Endocrine Pathology
Shiva Didehban; Alireza Abdollahi; Alipasha Meysamie
Abstract
Background & Objective: The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is ...
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Background & Objective: The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is papillary thyroid microcarcinoma (PTMC), which includes tumors smaller than 10 mm in diameter. Due to the advancements in diagnostic techniques, the incidence of this type of cancer is on the rise. In this study, we aimed to analyze the factors worsening the PTMC prognosis.Methods: In the first step, we searched various databases for the factors affecting this tumor. The relevant articles were collected and different outcomes of this tumor and its associated factors which were studied in more than one article, were classified. Finally, we conducted a meta-analysis of these outcomes and their related factors.Results: In the meta-analysis, a significantly association was found between the following factors: recurrence with gender (P<0.001) lymph node metastasis (LNM) (P= 0.003), and extrathyroidal invasion (P<0.001); lymph node metastasis with extrathyroidal invasion (P<0.001), and multifocality (P<0.001); central lymph node metastasis (CLNM) with gender (P=0.001), tumor size (P<0.001), extracapsular invasion (P<0.001), lateral cervical lymph node metastasis (P<0.001), and extrathyroidal invasion (P<0.001); lymph node metastasis resulted in poor outcomes (P<0.001); and finally tumor size with BRAFV600E mutation (P<0.001).Conclusion: In conclusion, it is essential to note that greater awareness and understanding of this tumor characteristics and special and separate attention to PTMC can significantly improve the society overall health.
Endocrine Pathology
Fakhrieh Kalavari; Parin Tanzifi; Tahereh Yosefi; Maryam Lotfi; Elham Nazar
Abstract
Background & Objective: Viral infections are associated with the pathogenesis and progression of human malignancies. Several studies have suggested the role of viral infections in papillary thyroid carcinoma (PTC). However, the results are still conflicting, and the potential role of viruses in PTC ...
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Background & Objective: Viral infections are associated with the pathogenesis and progression of human malignancies. Several studies have suggested the role of viral infections in papillary thyroid carcinoma (PTC). However, the results are still conflicting, and the potential role of viruses in PTC tumorigenesis remains to be elucidated. In the present study, we aimed to investigate the presence of parvovirus B19, cytomegalovirus (CMV), herpes simplex virus types 1 and 2 (HSV-1/HSV-2), and human papillomavirus (HPV) types 16 and 18 in PTC.Methods: In this cross-sectional study, paraffin-embedded tissue blocks of 40 patients with PTC were used. Tissue blocks were studied for the presence of the virus genome using real-time polymerase chain reaction (PCR).Results: Of the 40 patients with PTC, there was 1 positive case of HPV (2.5%), while 6 cases were positive for parvovirus B19. HSV and CMV DNAs were not detected in any cases.Conclusion: Correlations among HSV, CMV, and PTC are unexpected in our patient population. But parvovirus B19 and, to a lesser extent, HPV DNA genomes were detected in PTC using real-time PCR.
Endocrine Pathology
Mansoureh Shokripour; Mohammad Hadi Imanieh; Saghar Garayemi; Navid Omidifar; Babak Shirazi Yeganeh; Fadhil Althabhawee
Abstract
Background & Objective: The TSH reference range's validity affects the thyroid dysfunction diagnosis. The primary objective of this study is to determine the reference range, which is established according to age and region.Methods: The data were collected retrospectively from people over the age ...
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Background & Objective: The TSH reference range's validity affects the thyroid dysfunction diagnosis. The primary objective of this study is to determine the reference range, which is established according to age and region.Methods: The data were collected retrospectively from people over the age of one who visited Motahari Clinic for routine health checkups between August 2017 and October 2019. TSH, T4, T3, personal drug usage, and thyroid history were collected. After excluding subjects with thyroid diseases and outliers, a list of 1392 participants was analyzed. Hormone intervals of men and women ≥1 year old have been determined using the non-parametric method.Results: The non-disease subjects' TSH, T3, and T4 reference ranges were 0.64 to 5.94 lU/mL, 0.91 to 2.47 ng/dL, and 5.53 to 12.48 g/dL, respectively. According to this range, total thyroid dysfunction prevalence in our study in children was 8.94%. There was no significant difference between TSH, T4 level, and sex in the non-disease population (P=0.46 and 0.13, respectively), but there was a statistical difference between sex and T3 (P =0.03). Our study also illustrates that for subjects under 18 years old and above it, hormones (TSH, T3, T4) concentration is statistically different (P≤0.001).Conclusion: We found a statistical difference between hormone values after and before age 18 (P=≤0.01); therefore, it is not appropriate to use the same reference range for children under age 18 and adults. There was male dominance in the population 1-18 years old.
Endocrine Pathology
Hamid Asherloo; Seyed Ali Nabipoorashrafi; Atefeh Kashanizadeh; Mohammad Moradi; Majid Rezaei Tavirani; Massoud Baghai wadji
Abstract
Background & Objective: Papillary thyroid cancer (PTC) is the most common primary cancer originating from thyroid follicular cells. The aim of this study was to evaluate the positive predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer.
Methods: This was ...
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Background & Objective: Papillary thyroid cancer (PTC) is the most common primary cancer originating from thyroid follicular cells. The aim of this study was to evaluate the positive predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer.
Methods: This was a cross-sectional study. The study population was all known PTC patients who underwent total thyroidectomy and lymph node dissection of the central neck nodes based on the current indications. Confirmation of central lymph node involvement was performed by permanent smear after surgery. Data were analyzed using SPSS software version 22. A P-value below 0.05 was considered statistically significant.
Results: There was no significant relationship between age, gender, family history of PTC, family history of thyroid disease, multinodularity, history of other thyroid diseases, involvement of two thyroid lobes, and tumor grade with central lymph node involvement (P>0.05). There was a significant relationship between the tumor pathology and size with central lymph node involvement (P<0.05). Moreover, logistic multivariate regression analysis showed that female gender, multinodularity, and tumor size had a significant relationship with the incidence of central lymph node involvement (P<0.05).
Conclusion: Female gender, multinodularity, and larger tumor size may be predictors of micrometastasis in central lymph nodes in patients with papillary thyroid cancer.
Endocrine Pathology
Elena Jamali; Behrang Kazeminezhad; Mahsa Ahadi; Afshin Moradi; Hamideh Khabbazi
Abstract
Background & Objective: Eosinophils are normally found in different parts of the gastrointestinal tract and with less prevalence in the esophagus. Eosinophilic infiltration is increased as part of inflammatory reactions in various diseases. The aim of this study was to determine the count and distribution ...
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Background & Objective: Eosinophils are normally found in different parts of the gastrointestinal tract and with less prevalence in the esophagus. Eosinophilic infiltration is increased as part of inflammatory reactions in various diseases. The aim of this study was to determine the count and distribution of eosinophils in esophageal specimens obtained for different causes.Methods: Endoscopy and pathology reports of esophageal specimens in Shahid Beheshti University related hospitals, Tehran, Iran, were extracted from 2016 to 2019. The prevalence of gastroesophageal reflux disease (GERD), malignancy, eosinophilic esophagitis, and asymptomatic patients were determined as the percentages of total resection and biopsy specimens. Each group was calculated and randomly selected according to the inclusion criteria. All data were analyzed statistically using SPSS software.Results: A total of 258 biopsy and resection specimens were evaluated in this study. Fourty three cases (16.7%) diagnosed as normal esophageal mucosa , 42 cases (16.3%) as non-specific esophagitis, 155 cases (60.1%) diagnosed as gastroesophageal reflux disease, 4 cases (1.6%) showed malignancy and other diagnoses were recorded for 14 cases (5.4%). The numbers of eosinophils in the epithelium and lamina propria in the normal group were 0.1±0.5 and 2.08±2.33, respectively. The eosinophil count in different groups and its relation to different histopathologic findings were diverse.Conclusion: The number of eosinophils within the lamina propria was significantly higher than those found within other layers. . The highest mean eosinophil count was observed in the epithelium and the lamina propria of cases diagnosed as GERD.
Endocrine Pathology
Vahid Zand; Mansour Moghimi; Elmira Sadeghi; Pegah Kamal; Sedighe Vaziribozorg
Abstract
AbstractPapillary thyroid carcinoma (PTC) is considered as a relatively common type of malignancy showing a wide morphologic spectrum. Different variants of this tumor have been reported. Among PTC variants, PTC with nodular fasciitis-like stroma (PTC‑FLS) is rare. This variant consists of stromal ...
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AbstractPapillary thyroid carcinoma (PTC) is considered as a relatively common type of malignancy showing a wide morphologic spectrum. Different variants of this tumor have been reported. Among PTC variants, PTC with nodular fasciitis-like stroma (PTC‑FLS) is rare. This variant consists of stromal components rich in spindle cells and accounts for 60-80% of tumors. In addition, there are small foci of epithelial components in PTC‑FLS though its features are similar to conventional PTC. In this case study, we present a new case with PTC‑FLS. The case is a 28-year-old female who was referred to the ENT clinic due to a painless mass on the anterior part of her neck. The mass showed a gradual increase in size over the 6 months prior to her referral. Thyroid test results were normal. Ultrasound imaging demonstrated an 84 × 36 mm heterogeneous nodule in the right thyroid lobe without calcifications but increased vascularity. There were also some reactive lymph nodes in both sub-mandibular areas. An ultrasound-guided fine-needle aspiration (FNA) biopsy of the right thyroid lobe nodule revealed a benign thyroid adenomatoid nodule. Following right thyroid lobectomy, final pathologic studies confirmed a diagnosis of PTC with exuberant fibromatosis-like stroma. In the 20-day post-surgery visit, the patient was found asymptomatic. Re-evaluation of the left thyroid lobe and follow-up were recommended. In this study, a diagnosis of a rare variant of PTC, i.e., PTC-FLS, was made through a combination of ultrasonography, fine needle aspiration cytology, and histological examination.
Endocrine Pathology
Fatemeh Samiee Rad; Ali Emami
Abstract
Background & Objective: Coexistence of follicular epithelial and bilateral parafollicular cells derivative of carcinomas in Hashimoto’s thyroiditis and multinodular goiter background are a very rare event. Of course, all benign and malignant thyroid lesions are more prevalent in iodine deficient ...
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Background & Objective: Coexistence of follicular epithelial and bilateral parafollicular cells derivative of carcinomas in Hashimoto’s thyroiditis and multinodular goiter background are a very rare event. Of course, all benign and malignant thyroid lesions are more prevalent in iodine deficient areas. It seems that the context for identifying the pathways influencing thyroid carcinogenesis especially coincidence form has not yet been fully understood and needs further investigation. Here, we present a case with the synchronous occurrence of papillary thyroid carcinoma and medullary thyroid carcinoma in Hashimoto’s thyroiditis and multinodular goiter background.Case presentation: A 54-year-old woman complained of a painless mass in the anterior region of the neck. The physical examination of the patient revealed multiple nodules in her thyroid gland. In ultrasound findings, she had thyroid enlargement associated with multiple isoechoic and hypoechoic nodules in both lobes. Thyroid fine needle aspiration results suggested the diagnosis of medullary thyroid carcinoma in Hashimoto’s thyroiditis and multinodular goiter background. The frozen sections, permanent sampling, and IHC examination showed the coexistence of papillary thyroid carcinoma with bilateral medullary thyroid carcinoma in Hashimoto's disease and multinodular goiter background.Conclusion: Studies debated about the risk factors of these pathologies including the same environmental issues or mutations in genomes and they emphasized surgeons should be aware of these lesions for diagnosis and interventional treatments. Following up the Hashimoto’s thyroiditis and multinodular goiter is required for detecting occult malignancies, and hence the right management and treatment should be performed.
Endocrine Pathology
Elham Mirzaian; Shafighe Asgarikarchekani; Ashkan Abdoli
Abstract
Acinic cell carcinoma (ACC) is a low or intermediate-grade malignant epithelial neoplasm of the salivary glands that generally shows an indolent behavior. Most cases arise in the major salivary glands, especially the parotid gland. ACC is usually known as a low-grade malignant tumor; however, poorly ...
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Acinic cell carcinoma (ACC) is a low or intermediate-grade malignant epithelial neoplasm of the salivary glands that generally shows an indolent behavior. Most cases arise in the major salivary glands, especially the parotid gland. ACC is usually known as a low-grade malignant tumor; however, poorly differentiated and high-grade transformed variants have been reported and may have a tendency for late recurrence and metastasis.Our case was a 49-year-old woman with a history of a right parotid rapidly growing mass lesion, which was cytologically diagnosed as monomorphic adenoma on fine-needle aspiration (FNA). Finally, the diagnosis of ACC with dedifferentiated components was reported followed by parotidectomy. After 30 sessions of radiotherapy, she presented with hemifacial paresis. An imaging examination of the brain showed intracranial hemorrhage, and she underwent a craniotomy. We performed histopathological and immunohistochemistry (IHC) examinations and diagnosed metastatic ACC with the dedifferentiated components.Few studies have reported ACC cases with dedifferentiated components and aggressive behavior, and to the best of our knowledge, this is the first published English report from the Persian population.
Endocrine Pathology
Fatemeh Khatami; Bagher Larijani; Ramin Heshmat; Shirzad Nasiri; Hiva Saffar; Gita Shafiee; Azam Mossafa; Seyed Mohammad Tavangar
Abstract
Background & Objective: Papillary thyroid cancer (PTC) is considered to be the most common type of thyroid malignancies. Epigenetic alteration, in which the chromatin conformation and gene expression change without changing the sequence of DNA, can occur in some tumor suppressor genes and oncogenes. ...
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Background & Objective: Papillary thyroid cancer (PTC) is considered to be the most common type of thyroid malignancies. Epigenetic alteration, in which the chromatin conformation and gene expression change without changing the sequence of DNA, can occur in some tumor suppressor genes and oncogenes. Methylation is the most common type of epigenetic alterations that can be an excellent indicator of PTC invasive behavior. Methods: In this research, we determined the promoter methylation status of four tumor suppressor genes (SLC5A8, RASSF1, MGMT, and DNMT1) and compared the results of 55 PTC cases with 40 goiter patients. For methylation, we used the methylation-sensitive high resolution melting (MS-HRM) assay technique. The resulting graphs of each run were compared with those of 0%, 50%, and 100% methylated controls. Result: Our data showed that the promoter methylation of SLC5A8, Ras association domain family member 1(RASSF1), and MGMT were significantly different between PTC tissue and goiter with P-value less than 0.05. The most significant differences were observed in RASSF1; 77.2% of hyper-methylated PTC patients versus 15.6% hyper-methylated goiter samples (P<0.001). Conclusion: RASSF1 promoter methylation can be a PTC genetic marker. RASSF1 promoter methylation is under the impact of the methyltransferase genes (DNMT1 and MGMT), protein expression, and promoter methylation.
Endocrine Pathology
Fatemeh Samiee Rad; Sohayla Farajee; Erfan Torabi
Abstract
The most usual form of the endocrine carcinoma is thyroid cancer (TC). In addition to papillary thyroid carcinoma (PTC), recent studies revealed incidence of RET/PTC rearrangement in other tumors, like Hürthle cell carcinoma (HCC) and even in non-carcinomatous disorders like Hashimoto's thyroiditis. ...
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The most usual form of the endocrine carcinoma is thyroid cancer (TC). In addition to papillary thyroid carcinoma (PTC), recent studies revealed incidence of RET/PTC rearrangement in other tumors, like Hürthle cell carcinoma (HCC) and even in non-carcinomatous disorders like Hashimoto's thyroiditis. Here, we present a case with concurrence of papillary thyroid carcinoma and Hürthle cell carcinoma. A 60-year-old woman referred to our hospital with a mass in her neck. Physical examinations revealed painful swelling in the thyroid. Ultrasonographic examination showed two hypoechoic nodules in the right lobe. Hürthle cell variant papillary carcinoma was suggested in the cytology report of the fine needle aspiration. Permanent histopathological diagnosis was co-existence of papillary thyroid carcinoma and Hürthle cell carcinoma. The patient was asymptomatic in 14 months follow up. Concurrence of papillary carcinoma and Hürthle cell carcinoma is a rare form of thyroid malignancies, with doubtful cytogenetic findings and biological behaviors. The results showed that it is necessary for the surgeons and pathologists to be aware of lesions for the optimal diagnostic and therapeutic interventions. Also, it is vital to follow up patients with the Hashimot’s thyroiditis who have multiple nodules to detect occult thyroid cancers and decide for better therapeutic programs.
Endocrine Pathology
Srilatha P.S.; Jayitri Das; Vidya Monappa
Abstract
Medullary thyroid carcinoma (MTC) is a rare tumor arising from parafollicular C-cells. The oncocytic variant of MTC is an extremely rare diagnosis, with less than 20 cases reported. Here we present the case of a 36-year-old male patient with complaints of neck swelling and dysphagia. On fine needle aspiration ...
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Medullary thyroid carcinoma (MTC) is a rare tumor arising from parafollicular C-cells. The oncocytic variant of MTC is an extremely rare diagnosis, with less than 20 cases reported. Here we present the case of a 36-year-old male patient with complaints of neck swelling and dysphagia. On fine needle aspiration cytology (FNAC), a Hürthle cell neoplasm was suggested. Finally with histopathology and immunohistochemistry (IHC), a diagnosis of MTC oncocytic variant was established. This tumor can be easily misdiagnosed for any thyroid Hürthle cell lesions. An accurate diagnosis is important because MTC has different treatment protocols, and its oncocytic variant is expected to be associated with poorer patient survival. Thus, the oncocytic variant of MTC is a difficult diagnosis on FNAC. Histopathology and relevant IHC markers are necessary for a correct diagnosis.
Endocrine Pathology
Fatemeh Khatami; Seyed Mohammad Tavangar
Abstract
Pheochromocytomas (PCCs) are rare neuroendocrine tumors. The current diagnostic tools are based on biochemistry and histopathology results, but heterogeneity of diagnostic markers, signs and symptoms of PCCs bring a lot of difficulties for these two current methods. Unfortunately microscopic understanding ...
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Pheochromocytomas (PCCs) are rare neuroendocrine tumors. The current diagnostic tools are based on biochemistry and histopathology results, but heterogeneity of diagnostic markers, signs and symptoms of PCCs bring a lot of difficulties for these two current methods. Unfortunately microscopic understanding of PCCs is not adequate for its confident prognosis and management. There are data linking specific genotypes of PCCs tumors to specific locations, typical biochemical phenotypes or future clinical behaviors. The detection of a germ-line mutation possibly can guide us to an early diagnosis, appropriate treatment, and regular surveillance with better prognosis not only for the patient but also for their family members. Moreover, the latest discoveries in gene sequencing, circulating DNA (ctDNA) and circulating tumor cells (CTCs) will support the exact molecular pathogenesis of PCCs in order to provide an important basis for future PCCs managements.