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

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. 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.

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 risk of recurrence within the first five years is very low in patients with papillary thyroid carcinoma treated with radioiodine

Introduction: In older studies, the frequency of recurrence was approximately 20% among patients with papillary thyroid carcinoma (PTC) treated with radioactive iodine (RAI), but it is possible that many of these cases actually correspond to persistent disease and that the frequency of recurrence is overestimated. Objective: To reevaluate the frequency of recurrence within the first five years in patients with PTC adequately operated upon and treated with RAI who did not exhibit persistent disease (postoperative ultrasonography and post-therapy whole-body scanning showing no apparent tumor). Methods: We selected 293 patients [51 low risk (17.4%) and 242 intermediate risk (82.6%)] submitted to thyroidectomy followed by RAI who did not have persistent disease. Results: Five years after RAI therapy, a tumor was detected in 10 patients (3.4%) (lymph node metastases in seven, pulmonary metastases in two, and bone metastases in one). Structural recurrence was observed in only 2% of low-risk patients and in 3.3% of intermediate-risk patients, with disease progression in none of the low-risk patients and in only one (0.4%) of the intermediate-risk patients. Survival was 100%. Conclusion: The results of this study suggest that, after adequate total thyroidectomy and in the absence of persistent disease, the frequency of recurrence within the first five years is very low in patients with PTC (not high risk) treated with RAI.

[Clinical characteristics of the thyroid follicular carcinoma]. / Características clínicas del carcinoma folicular de tiroides.

BACKGROUND: the prevalence of thyroid follicular carcinoma (TFC) is 39 % in patients with an undetermined histological diagnosis. The aim was to know the prevalence of TFC in a hospital with high population concentration. METHODS: surgical reports with a final diagnosis of TFC were reviewed. The size of the tumor, age, gender, pre- and post-surgical diagnosis and comorbidities were retrieved. RESULTS: a total of 35 reports with a diagnosis of TFC were found: 30 (85 %) were females with a mean age 44 ± 16.9 years. The mean age was 57 ± 6.6 in males. The diagnoses before surgery were follicular carcinoma 14 (40 %), thyroid cancer 6 (17.1 %), thyroid adenoma 4 (11.4 %), goiter 3 (8.5 %), thyroid nodule 3 (8.5 %), one papillary carcinoma (2.8 %), one thyroid neoplasm (2.8 %), one poorly differentiated adenocarcinoma (2.8 %), one well differentiated follicular adenocarcinoma (2.8 %), and one medullary thyroid cancer (2.8 %). The comorbidities found were Hashimoto disease 2 (5.6 %) and papillary contralateral carcinoma 2 patients (5.6 %). CONCLUSIONS: follicular carcinomas of the thyroid of our population differ in clinical presentation compared with previous reports.

Introducción: se ha identificado carcinoma folicular en 39 % de los pacientes con nódulos tiroideos cuya citología prequirúrgica ha indicado resultados indeterminados. El propósito de esta investigación fue conocer la prevalencia de esta entidad en un hospital de concentración. Métodos: se buscaron los reportes quirúrgicos con diagnóstico de carcinoma folicular. Se registró tamaño del tumor, sexo y edad del paciente, diagnósticos pre y posquirúrgico y patologías asociadas. Resultados: se diagnosticó carcinoma folicular en 35 pacientes: 30 mujeres (85 %) y cinco hombres (15 %). La edad en los hombres fue de 57 ± 6.6 y de 44 ± 16.9 en las mujeres. Los diagnósticos preoperatorios fueron carcinoma folicular en 14 (40 %), cáncer tiroideo en seis (17.1 %), adenoma folicular en cuatro (11.4 %), bocio en tres (8.5 %), nódulo tiroideo en tres (8.5 %); carcinoma papilar, tumor de tiroides, carcinoma poco diferenciado de tiroides, adenocarcinoma folicular bien diferenciado, cáncer medular en un paciente (2.8 %) cada uno. Las patologías asociadas fueron tiroiditis de Hashimoto y carcinoma papilar contralateral, con dos pacientes cada uno (5.6 %). Conclusiones: la edad de los pacientes y la presentación clínica del carcinoma folicular difirieron de las informadas en otras investigaciones.