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Medical Education Center, Hamamatsu University School of Medicine, Shizuoka, Japan
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Department of Pharmacology, Hamamatsu University School of Medicine, Shizuoka, Japan
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cytology (FNAC) revealed a malignancy, consistent with a PTC. He was 162 cm tall and 57.8 kg of weight. His heart rate was 85 beats per min, and his blood pressure was 98/66 mm Hg. Thyroid function tests indicated that he was hyperthyroid with a TSH level
Department of Endocrinology, Portuguese Institute of Oncology, Lisbon, Portugal
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A 70-year-old male was referred with hyperthyroidism and multinodular goiter (MNG). Thyroid ultrasonography showed 2 nodules, one in the isthmus and the other in the left lobe, 51 and 38 mm in diameter, respectively. Neck CT showed a large MNG, thyroid scintigraphy showed increased uptake in the nodule in the left lobe, and fine-needle aspiration biopsy showed a benign cytology of the nodule in the isthmus. The patient declined surgery and was treated with methimazole. After being lost to follow-up for 3 years, the patient returned with complaints of dyspnea, dysphagia, and hoarseness; he was still hyperthyroid. Cervical CT showed a large mass in the isthmus and left lobe with invasion of surrounding tissues, the trachea, the esophagus, and the recurrent laryngeal nerve. Bronchoscopy showed extensive infiltration and compression of the trachea to 20% of its caliber. A tracheal biopsy revealed an anaplastic thyroid carcinoma. The tumor was considered unresectable, and radiotherapy was given. One month later, the patient died. The association between a toxic thyroid nodule and anaplastic thyroid carcinoma has apparently not been reported so far.
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NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
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Introduction: Struma ovarii (SO) is a rare ovarian teratoma characterized by the presence of thyroid tissue in more than 50% of the tumor. Malignant transformation is rare and the most common associated malignancy is papillary thyroid carcinoma (PTC). Pregnancy may represent a stimulus to differentiated thyroid cancer (DTC) growth in patients with known structural or biochemical evidence of disease, but data about malignant SO evolution during pregnancy are rare. We present the first reported case of a pregnant patient with malignant SO and biochemical evidence of disease. Case Presentation: A previously healthy 35-year-old female diagnosed with a suspicious left pelvic mass on routine ultrasound was submitted to laparoscopic oophorectomy which revealed a malignant SO with areas of PTC. A 15-mm thyroid nodule (Bethesda V in the fine-needle aspiration cytology) was detected by palpation and total thyroidectomy was performed. Histology revealed a 15 mm follicular variant of PTC (T1bNxMx). Subsequently, she received 100 mCi of radioactive iodine therapy (RAIT) with the whole-body scan showing only moderate neck uptake. Her suppressed thyroglobulin (Tg) before RAI was 1.1 ng/mL. She maintained biochemical evidence of disease, with serum Tg levels of 7.6 ng/mL. She got pregnant 14 months after RAIT, and during pregnancy, Tg increased to 21.5 ng/mL. After delivery, Tg decreased to 14 ng/mL but, 6 months later, rose again and reached 31.9 ng/mL on the last follow-up visit. TSH was always suppressed during follow-up. At the time of SO diagnosis, a chest computed tomography scan showed 4 bilateral lung micronodules in the upper lobes which were nonspecific, and 9 months after diagnosis, a pelvic MRI revealed a suspicious cystic nodule located on the oophorectomy bed. These lung and pelvic nodules remained stable during follow-up. Neck ultrasonography, abdominal MRI, and fluorodeoxyglucose-positron emission tomography showed no suspicious lesions. Discussion/Conclusion: As for DTC, pregnancy seems to represent a stimulus to malignant SO growth. This can be caused by the high levels of estrogen during pregnancy that may bind to receptors in malignant cells and/or by the high levels of hCG which is known to stimulate TSH receptors.
Center of Genomic Medicine, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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for malignancies are above 90% if they exclude the non-diagnostic and the suspicious cytological results [ 3 , 4 , 5 , 6 ]. One attempt to separate the suspicious FNA in benign and malignant nodules is to add additional diagnostic features to the
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) [ 5 ]. Accurate FNA cytology diagnosis is dependent upon a number of factors including the skills of the operator, FNA techniques, specimen preparation, and cytology interpretation, altogether affecting the false-negative rate of benign cytology
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( 15 ), molecular cytology diagnostics ( 16 ), as well as MIT for benign ( 17 ) and malignant nodules ( 18 ). The present document incorporates and updates aspects of these guidelines, where appropriate. For more in-depth information the reader is
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underwent biopsy, we immediately compressed the biopsy site and they were observed with self manual compression of the biopsy site for 20-30 min. We made an effort to obtain the qualified cytology and histology specimens at each FNA and CNB procedure
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Departments of Biopathology, Centre François Baclesse, Caen, France
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Introduction Fine needle aspiration (FNA) cytology of thyroid nodules is considered as the key tool to distinguish between benign and malignant tumors [ 1 ]. However, FNA cytology is classified as indeterminate in approximately 20–30% of
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Inclusion criteria were the presence of a thyroid nodule >5 mm and FNAB of this nodule performed or surgery planned at the time of ultrasound examination and finally performed within the study period. Exclusion criteria were absent cytology by FNAB or
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Fleury Medicine and Health, São Paulo, Brazil
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Fleury Medicine and Health, São Paulo, Brazil
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Fleury Medicine and Health, São Paulo, Brazil
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Fleury Medicine and Health, São Paulo, Brazil
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), NTD, ATD, and CRF, besides samples stimulated after the pentagastrin test and from the washout of fine-needle aspiration cytology (FNAC). Subjects and Methods Subjects and Samples We collected blood samples from 794 patients (2-84 years old
