CONTEXT: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a new entity replacing the diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC). Significant variability in the incidence of NIFTP diagnosed in different world regions has been reported. OBJECTIVE: To investigate the rate of adoption of NIFTP, change in practice patterns, and uniformity in applying diagnostic criteria among pathologists practicing in different regions. METHODS: Two surveys distributed to pathologists of the International Endocrine Pathology Discussion Group with multiple-choice questions on NIFTP adoption into pathology practice and whole slide images of 5 tumors to collect information on nuclear score and diagnosis. Forty-eight endocrine pathologists, including 24 from North America, 8 from Europe, and 16 from Asia/Oceania completed the first survey and 38 the second survey. RESULTS: A 94% adoption rate of NIFTP by the pathologists was found. Yet, the frequency of rendering NIFTP diagnosis was significantly higher in North America than in other regions (P = .009). While the highest concordance was found in diagnosing lesions with mildly or well-developed PTC-like nuclei, there was significant variability in nuclear scoring and diagnosing NIFTP for tumors with moderate nuclear changes (nuclear score 2) (case 2, P < .05). Pathologists practicing in North America and Europe showed a tendency for lower thresholds for PTC-like nuclei and NIFTP than those practicing in Asia/Oceania. CONCLUSION: Despite a high adoption rate of NIFTP across geographic regions, NIFTP is diagnosed more often by pathologists in North America. Significant differences remain in diagnosing intermediate PTC-like nuclei and respectively NIFTP, with more conservative nuclear scoring in Asia/Oceania, which may explain the geographic differences in NIFTP incidence.
- MeSH
- buněčné jádro patologie MeSH
- folikulární adenokarcinom * patologie epidemiologie diagnóza MeSH
- lékařská praxe - způsoby provádění statistika a číselné údaje MeSH
- lidé MeSH
- nádory štítné žlázy * epidemiologie patologie diagnóza MeSH
- papilární karcinom štítné žlázy epidemiologie patologie diagnóza MeSH
- papilární karcinom patologie epidemiologie diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Asie MeSH
- Evropa MeSH
- Oceánie MeSH
- Severní Amerika MeSH
WHO klasifikace tyreoidálních nádorů vstupují do druhého půlstoletí vývoje 5. vydáním. Trvalý nárůst informací je v porovnání s předchozím 4. vydáním kla- sifikace především v úrovni molekulárně biologické. To změnilo pohled na velmi tradiční jednotky – preferovaný název pro polynodózní strumu je (s ohledem na monoklonální povahu některých uzlů) folikulární nodulární tyreoidální nemoc. Odstraněny byly i některé terminologické relikty – název onkocyty nahradil Hürthleho buňky. Folikulární adenom má nově podtyp s papilární úpravou (a chybějícími jadernými znaky papilárního karcinomu). V již vžité jednotce NIFTP jsou nově vymezeny podtypy menší než 10 mm a onkocytární. Všechny onkocytární tumory mají arbitrárně stanoven minimální podíl onkocytů na 75 %. Multi- disciplinární přístup k léčbě tyreopatií a stratifikace terapeutických postupů podle rizika přineslo zavedení gradingu do řady nozologických jednotek karcinomů papilárního, folikulárního, medulárního. Grading využívající počtu mitóz stanoví jejich kvantifikaci na 2 mm² místo dříve užívaných nejednotných zorných polí velkého zvětšení (HPF). Upřesnění nastalo na podkladě genetických poznatků i v řadě dalších, méně častých diagnóz (např. zařazení spinocelulárního karcino- mu mezi anaplastické). V kategorii vzácných nádorů jsou nově formulovány karcinomy salivárního typu se dvěma zástupci: mukoepidermoidním a sekretoric- kým karcinomem. Kribriformně morulárně upravený karcinom řazený dříve jako varianta karcinomu papilárního je nově oddělen na podkladě imunologického a genetického profilu do nově vzniklé kategorie nádorů nejisté histogeneze. Do této kategorie je zařazen rovněž sklerozující mukoepidermoidní karcinom s eo- zinofilií. Mikrokarcinom jako samostatná jednotka není v 5. vydání obsažen. Nádor menší než 10 mm musí být charakterizován příslušnými znaky odpovídající kategorie. Thyroblastom nahrazuje terminologicky maligní teratom Část nově stanovených diagnostických kritérií je uplatnitelná i ve FNAB diagnostice. Nově zavedený grading u některých nozologických jednotek může výjimeč- ně i změnit diagnózu (NIFTP/EFVPTC/ neinvazivní HG FVPTC), ale především ovlivní volbu terapeutických postupů.
The WHO classification of thyroid tumours enters its second half-century of development with the 5th edition. Compared to the previous 4th edition of the clas- sification, the permanent increase in information is mainly at the molecular biological level. This has changed the view of very traditional entities – the preferred name for polynodous goiter is (given the monoclonal nature of some nodules) follicular nodular thyroid disease. Some terminological relics have also been re- moved – Hürthle cells are definitively referred to as oncocytes. Follicular adenoma has a new subtype with papillary arrangement (and missing nuclear features of papillary carcinoma). In the already used NIFTP unit, subtypes smaller than 10 mm and oncocytic are newly defined. All oncocytic tumours have an arbitrarily set minimum proportion of oncocytes at 75 %. A multidisciplinary approach to the treatment of thyropathies and the stratification of therapeutic procedures according to risk brought about the introduction of grading into several nosological units of papillary, follicular, and medullary carcinomas. Grading using the number of mitoses determines their quantification at 2 mm² instead of the previously used non-uniform HPFs (high power fields of view). Clarification was made on the basis of genetic findings in a number of other, less frequent diagnoses (e.g. classification of squamous cell carcinoma among anaplastic). Among rare tumors a new category of salivary gland - type carcinomas is formulated with two representatives: mucoepidermoid and secretory carcinoma. Cribriform morular carcinoma previously classified as a variant of papillary carcinoma is newly separated on the basis of the immunological and genetic profile into the newly created category of tumors of uncertain histogenesis. This category also includes sclerosing mucoepidermoid carcinoma with eosinophilia. Microcarcino- ma as a separate entity is not included in the 5th edition. A tumor smaller than 10 mm must be characterized by the appropriate features of the corresponding category. Thyroblastoma replaces terminologically malignant teratoma from the previous classification. Part of the newly established diagnostic criteria is also applicable in FNAB diagnosis. The newly introduced grading in some nosological units can exceptionally change the diagnosis (NIFTP/EFVPTC/non-invasive HG FVPTC), but above all it will affect the choice of therapeutic procedures.
BACKGROUND: The latest WHO classification of tumours of endocrine organs defines new units of borderline thyroid tumours (BTT). The aim of our study was to evaluate ultrasonographic and cytological features, mutation profile and surgery treatment in rare thyroid tumours. METHODS: An analysis of 8 BTT out of 487 patients, who underwent thyroid surgery between June 2016 and June 2020. The definitive diagnosis was made postoperatively by extensive histopathological examination. Molecular genetic analysis of genes associated with thyroid oncology (BRAF, HRAS, KRAS, NRAS, TERT, TP53, fused genes) were performed from one FNAB, and 7 formalin-fixed paraffin-embedded (FFPE) samples. RESULTS: BTT were found in a total of 8 patients (1.6%), with a predominance of men with respect to other operated patients. FNAB samples were classified in the Bethesda system as Bethesda I, Bethesda II and Bethesda III in one, four and three cases, respectively. Hemithyroidectomy and total thyroidectomy were performed equally in four patients. The histopathological diagnosis revealed non-invasive encapsulated follicular neoplasm with papillary-like nuclear features (NIFTP) in three patients, follicular tumour of uncertain malignant potential (FT-UMP) in three patients, well differentiated tumour of uncertain malignant potential (WDT-UMP) in one patient, and hyalinizing trabecular tumour (HTT) in one case. In NIFTP cases mutation in HRAS gene in one patient together with probable pathogenic variant in TP53 gene and in NRAS gene in two patients were detected. In HTT patient PAX8/GLIS3 fusion gene was detected. CONCLUSION: The surgical treatment of BTT is necessarily individual influenced by preoperative clinical, ultrasonographic, cytological and molecular genetic findings, and the presence of other comorbidities.
- MeSH
- folikulární adenokarcinom * patologie MeSH
- lidé MeSH
- nádory štítné žlázy * genetika chirurgie patologie MeSH
- tyreoidektomie MeSH
- uridinmonofosfát MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. OBJECTIVES: The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. METHOD: An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. RESULTS: Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5-5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8-1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9-10.8%) in benign, 29.2% (95% CI: 25.0-33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6-28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1-22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2-8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). CONCLUSIONS: Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.
- MeSH
- folikulární adenokarcinom * MeSH
- lidé MeSH
- nádory štítné žlázy * MeSH
- tenkojehlová biopsie MeSH
- uzle štítné žlázy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
Background: Brain metastases (BM) from differentiated thyroid cancer are rare. Stereotactic radiosurgery (SRS) is commonly used for the treatment of BMs; however, the experience with SRS for thyroid cancer BMs remains limited. The goal of this international, multi-centered study was to evaluate the efficacy and safety of SRS for thyroid cancer BMs. Methods: From 10 institutions participating in the International Radiosurgery Research Foundation, we pooled patients with established papillary or follicular thyroid cancer diagnosis who underwent SRS for histologically confirmed or radiologically suspected BMs. We investigated patient overall survival (OS), local tumor control, and adverse radiation events (AREs). Results: We studied 42 (52% men) patients who underwent SRS for 122 papillary (83%) or follicular (17%) thyroid cancer BMs. The mean age at SRS was 59.86 ± 12.69 years. The mean latency from thyroid cancer diagnosis to SRS for BMs was 89.05 ± 105.49 months. The median number of BMs per patient was 2 (range: 1-10 BMs). The median SRS treatment volume was 0.79 cm3 (range: 0.003-38.18 cm3), and the median SRS prescription dose was 20 Gy (range: 8-24 Gy). The median survival after SRS for BMs was 14 months (range: 3-58 months). The OS was significantly shorter in patients harboring ≥2 BMs, when compared with patients with one BM (Log-rank = 5.452, p = 0.02). Two or more BMs (odds ratio [OR] = 3.688; confidence interval [CI]: 1.143-11.904; p = 0.03) and lower Karnofsky performance score at the time of SRS (OR = 0.807; CI: 0.689-0.945; p = 0.008) were associated with shorter OS. During post-SRS imaging follow-up of 25.21 ± 30.49 months, local failure (progression and/or radiation necrosis) of BMs treated with SRS was documented in five (4%) BMs at 7.2 ± 7.3 months after the SRS. At the last imaging follow-up, the majority of patients with available imaging data had stable intracranial disease (33%) or achieved complete (26%) or partial (24%) response. There were no clinical AREs. Post-SRS peritumoral T2/fluid attenuated inversion recovery signal hyperintensity was noted in 7% BMs. Conclusion: The SRS allows durable local control of papillary and follicular thyroid cancer BMs in the vast majority of patients. Higher number of BMs and worse functional status at the time of SRS are associated with shorter OS in patients with thyroid cancer BMs. The SRS is safe and is associated with a low risk of AREs.
- MeSH
- analýza přežití MeSH
- doba přežití bez progrese choroby MeSH
- dospělí MeSH
- folikulární adenokarcinom sekundární chirurgie MeSH
- Karnofského skóre MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory mozku sekundární chirurgie MeSH
- nádory štítné žlázy patologie MeSH
- následné studie MeSH
- papilární karcinom sekundární chirurgie MeSH
- radiochirurgie škodlivé účinky metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: The rising incidence of thyroid cancer observed in the last few decades requires an improvement in diagnostic tools and management techniques for patients with thyroid nodules. AIMS: The aim of this study was to assess serum concentrations of IGF-1 and IGF-1R in patients diagnosed with thyroid cancers. METHODS: 36 patients diagnosed with papillary thyroid cancer (PTC), 11 subjects with follicular thyroid cancer (FTC), 9 patients with anaplastic thyroid cancer (ATC) and 19 subjects with multinodular nontoxic goiter (MNG) were enrolled to the study. The control group (CG) consisted of 20 healthy volunteers. Blood samples were collected one day before surgery. Serum IGF-1 and IGF-1R concentrations were measured using specific ELISA methods. RESULTS: Significantly higher concentrations of IGF-1 were found in patients with PTC as compared with controls but not that obtained from subjects diagnosed with MNG. The concentration of IGF-1R was significantly elevated in subjects with PTC and ATC as compared with healthy volunteers. Similarly, patients diagnosed with PTC or ATC presented significantly higher serum concentration of IGF-1R in comparison to the MNG group. CONCLUSIONS: Our results show that the IGF-1 - IGF-1R axis plays a significant role in the development of PTC and ATC and imply that serum concentrations of both cytokines may be considered as additional markers for the differentiation of malignancies during the preoperative diagnosis of patients with thyroid gland tumors. These results indicate that IGF-1R serum concentrations allow us to differentiate between MNG and PTC or ATC. Moreover IGF-1R serum values appear to be better predictor of PTC and ATC than IGF-1 concentrations.
- MeSH
- dospělí MeSH
- folikulární adenokarcinom krev patologie MeSH
- insulinu podobný růstový faktor I metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory štítné žlázy krev patologie MeSH
- papilární karcinom štítné žlázy krev patologie MeSH
- receptor IGF typ 1 krev MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- uzlová struma krev patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: U folikulárního karcinomu štítné žlázy jsou kostní metastázy pozorovány ve 2,3 -12,7 % případů. Nejčastěji se kostní metastázy vyskytují v obratlích, žebrech a pánevních kostech. V tomto článku s ohledem na dostupnou literaturu diskutujeme diagnózu a léčbu pacientky sledované pro metastázu v lebce u folikulárního karcinomu štítné žlázy. Kazuistika: Pacientka ve věku 51 let byla operována kvůli útvaru v pokožce hlavy. Výsledky histopatologického vyšetření ukázaly na metastázu folikulárního karcinomu štítné žlázy. Vzhledem k úplné excizi nádoru a benigním chirurgickým okrajům nebyla indikována radioterapie. Aspirační biopsie tenkou jehlou u pacientky prokázala folikulární karcinom štítné žlázy a pacientka podstoupila totální bilaterální tyreoidektomii. Celotělová scintigrafie provedená pomocí jodu I-131 odhalila difúzní aktivitu ve štítné žláze a metastázy v plicích a kostech (lebka, kost křížová, kloubní jamka pravého kyčelního kloubu). Pacientce byla naplánovaná léčba radiojodem. Závěr: Léčbou volby by v případě lebečních metastáz měla být totální / téměř totální tyreoidektomie a metastazektomie. Měla by být nabídnuta pooperační léčba radiojodem a radioterapie, přičemž radioterapie by měla být vyhrazena pro případy neoperovatelných a zbytkových nádorů.
Introduction: Bone metastasis is seen in 2.3 -12.7% of thyroid follicular carcinomas. Bone metastasis most commonly occurs in the vertebrae, costas and hip bones. In this report we discuss the diagnosis and treatment of a patient followed up due to skull metastasis of thyroid follicular carcinoma in light of literature. Case report: A 51-year-old female patient underwent surgery due a mass in the scalp. The histopathological examination was reported as metastasis of follicular thyroid carcinoma. No radiotherapy was indicated because of the total excision of the mass and the benign surgical margins. The patient, in whom fine needle aspiration biopsy showed the result of follicular carcinoma underwent a total bilateral thyroidectomy. Whole-body I-131 scintigraphy revealed diffuse activity involvement in the thyroid gland, and lung and bone (skull, sacrum, right acetabulum) metastasis. The patient was scheduled for radioactive iodine therapy. Conclusion: Total/near total thyroidectomy and metastasectomy should be the treatment of choice in skull metastasis. Postoperative radioactive iodine and radiotherapy should be offered. Radiotherapy should be reserved for inoperable and residual tumour cases.
- Klíčová slova
- lenvatinib, vandetanib,
- MeSH
- folikulární adenokarcinom terapie MeSH
- inhibitory proteinkinas aplikace a dávkování farmakologie MeSH
- lidé MeSH
- medulární karcinom farmakoterapie terapie MeSH
- nádory štítné žlázy * farmakoterapie MeSH
- papilární karcinom štítné žlázy farmakoterapie MeSH
- radioizotopy jodu terapeutické užití MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- sorafenib aplikace a dávkování farmakologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
- MeSH
- dospělí MeSH
- folikulární adenokarcinom mortalita patologie MeSH
- karcinom mortalita patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory kostí * mortalita sekundární MeSH
- nádory štítné žlázy * mortalita patologie MeSH
- neuroendokrinní karcinom mortalita patologie MeSH
- papilární karcinom štítné žlázy MeSH
- papilární karcinom MeSH
- program SEER MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- socioekonomické faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- souhrny MeSH
