A 23-year-old woman underwent left thyroid lobectomy and isthmusectomy for a 2 cm diameter firm mass on the left side of the neck that was also visualized on ultrasonography. The specimen consisted of a 22-gram thyroid gland composed of the left lobe, isthmus and a pyramidal lobe. Cut section of the left lobe showed a 3.5 cm diameter solitary, discrete and encapsulated mass with a tan lobulated and solid cut surface. The rest of the thyroid tissues had red-brown meaty cut surfaces. Microscopic section shows a follicular-patterned proliferation enclosed by a thin fibrous capsule with frequent Sanderson polster-like papillary excrescences. (Figures 1 and 2) Both the follicular and the papillary structures are lined by cuboidal to columnar follicular epithelial cells that had ample eosinophilic to pale cytoplasm and uniformly sized, minimally enlarged, generally round, and monolayered nuclei without nuclear grooving, folds, pseudoinclusions, and chromatin clearing. There are no mitotic figures seen. Some of the papillary structures have delicate vascular cores. (Figure 3) There are no psammoma bodies noted. The follicles contain variable amounts of pale eosinophilic colloid ranging from colloid-poor crowded follicles to those with ample colloid that have frequent peripheral scalloping. (Figure 4) Exhaustive sections failed to disclose capsular or vascular invasion. Based on the microscopic features, a diagnosis of follicular adenoma with papillary architecture was rendered.
Follicular thyroid carcinoma ; papillary thyroid carcinoma

Background: The majority of thyroid malignancies are differentiated thyroid carcinomas (DTCs). We examined the incidence, disease extent, recurrence and disease-specific mortality (DSM) of DTC among Filipinos residing in the Philippines and Filipino immigrants. Methodology: In accordance with the 2020 PRISMA statement, we performed a systematic literature search in MEDLINE, Google Scholar, EBSCO, Cochrane and Clinicaltrials.gov for the period January 1, 1980 until January 27, 2022. Pooled incidence rate ratio and pooled proportions of disease extent, recurrence and DSM were determined. Results: Literature search yielded 1,852 studies. Out of 26 articles retrieved, nine retrospective case controls and cohorts were included. Incidence of DTC was significantly higher in female Filipino immigrants compared with non-Hispanic whites (NHW). Distant metastases and recurrence were more common among Filipinos and Filipino immigrants compared with NHW. Limited data showed higher DSM in Filipino immigrants and NHW than Filipinos, which may be influenced by reporting bias. Conclusion This review supports the trend of increased incidence and recurrence of DTC among Filipinos, although case registries are essential to confirm these findings. In the setting of the newly released Philippine guidelines for DTC, prospective studies with active long-term follow-up will help detect any changes in the outcomes of DTC among Filipinos.
Filipino ; papillary thyroid carcinoma ; follicular thyroid carcinoma

We report a case of an uncommonly aggressive presentation of the rare entity of synchronous papillary (PTC) and follicular thyroid carcinomas (FTC) in a 67-year-old woman initially presenting with thyrotoxicosis from Graves’ disease. She was found to have two thyroid nodules with extensive intra-cardiac tumour thrombus, symptomatic left pelvis bony metastasis with pathological fracture, pulmonary metastases and mediastinal lymph node metastases. Further investigations suggested a diagnosis of synchronous papillary and metastatic follicular thyroid cancer. Treatment with radical surgery followed by adjuvant therapeutic radioiodine ablation was proposed, but the patient declined all forms of cancer-specific therapy and was elected solely for a palliative approach to treatment. We discuss the diagnostic considerations in arriving at the diagnosis of synchronous thyroid malignancy – in this case the clear features of PTC and the strong probability of FTC due to invasiveness and metastatic follicular lesions. This case underscores potential limitations of the ACR TI-RADS system, notably with certain ultrasonographic features suggesting malignancy that might not be adequately captured. Notably, the aggressive presentation of DTC in this case may be contributed by the concurrent presence of Graves’ Disease, suggesting heightened vigilance when assessing potential thyroid malignancies in such patients.
Papillary Thyroid Carcinoma ; Thyroid Cancer, Papillary ; Follicular Thyroid Carcinoma ; Adenocarcinoma, Follicular ; Graves Disease

Adenocarcinoma, Follicular/surgery* ; Carcinoma, Squamous Cell ; Humans ; Thyroid Neoplasms/surgery*

PURPOSE: The goal of this study was to validate the ultrasonography (US) and cytopathological features that are used in the diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) and to characterize the role of BRAF(V600E) mutation analysis in the diagnosis of FVPTC. METHODS: From May 2012 to February 2014, 40 thyroid nodules from 40 patients (mean age, 56.2 years; range, 26 to 81 years) diagnosed with FVPTC were included in this study. The US features of the nodules were analyzed and the nodules were classified as probably benign or suspicious for malignancy. Twenty-three thyroid nodules (57.5%) underwent BRAF(V600E) mutation analysis. Clinical information and histopathologic results were obtained by reviewing the medical records of the patients. RESULTS: Thirty nodules (75.0%) were classified as suspicious for malignancy, while 10 (25.0%) were classified as probably benign. Seven of the eight nodules (87.5%) with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology showed suspicious US features, while one of the two nodules (50.0%) with follicular neoplasm cytology presented suspicious US features. Five of the 23 nodules (21.7%) that underwent BRAF(V600E) mutation analysis had positive results, all of which were diagnosed as suspicious for malignancy or malignant based on cytology. None of the nodules with benign, AUS/FLUS, or follicular neoplasm cytology were positive for the BRAF(V600E) mutation. CONCLUSION: US features allow nodules to be classified as suspicious for malignancy, and the presence of suspicious US features in nodules with ambiguous cytology may aid in the diagnosis of FVPTC. BRAF(V600E) mutation analysis is of limited value in the diagnosis of FVPTC.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Carcinoma, Papillary, Follicular ; Diagnosis ; Humans ; Medical Records ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Ultrasonography*

PURPOSE: This study assessed the adequacy and accuracy of ultrasonography (US)-guided fine-needle aspiration (US-FNA) of solid thyroid nodules, less than 5 mm in maximum diameter. MATERIALS AND METHODS: From January to December 2009, US-FNA was performed for small solid thyroid nodules in 201 patients. Each thyroid nodule was classified into group A and B according to the largest diameter (1 mm < or = group A < 3 mm and 3 mm < or = group B < 5 mm). The adequacy and accuracy of US-FNA in two groups were compared using the histopathological results as a reference standard. RESULTS: Of the 227 thyroid nodules in 201 patients, the inadequacy of US-FNA in group A and B was 24.3% (18/74) and 13.1% (20/153), respectively, showing a statistically significant difference between the two groups (p = 0.0333, chi-square test). Eighty nodules were removed surgically in 72 patients, from which papillary thyroid carcinoma (n = 52), follicular thyroid carcinoma (n = 1), nodular hyperplasia (n = 26), and pseudonodule related to thyroiditis (n = 1) were confirmed. Based on the histopathological results of the 80 surgical nodules, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US-FNA in group A and B were 55.0% and 79.4%, 81.8% and 100%, 84.6% and 100%, 50% and 68.2%, and 64.5% and 85.7%, respectively. CONCLUSION: The adequacy and accuracy of US-FNA for solid thyroid nodules, > or = 3 mm in the largest diameter, were higher than those of US-FNA for very small nodules, < 3 mm in the largest diameter.
Adenocarcinoma, Follicular ; Biopsy, Fine-Needle ; Carcinoma ; Humans ; Hyperplasia ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroiditis

Thyroid carcinoma is the most common endocrine maligancy, and the worldwide incidence has been rising in recent years. Differentiated thyroid carcinoma is the most common thyroid malignancy, which include thyroid papillary carcinoma and follicular thyroid carcinoma, accounting for about 90 percent of thyroid carcinoma incidence. Currently, surgical treatment, iodine radiotherapy and TSH suppressive therapy are the commonly accepted effective treatments for differentiated thyroid carcinoma, and most patients can be cured. But there are still some patients not sensitive to the general treatments, who have lost the treatment of opportunity. Molecular targeted therapy is an agonistic or suppressive treatment for molecular biology targets of malignant tumor, and currently is a frontier research in the field of malignancy treatment. By retrieving and analyzing the related literature of molecular targeted therapy of thyroid carcinoma through PUBMED in the past 5 years, the article introduced the current status of molecular targeted therapy of thyroid carcinoma.
Adenocarcinoma, Follicular ; drug therapy ; Carcinoma ; drug therapy ; Carcinoma, Papillary ; Humans ; Molecular Targeted Therapy ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; drug therapy

The molecular approaches to human diseases are receiving greater attention following the completion of the Human Genome Project. Molecular biology techniques are being widely applied to the field of tumor biology, and thyroid carcinomas are not an exception; several genetic alterations have been suggested to play roles in thyroid carcinogenesis and its progression. Malignant tumors arising from thyroid follicular cells can be classified into papillary carcinoma, follicular carcinoma, poorly differentiated carcinoma and anaplastic carcinoma. BRAF mutation, RET/PTC rearrangement and RAS mutation are the suggested molecular causes of papillary thyroid carcinoma (PTC). RAS mutation, PAX8- PPARγ rearrangement, PTEN mutation or methylation, and PIK3CA mutation are known to induce follicular thyroid carcinoma (FTC). Poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma (ATC) are related to adding p53 or β-catenin gene alterations to those of papillary or follicular carcinomas. The more aggressive genetic alterations are added stepwise as thyroid tumors advance from differentiated PTC or FTC to less differentiated PDTC and finally to ATC. Studying the molecular mechanisms underlying thyroid carcinogenesis may help overcome the limitations of the current diagnostic methods and this may provide more accurate diagnostic and prognostic tools. Furthermore, research at the molecular level is essential for personalized therapies and creating targeted therapies for thyroid carcinomas.
Adenocarcinoma, Follicular ; Biology ; Carcinogenesis ; Carcinoma ; Carcinoma, Papillary ; Human Genome Project ; Humans ; Methylation ; Molecular Biology ; Oncogenes ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms*

Humans ; Thyroid Neoplasms/pathology* ; Carcinoma, Papillary/pathology* ; World Health Organization ; Adenocarcinoma, Follicular/pathology*

Incidence of thyroid carcinoma has increased dramatically; however, simultaneous occurrence of different tumors in a single thyroid gland is rare and the embryologic or molecular explanations for such cases lack a solid basis. We report on a 67-year-old woman who underwent surgery for cytologically undetermined nodules in the bilateral thyroid glands. Postoperative pathology findings indicated synchronous occurrence of discrete papillary, follicular, and medullary thyroid carcinoma. She has remained disease-free after postoperative radioactive iodine therapy (130 mCi). This is the fifth report on the synchronous occurrence of different tumors in a single thyroid gland worldwide, and the first ever in Asia.
Adenocarcinoma, Follicular ; Aged ; Asia ; Carcinoma, Medullary* ; Female ; Humans ; Incidence ; Iodine ; Neoplasms, Multiple Primary ; Pathology ; Thyroid Gland* ; Thyroid Neoplasms