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Original Articles
TERT mutations and aggressive histopathologic characteristics of radioiodine-refractory papillary thyroid cancer
Ju Yeon Pyo, Yoon Jin Cha, SoonWon Hong
Received June 1, 2024  Accepted July 29, 2024  Published online September 12, 2024  
DOI: https://doi.org/10.4132/jptm.2024.07.29    [Epub ahead of print]
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  • 28 Download
AbstractAbstract PDF
Background
Radioiodine (RI) ablation following thyroid-stimulating hormone suppression is an effective treatment for papillary thyroid cancer (PTC), typically leading to favorable outcomes. However, RI-refractory tumors exhibit aggressive behavior and poor prognoses. Recent studies highlight the role of genetic abnormalities in PTC signaling pathways, including the activation of telomerase reverse transcriptase (TERT), and the correlation of mutations with adverse outcomes.
Methods
This study analyzed mutations in BRAF V600E and the TERT-promoter genes, comparing clinicopathological features between RI-refractory and RI-responsive PTCs. Among 82 RI-refractory patients, formalin-fixed, paraffin-embedded tissues from initial surgeries were available for 26. Another 89 without distant metastasis over 5 years formed a matched RI-responsive control group.
Results
Histopathologically, RI-refractory PTCs showed increased frequencies of small tumor clusters without fibrovascular cores, hobnail features, and a high height-to-width ratio of tumor cells. These tumors were more likely to exhibit necrosis, mitosis, lymph node metastasis, extrathyroidal extension, and involvement of resection margins. TERT-promoter mutations were statistically significantly associated with these aggressive clinicopathologic features. Immunohistochemically, decreased expression of sodium iodide symporter and thyroglobulin stimulating hormone receptor proteins was common in RI-refractory PTCs, along with lower levels of oncogenic proteins such as vascular endothelial cell growth factor, vascular endothelial cell growth factor receptor 2, and nuclear factor kappa-light-chain-enhancer of activated B cells. Total loss of PTEN expression was occasionally observed. In contrast, all cases tested positive for cytoplasmic β-catenin.
Conclusions
RI-refractory PTCs are linked to TERT mutations and exhibit specific aggressive histopathologic features, particularly in tumor centers.
Diagnostic challenges in the assessment of thyroid neoplasms using nuclear features and vascular and capsular invasion: a multi-center interobserver agreement study
Agnes Stephanie Harahap, Mutiah Mutmainnah, Maria Francisca Ham, Dina Khoirunnisa, Abdillah Hasbi Assadyk, Husni Cangara, Aswiyanti Asri, Diah Prabawati Retnani, Fairuz Quzwain, Hasrayati Agustina, Hermawan Istiadi, Indri Windarti, Krisna Murti, Muhammad Takbir, Ni Made Mahastuti, Nila Kurniasari, Nungki Anggorowati, Pamela Abineno, Yulita Pundewi Setyorini, Kennichi Kakudo
Received June 23, 2024  Accepted July 24, 2024  Published online September 12, 2024  
DOI: https://doi.org/10.4132/jptm.2024.07.25    [Epub ahead of print]
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  • 18 Download
AbstractAbstract PDF
Background
The diagnosis of thyroid neoplasms necessitates the identification of distinct histological features. Various education/hospital centers located in cities across Indonesia likely result in discordances among pathologists when diagnosing thyroid neoplasms.
Methods
This study examined the concordance among Indonesian pathologists in assessing nuclear features and capsular and vascular invasion of thyroid tumors. Fifteen pathologists from different centers independently assessed the same 14 digital slides of thyroid tumor specimens. All the specimens were thyroid neoplasms with known BRAFV600E and RAS mutational status, from a single center. We evaluated the pre- and post-training agreement using the Fleiss kappa. The significance of the training was evaluated using a paired T-test.
Results
Baseline agreement on nuclear features was slight to fair based on a 3-point scoring system (k = 0.14 to 0.28) and poor to fair based on an eight-point system (k = –0.02 to 0.24). Agreements on vascular (κ = 0.35) and capsular invasion (κ = 0.27) were fair, whereas the estimated molecular type showed substantial agreement (κ = 0.74). Following the training, agreement using the eight-point system significantly improved (p = 0.001).
Conclusions
The level of concordance among Indonesian pathologists in diagnosing thyroid neoplasm was relatively poor. Consensus in pathology assessment requires ongoing collaboration and education to refine diagnostic criteria.
Educational exchange in thyroid core needle biopsy diagnosis: enhancing pathological interpretation through guideline integration and peer learning
Agnes Stephanie Harahap, Chan Kwon Jung
Received May 2, 2024  Accepted June 24, 2024  Published online July 24, 2024  
DOI: https://doi.org/10.4132/jptm.2024.06.24    [Epub ahead of print]
  • 561 View
  • 73 Download
AbstractAbstract PDF
Background
While fine needle aspiration cytology (FNAC) plays an essential role in the screening of thyroid nodules, core needle biopsy (CNB) acts as an alternative method to address FNAC limitations. However, diagnosing thyroid CNB samples can be challenging due to variations in background and levels of experience. Effective training is indispensable to mitigate this challenge. We aim to evaluate the impact of an educational program on improving the accuracy of CNB diagnostics.
Methods
The 2-week observational program included a host mentor pathologist with extensive experience and a visiting pathologist. The CNB classification by The Practice Guidelines Committee of the Korean Thyroid Association was used for the report. Two rounds of reviewing the case were carried out, and the level of agreement between the reviewers was analyzed.
Results
The first-round assessment showed a concordance between two pathologists for 247 thyroid CNB specimens by 84.2%, with a kappa coefficient of 0.74 (indicating substantial agreement). This finding was attributed to the discordance in the use of categories III and V. After peer learning, the two pathologists evaluated 30 new cases, which showed an overall improvement in the level of agreement. The percentage of agreement between pathologists on thyroid CNB diagnosis was 86.7%, as measured by kappa coefficient of 0.80.
Conclusions
This educational program, consisting of guided mentorship and peer learning, can substantially enhance the diagnostic accuracy of thyroid CNB. It is useful in promoting consistent diagnostic standards and contributes to the ongoing development of global pathology practices.
Review
Welcoming the new, revisiting the old: a brief glance at cytopathology reporting systems for lung, pancreas, and thyroid
Rita Luis, Balamurugan Thirunavukkarasu, Deepali Jain, Sule Canberk
J Pathol Transl Med. 2024;58(4):165-173.   Published online July 15, 2024
DOI: https://doi.org/10.4132/jptm.2024.06.11
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AbstractAbstract PDF
This review addresses new reporting systems for lung and pancreatobiliary cytopathology as well as the most recent edition of The Bethesda Reporting System for Thyroid Cytopathology. The review spans past, present, and future aspects within the context of the intricate interplay between traditional morphological assessments and cutting-edge molecular diagnostics. For lung and pancreas, the authors discuss the evolution of reporting systems, emphasizing the bridge between past directives and more recent collaborative efforts of the International Academy of Cytology and the World Health Organization in shaping universal reporting systems. The review offers a brief overview of the structure of these novel systems, highlighting their strengths and pinpointing areas that require further refinement. For thyroid, the authors primarily focus on the third edition of The Bethesda System for Reporting Thyroid Cytopathology, also considering the two preceding editions. This review serves as an invaluable resource for cytopathologists, offering a panoramic view of the evolving landscape of cytopathology reporting and pointing out the integrative role of the cytopathologist in an era of rapid diagnostic and therapeutic advancements.
Original Articles
Revisiting the utility of identifying nuclear grooves as unique nuclear changes by an object detector model
Pedro R. F. Rende, Joel Machado Pires, Kátia Sakimi Nakadaira, Sara Lopes, João Vale, Fabio Hecht, Fabyan E. L. Beltrão, Gabriel J. R. Machado, Edna T. Kimura, Catarina Eloy, Helton E. Ramos
J Pathol Transl Med. 2024;58(3):117-126.   Published online April 30, 2024
DOI: https://doi.org/10.4132/jptm.2024.03.07
  • 1,262 View
  • 226 Download
AbstractAbstract PDF
Background
Among other structures, nuclear grooves are vastly found in papillary thyroid carcinoma (PTC). Considering that the application of artificial intelligence in thyroid cytology has potential for diagnostic routine, our goal was to develop a new supervised convolutional neural network capable of identifying nuclear grooves in Diff-Quik stained whole-slide images (WSI) obtained from thyroid fineneedle aspiration.
Methods
We selected 22 Diff-Quik stained cytological slides with cytological diagnosis of PTC and concordant histological diagnosis. Each of the slides was scanned, forming a WSI. Images that contained the region of interest were obtained, followed by pre-formatting, annotation of the nuclear grooves and data augmentation techniques. The final dataset was divided into training and validation groups in a 7:3 ratio.
Results
This is the first artificial intelligence model based on object detection applied to nuclear structures in thyroid cytopathology. A total of 7,255 images were obtained from 22 WSI, totaling 7,242 annotated nuclear grooves. The best model was obtained after it was submitted 15 times with the train dataset (14th epoch), with 67% true positives, 49.8% for sensitivity and 43.1% for predictive positive value.
Conclusions
The model was able to develop a structure predictor rule, indicating that the application of an artificial intelligence model based on object detection in the identification of nuclear grooves is feasible. Associated with a reduction in interobserver variability and in time per slide, this demonstrates that nuclear evaluation constitutes one of the possibilities for refining the diagnosis through computational models.
Identification of invasive subpopulations using spatial transcriptome analysis in thyroid follicular tumors
Ayana Suzuki, Satoshi Nojima, Shinichiro Tahara, Daisuke Motooka, Masaharu Kohara, Daisuke Okuzaki, Mitsuyoshi Hirokawa, Eiichi Morii
J Pathol Transl Med. 2024;58(1):22-28.   Published online January 10, 2024
DOI: https://doi.org/10.4132/jptm.2023.11.21
  • 1,446 View
  • 207 Download
AbstractAbstract PDF
Background
Follicular tumors include follicular thyroid adenomas and carcinomas; however, it is difficult to distinguish between the two when the cytology or biopsy material is obtained from a portion of the tumor. The presence or absence of invasion in the resected material is used to differentiate between adenomas and carcinomas, which often results in the unnecessary removal of the adenomas. If nodules that may be follicular thyroid carcinomas are identified preoperatively, active surveillance of other nodules as adenomas is possible, which reduces the risk of surgical complications and the expenses incurred during medical treatment. Therefore, we aimed to identify biomarkers in the invasive subpopulation of follicular tumor cells.
Methods
We performed a spatial transcriptome analysis of a case of follicular thyroid carcinoma and examined the dynamics of CD74 expression in 36 cases.
Results
We identified a subpopulation in a region close to the invasive area, and this subpopulation expressed high levels of CD74. Immunohistochemically, CD74 was highly expressed in the invasive and peripheral areas of the tumor.
Conclusions
Although high CD74 expression has been reported in papillary and anaplastic thyroid carcinomas, it has not been analyzed in follicular thyroid carcinomas. Furthermore, the heterogeneity of CD74 expression in thyroid tumors has not yet been reported. The CD74-positive subpopulation identified in this study may be useful in predicting invasion of follicular thyroid carcinomas.
Reviews
The Asian Thyroid Working Group, from 2017 to 2023
Kennichi Kakudo, Chan Kwon Jung, Zhiyan Liu, Mitsuyoshi Hirokawa, Andrey Bychkov, Huy Gia Vuong, Somboon Keelawat, Radhika Srinivasan, Jen-Fan Hang, Chiung-Ru Lai
J Pathol Transl Med. 2023;57(6):289-304.   Published online November 14, 2023
DOI: https://doi.org/10.4132/jptm.2023.10.04
  • 1,799 View
  • 240 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, “First do not harm patients,” and an oriental filial piety “Do not harm one’s own body because it is a precious gift from parents,” which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.

Citations

Citations to this article as recorded by  
  • Welcoming the new, revisiting the old: a brief glance at cytopathology reporting systems for lung, pancreas, and thyroid
    Rita Luis, Balamurugan Thirunavukkarasu, Deepali Jain, Sule Canberk
    Journal of Pathology and Translational Medicine.2024; 58(4): 165.     CrossRef
  • Are we ready to bridge classification systems? A comprehensive review of different reporting systems in thyroid cytology
    Esther Diana Rossi, Liron Pantanowitz
    Cytopathology.2024;[Epub]     CrossRef
Reevaluating diagnostic categories and associated malignancy risks in thyroid core needle biopsy
Chan Kwon Jung
J Pathol Transl Med. 2023;57(4):208-216.   Published online July 11, 2023
DOI: https://doi.org/10.4132/jptm.2023.06.20
  • 1,776 View
  • 198 Download
  • 5 Web of Science
  • 4 Crossref
AbstractAbstract PDF
As the application of core needle biopsy (CNB) in evaluating thyroid nodules rises in clinical practice, the 2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules have officially recognized its value for the first time. CNB procures tissue samples preserving both histologic structure and cytologic detail, thereby supplying substantial material for an accurate diagnosis and reducing the necessity for repeated biopsies or subsequent surgical interventions. The current review introduces the risk of malignancy within distinct diagnostic categories, emphasizing the implications of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on these malignancy risks. Prior research has indicated diagnostic challenges associated with follicular-patterned lesions, resulting in notable variation within indeterminate diagnostic categories. The utilization of mutation-specific immunostaining in CNB enhances the accuracy of lesion classification. This review underlines the essential role of a multidisciplinary approach in diagnosing follicular-patterned lesions and the potential of mutation-specific immunostaining to strengthen diagnostic consensus and inform patient management decisions.

Citations

Citations to this article as recorded by  
  • Diagnostic implication of thyroid spherules for cytological diagnosis of thyroid nodules
    Heeseung Sohn, Kennichi Kakudo, Chan Kwon Jung
    Cytopathology.2024; 35(3): 383.     CrossRef
  • A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules
    Eun Kyung Lee, Young Joo Park, Chan Kwon Jung, Dong Gyu Na
    Endocrinology and Metabolism.2024; 39(1): 61.     CrossRef
  • The Diagnostic Role of Repeated Biopsy of Thyroid Nodules with Atypia of Undetermined Significance with Architectural Atypia on Core-Needle Biopsy
    Hye Hyeon Moon, Sae Rom Chung, Young Jun Choi, Tae-Yon Sung, Dong Eun Song, Tae Yong Kim, Jeong Hyun Lee, Jung Hwan Baek
    Endocrinology and Metabolism.2024; 39(2): 300.     CrossRef
  • Core needle biopsy for thyroid nodules assessment-a new horizon?
    David D Dolidze, Serghei Covantsev, Grigorii M Chechenin, Natalia V Pichugina, Anastasia V Bedina, Anna Bumbu
    World Journal of Clinical Oncology.2024; 15(5): 580.     CrossRef
Case Studies
Intrathyroidal metastasis of tonsillar squamous cell carcinoma masquerading as a primary thyroid tumor
Jai-Hyang Go
J Pathol Transl Med. 2023;57(4):242-245.   Published online July 11, 2023
DOI: https://doi.org/10.4132/jptm.2023.06.16
  • 1,308 View
  • 94 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Intrathyroidal metastasis of tonsillar squamous cell carcinoma is rare. To date, only six cases have been reported in the literature. This case was unusual and presented with thyromegaly before the diagnosis of the primary tumor. A 55-year-old male patient was suspected to have a primary thyroid tumor with nodal metastasis. The thyroid gland was diffusely enlarged, with no discernible mass. Histologically, the thyroid parenchyma revealed extensive endolymphatic tumor emboli, which were positive for p40 and p16 in a background of chronic lymphocytic thyroiditis. Positron emission tomography–computed tomography revealed hypermetabolic activity in the right tonsillar region. Tonsillar biopsy revealed human papillomavirus–positive squamous cell carcinoma. The present case is the first reported case of intrathyroidal metastasis of tonsillar squamous cell carcinoma with an initial clinical presentation of thyroid enlargement before the primary tumor of tonsillar cancer was diagnosed.

Citations

Citations to this article as recorded by  
  • Metastatic oropharyngeal squamous cell carcinoma to the thyroid: A case report and review of literature
    Hannah Walker, Jed Speers, Milena Fabry, Sameep Kadakia
    American Journal of Otolaryngology.2024; 45(4): 104306.     CrossRef
  • Metastasis to Thyroid from Recurrent Head and Neck Squamous Cell Carcinoma: A Case Series and Review of Literature
    Avneet Kaur, Rohit Nayyar, Harit Kumar Chaturvedi, Akshat Malik
    Indian Journal of Surgical Oncology.2024;[Epub]     CrossRef
Thyroid pathology, a clue to PTEN hamartoma tumor syndrome
Yurimi Lee, Young Lyun Oh
J Pathol Transl Med. 2023;57(3):178-183.   Published online March 30, 2023
DOI: https://doi.org/10.4132/jptm.2023.03.04
  • 1,871 View
  • 177 Download
  • 7 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is a hereditary disorder caused by germline inactivating mutations in the PTEN tumor suppressor gene. As a type of PHTS, Cowden syndrome is associated with abnormalities of the thyroid, breast, uterus, and gastrointestinal tract. A 52-year-old-woman visited the outpatient clinic of our endocrinology clinic with multiple thyroid nodules and Hashimoto's thyroiditis. Computed tomography imaging revealed a multinodular mass measuring up to 3.5 cm in the left thyroid lobe, causing laryngotracheal airway displacement. The total thyroidectomy specimen revealed multiple follicular adenomas and adenomatous nodules with lymphocytic thyroiditis and lipomatous metaplasia in the background. The patient was suspected of PTHS based on her thyroid pathology, family history, and numerous hamartomatous lesions of the breast, uterus, and skin. Her diagnosis was confirmed through molecular testing. This case demonstrates that pathologists must be well acquainted with thyroid pathology in PHTS.

Citations

Citations to this article as recorded by  
  • Dedifferentiated Leiomyosarcoma of the Uterine Corpus with Heterologous Component: Clinicopathological Analysis of Five Consecutive Cases from a Single Institution and Comprehensive Literature Review
    Suyeon Kim, Hyunsik Bae, Hyun-Soo Kim
    Diagnostics.2024; 14(2): 160.     CrossRef
  • Case report: Rare oral manifestations in Cowden syndrome with PTEN mutation
    Wei Yuan, Yanbin Liu, Haibin Sun, Ming Su, Lizheng Qin, Xin Huang
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Can thyroid histomorphology identify patients with PTEN hamartoma tumour syndrome?
    Melad N Dababneh, Laura Rabinowitz, Gilman Plitt, Charis Eng, Christopher C Griffith
    Histopathology.2024;[Epub]     CrossRef
  • A novel mutation in PTEN in anaplastic thyroid carcinoma: A case report
    Yanli Zhao
    Biomedical Reports.2024;[Epub]     CrossRef
Review
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: its updated diagnostic criteria, preoperative cytologic diagnoses and impact on the risk of malignancy
Hee Young Na, So Yeon Park
J Pathol Transl Med. 2022;56(6):319-325.   Published online November 9, 2022
DOI: https://doi.org/10.4132/jptm.2022.09.29
  • 3,012 View
  • 221 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Due to the extremely indolent behavior, a subset of noninvasive encapsulated follicular variant papillary thyroid carcinomas has been classified as “noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)” since 2016 and is no longer considered carcinoma. Since the introduction of this new terminology, changes and refinements have been made in diagnostic criteria. Initially, the incidence of NIFTP was estimated substantial. However, the reported incidence of NIFTP varies greatly among studies and regions, with higher incidence in North American and European countries than in Asian countries. Thus, the changes in the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) differ inevitably among regions. Because more conservative surgery is recommended for NIFTPs, distinguishing NIFTPs from papillary thyroid carcinomas in preoperative fine-needle aspiration cytology became one of the major concerns. This review will provide comprehensive overview of updates on diagnostic criteria, actual incidence and preoperative cytologic diagnoses of NIFTP, and its impact on the ROM in TBSRTC.

Citations

Citations to this article as recorded by  
  • Papillae, psammoma bodies, and/or many nuclear pseudoinclusions are helpful criteria but should not be required for a definitive cytologic diagnosis of papillary thyroid carcinoma: An institutional experience of 207 cases with surgical follow up
    Tarik M. Elsheikh, Matthew Thomas, Jennifer Brainard, Jessica Di Marco, Erica Manosky, Bridgette Springer, Dawn Underwood, Deborah J. Chute
    Cancer Cytopathology.2024; 132(6): 348.     CrossRef
  • ThyroSeq overview on indeterminate thyroid nodules: An institutional experience
    Sam Sirotnikov, Christopher C. Griffith, Daniel Lubin, Chao Zhang, Nabil F. Saba, Dehong Li, Amanda Kornfield, Amy Chen, Qiuying Shi
    Diagnostic Cytopathology.2024; 52(7): 353.     CrossRef
  • Oncocytic Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Case Report
    Kaveripakam Ajay Joseph, Sana Ahuja, Sufian Zaheer
    Indian Journal of Surgical Oncology.2024;[Epub]     CrossRef
  • Preoperative evaluation of thyroid nodules – Diagnosis and management strategies
    Tapoi Dana Antonia, Lambrescu Ioana Maria, Gheorghisan-Galateanu Ancuta-Augustina
    Pathology - Research and Practice.2023; 246: 154516.     CrossRef
  • Reevaluating diagnostic categories and associated malignancy risks in thyroid core needle biopsy
    Chan Kwon Jung
    Journal of Pathology and Translational Medicine.2023; 57(4): 208.     CrossRef
  • Strategies for Treatment of Thyroid Cancer
    Deepika Yadav, Pramod Kumar Sharma, Rishabha Malviya, Prem Shankar Mishra
    Current Drug Targets.2023; 24(5): 406.     CrossRef
  • Identification of NIFTP-Specific mRNA Markers for Reliable Molecular Diagnosis of Thyroid Tumors
    So-Yeon Lee, Jong-Lyul Park, Kwangsoon Kim, Ja Seong Bae, Jae-Yoon Kim, Seon-Young Kim, Chan Kwon Jung
    Endocrine Pathology.2023; 34(3): 311.     CrossRef
Case Study
Papillary and medullary thyroid carcinomas coexisting in the same lobe, first suspected based on fine-needle aspiration cytology: a case report
Hyun Hee Koh, Young Lyun Oh
J Pathol Transl Med. 2022;56(5):301-308.   Published online September 13, 2022
DOI: https://doi.org/10.4132/jptm.2022.08.03
  • 1,884 View
  • 95 Download
  • 1 Crossref
AbstractAbstract PDF
Because different types of thyroid malignancies have distinct embryological origins, coexisting tumors are rarely observed. We describe a coexisting papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) first suspected by fine-needle aspiration cytology (FNAC). A 57-year-old female presented with an irregular mass in the right thyroid lobe. The cytopathologic findings of fine-needle aspiration showed two components: a papillary-like arrangement consisting of cells with pale enlarged nuclei indicative of PTC and loose clusters comprised of oval cells with granular chromatin indicative of MTC. The diagnosis of a coexisting PTC and MTC was initially confirmed by calcitonin immunocytochemistry and later after total thyroidectomy. Although some surgical case reports of PTC and MTC coexisting in either the same or different lobes have been documented, a case suspected by FNAC before the surgery has rarely been reported. Because appropriate treatment and prognosis of PTC and MTC are different, cytopathologists should be aware of this rare entity.

Citations

Citations to this article as recorded by  
  • Dedifferentiated Leiomyosarcoma of the Uterine Corpus with Heterologous Component: Clinicopathological Analysis of Five Consecutive Cases from a Single Institution and Comprehensive Literature Review
    Suyeon Kim, Hyunsik Bae, Hyun-Soo Kim
    Diagnostics.2024; 14(2): 160.     CrossRef
Original Article
Correlation between myoferlin expression and lymph node metastasis in papillary thyroid carcinoma
Ji Min Na, Dong Chul Kim, Dae Hyun Song, Hyo Jung An, Hyun Min Koh, Jeong-Hee Lee, Jong Sil Lee, Jung Wook Yang, Min Hye Kim
J Pathol Transl Med. 2022;56(4):199-204.   Published online May 11, 2022
DOI: https://doi.org/10.4132/jptm.2022.03.19
  • 3,075 View
  • 169 Download
AbstractAbstract PDF
Background
Myoferlin is a multifunctional protein expressed in various normal and cancer cells, with novel oncogenic roles being newly discovered. Recently, correlations have been found between myoferlin expression and unfavorable prognosis in various carcinomas. This study investigated the prognostic role of myoferlin expression in papillary thyroid carcinoma (PTC), specifically that associated with nodal metastasis.
Methods
We collected clinicopathological data and PTC tissues from 116 patients who had been admitted to Gyeongsang National University Hospital in 2010. Immunohistochemical analysis was performed on surgical specimen-derived tissue microarray blocks. Myoferlin expression was graded, and the relationship between expression level and pathological features of tumors based on the American Joint Committee on Cancer staging system was evaluated.
Results
Of the 116 patient samples, 100 cases exhibited positive myoferlin expression. Higher grade of myoferlin expression was correlated with lower T category group (p = .010). Presence of lymph node metastasis was determined to be significantly correlated with low-grade myoferlin expression (p = .019), with no significant difference between pN1a and pN1b tumors.
Conclusions
Our study revealed an adverse correlation between myoferlin expression and pathological features of PTC, evidence of the potential prognostic role of myoferlin in PTC lymph node metastasis.
Case Studies
TTF1-positive SMARCA4/BRG1 deficient lung adenocarcinoma
Anurag Mehta, Himanshi Diwan, Divya Bansal, Manoj Gupta
J Pathol Transl Med. 2022;56(1):53-56.   Published online November 16, 2021
DOI: https://doi.org/10.4132/jptm.2021.09.16
  • 4,277 View
  • 175 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract PDF
SMARCA4/BRG1-deficient lung adenocarcinoma (SD-LUAD) is being recognized as a distinct subtype based on subtle differences in its clinical, morphological, and immunophenotypic attributes compared to other non–small cell lung carcinomas. We present here a case of SD-LUAD with curious thyroid transcription factor 1 (TTF1) expression in a morphologically heterogenous lung adenocarcinoma. The better differentiated area showed preservation of TTF1 expression, and a poorly differentiated tumor had loss of TTF1 expression with universal BRG1 loss.

Citations

Citations to this article as recorded by  
  • One Case of Non-Small Cell Lung Cancer with SMARCA4 Deletion Was Reported
    允龙 宋
    Medical Diagnosis.2024; 14(01): 137.     CrossRef
  • Delineation of a SMARCA4-specific competing endogenous RNA network and its function in hepatocellular carcinoma
    Lei Zhang, Ting Sun, Xiao-Ye Wu, Fa-Ming Fei, Zhen-Zhen Gao
    World Journal of Clinical Cases.2022; 10(29): 10501.     CrossRef
  • Novel germline SMARCA4 mutation in Small Cell Carcinoma of the Ovary, Hypercalcemic Type
    Anurag Mehta, Himanshi Diwan, Diksha Karki, Divya Bansal, Meenakshi Kamboj, Anila Sharma, Shrinidhi Nathany, Sakshi Mattoo, Dushyant Kumar
    Current Problems in Cancer: Case Reports.2022; 8: 100205.     CrossRef
Metastatic leiomyosarcoma of the thyroid gland: cytologic findings and differential diagnosis
Jiyeon Lee, Yunjoo Cho, Kyue Hee Choi, Inwoo Hwang, Young Lyun Oh
J Pathol Transl Med. 2021;55(5):360-365.   Published online August 13, 2021
DOI: https://doi.org/10.4132/jptm.2021.06.23
  • 3,096 View
  • 89 Download
  • 6 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Metastatic leiomyosarcoma to the thyroid is an extremely rare occurrence, and only 18 cases have been reported. Here, we report a case of a 37-year-old woman who presented with multiple masses on the scalp. Excisional biopsy was done and the mass revealed fascicles of smooth muscle fibers which showed positive staining for smooth muscle actin, thus confirming the diagnosis of leiomyosarcoma. The patient was also found to have a 0.9 cm mass within the left thyroid. Fine-needle aspiration was done and the cytological smear showed hypercellular spindle cell clusters with hyperchromatic and large nuclei. Normal thyroid follicular cells were found within or around tumor cells. In this report, we present the cytologic findings of metastatic leiomyosarcoma to the thyroid and offer differential diagnoses of the aspirated spindle cells.

Citations

Citations to this article as recorded by  
  • Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology
    Fernando López, Abir Al Ghuzlan, Mark Zafereo, Vincent Vander Poorten, K. Thomas Robbins, Marc Hamoir, Iain J. Nixon, Ralph P. Tufano, Gregory Randolph, Pia Pace-Asciak, Peter Angelos, Andrés Coca-Pelaz, Avi Khafif, Ohad Ronen, Juan Pablo Rodrigo, Álvaro
    Cancers.2023; 15(4): 1255.     CrossRef
  • A Rare Case of Metastatic Uterine Leiomyosarcoma to the Thyroid Gland
    R. Sathish Kumar, H. Akshaykumar, C. Ramesan, J. Dipin
    Indian Journal of Otolaryngology and Head & Neck Surgery.2023;[Epub]     CrossRef
  • Mesonephric-like Adenocarcinoma of the Ovary: Clinicopathological and Molecular Characteristics
    Hyun Hee Koh, Eunhyang Park, Hyun-Soo Kim
    Diagnostics.2022; 12(2): 326.     CrossRef
  • Alveolar Soft Part Sarcoma of the Uterus: Clinicopathological and Molecular Characteristics
    Yurimi Lee, Kiyong Na, Ha Young Woo, Hyun-Soo Kim
    Diagnostics.2022; 12(5): 1102.     CrossRef

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