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Thyroid cancer: The Kuala Lumpur experience

Abdullah M

ANZ J Surg, 2002 Sep;72(9):660-4.
PMID: 12269919

There have been few detailed studies on thyroid cancer (TC) in Malaysia, a multiethnic country with three major races - Malays, Chinese and Indians.

Matched MeSH terms: Thyroid Neoplasms/pathology
Malignant teratoma of the thyroid with predominantly neuroepithelial differentiation. Fine needle aspiration cytologic, histologic and immunocytochemical features of a case

Jayaram G, Cheah PL, Yip CH

Acta Cytol., 2000 May-Jun;44(3):375-9.
PMID: 10833994

BACKGROUND: Teratoma of the thyroid in adults is extremely rare, and most are malignant. Only nine cases have been adequately documented in the English-language literature, and there are no reports detailing the fine needle aspiration (FNA) cytologic characteristics.

CASE: A 32-year-old female presented with a left-sided nodular thyroid mass with left cervical lymphadenopathy. FNA cytology of the thyroid and lymph nodes was done. The cytologic and immunocytochemical features were that of a small round cell tumor with neuroepithelial (NE) differentiation, metastasizing to the cervical nodes. Microscopic study of the thyroidectomy specimen showed a tumor showing an NE pattern with occasional islands of squamous and cuboidal epithelium, leading to a diagnosis of malignant teratoma.

CONCLUSION: Knowledge of FNA cytologic features of rare but highly malignant lesions like thyroid teratomas allow early recognition so that suitable and possibly aggressive treatment protocols can be adopted in the hope of prolonging survival.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Dural metastasis mimicking meningioma: an interesting case

Hamid HA, Gee KY, Muhammad R, Abd Rahman ZA, Das S

Acta Medica (Hradec Kralove), 2009;52(1):19-22.
PMID: 19754003

Dural metastasis is a rare entity in clinical practice. We report a case of dural metastasis secondary to thyroid carcinoma, which on both preoperative CT and MRI and at surgery had the typical appearance of a meningioma. Histopathological findings confirmed metastatic follicular thyroid carcinoma as a primary site. Although rare, dural metastases can mimic a meningioma. Our experience in this case has led us to consider metastasis as a differential diagnosis even when a meningioma is suspected. We believe that reporting of the case of dural metastasis mimicking a meningioma may help clinicians in future.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Intratumour amyloidosis in Malaysians: an immunohistochemical study

Looi LM

Ann Acad Med Singap, 1986 Jan;15(1):52-6.
PMID: 3010797

Congo red screening of tumour material examined at the Department of Pathology, University of Malaya revealed intratumour deposits of amyloid in 12% of nasopharyngeal carcinomas, 66% of basal cell carcinomas, 100% of medullary carcinomas of the thyroid, 56% of islet cell tumours of the pancreas, 1 out of 16 carcinoids and 1 out of 100 thyroid adenomas. All the deposits were permanganate resistant and did not contain AA protein, indicating that what was encountered was not secondary amyloid. The deposits showed variable staining for immunoglobulin light chains and amyloid P component with a standard peroxidase antiperoxidase method. The possibility that intratumour amyloid has a neoplastic origin is discussed.

Matched MeSH terms: Thyroid Neoplasms/pathology
MicroRNAs and Lymph Node Metastasis in Papillary Thyroid Cancers

Mutalib NS, Yusof AM, Mokhtar NM, Harun R, Muhammad R, Jamal R

Asian Pac J Cancer Prev, 2016;17(1):25-35.
PMID: 26838219

Lymph node metastasis (LNM) in papillary thyroid cancer (PTC) has been shown to be associated with increased risk of locoregional recurrence, poor prognosis and decreased survival, especially in older patients. Hence, there is a need for a reliable biomarker for the prediction of LNM in this cancer. MicroRNAs (miRNAs) are small noncoding RNAs that regulate gene translation or degradation and play key roles in numerous cellular functions including cell-cycle regulation, differentiation, apoptosis, invasion and migration. Various studies have demonstrated deregulation of miRNA levels in many diseases including cancers. While a large number of miRNAs have been identified from PTCs using various means, association of miRNAs with LNM in such cases is still controversial. Furthermore, studies linking most of the identified miRNAs to the mechanism of LNM have not been well documented. The aim of this review is to update readers on the current knowledge of miRNAs in relation to LNM in PTC.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Fulltext Primary lymphoma of the thyroid: diagnostic and therapeutic considerations

Sarinah B, Hisham AN

Asian J Surg, 2010 Jan;33(1):20-4.
PMID: 20497878 DOI: 10.1016/S1015-9584(10)60004-8

Primary thyroid lymphoma is uncommon and accounts for less than 2-5% of all thyroid malignancies. The aim of the present study was to review our experience and management of primary thyroid lymphoma and to discuss the diagnostic and therapeutic considerations.

Matched MeSH terms: Thyroid Neoplasms/pathology
Follicular thyroid carcinoma with direct tumour extension into the great cervical veins and right atrium: is transcervical thrombectomy a safe option?

Taib NA, Hisham AN

Asian J Surg, 2007 Jul;30(3):216-9.
PMID: 17638642

Direct tumour extension into the internal jugular veins (IJV) and right atrium in thyroid cancer is extremely uncommon. We report three cases of advanced thyroid cancer invading into the IJV and right atrium. All three patients had well-differentiated thyroid cancer and presented with typical clinical picture of the superior cava syndrome coupled with significant compressive symptoms. Two patients had obvious tumour thrombus extending to the superior vena cava (SVC) and right atrium, whilst in one patient, the thrombus extended to the SVC close to the edge of the right atrium. In all three patients, the intraluminal tumour thrombus was clinically palpable. Involvement of the IJV, SVC and right atrium was confirmed with computed tomography (CT) scan and echocardiography. The decision to extract the thrombus transcervically was made on the basis of the positive "ring sign", which is a thin rim of contrast surrounding the tumour thrombus documented on CT. All three patients underwent total thyroidectomy with segmental resection and ligation of the IJV. The tumour thrombus was successfully extracted transcervically. The histopathology report confirmed follicular carcinoma in all three patients. Two patients had radioiodine ablation therapy postoperatively, and were well 18 months after operation. One patient who had lung metastases documented on chest CT succumbed to the disease due to massive haemoptysis 3 weeks after operation.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Fulltext Large fungating thyroid cancers: a unique surgical challenge

Harjit KD, Hisham AN

Asian J Surg, 2005 Jan;28(1):48-51.
PMID: 15691799

Large goitres are common in the developing world, particularly in Asia and Africa. Nonetheless, large fungating goitres are extremely rare and represent a unique challenge to surgeons. Surgery should always be considered, when the general condition of the patient permits, to provide a better quality of life as it offers the only hope of long-term survival. The potential gain with surgery is that it allows maximum benefit for more effective radioactive iodine ablation and radiotherapy treatment. We report two cases of large fungating thyroid cancers complicated by anaemia and foul-smelling discharge.

Matched MeSH terms: Thyroid Neoplasms/pathology
Fulltext Thyroid carcinoma in patients with familial adenomatous polyposis

Rohaizak M, Jasmi AY, Ismail MA, Munchar MJ, Meah FA

Asian J Surg, 2003 Jul;26(3):183-5.
PMID: 12925296 DOI: 10.1016/S1015-9584(09)60381-X

There has been a growing awareness of the association between papillary thyroid carcinoma and familial adenomatous polyposis (FAP). The cases of four young patients with papillary thyroid carcinoma occurring with FAP are presented. Three patients underwent surgery to provide specimens for detailed histological examination. The surgical specimens showed well-encapsulated multicentric tumours exhibiting a predominantly papillary architectural growth pattern. In some areas, follicular architecture and cribriform patterns were noted. Atypical areas of spindle cells in a trabecular or solid configuration, which are not normally seen in classical papillary thyroid carcinoma, were evident. Malignant cells exhibited a graduation of cuboidal to tall cells with abundant amphophilic cytoplasm. The nuclei did not exhibit the typical nuclear clearing as seen in papillary thyroid carcinoma, but nuclear grooving and inclusions were noted. Psammoma bodies were not seen in any of the specimens. In a limited review of these patients, features such as young age at presentation, multicentricity and unusual histology suggest that thyroid carcinoma associated with FAP may represent a distinct form of thyroid cancer.

Matched MeSH terms: Thyroid Neoplasms/pathology
Fulltext Solid variant of papillary thyroid carcinoma in a 14-year-old girl

Abdul Rahman WF, Md Hashim MN, Win TT, Bakrin IH

BMJ Case Rep, 2013;2013.
PMID: 23749834 DOI: 10.1136/bcr-2013-010001

Solid variant of papillary thyroid carcinoma (PTC) is a rare, poorly characterised variant and predominantly reported in children with a history of radiation exposure. This variant has a high propensity for extra-thyroidal extension and cervical lymph node metastases. A 14-year-old Malay girl who had no history of radiation exposure, presented with multiple cervical lymphadenopathy and it was clinically suspicious for tuberculosis or lymphoma. An incisional biopsy revealed a metastatic PTC. The patient underwent total thyroidectomy with bilateral lateral neck dissection and histopathology report was solid variant of PTC. Whole-body I(131) scan was performed which revealed an intense tracer uptake in the neck. She was planned for radioactive iodine ablation and now on regular follow-up for monitoring of possible tumour metastasis.

Matched MeSH terms: Thyroid Neoplasms/pathology
Wavelet energy-guided level set-based active contour: a segmentation method to segment highly similar regions

Achuthan A, Rajeswari M, Ramachandram D, Aziz ME, Shuaib IL

Comput Biol Med, 2010 Jul;40(7):608-20.
PMID: 20541182 DOI: 10.1016/j.compbiomed.2010.04.005

This paper introduces an approach to perform segmentation of regions in computed tomography (CT) images that exhibit intra-region intensity variations and at the same time have similar intensity distributions with surrounding/adjacent regions. In this work, we adapt a feature computed from wavelet transform called wavelet energy to represent the region information. The wavelet energy is embedded into a level set model to formulate the segmentation model called wavelet energy-guided level set-based active contour (WELSAC). The WELSAC model is evaluated using several synthetic and CT images focusing on tumour cases, which contain regions demonstrating the characteristics of intra-region intensity variations and having high similarity in intensity distributions with the adjacent regions. The obtained results show that the proposed WELSAC model is able to segment regions of interest in close correspondence with the manual delineation provided by the medical experts and to provide a solution for tumour detection.

Matched MeSH terms: Thyroid Neoplasms/pathology
Cytology of columnar-cell variant of papillary thyroid carcinoma

Jayaram G

Diagn Cytopathol, 2000 Apr;22(4):227-9.
PMID: 10787142

Columnar cell variant of papillary carcinoma (CCV-PC) thyroid is a rare and aggressive tumor composed of tall columnar cells that form papillae, glands and solid structures. This paper describes fine needle aspiration (FNA) cytologic features in a case of CCV-PC occurring in the right thyroid lobe of a 27-year-old female. Smears showed tall columnar cells in monolayered, three-dimensional, acinar and occasional papillary clusters. Nuclei were oval or elongated and monomorphic. Nuclear pseudostratification, resembling that seen in respiratory epithelial cells, was present in some of the cell clusters. Occasional cells showed squamous or Hurthle cell metaplasia. Nuclear grooves and intranuclear cytoplasmic inclusions were not seen. Sections of the right lobectomy specimen showed an well-encapsulated CCV-PC with capsular and vascular permeation. Tall cell variant of papillary carcinoma (TCV-PC) can be distinguished from CCV-PC by the oxyphilia of the tumor cells and the absence of nuclear pseudostratification. Colorectal and endometrial adenocarcinomas metastatic to the thyroid may be difficult to distinguish from CCV-PC.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery

Park JH, Lee J, Hakim NA, Kim HY, Kang SW, Jeong JJ, et al.

Head Neck, 2015 Dec;37(12):1705-11.
PMID: 24986508 DOI: 10.1002/hed.23824

This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve.

Matched MeSH terms: Thyroid Neoplasms/pathology
Fulltext Poorly differentiated thyroid carcinoma: A hospital-based clinicopathological study and review of literature

Win TT, Othman NH, Mohamad I

Indian J Pathol Microbiol, 2017 Apr-Jun;60(2):167-171.
PMID: 28631629 DOI: 10.4103/IJPM.IJPM_457_16

INTRODUCTION: Poorly differentiated thyroid carcinoma (PDTC) is a rare aggressive malignancy of thyroid follicular cells and has unique features in morphology and behavior. This study was aimed to describe the experience of a tertiary medical center with PDTC within a 10-year period.

MATERIALS AND METHODS: This is a descriptive retrospective study of eight cases of PDTC among 418 various thyroid carcinomas. All cases of PDTC were retrieved along with the clinicopathological information.

RESULTS: Only eight cases (1.9%) of PDTC were diagnosed among 418 thyroid carcinomas. Mean age was 48.12 with 3:5 (male:female) and tumor size ranged 3-12 cm. PDTC were diagnosed coexisting with one or more other pathologies; nodular hyperplasia (four cases), papillary carcinoma (one case), follicular carcinoma (three cases), and Hashimoto thyroiditis (two cases); with ≥60% PDTC component. Six cases associated with high-grade features died within 3 years after diagnosis.

DISCUSSION: Mean age in this study was younger including a 20-year-old girl. Younger age was associated with better prognosis. Most of the cases had underlying benign thyroid lesions and differentiated thyroid carcinoma. Most of the PDTC had poor prognosis associated with PDTC component ≥60%, tumor necrosis, high mitotic count, lymph node involvement, vascular invasion and distant metastasis; and these cases died within 3 years after diagnosis.

CONCLUSION: Although treatment of PDTC remains surgery followed by radioiodine therapy, correct histopathological diagnosis is important for clinicians and oncologists to predict the prognosis. All thyroid carcinoma should be sampled thoroughly not to miss small foci of PDTC component.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Fulltext Metastasis within a metastasis to the thyroid: A rare phenomenon

Wong YP, Affandi KA, Tan GC, Muhammad R

Indian J Pathol Microbiol, 2017 9 25;60(3):430-432.
PMID: 28937391 DOI: 10.4103/IJPM.IJPM_287_16

Metastatic disease involving the thyroid gland is uncommon. Solitary thyroid metastases from various primary sites particularly kidney, lung, and breast had been previously described. To the best of our knowledge, metastases from two topographically separate primary malignancies to the thyroid have never been documented hitherto. This is the first reported case of cancer-to-cancer metastasis involving an invasive breast carcinoma metastasized within a metastatic renal cell carcinoma in the nonneoplastic thyroid in a 58-year-old woman. Distinguishing a secondary thyroid metastases from a primary thyroid malignancy is utmost crucial as treatment differs. The possibility of tumor metastases from two separated primaries should always be considered in a tumor exhibiting malignant cell populations with two distinctive histomorphological appearances. The role of immunohistochemistry stains in equivocal cases cannot be overemphasized.

Matched MeSH terms: Thyroid Neoplasms/pathology*
Fulltext Energy and macronutrient intake and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition study

Zamora-Ros R, Rinaldi S, Tsilidis KK, Weiderpass E, Boutron-Ruault MC, Rostgaard-Hansen AL, et al.

Int J Cancer, 2016 Jan 01;138(1):65-73.
PMID: 26190646 DOI: 10.1002/ijc.29693

Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study was to investigate the associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from ten European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, and fiber were computed as g/1,000 kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we found significant associations only with total energy (HRQ4 vs .Q1 , 1.29; 95% CI, 1.00-1.68) and PUFA intakes (HRQ4 vs .Q1 , 0.74; 95% CI, 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across body mass index (BMI) groups, i.e., positive associations with starch and GI were found in participants with a BMI ≥ 25 and with sugar intake in those with BMI

Matched MeSH terms: Thyroid Neoplasms/pathology
Fulltext Outcome of Cervical Lymph Nodes Dissection for Thyroid Cancer with Nodal Metastases: A Southeast Asian 3-Year Experience

Lim RZM, Ooi JY, Tan JH, Tan HCL, Sikin SM

Int J Surg Oncol, 2019;2019:6109643.
PMID: 30941211 DOI: 10.1155/2019/6109643

Introduction: Therapeutic nodal dissection is still the mainstay of treatment for patients with lymph node metastases in many centres. The local data, however, on the outcome of therapeutic LND remains limited. Hence, this study aims to inform practice by presenting the outcomes of LND for thyroid cancer patients and our experience in a tertiary referral centre.
Methods: This is a single-centre retrospective observational study in a Malaysian tertiary endocrine surgery referral centre. Patients who underwent total thyroidectomy with lymph node dissection between years 2013 and 2015 were included and electronic medical records over a 3-year follow-up period were reviewed. The outcomes of different lymph node dissection (LND), including central neck dissection, lateral neck dissection, or both, were compared.
Results: Of the 43 subjects included, 28 (65.1%) had Stage IV cancer. Among the 43 subjects included, 8 underwent central LND, and 15 had lateral LND while the remaining 20 had dissection of both lateral and central lymph nodes. Locoregional recurrence was found in 16 (37.2%) of our subjects included, with no statistical difference between the central (2/8), lateral (7/15), and both (7/20). Postoperative hypocalcaemia occurred in 7 (16.3%) patients, and vocal cord palsy occurred in 5 (11.6%), whereas 9 patients (20.9%) required reoperation. Death occurred in 4 of our patients.
Conclusion: High recurrence and reoperative rates were observed in our centre. While the routine prophylactic LND remains controversial, high risk patients may be considered for prophylactic LND. The long-term risk and benefit of prophylactic LND with individualised patient selection in the local setting deserve further studies.

Matched MeSH terms: Thyroid Neoplasms/pathology
Comparison of free hand versus ultrasound-guided fine needle aspiration of thyroid with histopathological correlation

Krishnappa P, Ramakrishnappa S, Kulkarni MH

J Environ Pathol Toxicol Oncol, 2013;32(2):149-55.
PMID: 24099428

Fine-needle aspiration (FNA) cytology of the thyroid is usually performed on an outpatient basis. The results of FNA are operator dependent and may be affected by the lesion characteristics and the aspiration technique. In current practice ultrasound (US) is widely used to guide the needle for aspiration of nondominant nodules. Our study aimed to compare the free-hand FNA with US-guided FNA in the evaluation of thyroid nodules. A total of 91 cases of thyroid lesions were studied at the Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, India. All the cases underwent free-hand and US-guided FNA. The cytological samples from both procedures were analyzed for adequacy, cytological features, and possible diagnosis. The results were correlated with histopathological diagnosis whenever possible. Of 91 aspirates, 89 were satisfactory and 2 were unsatisfactory on US-guided FNA, whereas 85 were satisfactory and 6 were unsatisfactory in free-hand FNA. Of 91 cases 68 (74.7%) were nonneoplastic lesions and 21 (23.1%) were neoplastic lesions in US-guided FNA, whereas 67 cases (73.6%) were nonneoplastic and 18 cases (19.8%) were neoplastic in free-hand FNA. Histopathological study was possible in 25 patients, among whom 15 lesions were nonneoplastic and 10 were neoplastic. Sensitivity and specificity of US-guided FNA to detect neoplastic lesions were 81.81% and 92.85%, respectively, compared with free-hand FNA, for which the sensitivity and specificity were 54.54% and 92.85%, respectively. The diagnostic accuracy of guided FNA was 88% against the 76% accuracy rate of free-hand FNA. US-guided FNA provides a better representative sample and has a higher diagnostic rate in the evaluation of thyroid lesions.

Matched MeSH terms: Thyroid Neoplasms/pathology
Immunohistochemical localisation of RET and p53 mutant protein of thyroid lesions in a North-Eastern Malaysian population and its prognostic implications

Omar E, Madhavan M, Othman NH

Pathology, 2004 Apr;36(2):152-9.
PMID: 15203751

To investigate RET and p53 expression in local thyroid lesions, in order to shed light on the pathogenesis of papillary carcinoma and explain the high prevalence of this condition among the nodular hyperplasia (multi-nodular goitre) cases.

Matched MeSH terms: Thyroid Neoplasms/pathology
Fulltext Follicular thyroid carcinoma with insular component: a retrospective case study, immunohistochemical analysis and literature review

Htwe TT, Karim N, Lam AK

Singapore Med J, 2012 Mar;53(3):e49-51.
PMID: 22434304

This is a retrospective case study of a 61-year-old woman diagnosed with follicular thyroid carcinoma. The patient underwent thyroidectomy for the treatment of goitre after being admitted for shortness of breath. Microscopic and immunohistochemical studies were performed, which confirmed follicular carcinoma of the thyroid with an insular component. We also conducted a review of the literature on this uncommon entity.

Matched MeSH terms: Thyroid Neoplasms/pathology*

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