Cervical masses as manifestation of papillary thyroid carcinomas ≤10 mm in diameter, in patients with unknown thyroid disease

<p>Abstract</p> <p>Background</p> <p>Papillary thyroid microcarcinomas are tumors often found accidentally after thyroidectomy for other thyroid disorders.</p> <p>Methods</p> <p>Patients with enlarged lateral cervical masses, with unknown thyroid disease, found to have metastases from papillary thyroid carcinoma ≤10 mm in diameter, were compared to patients operated on for nodular or multinodular goiter, who were incidentally found to have papillary thyroid microcarcinomas.</p> <p>Results</p> <p>Group A included 24 patients with an enlarged lateral cervical mass whereas group B included 30 patients presenting with nodular or multinodular goiter. Patients in both groups underwent surgery. After thyroidectomy and lymph node dissection, pathology revealed multifocal papillary carcinomas of 1–10 mm, with invasion of the thyroid capsule and surrounding soft tissue in most of the cases in group A. Two patients presented with distant metastases at diagnosis which were surgically removed. During follow up, 3 patients (12.5%) presented with new cervical metastases which were surgically removed or treated with additional radioactive iodine. At last follow-up, all patients were alive. In contrast, all patients in group B had unifocal papillary thyroid carcinoma 1–10 mm in maximum diameter, with no infiltration or extension into the adjacent tissue, or cervical lymph node metastases.</p> <p>Conclusion</p> <p>Two groups of papillary thyroid microcarcinomas characterized by different clinical and biological behaviours are identified. Significant differences were found between these groups concerning the age, tumor size, number of tumor foci, lymph nodes metastases and extrathyroidal extension of the tumor. Papillary thyroid carcinomas of small (≤10 mm) size may have aggressive behaviour or be metastatic, and this subgroup should be treated and followed up as are other large, differentiated thyroid cancers.</p

The Immunocytochemistry Is a Valuable Tool in the Diagnosis of Papillary Thyroid Cancer in FNA's Using Liquid-Based Cytology

Introduction. Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid. An accurate cytological diagnosis is based on distinctive cytological features in combination with immunocytochemistry. Methods. A number of 83 fine needle aspirations, positive for papillary thyroid cancer (44 from thyroid nodules and 39 from cervical lymph nodes), were studied using Thin Layer Cytology. A panel of the immunomarkers Cytokeratin-19, Galectin-3, HBME1, CD-44, CD-56, and E-Cadherin was performed. Results. Positive expression of CK-19 was observed in 77 cases (92.7%), of Galectin-3 in 74 cases (89.1%), of HBME1 in 65 (78.3%), and of CD-44 in 72 cases (86.7%). Loss of expression of CD-56 was observed in 80 cases (96.4%) and of E-cadherin in 78 (93.9%). Conclusions. Our data suggest that Thin Layer Cytology increases the diagnostic accuracy in papillary carcinoma and seems to be a promising technique for further investigation of thyroid lesions permitting the possibility to use archive material. Positive immunoexpression of CK-19, Galectin-3, HBME-1, and CD-44 improves the diagnostic accuracy of papillary thyroid cancer. Furthermore, loss of E-cadherin and of CD-56 expression is a feature of malignancy

Histological subtype is the most important determinant of survival in metastatic papillary thyroid cancer

<p>Abstract</p> <p>Background</p> <p>Papillary thyroid cancer (PTC) comprises the commonest type of thyroid cancer and carries the highest rate of survival. However, when metastatic disease occurs, survival is significantly affected.</p> <p>Methods</p> <p>We aimed to identify prognostic histopathological and clinical factors that modify survival in metastatic PTC. All cases of metastatic PTC treated at our department in the last 20 years were reviewed and analyzed.</p> <p>Results</p> <p>Histological subtype was the most important determinant of survival, as classic PTC demonstrated clearly improved survival compared to follicular subtype of PTC and other less frequently seen histological subtypes. The instant risk of death for the other histological subtypes was 4.56 times higher than the risk for the classic papillary type. Overall, a 10-year survival of 76.6% in our patients was seen.</p> <p>Conclusions</p> <p>Patients with aggressive variants of PTC are more at risk for the development of metastatic disease. In these patients, established treatment modalities (surgery, radioiodine therapy) should be offered promptly, as well as close follow-up.</p

Loss of efficacy of pasireotide after its re-administration: is there a reason why?

Pasireotide is a recently approved medical treatment for persistent or recurrent Cushing’s disease (CD). However, an escape from the initial successful response has not yet been described. A 42-year-old female presented with several symptoms indicative of hypercortisolism. Biochemical evaluation and imaging were consistent with CD due to a pituitary adenoma. Surgical excision of the adenoma was unsuccessful and gamma-knife radiosurgery was followed. Our patient remained hypercortisolemic thus treatment with pasireotide (900 ug subcutaneously twice daily) was decided. Biochemical and clinical remission was noted shortly thereafter. Moderate adverse events led to dose reduction to 600 ug subcutaneously twice daily. The patient remained in remission for 6 months, when treatment was discontinued due to cholecystitis. One month after cholecystectomy, pasireotide was restarted with no clinical or biochemical benefit that time. Pasireotide is an effective medical treatment for CD. Nevertheless, a loss of its initial efficacy may rarely be described

Papillary Thyroid Carcinomas in Patients under 21 Years of Age: Clinical and Histologic Characteristics of Tumors &lt;= 10 mm

Objective To compare clinical and histologic characteristics of papillary thyroid carcinomas (PTCs) &lt;= 10 mm in patients &lt;= 21 years old with larger ones and with microcarcinomas in adults. Study design Retrospective study of patients with PTC diagnosed between 1983 and 2012. Medical records were reviewed and information about age, sex, tumor size, intra/extrathyroid extension, lymph node, and distant metastases were collected. Results Patients &lt;= 21 years old (n = 93) and adults (n = 1235) with PTC were identified. Among the former, 34 had PTC &lt;= 10mm (37.4%) and among the latter, 584 had papillary thyroid microcarcinoma (PTM) (47.3%), P = .082. Patients with tumors &lt;= 10 mm less frequently had extrathyroidal extension and lymph node metastases compared with larger tumors (8.8% vs 33.3%, P = .017, and 60.0% vs 95.2%, P = .001, respectively). The percentage of PTC &lt;= 10 mm increased with age (7.1%, 32.0%, and 48.1% in age groups &lt;= 15, 15-18, and &gt; 18 to &lt;= 21 years old, respectively; P = .016). Mean tumor size was larger (6.8 +/- 2.7 vs 5.8 +/- 2.8 mm, P = .030), and lymph nodes metastases were more frequent (41.2% vs 18.6%, P = .003) in patients &lt;= 21 years of age compared with adults with PTM. The frequency of multifocal cancers decreased between 1983-1992, 1993-2002, and 2003-2012 (66.7%, 53.6%, and 27.1%, respectively, P = .019). Conclusions The frequency of PTC &lt;= 10 mm is low in children, increases in adolescents, and reaches that of adults at 18-21 years of age. Mean tumor size is larger and metastases to regional lymph nodes more frequent in comparison with PTM in adults. Whether their treatment and follow-up could be based on guidelines used for PTM in adults is questionable

Breast metastasis from medullary thyroid carcinoma in a male patient: case report and review of the literature

Medullary thyroid carcinoma (MTC) is a rare malignancy that may metastasize to liver, lungs and bones. Breast is an unusual metastatic site for MTC and only 20 female cases have been reported in the literature. We present a male patient in whom histological examination and immunohistochemistry of a breast mass were indicative of breast metastasis from MTC. A 67-year-old man with recent diagnosis of MTC and metastases to cervical and upper mediastinum lymph nodes was referred to our department for further treatment. At first evaluation, diagnostic imaging techniques showed lung and bone metastases and three months later the presence of liver metastases. Due to the extension of the disease, treatment with vandetanib was decided, but serious adverse events led to its interruption after two weeks. During follow-up, patient developed a painful swelling in the right breast. Ultrasound and mammography showed the presence of multiple masses to the right breast suspicious for malignancy. Core needle biopsy and histological examination of the specimen confirmed the presence of metastatic MTC. Palliative external beam irradiation was used to relieve local pain and, after one month, the patient died. Consequently, breast masses should be cautiously evaluated, mainly in the presence of a known primary malignancy. Histological and/or cytopathological examination are requisite diagnostic tools, while external beam irradiation and tyrosine kinase inhibitors may be used as palliative therapies in the concurrent presence of breast metastases from MTC