RARE ASSOCIATION BETWEEN HASHITOXICOSIS, BASEDOW DISEASE AND PAPILLARY THYROID CARCINOMA.

We present the case of a 32 yeas old male, diagnosed 7 years ago with Graves disease, with numerous recidives which needed anti-thyroid medication, with poor response (hypo to hyper-thyroid status, with high variations of TSH and FT4) whom after a period of remission (8 months, no treatment) came in for a polymorphic symptomatology sugestive for hyperthyroidism. The hyperthyroid state was confirmed he had high TRAb (31 UI/ml vs. <1.75 UI/ml) - on his last check in the detection rate of TRAb was under 0.3 UI/ml. The thyroid ultrasound revels on the left lobe a small mass of 0.8/0.8 cm, with EU-TIRADS score of 4, that was newly diagnosed. Postoperative histopathology revealed papillary microcarcinoma developed on Hashitoxicosis- pT1aN0, of 1 mm in the middle of left thyroid lobe. The particularity of this case consists in a long evolution of Graves disease with numerous relapses, the appearance of a thyroid nodule after 7 years in which they identified a papillary microcacinoma associated with Hashimoto thyroiditis and also the postoperative recovery that was slowed by the parathyreoprive tetany.

UTILITY OF THE 2023 BETHESDA SYSTEM AUS SUBCATEGORIZATION ON THYROID ASPIRATES.

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is widely used for the standardized reporting of thyroid fine-needle aspiration (FNA) cytology. The 2023 revision of TBSRTC introduced specific subcategories for the classification of atypia of undetermined significance (AUS). This study tests the association between AUS subtypes and malignant diagnoses, namely AUS-nuclear atypia and AUS-other, in archived thyroid - FNA specimens with atypia from 2018-2022 at King Abdulaziz University Hospital. A total of 104 thyroid - FNA specimens with AUS were re-evaluated cytologically and correlated with subsequent surgical outcomes, along with a discussion of discrepant cases.

Cytologic and Clinicopathologic Features of Papillary Thyroid Carcinoma with Prominent Hobnail Features on FNAC.

The hobnail variation of papillary thyroid cancer (PTC) is an uncommon, aggressive variety with hobnail characteristics on more than 30% of the tumour cells. Because of the entity's rarity, the clinical behaviour and pathologic characteristics of these tumours are still unknown. The purpose of this case study was to look at the cytologic, clinical, and pathological aspects of the hobnail variant of PTC, because of its severe clinicopathologic features and poor outcome, the unusual hobnail type of PTC may necessitate more aggressive treatment than traditional PTCs. The cytologic features of the hobnail variety are distinctive, and FNAC specimens can be used to provide a preoperative diagnosis. Diagnostic parameters for proportion of hobnail morphology need to be refined further. More research is needed to understand how detection of this high-risk variation affects clinical treatment.

Differentiated Thyroid Cancers with Synchronous Second Primary Cancers: Case Series.

The incidence of synchronous second primary cancer (SSPC) with DIfferentiated Thyroid Cancers (DTC) is a very rare entity. Very few case reports and case series were published in the literature. To enumerate the clinicopathological data of patients with DTC with SSPC. This is a single-center retrospective study. All the patients diagnosed with DTC and SSPC from January 2016 to July 2023 were included in the study. The demographic, clinicopathological data, and survival data were collected from the institute's database. Twelve patients were found to have DTC with SSPC. All the patients had papillary thyroid cancer. Ten patients had head and neck squamous cell carcinoma, one patient had malignant phyllodes tumor, and another patient had endometrioid adenocarcinoma as the SSPC. Six patients were diagnosed during preoperative evaluation, one patient was diagnosed 3 months after the oral malignancy diagnosis, and five patients were diagnosed with PTC in cervical nodes after neck dissection. Complete thyroid removal was done in six patients and hemithyroidectomy in two patients. The median follow-up was 25.55 months. The median overall survival was 40.97 months. Head and neck SCC is the most common SSPC with DTC. Since these are rare scenarios multi-disciplinary panel discussion can help in deciding management.

A comprehensive prediction model for central lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis: BRAF may not be a valuable predictor.

Purpose: Papillary thyroid carcinoma (PTC) frequently coexists with Hashimoto's thyroiditis (HT), which poses challenges in detecting central lymph node metastasis (CLNM) and determining optimal surgical management. Our study aimed to identify the independent predictors for CLNM in PTC patients with HT and develop a comprehensive prediction model for individualized clinical decision-making. Patients and methods: In this retrospective study, a total of 242 consecutive PTC patients who underwent thyroid surgery and central lymph node dissection between February 2019 and December 2021 were included. 129 patients with HT were enrolled as the case group and 113 patients without HT as control. The results of patients' general information, laboratory examination, ultrasound features, pathological evaluation, and BRAF mutation were collected. Multivariate logistic regression analysis was used to identify independent predictors, and the prediction model and nomogram were developed for PTC patients with HT. The performance of the model was assessed using the receiver operating characteristic curve, calibration curve, decision curve analysis, and clinical impact curve. In addition, the impact of the factor BRAF mutation was further evaluated. Results: Multivariate analysis revealed that gender (OR = 8.341, P = 0.013, 95% CI: 1.572, 44.266), maximum diameter (OR = 0.316, P = 0.029, 95% CI: 0.113, 0.888), multifocality (OR = 3.238, P = 0.010, 95% CI: 1.319, 7.948), margin (OR = 2.750, P = 0.046, 95% CI: 1.020, 7.416), and thyrotropin receptor antibody (TR-Ab) (OR = 0.054, P = 0.003, 95% CI: 0.008, 0.374) were identified as independent predictors for CLNM in PTC patients with HT. The area under the curve of the model was 0.82, with accuracy, sensitivity, and specificity of 77.5%, 80.3% and 75.0%, respectively. Meanwhile, the model showed satisfactory performance in the internal validation. Moreover, the results revealed that BRAF mutation cannot further improve the efficacy of the prediction model. Conclusion: Male, maximum diameter > 10mm, multifocal tumors, irregular margin, and lower TR-Ab level have significant predictive value for CLNM in PTC patients with HT. Meanwhile, BRAF mutation may not have a valuable predictive role for CLNM in these cases. The nomogram constructed offers a convenient and valuable tool for clinicians to determine surgical decision and prognostication for patients.

Impact of periodic neck ultrasonography on locoregional disease control in surveillance after total thyroidectomy for patients with low- and intermediate-risk papillary thyroid carcinoma: a propensity score-matched study.

This study aimed to evaluate the impact of periodic neck ultrasonography (US) on postoperative surveillance for locoregional disease control of patients with low- and intermediate-risk papillary thyroid carcinoma (PTC) who underwent total thyroidectomy. This retrospective cohort study included patients with PTC who underwent total thyroidectomy and central neck dissection at our institution between January, 2000 and December, 2016. The patients were divided into two groups: the physical examination (PE) group (follow-up by PE without periodic US) and the US group (follow-up by PE with periodic US). Serum thyroglobulin levels were measured periodically in both groups. Propensity score matching was used to rigorously balance the significant variables and assess the 10-year postoperative outcomes between the groups. Of the 189 patients, 150 were included after matching (75 in each group). There were no significant differences between the two groups in terms of background characteristics. The median follow-up period was 127.9 months. There was no significant difference in locoregional relapse-free survival between the PE and US groups (97.0 vs. 98.7%, p = 0.541). The overall survival was 96.7% and 98.7% in the PE and US groups, respectively, with no significant difference (p = 0.364). This study demonstrated that the addition of periodic US to PE for postoperative surveillance of patients with low- and intermediate-risk PTC who underwent total thyroidectomy did not significantly affect locoregional control.

Analysis of BRAF Gene Mutation in Hashimoto's Thyroiditis With Multifocal Papillary Thyroid Carcinoma.

BACKGROUND: Thyroid cancer (TC) is a highly prevalent malignant tumor of the head and neck. Papillary thyroid carcinoma (PTC) is the primary pathological type of TC, accounting for more than 80% of all TCs. BRAF mutations are closely associated with PTC. However, the relationship among HT, PTC, and BRAF mutations has not yet been clarified. We aimed to investigate the BRAF mutation in Hashimoto's thyroiditis (HT) with PTC. METHODS: A total of 72 patients with multifocal PTC were included and grouped based on surgical pathology examination. Group A (n = 32) had pure multifocal PTC and Group B (n = 40) had HT with multifocal PTC. Various features were compared: BRAF mutation, multifactorial analysis of BRAF mutations, pathological features in patients with HT and multifocal PTC, and multifactorial analysis of factors affecting HT with multifocal PTC. RESULTS: Significant differences were seen in thyroid peroxidase antibody levels, central lymph node metastasis, extra-thyroidal invasion, main and non-main lesion diameters, and BRAF mutation positivity (P < 0.05). Patients with the BRAF mutation had significantly higher rates of extra-thyroidal invasion and lymph node metastasis than those without the BRAF mutation (P < 0.05). Logistic regression analysis showed that BRAF mutation and main lesion nodule diameter were independent risk factors affecting extra-thyroidal invasion and central lymph node metastasis in patients with HT and multifocal PTC (P < 0.05). DISCUSSION: BRAF mutations were more prevalent and closely associated with extra-thyroidal invasion and central lymph node metastasis in patients with HT and multifocal PTC.

Machine Learning Streamlines the Morphometric Characterization and Multiclass Segmentation of Nuclei in Different Follicular Thyroid Lesions: Everything in a NUTSHELL.

The diagnostic assessment of thyroid nodules is hampered by the persistence of uncertainty in borderline cases and further complicated by the inclusion of noninvasive follicular tumor with papillary-like nuclear features (NIFTP) as a less aggressive alternative to papillary thyroid carcinoma (PTC). In this setting, computational methods might facilitate the diagnostic process by unmasking key nuclear characteristics of NIFTP. The main aims of this work were to (1) identify morphometric features of NIFTP and PTC that are interpretable for the human eye and (2) develop a deep learning model for multiclass segmentation as a support tool to reduce diagnostic variability. Our findings confirmed that nuclei in NIFTP and PTC share multiple characteristics, setting them apart from hyperplastic nodules (HP). The morphometric analysis identified 15 features that can be translated into nuclear alterations readily understandable by pathologists, such as a remarkable internuclear homogeneity for HP in contrast to a major complexity in the chromatin texture of NIFTP and to the peculiar pattern of nuclear texture variability of PTC. A few NIFTP cases with available next-generation sequencing data were also analyzed to initially explore the impact of RAS-related mutations on nuclear morphometry. Finally, a pixel-based deep learning model was trained and tested on whole-slide images of NIFTP, PTC, and HP cases. The model, named NUTSHELL (NUclei from Thyroid tumors Segmentation to Highlight Encapsulated Low-malignant Lesions), successfully detected and classified the majority of nuclei in all whole-slide image tiles, showing comparable results with already well-established pathology nuclear scores. NUTSHELL provides an immediate overview of NIFTP areas and can be used to detect microfoci of PTC within extensive glandular samples or identify lymph node metastases. NUTSHELL can be run inside WSInfer with an easy rendering in QuPath, thus facilitating the democratization of digital pathology.

Selpercatinib prior to radioactive iodine for pediatric papillary thyroid carcinoma.

OBJECTIVES: We introduced selpercatinib prior to radioactive iodine therapy prior to radioactive iodine therapy (RAI) for pediatric papillary thyroid cancer (PTC) to enhance the tumorical effects of RAI. CASE PRESENTATION: PTC has an excellent prognosis but is commonly associated with local and distant metastases. Successful complete response to the current standard of care, thyroidectomy with lymph node resection and RAI, is achieved in only a small minority of cases with metastases. The direct effect of tyrosine kinase inhibitors (TKIs) on tumor regression has been confirmed in several randomized controlled studies, while the increased RAI uptake has been reported in small case series, but typically TKIs are currently reserved third-line. Selpercatinib is a TKI that specifically has a durable effect in RET-fusion positive malignancies. We describe a 10-year-old Hispanic girl with metastatic PTC treated with total thyroidectomy and extensive lymph node resection. Evaluation for relevant genetic drivers of the malignancy revealed a strong overexpression of the RET tyrosine kinase domain indicative of a RET gene fusion. Selpercatinib 120 mg twice daily given orally was initiated prior to the initial dose of RAI to achieve further tumor regression by a direct cytostatic effect and then secondarily enhancement of RAI uptake. Minimal side effects occurred, specifically intermittent mild skin rashes that resolved. Resolution of distal lung metastases was noted on CT imaging. RAI was then administered 9 months afterward, with ultimately achievement of a low thyroglobulin level 1.0 ng/mL 11 months after RAI. CONCLUSIONS: In conclusion, selpercatinib given prior to the initial dose of adjunctive RAI for RET-fusion positive PTC is a well-tolerated intervention that further reduces tumor burden and potentially enhances the tumorcidal effects of RAI.

Concurrent Oral Squamous Cell Carcinoma and Incidental Papillary Thyroid Carcinoma Metastasis in Cervical Lymph Nodes: A Case Report.

Oral squamous cell carcinoma (OSCC) is the most common of all head and neck cancers accounting for 90% of all oral malignancies. It is commonly associated with the use of tobacco smoking or quid form. The incidence of oral carcinoma is higher in males than females with a ratio of 1.4:1, though females commonly adopt tobacco quid chewing habit. OSCC metastasis to cervical lymph node at the rate of 20-42.6% according to studies reported so far. Papillary thyroid carcinoma (PTC) occurs with a higher incidence in females than males with metastasis into cervical lymph nodes though the primary lesion frequently goes undetected. Concurrent metastasis of OSCC and PTC to the cervical lymph node during neck dissection has been reported rarely in the literature. This case report presents a 48-year-old female with lymph node metastasis of carcinoma of the right mandibular posterior alveolar region concurrently with metastasis of PTC (with primary lesion clinically undetected) encountered during cervical lymph node examination.

Evaluation of the Her-2/neu value in papillary thyroid carcinoma and its relation to histopathological prognostic findings.

INTRODUCTION: Thyroid cancer is an important endocrine malignancy worldwide, including papillary carcinoma, which is responsible for more than 90 % of thyroid malignancies. Human epidermal growth factor receptor 2 (Her-2/neu) overexpression plays a significant act in the development, progression, and invasion of various tumors through effects on the cell cycle, angiogenesis, cell movement, and apoptosis. OBJECTIVE AND METHODS: The study was conducted as a cross-sectional study, using tissue samples from 53 patients who underwent lobectomy or total thyroidectomy between 2020 and 2022. For histopathological examination and to determine the pathological features of the tumor, tumor specimens were stained for immunohistochemistry using a monoclonal antibody against Her-2/neu. RESULTS: In this study, Her-2/neu was expressed in 13.2 % of PTC patients and not expressed in normal thyroid tissue. No significant relationship was established between Her-2/neu expression and tumor histological subtype, as well as tumor size, sex, or tumor focality. Furthermore, there was no significant association between Her-2/neu expression and vascular invasion or extrathyroidal extension of the tumor. CONCLUSION: No significant Her-2/neu expression was observed in the malignant thyroid tissue. These findings raise questions about the value of Her-2/neu as a potential prognostic factor or target of a specific anticancer treatment for thyroid cancer.

A high Ki-67 labeling index and high thyroglobulin doubling rate are significant predictors of excision-site recurrence of papillary thyroid carcinoma following airway resection for locally curative surgery.

BACKGROUND: Papillary thyroid carcinoma (PTC) occasionally invades the trachea and requires airway resection. Tracheal excision site recurrence (ESR) is a serious problem. We investigated predictors of ESR in patients with PTC who underwent airway resection for locally curative surgery. METHODS: We enrolled 149 patients with PTC who underwent airway resection (median age at the initial surgery: 67 years), including partial-thickness resection (n = 73) or full-thickness resection (n = 76), for grossly curative surgery. The median postoperative follow-up period was 93 months. RESULTS: To date, 11 patients (6.7%) underwent ESR: 6 underwent full-thickness resection and 5 underwent partial-thickness resection. The time to ESR ranged from 14 to 113 months (median: 57 months) after the initial surgery. None of the 11 ESR patients underwent adjuvant external beam radiotherapy (EBRT) and none of the 4 airway resection patients who underwent EBRT developed ESR. The 5- and 10-year ESR rates were 4.3% and 11.3%, respectively. In the multivariate analysis (forward-backward stepwise selection method), a Ki-67 labeling index (LI) ≥5% (p = 0.048) and the thyroglobulin doubling rate (Tg-DR) >0.33/year (p = 0.009) (for Tg-antibody negative cases) were independent predictors of ESR. Nine of the 11 patients underwent ESR resection and only one developed a second recurrence. CONCLUSIONS: A high Ki-67 LI was a static predictor, and high Tg-DR was a dynamic predictor, of ESR in patients with PTC following airway resection. In such patients, careful postoperative monitoring for ESR is necessary and adjuvant therapies, such as EBRT, may be considered.

Investigating the Involvement of Mediastinal Lymph Nodes in Patients with Papillary Thyroid Carcinoma.

Background: Papillary thyroid carcinoma (PTC) is also the most common endocrine malignancy. In the present study, we aimed to evaluate the metastasis pattern of upper mediastinal lymph node involvement in patients with PTC. Materials and Methods: This is a descriptive cross-sectional study that was performed in 2020 in Isfahan, Iran, on 73 patients with PTC who were candidates for total thyroidectomy. Demographic data including age and gender were collected. The frequency distribution of upper mediastinal lymph node involvements and their relationships with mass size, gender, and age, location of tumor in the thyroid gland and involvement of lateral lymph nodes in the neck were evaluated. Results: The mean mass size was 17.27 mm. The most involved thyroid lobe in patients with upper mediastinal lymph node involvement was the right lobe (16.5%). In terms of mediastinal lymph node involvement, there were no significant relationships between the two sexes (P = 0.161), primary mass size (P = 0.151), and thyroid mass location (P = 0.739) with mediastinal lymph node involvement. There was a significant relationship between lateral lymph node involvement of the neck (P = 0.007) and age groups (P = 0.042) with involvement of the upper mediastinal lymph nodes. Based on our results, the upper mediastinal lymph node involvement was more frequent among patients under 40 years of age. Conclusion: Upper mediastinal lymph node metastasis in PTC was significantly more frequent in cases with younger ages (lower than 40 years) and involvements of lateral lymph nodes in the neck.

MRI features of histological subtypes of thyroid cancer in comparison with CT findings: differentiation between anaplastic, poorly differentiated, and papillary thyroid carcinoma.

PURPOSE: This study aimed to evaluate the MRI features of the main histological subtypes of thyroid cancer and enable differentiation between anaplastic thyroid carcinoma (ATC), poorly differentiated thyroid carcinoma (PDTC), and papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: This study included 79 patients with histopathologically proven thyroid cancer (14 ATCs, 8 PDTCs, and 57 PTCs) who underwent neck MRI. MRI images were retrospectively reviewed and compared between the three pathologies. RESULTS: The maximum diameter was larger in ATCs and PDTCs than in PTCs (65.2 mm and 38.4 mm vs. 26.0 mm, p < 0.01). The signal intensity ratio of the solid components on T2-weighted images (T2WIs) was higher in ATCs than in PTCs (1.13 vs. 0.89, p < 0.05). The predominant signal intensity of the solid components on T2WI exhibited hyperintensity relative to the spinal cord in ATCs more frequently than in PTCs (71% vs. 30%, p < 0.01), whereas hypointensity was more frequent in PTCs than in ATCs and PDTCs (60% vs. 0% and 13%, p < 0.01). Intratumoral ring-shaped hypointensity on T2WI was more frequent in ATCs than in PDTCs and PTCs (64% vs. 13% and 18%, p < 0.01). An ill-defined margin was more frequent in ATCs and PDTCs than in PTCs (93% and 63% vs. 25%, p < 0.01). Extrathyroidal extension, tracheal invasion, esophageal invasion, vascular invasion, and venous thrombosis were more frequently observed in ATCs than in PTCs (p < 0.05). CONCLUSIONS: MRI could characterize the differences between ATCs, PDTCs, and PTCs.

Correlation between gene mutations and clinical characteristics in papillary thyroid cancer: a retrospective analysis of BRAF mutations and RET rearrangements.

INTRODUCTION: Activation of the MAPK pathway by genetic mutations (such as BRAF and RET) initiates and accelerates the growth of papillary thyroid carcinoma (PTC). However, the correlation between genetic mutations and clinical features remains to be established. Therefore, this study aimed to retrospectively analyze major genetic mutations, specifically BRAF mutations and RET rearrangements, and develop a treatment algorithm by comparing background and clinical characteristics. METHOD: One hundred thirteen patients with primary PTC were included in this study. BRAF mutations were detected via Sanger sequencing and RET rearrangements were detected via fluorescence in situ hybridization (FISH) analysis, and reverse transcription polymerase chain reaction (RT-PCR). The patients were categorized into two groups based on the presence of BRAF mutations and RET rearrangements and their clinical characteristics (age, sex, TNM, stage, extratumoral extension, tumor size, unifocal/multifocal lesions, vascular invasion, differentiation, chronic thyroiditis, preoperative serum thyroglobulin level, and 18F-fluorodeoxyglucose (FDG) uptake) were compared subsequently. RESULT: After excluding unanalyzable specimens, 80 PTC patients (22 males and 58 females, mean age: 57.2 years) were included in the study. RET rearrangements were positive in 8 cases (10%), and BRAF mutation was positive in 63 (78.6%). The RET rearrangement group was significantly associated with younger age (p = 0.024), multifocal lesion (p = 0.048), distant metastasis (p = 0.025) and decreased 18F-fluorodeoxyglucose uptake (p < 0.001). The BRAF mutation group was significantly associated with unifocal lesions (p = 0.02) and increased 18F-FDG uptake (p = 0.004). CONCLUSION: In this study, an increase in M classification cases was found in the RET rearrangements group. However, genetic mutations were not associated with the clinical stage, and no factors that could be incorporated into the treatment algorithm were identified.

Demographic and Prognostic Factors of the Columnar Cell Variant of Papillary Thyroid Carcinoma: A National Cancer Database Study.

Objective The columnar cell variant of papillary thyroid carcinoma (PTC-CC) is a rare, malignant tumor of the thyroid gland. This study uses the National Cancer Database (NCDB) to analyze demographic and prognostic factors affecting the overall survival rates of PTC-CC. Methods From 2004 to 2020, 7,079 patients diagnosed with columnar cell papillary thyroid carcinoma were identified in the NCDB. Patient demographics were reviewed based on categories listed in the NCDB participant user file data dictionary. Kaplan-Meier curves, log-rank tests, and multivariable Cox hazard regression models were used to analyze the significance of demographic and prognostic factors on overall survival rates of PTC-CC. Results Multivariate analysis demonstrated each five-year increment in age was associated with a 30% increase in mortality (hazard ratio (HR) = 1.30, 95% confidence interval (CI): 1.25-1.36, P < 0.001). Charlson-Deyo scores displayed similar incremental increases, such that patients with a score ≥ 3 had a 154% increase in mortality risk relative to a score of 0 (HR = 2.54; 95% CI: 1.75-3.68, P < 0.001). Black individuals had a 70% increase in mortality compared to White individuals (HR = 1.70, 95% CI: 1.25-2.30, P < 0.001), while all Other races had the highest 10-year survival rate of 92.7%. Females had a significant 37% decrease in mortality compared to males (HR = 0.63, 95% CI: 0.54-0.73, P < 0.001). Patients in the lowest income quartiles were found to have a significant increase in mortality compared to the highest income group (HR = 0.54; 95% CI: 0.41-0.71, P < 0.001). Survival rates were negatively correlated with NCDB Analytic Staging increases. Conclusion In general, age, sex, race, education, income, comorbidities, and cancer staging were found to be predictive factors of overall survival rates of PTC-CC. However, insurance status and education levels did not result in significant differences.

Surgical management and outcomes of T4a papillary thyroid carcinoma: a single-centre study of 602 cases.

OBJECTIVE: This study aimed to investigate the clinical characteristics and risk factors associated with the disease progression of T4a papillary thyroid carcinoma (PTC). METHODS: In all, 602 patients (230 males; 372 females), aged 8-82 years, with T4a PTC who were admitted for initial surgery between April 2010 and September 2022 were retrospectively analysed. RESULTS: Tracheal invasion was observed in 271 (45.0%), oesophageal invasion in 190 (31.6%), recurrent laryngeal nerve (RLN) invasion in 516 (85.7%), and larynx invasion in 22 (3.7%) patients. The 5-year progression-free survival was 89.8%, and disease-specific survival was 96.0%, with a postoperative disease progression rate of 9.6% (54 patients) and mortality rate of 5.17% (29 patients). Disease recurrence was most likely to occur at the initial surgical site. Age ≥55 years, preoperative vocal cord paralysis, microvascular invasion, trachea invasion, and metastases to >5 cervical lymph nodes were independent risk factors for disease progression in patients with M0 stage. Male sex, preoperative vocal cord paralysis, microvascular invasion, specific pathological type, and laryngeal invasion were associated with an increased risk of disease progression for all T4a patients, while lobectomy, total thyroidectomy, tumour shaving on the RLN surface, total RLN resection, and absence of radioactive iodine therapy were not. CONCLUSIONS: Surgery was the primary treatment for patients with stage T4a PTC and most patients had a satisfactory prognosis. Surgeons should comprehensively evaluate each patient before deciding the surgical approach.

Pralsetinib as neoadjuvant therapy for RET-Altered differentiated thyroid cancer: Two case reports.

BACKGROUND: 5-10% of thyroid cancers are at locally advanced stage. Neoadjuvant targeted therapy will likely create surgical opportunities for these patients with unresectable or borderline resectable tumors. Pralsetinib, a RET inhibitor, has been approved for advanced or metastatic RET-altered thyroid cancer. However, there is no evidence on the efficacy of pralsetinib as neoadjuvant therapy in locally advanced RET-altered thyroid cancer. CASE REPORT: Two patients with locally advanced pappilary thyroid carcinoma (PTC) were treated with pralsetinib (400 mg daily) to reduce tumor size and increase the chance of R0 resection. Both PTCs, characterized by RET-fusion, underwent successful R0 resection without major surgical complications after 4-months neoadjuvant pralsetinib. CONCLUSION: There is a potential for pralsetinib as a neoadjuvant treatment in PTC with RET-fusion.

Decoding the past and future of distant metastasis from papillary thyroid carcinoma: a bibliometric analysis from 2004 to 2023.

Background: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, and its distant metastasis (PTCDM), although uncommon, seriously affects the survival rate and quality of life of patients. With the rapid development of science and technology, research in the field of PTCDM has accumulated rapidly, presenting a complex knowledge structure and development trend. Methods: In this study, bibliometric analysis was used to collect 479 PTCDM-related papers published between 2004 and 2023 through the Web of Science (WoS) Core Collection (WoSCC) database. Keyword clustering analysis was performed using VOSviewer and citespace, as well as dual-map overlay analysis, to explore knowledge flows and interconnections between different disciplines. Results: The analysis indicated that China, the United States, and South Korea were the most active countries in conducting research activities. Italy's research was notable due to its higher average citation count. Keyword analysis revealed that "cancer," "papillary thyroid carcinoma," and "metastasis" were the most frequently used terms in these studies. The journal co-citation analysis underscored the dominant roles of molecular biology, immunology, and clinical medicine, as well as the growing importance of computer science in research. Conclusion: This study identified the main trends and scientific structure of PTCDM research, highlighting the importance of interdisciplinary approaches and the crucial role of top academic journals in promoting high-quality research. The findings not only provide valuable information for basic and clinical research on thyroid cancer but also offer guidance for future research directions.