Incidence, recurrence and mortality among Filipinos with differentiated thyroid cancer: A systematic review / Journal of the ASEAN Federation of Endocrine Societies

Background@#The majority of thyroid malignancies are differentiated thyroid carcinomas (DTCs). We examined the incidence, disease extent, recurrence and disease-specific mortality (DSM) of DTC among Filipinos residing in the Philippines and Filipino immigrants.@*Methodology@# In accordance with the 2020 PRISMA statement, we performed a systematic literature search in MEDLINE, Google Scholar, EBSCO, Cochrane and Clinicaltrials.gov for the period January 1, 1980 until January 27, 2022. Pooled incidence rate ratio and pooled proportions of disease extent, recurrence and DSM were determined.@*Results@#Literature search yielded 1,852 studies. Out of 26 articles retrieved, nine retrospective case controls and cohorts were included. Incidence of DTC was significantly higher in female Filipino immigrants compared with non-Hispanic whites (NHW). Distant metastases and recurrence were more common among Filipinos and Filipino immigrants compared with NHW. Limited data showed higher DSM in Filipino immigrants and NHW than Filipinos, which may be influenced by reporting bias.@*Conclusion@#This review supports the trend of increased incidence and recurrence of DTC among Filipinos, although case registries are essential to confirm these findings. In the setting of the newly released Philippine guidelines for DTC, prospective studies with active long-term follow-up will help detect any changes in the outcomes of DTC among Filipinos.

Follicular thyroid adenoma with papillary architecture

@#A 23-year-old woman underwent left thyroid lobectomy and isthmusectomy for a 2 cm diameter firm mass on the left side of the neck that was also visualized on ultrasonography. The specimen consisted of a 22-gram thyroid gland composed of the left lobe, isthmus and a pyramidal lobe. Cut section of the left lobe showed a 3.5 cm diameter solitary, discrete and encapsulated mass with a tan lobulated and solid cut surface. The rest of the thyroid tissues had red-brown meaty cut surfaces. Microscopic section shows a follicular-patterned proliferation enclosed by a thin fibrous capsule with frequent Sanderson polster-like papillary excrescences. (Figures 1 and 2) Both the follicular and the papillary structures are lined by cuboidal to columnar follicular epithelial cells that had ample eosinophilic to pale cytoplasm and uniformly sized, minimally enlarged, generally round, and monolayered nuclei without nuclear grooving, folds, pseudoinclusions, and chromatin clearing. There are no mitotic figures seen. Some of the papillary structures have delicate vascular cores. (Figure 3) There are no psammoma bodies noted. The follicles contain variable amounts of pale eosinophilic colloid ranging from colloid-poor crowded follicles to those with ample colloid that have frequent peripheral scalloping. (Figure 4) Exhaustive sections failed to disclose capsular or vascular invasion. Based on the microscopic features, a diagnosis of follicular adenoma with papillary architecture was rendered.

Isolated metastasis of the ascending ramus of the mandible of thyroid follicular carcinoma: a case report / 临床耳鼻咽喉头颈外科杂志

The mandibular metastatic spread of carcinoma from the thyroid gland is exceedingly rare. Follicular thyroid carcinoma is the second most common type of thyroid carcinoma，accounting for approximately 10% to 15% of all thyroid cancers. The prognosis of FTC is relatively satisfactory. Due to its rich blood transport, it is easy to metastasize hematological, with the main sites of metastasis are bone and lung. However，mandibular metastasis of thyroid follicular carcinoma is rare. We report a case of thyroid follicular carcinoma that metastasized to the ascending ramus of the mandible 21 years after surgery.The operation was successfully completed, and there was no recurrence during postoperative follow-up. Due to the absence of obvious clinical symptoms in the patient, the diagnosis and treatment were challenging. We have provided detailed radiographic and pathological images to facilitate understanding and discussion of the disease.

Características clínicas asociadas al hallazgo de cáncer de tiroides originado a partir de nódulos calientes en pacientes con hipertiroidismo: reporte de un caso y revisión sistemática de la literatura / Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature

Abstract Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in patients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule.

Resumen La coexistencia entre cáncer de tiroides e hipertiroidismo es infrecuente, y la mayoría de las lesiones nodulares a partir de las cuales se documenta un tumor maligno en este grupo de pacientes corresponden a nódulos fríos. Justificado en el creciente número de reportes en la literatura acerca de tumores malignos diagnosticados a partir de nódulos calientes, se realizó una revisión sistemática que tuvo como objetivo determinar los posibles factores asociados con el diagnóstico de cáncer de tiroides a partir de nódulos calientes en pacientes con hipertiroidismo. Los resultados sugieren que el diagnóstico clínico de bocio nodular tóxico, lesiones nodulares de diámetro mayor de 10 mm y tipo histológico compatible con carcinoma folicular, son factores que aumentan por sí solos el riesgo de realizar el diagnóstico de cáncer a partir de un nódulo caliente.

Características clínicas asociadas al hallazgo de cáncer de tiroides originado a partir de nódulos calientes en pacientes con hipertiroidismo: reporte de un caso y revisión sistemática de la literatura / Clinical characteristics associated with the finding of thyroid cancer originating from hot nodules in patients with hyperthyroidism: a case report and systematic review of the literature

La coexistencia entre cáncer de tiroides e hipertiroidismo es infrecuente, y la mayoría de las lesiones nodulares a partir de las cuales se documenta un tumor maligno en este grupo de pacientes corresponden a nódulos fríos. Justificado en el creciente número de reportes en la literatura acerca de tumores malignos diagnosticados a partir de nódulos calientes, se realizó una revisión sistemática que tuvo como objetivo determinar los posibles factores asociados con el diagnóstico de cáncer de tiroides a partir de nódulos calientes en pacientes con hipertiroidismo. Los resultados sugieren que el diagnóstico clínico de bocio nodular tóxico, lesiones nodulares de diámetro mayor de 10 mm y tipo histológico compatible con carcinoma folicular, son factores que aumentan por sí solos el riesgo de realizar el diagnóstico de cáncer a partir de un nódulo caliente

Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in pa-tients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore

INTRODUCTION@#The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the risk of malignancy (ROM) in fine-needle aspiration cytology (FNAC) per The Bethesda System for Reporting Thyroid Cytopathology has not been well reported in Singapore.@*METHODS@#We retrospectively identified 821 thyroid nodules with preoperative FNAC from 788 patients out of 1,279 consecutive thyroidectomies performed between January 2010 and August 2016 in a tertiary general hospital in Singapore. Possible cases of NIFTP were reviewed for reclassification and the impact of NIFTP on ROM was analysed.@*RESULTS@#The incidence of NIFTP was 1.2% (10 out of 821). If NIFTP is considered benign, ROM in Bethesda I through VI were 8.6%, 3.5%, 26.3%, 20.0%, 87.7%, 97.0% versus 8.6%, 4.2%, 28.1%, 26.7%, 89.2% and 100% if NIFTP is considered malignant. Eight patients with NIFTP had follow-up of 15 to 110 months. One had possible rib metastasis as evidenced by I131 uptake but remained free of structural or biochemical disease during a follow-up period of 110 months. None had lymph node metastasis at presentation, nor locoregional or distant recurrence.@*CONCLUSION@#Classifying NIFTP as benign decreased ROM in Bethesda II through VI, but the benignity of NIFTP requires more prospective studies to ascertain. The impact of NIFTP on ROM in our institution also appears to be lower than that reported in the Western studies.

Follicular Lesions with Papillary Nuclear Characteristics: Differences in Chromatin Detected by Computerized Image Analysis

ABSTRACT Objective: Follicular lesions of the thyroid with papillary carcinoma nuclear characteristics are classified as infiltrative follicular variant of papillary thyroid carcinoma-FVPTC (IFVPTC), encapsulated/well demarcated FVPTC with tumour capsular invasion (IEFVPTC), and the newly described category "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) formerly known as non-invasive encapsulated FVPTC. This study evaluated whether computerized image analysis can detect nuclear differences between these three tumour subtypes. Materials and methods: Slides with histological material from 15 cases of NIFTP and 33 cases of FVPTC subtypes (22 IEFVPTC, and 11 IFVPTC) were analyzed using the Image J image processing program. Tumour cells were compared for both nuclear morphometry and chromatin textural characteristics. Results: Nuclei from NIFTP and IFVPTC tumours differed in terms of chromatin textural features (grey intensity): mean (92.37 ± 21.01 vs 72.99 ± 14.73, p = 0.02), median (84.93 ± 21.17 vs 65.18 ± 17.08, p = 0.02), standard deviation (47.77 ± 9.55 vs 39.39 ± 7.18; p = 0.02), and coefficient of variation of standard deviation (19.96 ± 4.01 vs 24.75 ± 3.31; p = 0.003). No differences were found in relation to IEFVPTC. Conclusion: Computerized image analysis revealed differences in nuclear texture between NIFTP and IFVPTC, but not for IEFVPTC.

The Difference in Thyroid Stimulating Hormone Levels between Differentiated Carcinoma and Benign Enlargement

Abstract Introduction Papillary and follicular thyroid carcinoma are common head and neck cancers. This cancer expresses a thyroid stimulating hormone (TSH) receptor that plays a role as a cancer stimulant substance. This hormone has a diagnostic value in the management of thyroid carcinoma. Objective The present study aimed to determine the difference in TSH levels between differentiated thyroid carcinoma and benign thyroid enlargement. Methods The present research design was a case-control study. The subjects were patients with thyroid enlargement who underwent thyroidectomies at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Thyroid stimulating hormone levels were mea- sured before the thyroidectomies. The inclusion criteria for the case group were: 1) differentiated thyroid carcinoma, and 2) complete data; while the inclusion criteria for the control group were: 1) benign thyroid enlargement, and 2) complete data. The exclusion criteria for both groups were: 1) patients suffering from thyroid hormone disorders requiring therapy before thyroidectomy surgery, 2) patients receiving thyroid suppression therapy before the thyroidectomy was performed, and 3) patients suffering from severe chronic diseases such as renal insufficiency, and severe liver disease. Results There were 40 post-thyroidectomy case group patients and 40 post-thyroidect- omy control group patients. There were statistically significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement (p = 0.001; odds ratio [OR] = 8.42; 95% confidence interval [CI]: 3.19-36.50). Conclusion Based on these results, it can be concluded that there were significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement.

Thyroid-like follicular carcinoma of the kidney presenting on a ten year-old prepubertal girl

ABSTRACT The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.

Follicular thyroid carcinoma metastatic to skin: a small papule and a big diagnostic change

Abstract: Cutaneous metastases are uncommon in daily practice, although very important, since they may be the first manifestation of an undiscovered primary neoplasm or the first indication of recurrence. Cutaneous metastases from the breast are the most frequent in women and cutaneous metastases from the lung are the most frequent in men. Thyroid carcinoma, despite representing the most frequent endocrine neoplasm, is considered a rare neoplasm, corresponding to 1% of malignant neoplasms diagnosed. Cutaneous metastases from follicular carcinoma are rare and occur mainly in the head and neck area. We report a case of cutaneous metastasis in a patient with follicular thyroid carcinoma and breast carcinoma. Because of the association of these two neoplasms, the possibility of Cowden Syndrome - multiple hamartoma syndrome - was raised, but was excluded by genetic analysis of PTEN gene.

Distant metastasis of follicular thyroid carcinoma to the mandible: a rare case report

Treatment of metastatic carcinoma of the oral cavity can be a challenge due to its rarity. The current case report details metastatic carcinoma of the mandible originating from follicular thyroid carcinoma, which is the second most prevalent tumor of the thyroid. As the mandibular lesion developed, the primary thyroid lesion of thyroid. Here, we report a case of metastatic carcinoma of the mandible in a 67-year-old female that was treated with partial mandibulectomy and fibular free flap.

Impact of body mass index on survival outcome in patients with differentiated thyroid cancer / Impacto do índice de massa corporal sobre o desfecho de sobrevida em pacientes com câncer diferenciado de tireoide

Abstract Introduction Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. Objective We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. Methods Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5 kg/m2 (underweight); (b) 18.5-25 kg/m2 (normal weight); (c) 26-30 kg/m2 (overweight); (d) 31-40 kg/m2 (obese) and (e) >40 kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. Results Median follow up period was 5.2 years (0.6-10). Mean body mass index was 31.3 kg/m2 (17-72); body mass index 31-40 kg/m2 was predominant (89 patients, 42.6%) followed by 26-30 kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p = 0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. Conclusion Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

Resumo Introdução Sabe-se que o aumento do índice de massa corpórea está associado à alta prevalência de câncer diferenciado de tireoide; entretanto, os dados sobre seu impacto no desfecho de sobrevivência após tireoidectomia e terapia adjuvante são escassos. Objetivo Objetivou-se avaliar o impacto do índice de massa corpórea nas taxas de sobrevida global e sobrevida livre de doença em pacientes com câncer diferenciado de tireoide. Método Entre 2000 e 2011, 209 pacientes com câncer diferenciado de tireoide (papilar/folicular/de células de Hurthle) foram tratados através de tireoidectomia, seguida de tratamento com iodo radioativo-131 adjuvante e supressão de hormônio estimulante da tireoide. Com base no índice de massa corpórea, os pacientes foram divididos em cinco grupos; (a) < 18,5 kg/m2 (baixo peso); (b) 18,5-25 kg/m2 (peso normal); (c) 26-30 kg/m2 (sobrepeso); (d) 31-40 kg/m2 (obesos) e (e) > 40 kg/m2 (obesos mórbidos). Várias características demográficas, clínicas e de tratamento e toxicidade associada e desfechos (sobrevida global e sobrevida livre de doença) foram analisadas e comparadas. Resultados O período médio de acompanhamento foi de 5,2 anos (0,6-10). O índice de massa corpórea médio foi de 31,3 kg/m2 (17-72); o índice de massa corpórea de 31-40 kg/m2 foi predominante (89 pacientes, 42,6%), seguido por 26-30 kg/m2, observado em 58 pacientes (27,8%). Observaram-se 18 recidivas locorregionais (8,6%) e 12 metástases distantes (5,7%). As taxas de sobrevida livre de doença e sobrevida global de 10 anos foram de 83,1% e 58,0%, respectivamente. Não foi encontrado impacto significativo do índice de massa corpórea nas taxas de sobrevida global ou sobrevida livre de doença (p = 0,081). Da mesma forma, a análise multivariada mostrou que o índice de massa corpórea não foi um fator prognóstico independente para sobrevida global e sobrevida livre de doença. Conclusão Embora o índice de massa corpórea possa aumentar o risco de câncer de tireoide, ele não tem impacto no resultado do tratamento; contudo, outros estudos são necessários.

Usefulness of dynamic risk stratification in pediatric patients with differentiated thyroid carcinoma

PURPOSE: Recently, the American Thyroid Association (ATA) dynamic risk stratification (DRS) has been verified to be more valuable than the static anatomical staging system for predicting prognosis in patients with differentiated thyroid carcinoma (DTC). The purpose of this retrospective study was to compare the clinical usefulness of DRS, which is based on the response to initial treatment, with that of ATA initial risk stratification in pediatric patients. METHODS: A total of 144 pediatric patients underwent thyroid operation from August 1982 to December 2013 at Yonsei University Hospital (Seoul, Korea). Among them, 128 patients with complete clinical data were enrolled in this study. Clinicopathologic features and surgical outcomes were retrospectively analyzed by medical chart review. The mean follow-up duration was 11.5 years. RESULTS: The mean tumor size was 2.1 cm; 80.4% of patients were diagnosed with conventional papillary thyroid carcinoma, and 7.0% of patients were diagnosed with follicular thyroid carcinoma. Low-risk patients had the highest probability of an excellent response to initial treatment (66.6%). High-risk patients had the highest probability of a structural incomplete response (100%) and the lowest probability of an excellent response (11.1%). The ATA risk stratification and the DRS system were independent risk factors for disease-free survival (DFS) (P = 0.041 and P < 0.001, respectively). CONCLUSION: The DRS system, which is based on the response to initial treatment, can offer more useful prognostic information compared with ATA risk stratification in pediatric patients with DTC.

Complementary Role of Elastography Using Carotid Artery Pulsation in the Ultrasonographic Assessment of Thyroid Nodules: A Prospective Study

OBJECTIVE: The aim of this study was to evaluate the diagnostic performance of gray-scale ultrasonography (US), Doppler scan, and elastography using carotid artery pulsation in the diagnosis of thyroid nodules and to find a complementary role of elastography. MATERIALS AND METHODS: A total 197 thyroid nodules with 91 malignant and 106 benign pathologic results from 187 patients (41 males and 146 females; age range, 20–83 years; mean age, 49.4 years) were included in this prospective study. The gray-scale, Doppler US images, elastography with elasticity contrast index (ECI), and stiffness color were assessed. The diagnostic performances of each dataset were assessed in order to differentiate benign from malignant thyroid nodules. RESULTS: The optimal cut-off value of the ECI was 1.71. The area under receiver operating characteristic curve (Az value) was 0.821 for gray-scale US, 0.661 for the ECI, 0.592 for stiffness color, and 0.539 for Doppler US. The Az value for a combined assessment of gray-scale US and the ECI was higher than that for the gray-scale US alone; however, there was no statistical difference between the two (p = 0.219). The median ECI values of follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FVPTC) were significantly lower than those of the other malignant lesions (p = 0.005). Meanwhile, the diffuse sclerosing variant of PTC and a metastatic nodule showed the two highest median values of the ECI. CONCLUSION: For differentiating thyroid nodules, the diagnostic performances of the combination of gray-scale US and elastography with the ECI were similar to, but not superior, to those of gray-scale US alone. FVPTC and FTC have a significantly lower ECI value than those of the other malignant lesions.

Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer

ABSTRACT Objectives: We sought to assess the relationship between stimulated thyroglobulin (sTg) before radioactive iodine therapy (RIT), and the dynamic risk stratification 1 year after treatment, and to establish the utility of the sTg as a predictor of response to therapy in these patients. A retrospective chart review of patients with differentiated thyroid cancer (DTC) who underwent RIT after surgery and were followed for at least 1 year, was carried out. Subjects and methods: Patients were classified according to the dynamic risk stratification 1 year after initial treatment. The sTg values before RIT were compared among the groups. ROC curve analysis was performed. Results: Fifty-six patients were enrolled (mean age 44.7 ± 14.4 years, 80.7% had papillary carcinoma). Patients with excellent response had sTg = 2.1 ± 3.3 ng/mL, those with indeterminate response had sTg = 8.2 ± 9.2 ng/mL and those with incomplete response had sTg = 22.4 ± 28.3 ng/mL before RIT (p = 0.01). There was a difference in sTg between excellent and incomplete response groups (p = 0.009) while no difference was found between indeterminate and either excellent or incomplete groups. The ROC curve showed an area under the curve of 0.779 assuming a sTg value of 3.75 ng/mL. Conclusion: Our study results suggest that the higher the sTg before RIT, the greater the likelihood of an incomplete response to initial treatment. A sTg cut-off of 3.75 ng/mL was found to be a good predictor of response to initial treatment in patients with DTC.

Deaths related to differentiated thyroid cancer: a rare but real event

ABSTRACT Objective The present study describes the clinical and tumor characteristics of patients that died from differentiated thyroid cancer and reports on the cause and circumstances of death in these cases. Subjects and methods Retrospective analysis of all the differentiated thyroid cancer (DTC) related deaths at a single institution over a 5-year period, with a total of 33 patients. Results Most of the patients were female (63.6%), with a mean age at diagnosis of 58.2 years. The most common histologic type was papillary (66.7%) and 30.3% were follicular. The distribution according to the TNM classification was: 15.4% of T1; 7.7% T2; 38.4% T3; 19.2% of T4a and 19.2% of T4b. Forty-four percent of cases were N0; 20% N1a and 36.6% of N1b. Twelve patients were considered non-responsive to radioiodine. Only one of the patients did not have distant metastases. The most common metastatic site was the lung in 69.7%. The majority of deaths were due to pulmonary complications related to lung metastases (17 patients, 51.5%), followed by post-operative complications in 5 cases, neurological disease progression in 3 cases, local invasion and airway obstruction in one patient. Median survival between diagnosis and death was reached in 49 months while between disease progression and death it was at 22 months. Conclusion Mortality from DTC is extremely rare but persists, and the main causes of death derive from distant metastasis, especially respiratory failure due to lung metastasis. Once disease progression is established, median survival was only 22 months.

Korean Thyroid Imaging Reporting and Data System features of follicular thyroid adenoma and carcinoma: a single-center study

PURPOSE: This study aimed to assess the diagnostic efficacy of Korean Thyroid Imaging Reporting and Data System (K-TIRADS) features for distinguishing follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC). METHODS: From January 2013 to July 2016, 46 follicular neoplasms in 45 patients who underwent preoperative thyroid ultrasonography (US) and thyroid surgery were included. The US features of each thyroid nodule were retrospectively evaluated by a single radiologist using a picture archiving and communication system. The diagnostic indices of K-TIRADS for follicular neoplasms were calculated according to whether K-TIRADS category 4 lesions were excluded or classified as benign or malignant. RESULTS: Of the 46 follicular neoplasms (mean size, 3.1±1.6 cm), 37 were FTAs (mean size, 3.1±1.7 cm) and nine were FTCs (mean size, 3.0±1.5 cm). A statistically significant difference was found between FTAs and FTCs regarding the margin (P=0.035), while no significant differences were observed in the composition, echogenicity, shape, orientation, calcification, or vascularity of the lesions (P<0.05). The FTAs belonged to K-TIRADS categories 3 (n=22) and 4 (n=15), while the FTCs belonged to K-TIRADS categories 3 (n=4), 4 (n=4), and 5 (n=1). However, there was no statistically significant difference in the distribution of K-TIRADS categories between FTAs and FTCs (P=0.184). CONCLUSION: K-TIRADS features were not helpful for distinguishing FTA from FTC, although follicular neoplasms showed a high prevalence of K-TIRADS categories 3 and 4.

Follicular thyroid cancer with sternal metastasis - challenges and outcomes

Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.

Extremely Well-Differentiated Papillary Thyroid Carcinoma Resembling Adenomatous Hyperplasia Can Metastasize to the Skull: A Case Report

We describe herein histologic, immunohistochemical, and molecular findings and clinical manifestations of a rare case of an extremely well differentiated papillary thyroid carcinoma (EWD-PTC). Similarly, it is also difficult to diagnose follicular variant papillary thyroid carcinoma (FVPTC), whose diagnosis is still met with controversy. A recently reported entity of well-differentiated tumor of uncertain malignant potential (WDT-UMP) is added to the diagnostic spectrum harboring EWD-PTC and FVPTC. We report this case, because EWD-PTC is different from FVPTC in its papillary architecture, and also from WDT-UMP in its recurrence and metastatic pattern. These morphologically deceptive entities harbored diagnostic difficulties in the past because the diagnosis depended solely on histology. However, they are now diagnosed with more certainty by virtue of immunohistochemical and molecular studies. We experienced a case of EWD-PTC, which had been diagnosed as adenomatous hyperplasia 20 years ago and manifested recurrence with lymph node (LN) metastasis 7 years later. After another 7 years of follow-up, a new thyroid lesion had developed, diagnosed as FVPTC, with LN metastasis of EWD-PTC. One year later, the patient developed metastatic FVPTC in the skull. Immunohistochemically, the EWD-PTC was focally positive for CK19, negative for galectin-3, and focally negative for CD56. Molecular studies revealed BRAF-positivity and K-RAS negativity. The FVPTC in the left thyroid showed both BRAF and K-RAS negativity. In conclusion, EWD-PTC and FVPTC share similar histologic features, but they are different tumors with different molecular biologic and clinical manifestations. A large cohort of EWD-PTC should be included in further study.