Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.
Adenocarcinoma, Follicular

Thyroid function is usually normal in differentiated thyroid carcinoma. We describe a case of a female patient who had metastatic follicular thyroid carcinoma (FTC) to the spine and lungs, who was clinically euthyroid but had very low free tetraiodothyronine (fT4) and normal thyroid stimulating hormone (TSH). Free triiodothyronine (fT3) and total T3 (TT3) were normal. Levothyroxine treatment increased fT4 marginally but caused a two- to three-fold rise in fT3 and TT3 along with suppressed TSH. This is likely due to hyperconversion of T4 to T3 from elevation in D2 deiodinase activity in the tumor. This phenomenon has been reported to occur in about 20% of metastatic FTC.
Adenocarcinoma, Follicular

Thyroid function is usually normal in differentiated thyroid carcinoma. We describe a case of a female patient who had metastatic follicular thyroid carcinoma (FTC) to the spine and lungs, who was clinically euthyroid but had very low free tetraiodothyronine (fT4) and normal thyroid stimulating hormone (TSH). Free triiodothyronine (fT3) and total T3 (TT3) were normal. Levothyroxine treatment increased fT4 marginally but caused a two- to three-fold rise in fT3 and TT3 along with suppressed TSH. This is likely due to hyperconversion of T4 to T3 from elevation in D2 deiodinase activity in the tumor. This phenomenon has been reported to occur in about 20% of metastatic FTC.
Adenocarcinoma, Follicular

Simultaneously occurring malignancies may be detected in different organs or tissues at any given time. Patients diagnosed with a tumor may be found to have another tumor or second primary cancer. Second primary cancers (SPCs) may be further classified as synchronous or metachronous. Synchronous SPCs are lesions detected simultaneously or within 6 months after the diagnosis of the primary tumor while metachronous SPCs are tumors diagnosed 6 months after primary tumor diagnosis.1There is an increased risk of having second primary cancer in Head and Neck Squamous Cell Carcinoma (HNSCC) patients.1 In a study by Strojan et al. in 2013, among 2,106 head and neck cancer patients, 2.4% developed synchronous second primary cancers.2 A systematic review by Coco-Pelaz et al. in 2020, showed that second primary tumors most frequently occur in the head and neck area followed by the lungs and esophagus.3We present a case of follicular thyroid carcinoma with an incidental finding of cervical lymph-node metastatic squamous cell carcinoma from the tonsil and discuss the clinical presentation, ancillary procedures and management.
Adenocarcinoma, Follicular ; Positron-Emission Tomography

Malignant struma ovarii is extremely rare and difficult to diagnose histologically, particularly in cases of follicular carcinoma. This case study is intended to describe three cases of follicular proliferative lesion arising in struma ovarii that we experienced. The first case was clearly malignant given the clinical picture of multiple recurrences, but there was little histological evidence of malignancy. Our second case featured architectural and cellular atypia and necrosis and was diagnosed as malignant despite the absence of vascular and stromal invasion. Our third case exhibited solid microfollicular proliferation without any definite evidence of malignancy (even the molecular data was negative); however, we could not completely exclude malignant potential after conducting a literature review. In cases such as our third case, it has been previously suggested that a diagnostic term recognizing the low-grade malignant potential, such as "proliferative stromal ovarii" or "follicular proliferative lesion arising in the stromal ovarii" would be appropriate.
Adenocarcinoma, Follicular ; Necrosis ; Recurrence ; Struma Ovarii*

BACKGROUND: Currently, in follicular lesion of aspirates of thyroid, pathologic evaluation of surgical specimen is the only diagnostic method whether the patient had follicular thyroid malignancy or not. The aim of this study is the evaluation of the clinical utility of HBME-1 immunostaining in the diagnosis of follicular thyroid malignancy in surgical specimen, and to establish the diagnostic guideline of HBME-1 immunostaining. METHODS: From 1994 to Sep. 1999, the 72 paraffin embedded tissue, which was already diagnosed as thyroid follicular carcinoma or adenoma through the pathologic evaluation of surgical specimen, were studied. Among 72 specimens, the 29 follicular carcinoma were included, and the others were follicular adenoma. The specimens were stained with HBME-1 monoclonal antibody by standard avidin-biotin peroxidase complex methods. One limited pathologist had read the findings of the immunostaining with a basis such as percent of tumor area. These percentage were divided to 4 grade as follows: 1) Grade 0: negative stained, 2) Grade 1: stained area < 30%, 3) Grade 2: 30 < or = stained area < 60%, and 4) Grade 3: stained area > or = 60%. After we had set a basis of follicular carcinoma as more than Grade 2, defined the clinical utility of HBME-1 immunostaining. The clinical utility was based that the concordance rate between pathologic diagnosis and the findings of immunostaining was more than 80% in both groups. RESULTS: 1) There was significant difference between two groups in intensity of cellular staining (p=0.04, x2). But, there might not be helpful to rule out follicular carcinoma of thyroid from adenoma in fine-needle aspirates. 2) In both groups, the percent of stained area of tumor was very diverse from 0% to 100%, and was statistically significant different (p=0.007). 3) Because the only 5 cases of normal tissue in both groups were stained weakly, the HBME-1 immunostaining was like to specific reaction with tumor tissue in both groups. 4) When we had set a basis of follicular thyroid carcinoma as more than Grade 2 (> or = 30%), the concordance rate between pathologic diagnosis and the findings of immuno- staining was 69.7% in follicular adenoma, 65.5% in follicular carcinoma, respectively. CONCLUSION: The HBME-1 immunostaining may not be help to differentiate follicular carcinoma from adenoma.
Adenocarcinoma, Follicular ; Adenoma ; Diagnosis* ; Humans ; Paraffin ; Peroxidase ; Thyroid Gland*

Adenocarcinoma, Follicular ; genetics ; Humans ; Mutation ; Thyroid Neoplasms ; genetics

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

Adenocarcinoma, Follicular/diagnosis* ; Diagnosis, Differential ; Humans ; Metabolomics ; Thyroid Neoplasms/therapy*

Adenocarcinoma, Follicular/surgery* ; Humans ; Mucins ; Thyroid Neoplasms/surgery*