abr. 2017. ilus
Article in Spanish | LILACS | ID: biblio-998942

ABSTRACT

INTRODUCTION: Riedel´s thyroiditis is a thyroid inflammation with invasive fibrosis. CASE REPORT: Female 84 years old, studied by dysphagia to liquids and dysphonia, with cervical mass poorly demarcated and immobile. Computed Tomography (CT) (CT) showed tumor that diverted the trachea and esophagus compressed. Fine Needle Aspiration (FNA) obtained cells with atypia. Thyroidectomy was performed, appreciating a stony tumor which included the right recurrent laryngeal nerve. Given the high suspicion of thyroid malignancy tracheostomy it was performed. The pathology report as fibrosing Riedel thyroiditis. DISCUSSION: This is the less common type of chronic thyroiditis. Etiology is unknown. The normal thyroid parenchyma is replaced by fibrous connective tissue. Clinically usually a hard mass, fast growing, why is confused with thyroid carcinoma and Hashimoto's thyroiditis. It´ss more common in women and is usually bilateral. The CT or MRI (Magnetic Resonance Imaging) help assess the extent. Puncturing the mass could give us the diagnosis but is often difficult. Treatment to relieve symptoms or rule out malignancy is surgery. The prognosis is usually good. CONCLUSIONS: Riedel´s thyroiditis is an entity with histopathologic diagnosis essential


Subject(s)
Humans , Thyroiditis/pathology , Thyroid Neoplasms/diagnosis , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroidectomy , Thyroiditis/surgery , Thyroiditis/pathology , Tomography, X-Ray Computed , Diagnosis, Differential
19.
Article in English | WPRIM | ID: wpr-112717

ABSTRACT

BACKGROUND: No previous studies have been published on poorly differentiated thyroid carcinoma (PDTC) in Southeast Asia. METHODS: We included all adult PDTC patients diagnosed using the Turin criteria at the Philippine General Hospital from 2006 to 2015. The data collected included demographics, clinical presentation, histopathology, treatment, and outcomes. Tests of association were employed to compare these data with foreign studies on PDTC, as well as with local studies on well differentiated thyroid carcinoma (WDTC) and anaplastic thyroid carcinoma (ATC). RESULTS: Eighteen PDTC cases were identified. The median age was 62 years old, with the majority being females. All patients had goiter on presentation, and most were stage IV at the time of diagnosis. In terms of PDTC subtype, insular and trabecular patterns were equally common. Extrathyroidal extension was documented in eight patients, while five patients each had nodal and distant metastasis. All but one patient underwent surgery; however, less than half received adjuvant radioiodine therapy. The 5-year survival rate was 83%. Three patients (16.7%) died at a median of 12 months after diagnosis. Nine (50%) are still alive with persistent and/or recurrent disease at a median of 39 months after diagnosis. CONCLUSION: The behavior of PDTC in this Southeast Asian population was found to be similar to patterns observed in other regions, and exhibited intermediate features between WDTC and ATC. Appropriate surgery provided excellent 5-year survival rates, but the role of adjuvant therapy remains unclear. Larger studies are needed to identify prognostic factors in this population.


Subject(s)
Adult , Asia, Southeastern , Asian Continental Ancestry Group , Demography , Diagnosis , Female , Goiter , Hospitals, General , Humans , Neoplasm Metastasis , Philippines , Retrospective Studies , Survival Rate , Thyroid Carcinoma, Anaplastic , Thyroid Gland , Thyroid Neoplasms
20.
Article in English | WPRIM | ID: wpr-63852

ABSTRACT

PURPOSE: The Notch signaling pathway is widely expressed in normal, reactive, and neoplastic tissues; however, its role in thyroid tissues has not been fully elucidated. Therefore, this study was conducted to characterize the expression of the Notch signaling pathway in papillary thyroid cancer (PTC) cells and anaplastic thyroid cancer (ATC) cells. MATERIALS AND METHODS: Expression of activated Notch1 in ATC and PTC paraffin-embedded tissues was determined by immunohistochemistry. The small interfering RNA techniquewas employed to knock down Notch1 expression in ATC and PTC cell lines. RESULTS: The expression of activated Notch1 was higher in ATC cases than in PTC cases. Inhibition of Notch1 significantly reduced proliferation and migration of ATC cells, but not PTC cells. In addition, inhibition of Notch1 in ATC cells significantly reduced the expression of key markers of epithelial-mesenchymal transition and cancer stem cells. Conversely, changes in the expression of these proteins were not observed in PTC cells. CONCLUSION: The results of this study suggest that Notch1 expression plays different roles in tumor progression in ATC and PTC cells. We also found that Notch1 expression was significantly related to the highly invasive or proliferative activity of ATC cells.


Subject(s)
Cell Line , Epithelial-Mesenchymal Transition , Immunohistochemistry , Neoplastic Stem Cells , RNA, Small Interfering , Thyroid Carcinoma, Anaplastic , Thyroid Gland , Thyroid Neoplasms
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