Journal articles: 'Hurthle Cell Tumors Thyroid'

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Cornianu, Marioara. "Proliferative Activity of Thyroid Hurthle Cell Tumors." Acta Endocrinologica (Bucharest) 2, no. 3 (2006): 269–81. http://dx.doi.org/10.4183/aeb.2006.269.

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Suh, Young-Jin, Chung-Soo Chun, Young-Hyug Kim, Hyun-Min Cho, Yong-Sung Won, Hyung-Min Chin, Jun-Gi Kim, and Woo-Bae Park. "Hurthle Cell Tumors of the Thyroid Gland." Korean Journal of Endocrine Surgery 1, no. 1 (2001): 89. http://dx.doi.org/10.16956/kjes.2001.1.1.89.

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Johnson, Terri L., Ricardo V. Lloyd, Richard E. Burney, and Norman W. Thompson. "Hurthle cell thyroid tumors. An immunohistochemical study." Cancer 59, no. 1 (January 1, 1987): 107–12. http://dx.doi.org/10.1002/1097-0142(19870101)59:1<107::aid-cncr2820590123>3.0.co;2-u.

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Ganly, Ian, Julio Ricarte Filho, Stephanie Eng, Ronald Ghossein, Luc G. T. Morris, Yupu Liang, Nicholas Socci, et al. "Genomic Dissection of Hurthle Cell Carcinoma Reveals a Unique Class of Thyroid Malignancy." Journal of Clinical Endocrinology & Metabolism 98, no. 5 (May 1, 2013): E962—E972. http://dx.doi.org/10.1210/jc.2012-3539.

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Context: Hurthle cell cancer (HCC) is an understudied cancer with poor prognosis. Objective: Our objective was to elucidate the genomic foundations of HCC. Design and Setting: We conducted a large-scale integrated analysis of mutations, gene expression profiles, and copy number alterations in HCC at a single tertiary-care cancer institution. Methods: Mass spectrometry-based genotyping was used to interrogate hot spot point mutations in the most common thyroid oncogenes: BRAF, RET, NRAS, HRAS, KRAS, PIK3CA, MAP2K1, and AKT1. In addition, common oncogenic fusions of RET and NTRK1 as well as PAX8/PPARγ and AKAP9-BRAF were also assessed by RT-PCR. Global copy number changes and gene expression profiles were determined in the same tumor set as the mutational analyses. Results: We report that the mutational, transcriptional, and copy number profiles of HCC were distinct from those of papillary thyroid cancer and follicular thyroid cancer, indicating HCC to be a unique type of thyroid malignancy. Unsupervised hierarchical clustering of gene expression showed the 3 groups of Hurthle tumors (Hurthle cell adenoma [HA], minimally invasive Hurthle cell carcinoma [HMIN], and widely invasive Hurthle cell carcinoma [HWIDE] clustered separately with a marked difference between HWIDE and HA. Global copy number analysis also indicated distinct subgroups of tumors that may arise as HWIDE and HMIN. Molecular pathways that differentiate HA from HWIDE included the PIK3CA-Akt-mTOR and Wnt/β-catenin pathways, potentially providing a rationale for new targets for this type of malignancy. Conclusions: Our data provide evidence that HCC may be a unique thyroid cancer distinct from papillary and follicular thyroid cancer.

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Carcangiu, M. L., S. Bianchi, D. Savino, I. M. Voynick, and J. Rosai. "Follicular Hurthle cell tumors of the thyroid gland." Cancer 68, no. 9 (November 1, 1991): 1944–53. http://dx.doi.org/10.1002/1097-0142(19911101)68:9<1944::aid-cncr2820680917>3.0.co;2-i.

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Palo, Seetu, Archana H. Deshpande, and Citrawati B. Gargade. "Hurthle cell adenoma and papillary microcarcinoma: a rare case of thyroid collision tumor." International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 4 (March 24, 2021): 695. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20211198.

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Collision tumors of the thyroid gland are histologically distinct tumors coexisting within the gland. Here, we depict a case of a 36-year-old woman who presented with anterior neck swelling of one-year duration. Local examination revealed a 3×2 cm, firm, right solitary thyroid nodule. Fine needle aspiration cytology was suggestive of Hurthle cell neoplasm. Patient underwent a right hemi-thyroidectomy. Histopathological examination showed co-existence of Hurthle cell adenoma and papillary thyroid microcarcinoma. The patient was asymptomatic during six months follow up. It is important that the surgeons and pathologists are aware of these collision tumors so that optimal therapeutic interventions can be carried out.

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Chao, Tzu-Chieh, Jen-Der Lin, and Miin-Fu Chen. "Surgical Treatment of Hurthle Cell Tumors of the Thyroid." World Journal of Surgery 29, no. 2 (January 20, 2005): 164–68. http://dx.doi.org/10.1007/s00268-004-7669-9.

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Nagoti, Sarada, Anunayi J., and Manthan Patel. "The role of cell cycle regulatory protein p53 in Follicular neoplasms of thyroid with hurthle cells." International Journal of Scientific Reports 2, no. 5 (May 19, 2016): 99. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20161468.

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Background: The disease biology of Follicular neoplasms of thyroid with hurthle cells is poorly understood. Very few studies in literature have addressed the role of p53 in these neoplasms. The aim of the present study is to analyze the histomorphological features of Follicular neoplasms with hurthle cell change and to evaluate the role of p53 in their tumor biology.Methods:32 cases of Follicular neoplasms of thyroid with focal and pure hurthle cell change over a period of 2.5 years were studied histologically and immunohistochemically using p53 antibody (Biogenex). They included 20 follicular adenomas with focal hurthle cells, 10 pure hurthle cell adenomas and 2 hurthle cell carcinomas.Results: All cases showed nuclear p53 positivity in hurthle cells. Muller-Hocker et al criteria was used for frequency scoring. Out of the 32 cases, 12 cases of pure hurthle cells showed score 3, Remaining 20 cases of follicular adenomas with focal hurthle cell change showed score 3 in cases with >50% hurthle cells, score 2 in cases with 20-40% hurthle cells and score 0 in cases with <10% hurthle cells.Conclusions:The study showed a good correlation of p53 protein expression with tumor progression and aggressiveness. Hence this indicates that molecular alterations in p53 pathway play a role in tumor biology in Follicular neoplasms of thyroid with hurthle cell change.

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Rana, Chanchal. "Hurthle Cell Adenoma and Papillary Microcarcinoma in Thyroid: Collision Tumors." World Journal of Endocrine Surgery 10, no. 2 (2018): 134–36. http://dx.doi.org/10.5005/jp-journals-10002-1232.

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Ding, Li, Yunhui Jiang, and Wan Yang. "Approach the Invasive Potential with Hurthle Cell Tumors of Thyroid." Pathology & Oncology Research 25, no. 2 (December 11, 2018): 697–701. http://dx.doi.org/10.1007/s12253-018-0546-x.

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Kolson Kokohaare, Eva, Francesco M. G. Riva, Jonathan M. Bernstein, Aisha B. Miah, and Khin Thway. "Malignant Solitary Fibrous Tumor Metastatic to Widely Invasive Hurthle Cell Thyroid Carcinoma: A Distinct Tumor-to-Tumor Metastasis." International Journal of Surgical Pathology 26, no. 6 (April 4, 2018): 521–24. http://dx.doi.org/10.1177/1066896918767321.

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We illustrate a case of synchronous malignant solitary fibrous tumor of the thoracic cavity, and widely invasive thyroid Hurthle cell carcinoma. The Hurthle cell carcinoma was found to harbor distinct areas of malignant solitary fibrous tumor. This is a unique case of tumor-to-tumor metastasis that, to the best of our knowledge, has not been previously reported.

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El-Naggar, A. K., J. G. Batsakis, M. A. Luna, and R. C. Hickey. "Hurthle Cell Tumors of the Thyroid: A Flow Cytometric DNA Analysis." Archives of Otolaryngology - Head and Neck Surgery 114, no. 5 (May 1, 1988): 520–21. http://dx.doi.org/10.1001/archotol.1988.01860170050016.

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Zhang, Rusheng, Francis H. Straus, and Leslie J. DeGroot. "Cell-Specific Viral Gene Therapy of a Hurthle Cell Tumor." Journal of Clinical Endocrinology & Metabolism 87, no. 3 (March 1, 2002): 1407–14. http://dx.doi.org/10.1210/jcem.87.3.8276.

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We evaluated the effectiveness of a replication-defective adenovirus-transducing thymidine kinase (TK) gene under the control of the rat Tg (rTg) promoter (AdrTgtk) in therapy of a human Hurthle cancer (XTC-1 cell) in vitro and in vivo. The ganciclovir (GCV) sensitivity of infected XTC-1 cells was assessed in vitro by H3-thymidine incorporation assay and Trypan-blue exclusion, and by an in vivo tumor development assay. Proliferation was strongly inhibited by adding GCV into the culture medium of infected cells, but not uninfected cells, proving cell infection and expression of TK in the XTC-1 cells. AdrTgtk, and also viruses that have the noncell-specific cytomegalovirus (CMV) promoter-directing expression of TK (AdCMVtk), or luciferase (AdCMVLuc), were used to transduce XTC-1 cells to evaluate killing effects. After infection with AdCMVtk or AdrTgtk, followed by GCV treatment, 70% of infected cells were killed in the presence of GCV, compared with less than 20% of cells infected by AdCMVLuc and treated with GCV. In vivo toxicity was studied in BALB/c mice. When adenovirus is given iv, liver is the major organ infected. No significant changes of the serum transaminase levels and no histological abnormalities were found in animals treated with AdrTgtk/GCV given iv, compared with control animals. High levels of serum transaminases, lymphocyte infiltration, some Kupffer’s cell prominence, and extensive single-cell hepatocyte death were found in AdCMVtk/GCV-treated animals, indicating severe liver damage induced, as expected, by the noncell-specific CMV promoter. XTL-1 cells (2 × 106) were injected sc into BALB/c-severe combined immunodeficient mice (BALB/c-SCID), and the mice developed tumors after 3 wk. After intratumoral injection of AdrTgtk and treatment with GCV, tumors stabilized in 15 of 17 mice within 3 wk, 9 tumors remained stabilized after 5 wk of treatment, and 2 disappeared during observation. In AdCMVLuc/GCV-treated control mice, almost all tumors grew continuously. The average tumor size in AdrTgtk-treated mice was significantly smaller than that of control animals after 2 wk of treatment. Our data confirm the effectiveness and specificity of an adenovirus using rTg promoter to express TK, and support its future application to thyroid cancer gene therapy in humans.

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Rosario, Pedro Weslley, and Gabriela Franco Mourão. "Hurthle Cells Adenoma With Distant Metastases Refractory to Radioiodine." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A890—A891. http://dx.doi.org/10.1210/jendso/bvab048.1818.

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Abstract Introduction: Adenoma of the thyroid is defined as an encapsulated follicular tumor that is well delimited in relation to the adjacent parenchyma and whose cells do not exhibit the nuclear alterations of papillary thyroid carcinoma (PTC), and in the absence of capsular and vascular invasion. Adenoma, including the of Hurthle cells, is considered a benign tumor. No additional treatment is recommended after resection of the tumor. Case: A 64-year-old man was submitted to total thyroidectomy because of a nodule measuring 3.5 cm with indeterminate cytology (predominance of Hurthle cells). Histology revealed an Hurthle cells adenoma of 3.2 cm. The tumor did not exhibit vascular or capsular invasion, the cells did not contain nuclei of PTC, and no necrosis or mitoses were observed. Five years after surgery, serum thyroglobulin (Tg) was elevated (25 ng/ml) during euthyroidism (TSH 0.6 mUI/l) and in the absence of anti-Tg antibodies. Serum calcitonin was undetectable. The patient developed a progressive increase in Tg and neck ultrasonography (US), chest computed tomography (CT), and FDG-PET/CT were performed. US revealed atypical lymph nodes (the largest with 12 mm) and cytology showed abundance of Hurthle cells. Chest CT detected multiple nodules, the largest measuring 15 mm, and FDG-PET/CT revealed areas of cervical and pulmonary uptake corresponding to the lesions seen on US and CT. The patient received 100 mCi radioactive iodine and post-therapy whole-body scanning showed mild uptake only in the thyroid bed. The patient continues to show progressive increase in Tg (last measurement > 1,000 ng/ml), as well as progression of metastases. He remains under follow-up and on therapy with tyrosine kinase inhibitor. The histology result was revised by two pathologists with broad experience in thyroid pathology who confirmed the initial findings compatible with adenoma. Conclusion: The present case shows that, although rare, Huthle cells tumors can develop metastases even when the tumor is < 4 cm and unequivocally without nuclei of PTC or capsular and vascular invasion, thus considered benign (adenoma). As observed in this case, these metastases can be macrometastases, distant, and refractory to radioiodine. Reference: Lloyd RV, Osamura RY, Klöppel G, Rosai J, ed. WHO Classification of Tumours of Endocrine Organs. 4th edition Lyon: IARC; 2017

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Cacchi, C., H. M. Arnholdt, C. J. Haas, H. Kretsinger, L. Axt, and B. Märkl. "Galectin-3 and Cyclin D3 Immunohistochemistry and Tumor Dimensions Are Useful in Distinguishing Follicular Oncocytic Carcinomas from Oncocytic Adenomas of the Thyroid." International Journal of Endocrinology 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/276854.

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Aims. Oncocytic (Hurthle) follicular cell tumors (OTs) of the thyroid are both adenomas (OAs) and follicular carcinomas (OCs). The routine diagnosis of these tumors can be problematic even after an accurate sampling and histological examination. Beside preoperative evaluation due to the tumor’s dimension several studies have been performed to find markers able to distinguish malignant from benign follicular tumors in the thyroid, with Galectin-3 being one of the most effective. Recently, some authors suggested cyclin D3 as adjunct to the diagnosis of the oncocytic lesions of the thyroid.Methods and Results. In this paper we assess the role of Galectin-3 and cyclin D3 in a well-selected group of follicular oncocytic tumors (14 OCs and 26 OAs). The diameter of each lesion was also evaluated. The combination of Galectin-3 and cyclin D3 has a good specificity (81%) and sensitivity (100%). Moreover, the maximum diameter (in cm) of OCs is greater than OAs (4.1 versus 2.3).Conclusions. We believe that the use of Galectin-3 and cyclin D3 in OTs of the thyroid can be a helpful panel in daily practice when histology is doubtful.

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Kiziridou, Anastasia, Agni Pantidou, Chariclea Destouni, and Theano Toliou. "Immunohistochemical expression of CD44 in thyroid gland lesions." Archive of Oncology 11, no. 1 (2003): 5–8. http://dx.doi.org/10.2298/aoo0301005k.

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BACKGROUND: CD44 is a polymorphic family of cell surface proteoglycans and glycoproteins implicated in cell-to-cell and cell-to-matrix adhesion interactions and tumor metastasis. Its expression appears to be an indicator of invasive and metastatic behavior in carcinomas. The purpose of our study is to investigate the immunohistochemical expression of CD44 protein in thyroid lesions and its association to other histopathological parameters. METHODS: Samples from thyroid lesions were obtained from 40 patients treated in our hospital. The material consisted of 5 cases of multinodular goiter, 7 cases of thyroiditis (Hashimoto type), 5 cases of follicular adenoma, 4 cases of Hurthle cell tumor, 15 cases of thyroid carcinoma (11 papillary carcinomas, and 4 myeloid tumors), and 4 cases of normal thyroid tissue. Immunostaining was performed using the Ventana ES automated immunostainer. A monoclonal antibody was used and avidin-biotin method was applied to paraffin-embedded samples. A membranous immunostaining pattern was considered positive. RESULTS: CD44 expression was detected in three adenomas (60%), mostly of follicular type, and in eight carcinomas (72%). The CD44 immunostaining was especially apparent in papillary type of carcinomas which showed high expression. In normal thyroid tissue, a reduced CD44 expression was observed. CONCLUSION: The results of our study indicate that deregulated expression of CD44 contributes to the ability of thyroid carcinomas for invasion and metastasis and may constitute a prognostic factor for malignant biological behavior.

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Har-el, Gady, Tuvia Hadar, Karl Segal, Rudy Levy, and Jack Sidi. "Hurthle cell carcinoma of the thyroid gland. A tumor of moderate malignancy." Cancer 57, no. 8 (April 15, 1986): 1613–17. http://dx.doi.org/10.1002/1097-0142(19860415)57:8<1613::aid-cncr2820570829>3.0.co;2-3.

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Orlando, Christine A., Karl Salman, Jeffrey L. Miller, and Sonya Naryshkin. "Clear-cell change in follicular adenoma mimicking hurthle-cell tumor on thyroid aspiration biopsy cytology." Diagnostic Cytopathology 7, no. 3 (May 1991): 273–76. http://dx.doi.org/10.1002/dc.2840070312.

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Landa, Iñigo, Ian Ganly, Timothy A. Chan, Norisato Mitsutake, Michiko Matsuse, Tihana Ibrahimpasic, Ronald A. Ghossein, and James A. Fagin. "Frequent Somatic TERT Promoter Mutations in Thyroid Cancer: Higher Prevalence in Advanced Forms of the Disease." Journal of Clinical Endocrinology & Metabolism 98, no. 9 (September 1, 2013): E1562—E1566. http://dx.doi.org/10.1210/jc.2013-2383.

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Background: TERT encodes the reverse transcriptase component of telomerase, which adds telomere repeats to chromosome ends, thus enabling cell replication. Telomerase activity is required for cell immortalization. Somatic TERT promoter mutations modifying key transcriptional response elements were recently reported in several cancers, such as melanomas and gliomas. Objectives: The objectives of the study were: 1) to determine the prevalence of TERT promoter mutations C228T and C250T in different thyroid cancer histological types and cell lines; and 2) to establish the possible association of TERT mutations with mutations of BRAF, RAS, or RET/PTC. Methods: TERT promoter was PCR-amplified and sequenced in 42 thyroid cancer cell lines and 183 tumors: 80 papillary thyroid cancers (PTCs), 58 poorly differentiated thyroid cancers (PDTCs), 20 anaplastic thyroid cancers (ATCs), and 25 Hurthle cell cancers (HCCs). Results: TERT promoter mutations were found in 98 of 225 (44%) specimens. TERT promoters C228T and C250T were mutually exclusive. Mutations were present in 18 of 80 PTCs (22.5%), in 40 of 78 (51%) advanced thyroid cancers (ATC + PDTC) (P = 3 × 10−4 vs PTC), and in widely invasive HCCs (4 of 17), but not in minimally invasive HCCs (0 of 8). TERT promoter mutations were seen more frequently in advanced cancers with BRAF/RAS mutations compared to those that were BRAF/RAS wild-type (ATC + PDTC, 67.3 vs 24.1%; P < 10−4), whereas BRAF-mutant PTCs were less likely to have TERT promoter mutations than BRAF wild-type tumors (11.8 vs 50.0%; P = .04). Conclusions: TERT promoter mutations are highly prevalent in advanced thyroid cancers, particularly those harboring BRAF or RAS mutations, whereas PTCs with BRAF or RAS mutations are most often TERT promoter wild type. Acquisition of a TERT promoter mutation could extend survival of BRAF- or RAS-driven clones and enable accumulation of additional genetic defects leading to disease progression.

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Chiappetta, Gennaro, Paolo Toti, Francesco Cetta, Ada Giuliano, Francesca Pentimalli, Ida Amendola, Stefano Lazzi, et al. "TheRET/PTCOncogene Is Frequently Activated in Oncocytic Thyroid Tumors (Hurthle Cell Adenomas and Carcinomas), but Not in Oncocytic Hyperplastic Lesions." Journal of Clinical Endocrinology & Metabolism 87, no. 1 (January 2002): 364–69. http://dx.doi.org/10.1210/jcem.87.1.8180.

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Manxhuka-Kerliu, Suzana, Emine Devolli-Disha, Arsim Gerxhaliu, Halil Ahmetaj, Arijeta Baruti, Sadushe Loxha, and Hajdin Thaqi. "Prognostic Values of Thyroid Tumours." Bosnian Journal of Basic Medical Sciences 9, no. 2 (May 20, 2009): 111–19. http://dx.doi.org/10.17305/bjbms.2009.2829.

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Thyroid cancer accounts for approximately 1% of total cancer cases in developed countries. The aim of this study has been to analyze the histopathological variants of thyroid tumours with regard to gender and age. Despite their relative rarity in our material, they exhibit a wide range of morphological patterns and biological behaviourDuring the period from 2001-2007, 138 biopsy cases of thyroid tumours, which were fixed in buffered neutral formalin and embedded in paraffin, have been reviewed. Tissue sections ^m thick) were cut and stained with hematoxylin and eosin (H&E).Follicular adenomas have been found in 39, 1% of cases, thyroid carcinomas in 60, 12%, whereas thyroid secondary carcinomas have been found in 0, 72% of cases. As far as histological variants of thyroid carcinomas are concerned, most frequently found were papillary carcinomas in 39,85% of cases; followed by follicular carcinomas in 9,42% of cases; follicular variants of papillary carcinomas in 5,79% of cases; medullary carcinomas in 3,62% of cases, while anaplastic and Hurthle cell carcinomas have been found in 0,72% of cases each. All histological variants of thyroid tumours occurred more frequently in women than in men. Papillary carcinoma has been found in 80% of female cases. Thyroid tumours in our material mainly occurred in the third, the fourth and the fifth decade of life.Our data indicate that apart from the fact that papillary carcinomas, well differentiated, and characterised by relatively good prognosis, were most frequent variants, certain morphological variants of it were associated with poor prognosis.

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Malith, V., I. Bombil, N. Harran, and TE Luvhengo. "Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting." South African Journal of Surgery 56, no. 3 (2018): 20–23. http://dx.doi.org/10.17159/2078-5151/2018/v56n3a2557.

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Okere, PCN, DB Olusina, and MO Enyinnah. "Hurthle cell tumor of the thyroid gland: Report of a rare case and review of literature." Nigerian Journal of Clinical Practice 17, no. 3 (2014): 375. http://dx.doi.org/10.4103/1119-3077.130249.

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Dogan, Omer Faruk, Deniz Hanci, Arzu Sungur, Omer Faruk Unal, and Metin Demircin. "An Unusual Case of Thyroid Hurtle Cell Carcinoma with Direct Extension to the Right Brachiocephalic Vein, Right Auricle, and Right Atrium: Case Report." Heart Surgery Forum 8, no. 2 (March 25, 2005): 114. http://dx.doi.org/10.1532/hsf98.20041171.

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The clinical behavior of various types of thryroid tumor have been much studied during the past several decades, and the histologic features, surgical management, and prognostic factors of follicular and papillary tumors in particular have been clarified to a considerable degree. On the other hand, there is still controversy concerning management of Hurtle cell tumor (HCT) of the thyroid. HCT is not a common disease, making it impossible to obtain sufficient clinical data at a single institution. It has been reported that all HCT are aggressive and should be treated as malignant tumors. It is believed that an accurate differential diagnosis can be made between cancer and adenoma on the basis of pathological studies. We describe a patient with HCT of the thyroid extending into the right atrium. To our knowledge, after a Medline search, this is the first such case in the medical literature. The interesting features are described, and the relevant literature is briefly reviewed.

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Flagg, Andrew, Lisa Rooper, Sheila Sheth, Mohammad Shaear, Prasanna Santhanam, Jason Prescott, Matt T. Olson, Justin A. Bishop, and Jennifer S. Mammen. "ADDITIONAL SURGERY FOR OCCULT RISK FACTORS AFTER LOBECTOMY IN SOLITARY THYROID NODULES IS PREDICTED BY CYTOPATHOLOGY CLASSIFICATION AND TUMOR SIZE." Endocrine Practice 26, no. 7 (July 2020): 754–60. http://dx.doi.org/10.4158/ep-2019-0473.

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Objective: Clinical practice for differentiated thyroid cancer is moving towards lobectomy rather than total thyroidectomy in patients at low risk of recurrence. However, recurrence risk assessment depends on post-operative findings, while the surgical decision is based on preoperative factors. We determined the preoperative predictors of occult higher-risk pathology and rates of completion thyroidectomy among surgical candidates with nonbenign thyroid nodules 10 to 40 mm and no evidence of extrathyroidal extension or metastasis on preoperative evaluation. Methods: Thyroid surgery cases at a single institution from 2005–2015 were reviewed to identify those meeting American Thyroid Association (ATA) criteria for lobectomy. ATA-based risk stratification from postoperative surgical pathology was compared to preoperative cytopathology, ultrasound, and clinical findings. Results: Of 1,995 thyroid surgeries performed for nonbenign thyroid nodules 10 to 40 mm, 349 met ATA criteria for lobectomy. Occult high-risk features such as tall cell variant, gross extrathyroidal invasion, or vascular invasion were found in 36 cases (10.7%), while intraoperative lymphadenopathy led to surgical upstaging in 13 (3.7%). Intermediate risk features such as moderate lymphadenopathy or minimal extrathyroidal extension were present in an additional 44 cases. Occult risk features were present twice as often in Bethesda class 6 cases (35%) as in lower categories (12 to 17%). In multivariable analysis, Bethesda class and nodule size, but not age, race, sex, or ultrasound features, were significant predictors of occult higher-risk pathology. Conclusion: Most solitary thyroid nodules less than 4 cm and with cytology findings including atypia of undetermined significance through suspicious for papillary thyroid cancer would be sufficiently treated by lobectomy. Abbreviations: ATA = American Thyroid Association; CND = central neck dissection; DTC = differentiated thyroid cancer; ETE = extrathyroidal extension; FNA = fine needle aspiration; FTC/HCC = follicular thyroid carcinoma/Hurthle cell carcinoma; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; OR = odds ratio; PTC = papillary thyroid cancer; US = ultrasound

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Koshy, Jason, Vicki Schnadig, and Ranjana Nawgiri. "Is fine needle aspiration cytology a useful diagnostic tool for granular cell tumors? A cytohistological review with emphasis on pitfalls." CytoJournal 11 (October 21, 2014): 28. http://dx.doi.org/10.4103/1742-6413.143304.

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Background: Granular cell tumors (GCT) formerly known as Abrikossoff tumor or granular cell myoblastoma, are rare neoplasms encountered in the fine needle aspiration (FNA) service. Named because of their highly granular cytoplasm which is invariably positive for the S-100 antibody, the classic GCT is thought to be of neural origin. The cytomorphological features range from highly cellular to scanty cellular smears with dispersed polygonal tumor cells. The cells have abundant eosinophilic granular cytoplasm, eccentric round to oval vesicular nuclei with small inconspicuous nucleoli. The fragility of the cells can result in many stripped nuclei in a granular background. The differential diagnosis occasionally can range from a benign or reactive process to features that are suspicious for malignancy. Some of the concerning cytologic features include necrosis, mitoses and nuclear pleomorphism. Methods: We identified 6 cases of suspected GCT on cytology within the last 10 years and compared them to their final histologic diagnoses. Results: Four had histologic correlation of GCT including one case that was suspicious for GCT on cytology and called atypical with features concerning for a malignant neoplasm. Of the other two cases where GCT was suspected, one showed breast tissue with fibrocystic changes, and the other was a Hurthle cell adenoma of the thyroid. Conclusions: These results imply that FNA has utility in the diagnosis of GCT, and should be included in the differential diagnoses when cells with abundant granular cytoplasm are seen on cytology. Careful attention to cytologic atypia, signs of reactive changes, use of immunohistochemistry, and clinical correlation are helpful in arriving at a definite diagnosis on FNA cytology.

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Renshaw, Andrew A., Edward Wang, Jennifer Haja, David Wilbur, Michael R. Henry, and Jonathan H. Hughes. "Fine-Needle Aspiration of Papillary Thyroid Carcinoma: Distinguishing Between Cases That Performed Well and Those That Performed Poorly in the College of American Pathologists Nongynecologic Cytology Program." Archives of Pathology & Laboratory Medicine 130, no. 4 (April 1, 2006): 452–55. http://dx.doi.org/10.5858/2006-130-452-faoptc.

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Abstract Context.—Although the cytologic features of papillary thyroid carcinoma in fine-needle aspiration specimens are well known, the correlation of these features with the ability of cytologists to identify this tumor has not been well studied. Objective.—To compare the cytologic features of cases of papillary thyroid carcinoma that performed poorly with those of cases that performed well. Design.—The cytologic features of 13 cases of papillary thyroid carcinoma from the College of American Pathologists Nongynecologic Cytology Program that performed poorly were compared with those of 15 cases that performed well. Results.—Compared with cases that performed well, cases that performed poorly were significantly more likely to lack marked nuclear enlargement (38% vs 100%, P < .001), lack pale chromatin (8% vs 47%, P = .04), and lack intranuclear inclusions (8% vs 53%, P = .02). The differences between the 2 groups in staining, type of preparation, nuclear grooves, nuclear crowding, colloid, cellularity, nuclear pleomorphism, and Hurthle cell change were not significant. Conclusions.—Cases of papillary thyroid carcinoma that lack marked nuclear enlargement, pale chromatin, and intranuclear inclusions are significantly more difficult to recognize than cases that have these features. Increased awareness of these types of cases might improve the performance of thyroid fine-needle aspiration in clinical practice.

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Grebe, Stefan K. G., Bryan McIver, Ian D. Hay, Patricia S. C. Wu, Lea M. Z. Maciel, Harry A. Drabkin, John R. Goellner, Clive S. Grant, Robert B. Jenkins, and Norman L. Eberhardt. "Frequent Loss of Heterozygosity on Chromosomes 3p and 17p without VHL or p53 Mutations Suggests Involvement of Unidentified Tumor Suppressor Genes in Follicular Thyroid Carcinoma1." Journal of Clinical Endocrinology & Metabolism 82, no. 11 (November 1, 1997): 3684–91. http://dx.doi.org/10.1210/jcem.82.11.4352.

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Follicular thyroid carcinoma (FTC) exhibits frequent loss of heterozygosity (LOH) on chromosomes 10q and 3p, suggesting involvement of tumor suppressor genes. We screened 14 FTC (10 Hurthle cell carcinomas and 4 nonoxyphilic FTC), 14 papillary thyroid carcinomas, and 7 follicular adenomas for LOH on chromosome arms 1p, 3p, 3q, 10p, 10q, 11p, 11q, 13q, 17p, and 17q. LOH was more frequent in FTC than in follicular adenoma or papillary thyroid carcinoma. In FTC, rates of LOH on 3p (86%), 17p (72%), and 10q (57%) were higher than the average rate of LOH (33%; P < 0.05). Most frequently involved were 3p21–25 and 17p13.1–13.3, the sites for the VHL (3p25–26) and p53 (17p13.1) tumor suppressors. We, therefore, characterized these genes by dideoxy fingerprinting and DNA sequencing. Two FTC had mutations in p53, but only 1 of these exhibited LOH at 17p. No VHL gene mutations were found. Thus, neither p53 nor VHL genes play a significant role in the pathogenesis of differentiated thyroid cancer. LOH on 17p, but not on 3p or 10q, was correlated with mortality. Accordingly, 3p and 10q LOH may represent early, and 17p LOH late, events in FTC development. The data suggest the presence of novel tumor suppressor genes on chromosomes 3p and 17p that may be important in the pathogenesis of FTC.

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Boyce-Fappiano, David, Olsi Gjyshi, Todd A. Pezzi, Pamela K. Allen, Moaaz Solimman, Nicolette Taku, Michael B. Bernstein, et al. "Spine stereotactic radiosurgery for metastatic thyroid cancer: a single-institution experience." Journal of Neurosurgery: Spine 32, no. 6 (June 2020): 941–49. http://dx.doi.org/10.3171/2019.12.spine191269.

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OBJECTIVEPatients with metastatic thyroid cancer have prolonged survival compared to those with other primary tumors. The spine is the most common site of osseous involvement in cases of metastatic thyroid cancer. As a result, obtaining durable local control (LC) in the spine is crucial. This study aimed to evaluate the efficacy of spine stereotactic radiosurgery (SSRS) in patients with metastatic thyroid cancer.METHODSInformation on patients with metastatic thyroid cancer treated with SSRS for spinal metastases was retrospectively evaluated. SSRS was delivered with a simultaneous integrated boost technique using single- or multiple-fraction treatments. LC, defined as stable or reduced disease volume, was evaluated by examining posttreatment MRI, CT, and PET studies.RESULTSA total of 133 lesions were treated in 67 patients. The median follow-up duration was 31 months. Dose regimens for SSRS included 18 Gy in 1 fraction, 27 Gy in 3 fractions, and 30 Gy in 5 fractions. The histology distribution was 36% follicular, 33% papillary, 15% medullary, 13% Hurthle cell, and 3% anaplastic. The 1-, 2-, and 5-year LC rates were 96%, 89%, and 82%, respectively. The median overall survival (OS) was 43 months, with 1-, 2-, and 5-year survival rates of 86%, 74%, and 44%, respectively. There was no correlation between the absolute biological equivalent dose (BED) and OS or LC. Patients with effective LC had a trend toward improved OS when compared to patients who had local failure: 68 versus 28 months (p = 0.07). In terms of toxicity, 5 vertebral compression fractures (2.8%) occurred, and only 1 case (0.6%) of greater than or equal to grade 3 toxicity (esophageal stenosis) was reported.CONCLUSIONSSSRS is a safe and effective treatment option with excellent LC and minimal toxicity for patients with metastatic thyroid cancer. No association with increased radiation dose or BED was found, suggesting that such patients can be effectively treated with reduced dose regimens.

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Wiesner, W., H. Engel, G. K. von Schulthess, G. P. Krestin, and I. Bicik. "FDG PET-negative liver metastases of a malignant melanoma and FDG PET-positive Hurthle cell tumor of the thyroid." European Radiology 9, no. 5 (May 21, 1999): 975–78. http://dx.doi.org/10.1007/s003300050779.

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Fung, Russell, Madeline Fasen, Firas Warda, Patrick Natter, Stacey Nedrud, Rui Fernandes, Ahmad Alkhasawneh, and Gunjan Y. Gandhi. "Clavicular Metastasis as an Initial Presentation of Papillary Thyroid Cancer." Case Reports in Endocrinology 2021 (August 26, 2021): 1–7. http://dx.doi.org/10.1155/2021/6662071.

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Objective. We present the case of a 44-year-old man with a large neck mass to highlight the unique presentation of papillary thyroid carcinoma (PTC) metastatic to the clavicle. Methods. We reviewed the medical record for a detailed history and physical examination findings. Our radiology colleagues examined the diagnostic imaging studies performed. The pathology team reviewed the neck mass biopsy and the confirmatory surgical pathology after total resection of the mass. Results. A 44-year-old man presented with an enlarging neck mass. Initial X-rays revealed a large soft tissue density mass that extended to the midline of the right clavicle. A neck ultrasound established a 5.4 × 3.6 cm mass with increased vascularity and calcification extending from the thyroid. A CT scan noted the extension of the mass into the adjacent sternoclavicular junction with osteolysis of the middle third of the clavicle and the superior aspect of the sternal body. Fine-needle aspiration revealed a thyroid neoplasm with follicular features and positive immunostaining consistent with thyroid carcinoma. The patient underwent a composite resection of the tumor, including a segmental osteotomy of approximately two-thirds of the medial clavicle. The pathology report confirmed PTC with extrathyroidal extension and clavicle involvement (staged pT4a pN0), with further genomic findings showing positive KRAS mutation. Conclusion. Clavicular metastasis from differentiated thyroid cancer is rare. While the prognosis is generally favorable, various factors, including age greater than 45 years, poor differentiation, follicular thyroid carcinoma, Hurthle cell variant, and extrapulmonary metastasis, have typically been associated with poorer cancer-specific survival.

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Qasem, Ebtesam, Avaniyapuram Kannan Murugan, Hindi Al-Hindi, Mingzhao Xing, Mai Almohanna, Meshael Alswailem, and Ali S. Alzahrani. "TERT promoter mutations in thyroid cancer: a report from a Middle Eastern population." Endocrine-Related Cancer 22, no. 6 (September 9, 2015): 901–8. http://dx.doi.org/10.1530/erc-15-0396.

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Telomerase reverse transcriptase (TERT) promoter mutations C228T and C250T have recently been described in follicular cell-derived thyroid cancer (TC) in patients from North America and Europe. In this study, we explored whether these findings could be replicated in patients from a different ethnic group. We screened 17 benign thyroid adenomas and 265 TC samples from patients in the Middle East for these mutations by PCR and direct sequencing using DNA isolated from paraffin-embedded tumor tissues. None of the 17 benign adenomas harbored TERT promoter mutations. Of 265 TC, 34 (12.8%) harbored TERT promoter mutations, including 10/153 (6.5%) conventional papillary TC (CPTC), 8/57 (14.0%) follicular variant PTC, 9/30 (30%) tall cell variant PTC, 1/3 (30%) Hurthle cell thyroid cancer (HTC), 1/5 (20%) follicular TC, and 5/13 (38.5%) poorly differentiated TC. C250T mutation was present in only 6/265 (2.3%) cases, while C228T mutation was present in a total of 28/265 (10.6%) cases. These two mutations were mutually exclusive. TERT promoter mutations were significantly more common in older (≥45 years) than younger patients and were associated with larger tumour size, vascular invasion, higher TNM stage (stage III and IV), BRAFV600E mutation and persistent/recurrent disease at 6–12 months after initial treatment and at the last follow up. These associations were stronger in non-CPTC. Thus, this study on a large cohort of TC patients from Middle East demonstrates that TERT promoter mutations are relatively common, especially in the non-CPTC, and are associated with more aggressive histopathological features, BRAFV600E mutation, and disease persistence/recurrence than the WT TERT.

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Yu, Nathan Y., Aditya Khurana, Daniel J. Ma, Michelle A. Neben-Wittich, Michael A. Golafshar, Lisa A. McGee, Jean-Claude M. Rwigema, Robert L. Foote, and Samir H. Patel. "Initial Experience with Proton Beam Therapy for Differentiated Thyroid Cancer." International Journal of Particle Therapy 8, no. 1 (June 1, 2021): 311–18. http://dx.doi.org/10.14338/ijpt-d-20-00053.

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Abstract Purpose External beam radiotherapy is used in a subset of high-risk patients with differentiated thyroid cancer (DTC). Recurrent, radioactive iodine (RAI)–refractory DTC carries a poor prognosis. We report our initial experience of intensity-modulated proton therapy (IMPT) for recurrent, RAI-refractory DTC. Patients and Methods Fourteen patients with recurrent, RAI-refractory DTC were consecutively treated with IMPT from November 2016 to March 2020 at our multisite institution. Patient, tumor, and treatment characteristics were recorded. Overall survival and local-regional recurrence-free survival were recorded and estimated using the Kaplan-Meier method. Acute and late treatment-related toxicities were recorded based on the Common Terminology Criteria for Adverse Events version 5.0. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Module at baseline and after IMPT. Eleven patients were included in the final analysis. Results Median follow-up was 8 months (range, 3-40) for all patients. Median age at treatment with IMPT was 64 years (range, 40-77), and the majority were men (64%). Recurrent histologies included papillary (55%), Hurthle cell (36%), and poorly differentiated (9%) carcinoma; 1 patient had tall cell variant. Concurrent chemotherapy was not administered for any patient in this cohort. At 8 months, all patients were alive without local-regional failure. Acute grade 3 toxicities were limited to 1 patient with dysphagia, requiring feeding tube placement. Two patients experienced late grade 3 esophageal stenosis requiring dilation. There were no grade 4 or 5 toxicities. There were no differences in pretreatment versus posttreatment patient-reported outcomes in terms of dysphagia or hoarseness. Conclusion In our early experience, IMPT provided promising local-regional control for recurrent, RAI-refractory DTC. Further study is warranted to evaluate the long-term efficacy and safety of IMPT in this patient population.

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Kunjumohamed, Fathimabeebi P., Abdulhakeem Al Rawahi, Noor B. Al Busaidi, and Hilal N. Al Musalhi. "Disease-free Survival of Patients with Differentiated Thyroid Cancer: A Study from a Tertiary Center in Oman." Oman Medical Journal 36, no. 2 (March 15, 2021): e246-e246. http://dx.doi.org/10.5001/omj.2021.54.

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Objectives: As with global trends, the prevalence of differentiated thyroid cancer (DTC) has increased in recent years in Oman. However, to the best of our knowledge, no local studies have yet been published evaluating the prognosis of DTC cases in Oman. This study aimed to assess disease-free survival (DFS) and prognostic factors related to DTC among Omani patients attending a tertiary care center. Methods: This retrospective, observational cohort study was conducted between January 2006 and May 2016 at the National Diabetes and Endocrine Center in Oman. Data related to DFS and prognostic factors were obtained from the electronic medical records of all ≥ 18-year-old patients diagnosed with DTC during the study period. Results: A total of 346 DTC cases were identified. Overall, 82.7% of patients were disease-free at their last follow-up appointment. Univariate analysis indicated that various tumor characteristics including histological subtype (i.e., papillary carcinoma, Hurthle cell cancer, and minimally invasive follicular thyroid carcinoma), lymph node status, number of lymph node metastases, distant metastasis status, and TNM status (primary tumor (T), regional lymph node (N), distant metastasis (M) stage) were strong prognostic factors for DFS (p < 0.050). According to multivariate regression analysis, lymph node status, extrathyroidal extension, and angiovascular invasion were independent predictors of DFS (p < 0.050). Conclusions: The overall prognosis of DTC among Omani patients was excellent. Treatment and follow-up strategies for patients with DTC should be tailored based on the individual’s risk factor profile.

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Cohen, E. E., E. E. Vokes, L. S. Rosen, M. S. Kies, A. A. Forastiere, F. P. Worden, M. A. Kane, K. F. Liau, D. R. Shalinsky, and R. B. Cohen. "A phase II study of axitinib (AG-013736 [AG]) in patients (pts) with advanced thyroid cancers." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 6008. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.6008.

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6008 Background: Elevated VEGF-A and VEGF-C have been reported in thyroid tumor tissue compared with normal thyroid. AG is a potent, small molecule inhibitor of VEGF receptors 1, 2 and 3. The efficacy and safety of AG therapy in pts with advanced thyroid cancers was examined in this single-arm, multi-center study. Methods: 60 pts with metastatic or unresectable locally-advanced thyroid cancer refractory to, or not suitable candidates for, 131iodine (131I) treatment, with measurable disease received AG at a starting dose of 5 mg orally BID. The primary endpoint was response rate (RR) by RECIST criteria. A Simon 2-stage minimax design was used (a=0.1; β=0.1; null RR=5%; alternative RR=20%). Samples were collected pretreatment and q8wks to explore relationships between clinical response and plasma soluble proteins. Results: Median age was 59 yrs (26–84), 35 (58%) were male. Histological subtypes included papillary: 29 pts (48%); follicular: 15 pts (25%)-11 (18%) with Hurthle cell variant; medullary: 12 pts (20%); anaplastic: 2 pts (3%), and other/unknown: 2 pts (3%). 53 pts (88%) had prior surgery, 42 (70%) had prior 131I treatment, 27 (45%) had prior external beam radiation, and 9 (15%) had prior chemotherapy. Partial response (PR) by investigator report was achieved in 13 pts (22% CI: 12.1, 34.2), with 31- 68% maximum tumor regression and duration of response (DOR) of 1–16 months. 30 pts (50%) have stable disease with a duration range of 4–13 months and 13–67% maximum tumor regression in 28 pts. Response assessments are ongoing. The treatment duration range is 6–670 days with 38 pts currently on study. Median PFS has not been reached with a median follow up of 273 days. The most common treatment-related adverse events were fatigue (37%), proteinuria (27%), stomatitis/mucositis (25%), diarrhea (22%), hypertension (20%) and nausea (18%). AG therapy consistently decreased soluble VEGFR2 and VEGFR3, and increased VEGF in the blood, demonstrating pharmacodynamic activity against targeted VEGF receptors. Conclusions: AG has substantial anti-tumor activity in advanced thyroid cancer with demonstrated pharmacodynamic activity. A global pivotal trial testing AG in doxorubicin refractory thyroid cancer is ongoing. [Table: see text]

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Chablani, Sumedha, Sana Ghaznavi, and R. Michael Tuttle. "Clinical Outcomes of Differentiated Thyroid Cancer With Gross Extrathyroidal Extension Into the Strap Muscles: A Case Control Study." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A858—A859. http://dx.doi.org/10.1210/jendso/bvab048.1753.

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Abstract Background: The 8th edition of the American Joint Committee on Cancer/tumor-node-metastasis (AJCC/TNM) staging system for differentiated thyroid cancer (DTC), implemented in January 2018, classifies patients >/= 55 years of age with gross extrathyroidal extension (ETE) of the primary tumor into the overlying strap muscles as prognostic stage II. However, it remains controversial as to whether or not gross ETE into the strap muscles is an independent predictor of recurrence, response to therapy, need for additional therapies, or overall survival. Using a case control study design, we evaluated the prognostic significance of gross ETE among adults. Methods: After obtaining IRB approval, we used the tumor registry at our institution to retrospectively identify 51 AJCC stage II patients with DTC aged >/= 55 years with gross ETE into only the strap muscles (51/2,225 patients). For each of the 51 cases, we identified one control who matched on all of the following important prognostic factors: age at diagnosis (± 5 years), sex, histology, size of tumor (± 1 cm), lymph node metastases, distant metastases, completeness of resection, receipt of radioactive iodine (RAI) therapy, and duration of follow-up (± 5 years). The controls (n=51) had no gross ETE. Results: In the 51 patients with gross ETE into only the strap muscles, the mean age at diagnosis was 64 years, 77% were female, 37% had lymph node metastases, and none had distant metastases. The average tumor size was 2.1 cm with the majority of patients (49/51) demonstrating papillary thyroid carcinoma (1 follicular thyroid carcinoma and 1 Hurthle cell thyroid carcinoma). Only 6% of patients (3/51) had incomplete resections and 92% (47/51) received RAI therapy. The mean duration of follow-up was 8 years. There were no statistically significant differences between the cases and controls on each of the pre-specified prognostic variables described in the methods. In addition, there were no statistically significant differences between the groups in terms of rates of recurrence: cases 18% (9/51) and controls 29% (15/51) (p=0.24), best response to initial therapy (excellent, biochemical incomplete, structural incomplete, or indeterminate response to therapy), and need for subsequent interventions including surgery, RAI, external beam radiation, or systemic therapy. Furthermore, there were no statistically significant differences between the cases and controls with respect to 10-year disease-free survival (cases 83% and controls 68%, p=0.90) and 10-year overall survival (cases 97% and controls 89%, p=0.10). Conclusions: In a case control analysis with a mean follow up of 8 years, the presence of ETE into the strap muscles was not an independent predictor of worse clinical outcomes in adults >/= 55 years old with DTC. These findings can be used to inform the future editions of the AJCC/TNM and American Thyroid Association staging systems for DTC.

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Chae, Young Kwang, Megan Othus, Sandip Patel, Sarah Fenton, Ding Wang, Cristina Rodriguez, Adedayo Onitilo, et al. "270 A phase II basket trial of dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors (DART) SWOG S1609: the thyroid tumor cohort." Journal for ImmunoTherapy of Cancer 8, Suppl 3 (November 2020): A288. http://dx.doi.org/10.1136/jitc-2020-sitc2020.0270.

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BackgroundCheckpoint inhibitors acting against PD-1 and CTLA-4 have provided significant benefit for patients. However, their efficacy in rare tumors has not been determined. This abstract presents the results of combination therapy with anti-CTLA and anti-PD-1 in the thyroid cohort of SWOG S1609 Dual Anti-CTLA-4 & Anti-PD-1 blockade in Rare Tumors (DART).MethodsThis study is a prospective, open-label, multicenter phase 2 clinical trial of ipilimumab (1 mg/kg intravenously every 6 weeks) plus nivolumab (240 mg intravenously every 2 weeks) in rare tumors. Here we report the outcomes from thyroid cancer patients. The primary endpoint is objective response rate (ORR) (RECIST v1.1) (confirmed complete response (CR) and partial responses (PR)); progression-free survival (PFS), overall survival (OS), stable disease (SD) >6 months, and toxicity are secondary endpoints.ResultsTwenty-one patients were registered and seventeen were eligible and received therapy. Median age of the patients was 59 (range 33–78), 59% (N=10) of enrolled patients were male. The most common subtype of thyroid cancer was papillary (47%, N=8), then medullary (24%, N=4), anaplastic (24%, N=4) and Hurtle cell histology (6%, N=1). The ORR was 12% [CR, 0%, N= 0; PR, 12%, N= 2; 1 papillary and 1 anaplastic subtype]; in addition 12% (N=2) had unconfirmed PR (both papillary subtype). Of note, 1 out of 4 patients with anaplastic thyroid carcinoma (25%) had a response that lasted more than two years. 35% (N=6) of patients had SD for over 6 months, 12% (N=2) had SD for less than 6 months (figure 1 a&b). Clinical benefit rate including all PRs and SD over 6 months was 59% (N=10/17). Additionally, one patient with papillary thyroid carcinoma that withdrew early due to toxicities (neuropathic pain and arthralgias) had stable disease for over one year (not included in response assessment). 6-month PFS was 58% (95% confidence interval; 39–88) and median PFS was 9.5 months (4.99-infinity); 6-month OS was 88% (74–100%) and median OS was not reached. One patient died while enrolled. 94.1% (N=16) experienced toxicities with 52.9% (N=9) experiencing grade 3–5 toxicities. The most common adverse events were fatigue (41.2%, N=7), elevated lipase (29.4%, N=5), acute kidney injury, diarrhea, muscle weakness, anorexia, pruritis, nausea and alanine aminotransferase elevation (21.1%, N=3 each). The most common immune-mediated adverse events were acute kidney injury and elevated lipase (29.4%, N=5 each).Abstract 263 Figure 1a. Waterfall plot indicating maximum change in baseline tumor measurement following treatment. Crosshatch indicate patients failed therapy and do not have tumor measurements available due to early clinical progression or progression due to new lesions without RECIST measurable changes (N=2). b. Swimmer’s plot of PFS following therapy. Triangles idicated confirmed PR, targets indicate unconfirmed PR and squares indicate SD.ConclusionsCombination therapy with ipilimumab plus nivolumab in thyroid cancer resulted in an ORR of 12% with two partial responses in seventeen treated patients.Trial RegistrationNCT02834013Ethics ApprovalThe study was approved by the NCI Adult Central Institutional Review Board, approval number 02834013.

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Farrand, Kathryn, Brett Delahunt, Xiao-li Wang, Bryan McIver, Ian D. Hay, John R. Goellner, Norman L. Eberhardt, and Stefan K. G. Grebe. "High Resolution Loss of Heterozygosity Mapping of 17p13 in Thyroid Cancer: Hurthle Cell Carcinomas Exhibit a Small 411-Kilobase Common Region of Allelic Imbalance, Probably Containing a Novel Tumor Suppressor Gene." Journal of Clinical Endocrinology & Metabolism 87, no. 10 (October 2002): 4715–21. http://dx.doi.org/10.1210/jc.2002-020708.

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Singh, Rahul Kumar, Amit Goyal, Poonam Elhence, and Amit Kumar. "Bilateral Hurthle cell adenoma of thyroid: a rare case report." International Journal of Otorhinolaryngology and Head and Neck Surgery 3, no. 2 (March 25, 2017): 462. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20171216.

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Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid. Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies.

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Lorch, Jochen H., Naifa Busaidy, Daniel T. Ruan, Pasi A. Janne, Sewanti Atul Limaye, Lori J. Wirth, Justine A. Barletta, et al. "A phase II study of everolimus in patients with aggressive RAI refractory (RAIR) thyroid cancer (TC)." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6023. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6023.

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6023 Background: We present results of an open label phase II study of the mTOR inhibitor Everolimus in patients (pts) with RAIR TC. Methods: Pts with metastatic, incurable RAIR TC who had shown radiographic progression within 6 months prior to enrollment received Everolimus 10mg orally once daily. Responses were monitored by CT's every two months. The primary endpoint was progression free survival. Sequential biopsies were obtained in selected pts. Results: Enrollment to the differentiated TC (DTC) cohort finished in Jan 2013 and included 33 pts, among them 11 with Hurthle cell TC. Exploratory cohorts enrolled 10 pts with medullary [MTC] and 5 with anaplastic [ATC] with 2 added openings remaining for ATC. For the DTC cohort, median time on study to date is 10 months (mo) (<1-23+). 31 pts are evaluable at this time. PFS in the DTC cohort by Kaplan-Meier (K-M) analysis is 16.0 mo (95%CI 10-NR). Currently, disease stability for 6 and 12 mo or more was achieved in 18 and 10/31 pts, respectively, 11 pts remain on study. Median OS was not reached but 1 year survival by K-M analysis was 76%. One pt achieved a PR. 3 pts with DTC underwent sequential biopsies which revealed activation of autophagy while markers for apoptosis were not detected. Among 10 MTC pts, one achieved a PR and 9 pts had stable disease for 6 mo or more (6-33+). Among 5 ATC pts, 3 progressed, one has ongoing disease stability for 5 mo. One patient achieved a complete response that lasted for 18 mo and whole exome sequencing revealed somatic loss of function mutation affecting the Tuberous Sclerosis 2 (TSC2) protein, a negative regulator of mTOR activity [TSC2 (Q1178*) and FLCN (R17fs)]. Most common treatment-related adverse events were as anticipated and included fatigue, stomatitis and infections. Grade (gr) 3 events included infection 5, weight loss 3, leukopenia 3, thrombocytopenia 3, fatigue 3, hypophosphatemia 2, stomatitis 2, pneumonitis 1 and thrombosis 1pts. One pt had gr 4 hypercholesterinemia and one pt had gr 4 leukopenia. Conclusions: Everolimus has significant anti-tumor activity in pts with advanced TC. Activation of autophagy could account for high rate of disease stability. Sequencing may identify mechanistic basis and predictive markers for treatment response. Clinical trial information: NCT00936858.

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Gray, Michael W., and Richard T. Caleel. "Hurthle cell carcinoma of the thyroid." Journal of the American Osteopathic Association 96, no. 4 (April 1, 1996): 250. http://dx.doi.org/10.7556/jaoa.1996.96.4.250.

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Dahl, Linda D., David Myssiorek, and Keith S. Heller. "Hurthle Cell Neoplasms of the Thyroid." Laryngoscope 112, no. 12 (December 2002): 2178–80. http://dx.doi.org/10.1097/00005537-200212000-00009.

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Sandoval, M. A. S., and E. Paz-Pacheco. "Hurthle cell carcinoma of the thyroid." Case Reports 2011, feb09 1 (February 9, 2011): bcr1120103536. http://dx.doi.org/10.1136/bcr.11.2010.3536.

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Yiing, Wong Chun, Irfan Mohamad, Farveen Marican, and Mutum Samarendra. "Hurthle cell carcinoma: a rare variant of thyroid malignancy." Bangladesh Journal of Medical Science 9, no. 2 (August 4, 2010): 103–6. http://dx.doi.org/10.3329/bjms.v9i2.5659.

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Hurthle cell carcinoma is a rare entity of differentiated thyroid carcinoma. Modality of treatment is controversial due to the nature and rarity of the disease. However, total thyroidectomy followed by adjuvant treatment is prudent in this variant of thyroid malignancy in view of its aggressive nature. We report a case of Hurthle cell carcinoma of thyroid in an elderly male in which the pre operative diagnosis was follicular carcinoma. The outline of management is discussed. Keywords: Hurthle cell carcinoma; thyroid malignancy; management. DOI: 10.3329/bjms.v9i2.5659Bangladesh Journal of Medical Science Vol.09 No.2 Apr 2010 pp.103-106

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Krhin, Blaz, Katja Goricar, Barbara Gazic, Vita Dolzan, and Nikola Besic. "Functional polymorphisms in antioxidant genes in Hurthle cell thyroid neoplasm - an association of GPX1 polymorphism and recurrent Hurthle cell thyroid carcinoma." Radiology and Oncology 50, no. 3 (September 1, 2016): 289–96. http://dx.doi.org/10.1515/raon-2016-0031.

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Abstract Background Hurthle cells of the thyroid gland are very rich in mitochondria and oxidative enzymes. As a high level oxidative metabolism may lead to higher level of oxidative stress and can be associated with an increased risk for cancer, we investigated whether common functional polymorphisms in antioxidant genes (SOD2, CAT, GPX, GSTP1, GSTM1 and GSTT1) are associated with the development or clinical course of Hurthle cell thyroid carcinoma (HCTC). Methods A retrospective study was performed in 139 patients treated by thyroid surgery for a Hurthle cell neoplasm. HCTC, Hurthle cell thyroid adenoma (HCTA) or Hurthle cell thyroid nodule (HCTN) were diagnosed by pathomorphology. DNA was extracted from cores of histologically confirmed normal tissue obtained from formalin-fixed paraffin-embedded specimens and genotyped for investigated polymorphisms. Logistic regression was used to compare genotype distributions between patient groups. Results HCTC, HCTA and HCTN were diagnosed in 53, 47 and 21 patients, respectively. Metastatic disease and recurrence of HCTC were diagnosed in 20 and 16 HCTC patients, respectively. Genotypes and allele frequencies of investigated polymorphisms did not deviate from Hardy-Weinberg equilibrium in patients with HCTC, HCTA and HCTN. Under the dominant genetic model we observed no differences in the genotype frequency distribution of the investigated polymorphisms when the HCTA and HCTN group was compared to the HCTC group for diagnosis of HCTC or for the presence of metastatic disease. However, GPX1 polymorphism was associated with the occurrence of recurrent disease (p = 0.040). Conclusions GPX1 polymorphism may influence the risk for recurrent disease in HCTC.

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Cabanillas, M. E., S. G. Waguespack, Y. Bronstein, M. Williams, L. Feng, S. I. Sherman, and N. L. Busaidy. "Treatment (tx) with tyrosine kinase inhibitors (TKIs) for patients (pts) with differentiated thyroid cancer (DTC): The M. D. Anderson Cancer Center (MDACC) experience." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6060. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6060.

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6060 Background: DTC is a relatively common tumor and about 20% will develop distant metastases (mets) of which at least 50% will not respond to standard tx. Until recently, tx for pts with progressive, RAI negative disease was limited. However, the identification of biologic targets in DTC has led to several trials with TKIs. Objectives: We sought to describe the MDACC experience with off-label use of TKIs to determine which pts benefit the most. Methods: Adult pts with a diagnosis of DTC treated with single agent sorafenib (SOR) or sunitinib (SUN), and who had a baseline and at least 1 follow-up (f/u) scan after 3 months (mos) of therapy, were included. All imaging data, as well as the TSH-suppressed thyroglobulin (TG) levels corresponding to each scan date were collected. RECIST was used to determine response. Results: We identified 33 pts from our clinical database. 15 pts met inclusion criteria: 9 women, 6 men. No pts were excluded due to progression or death before 3 mos. Median age 61 years (range, 38–83). 7 patients had papillary, 6 follicular (including 2 insular subtypes), 2 Hurthle cell. Most patients had RAI negative disease. SOR was used in 13, SUN in 2. Both SUN pts had been on SOR; 1 failed and 1 had intolerable side effects to SOR. Median time on tx was 42 weeks. All pts had evidence of PD prior to start of tx. Best response was 3 (20%) PR, 9 (60%) SD, 3 (20%) PD. Clinical benefit (PR+SD) = 80%. The SUN pt who was refractory to SOR had a 38% reduction in tumor size. The most noticeable activity occurred in lung (median change: -16%), whereas lymph nodes had PD or SD (median change: +3%). The 2 pts with pleural mets had PD. Four pts had bone mets: 2 had XRT and had SD in bone, while the other 2 did not have XRT and had PD in bone. At 12 mos PFS was 65% and OS was 85%. Median f/u time was 16 mos. All histologic types had similar responses. Log (TG) correlated with response (p = 0.0005). Conclusions: SOR and SUN are effective in pts with widely metastatic, progressive DTC, with most pts achieving SD or PR. The most noticeable responses occurred in the lungs in contrast with minimal changes in nodal mets, suggesting a tissue-specific response to tx. Log (TG) significantly correlated with response to tx and therefore may have value as a surrogate marker of response. [Table: see text]

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47

Sidhu, Stan. "HURTHLE CELL NEOPLASM OF THE THYROID GLAND." ANZ Journal of Surgery 78, no. 3 (March 2008): 115. http://dx.doi.org/10.1111/j.1445-2197.2007.04381.x.

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Ahmed, Mohammed, Hussam Bin Yousef, William Greer, Haroon Faraz, Saif Al Sobhi, Ali Al Zahrani, Hussein Raef, Abduallah Al Ghamdi, Yusuf Al Kadhi, and Fouad Al Dayel. "HURTHLE CELL NEOPLASM OF THE THYROID GLAND." ANZ Journal of Surgery 78, no. 3 (March 2008): 139–43. http://dx.doi.org/10.1111/j.1445-2197.2007.04389.x.

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Lossos, Izidore S., and Raphael Breuer. "Endobronchial Metastasis From Hurthle Cell Thyroid Carcinoma." Chest 97, no. 3 (March 1990): 768. http://dx.doi.org/10.1378/chest.97.3.768b.

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White, S. A., and M. J. Goddard. "Metastatic hurthle cell tumour causing central airway obstruction." Journal of Laryngology & Otology 107, no. 10 (October 1993): 957–59. http://dx.doi.org/10.1017/s0022215100124910.

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AbstractA Hurthle cell tumour is a variant of follicular thyroid cell carcinoma. This is a report of metastatic Hurthle cell tumour causing central airway obstruction, emphasizing the difficulty in differentiating benign from malignant lesions.

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Journal articles on the topic 'Hurthle Cell Tumors Thyroid'

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