Thyroid Unit

Witry-lès-Reims, France

Thyroid Unit

Witry-lès-Reims, France
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Altinay S.,Thyroid Unit | Namal E.,Bagclar Training and Education Hospital | Erturkuner P.,Istanbul University
Oncology Letters | Year: 2014

Angiomatoid tumors of the thyroid gland are rare endocrine neoplasms, which exhibit an aggressive behavior. Angiosarcomas of the thyroid are generally reported from the European Alpine region and have a histogenesis that has been under debate for a number of years. The current study presents a rare case of angiosarcoma of the thyroid in a 62-year-old Turkish female. The patient had a 10-year history of goiter and was from the Black Sea region, an endemic goiter region of Turkey. The patient was not taking any medication at the time of admission and swelling had been observed on the right side of the neck throughout the previous few months. Thyroid function tests, which analyzed the levels of thyroid-stimulating hormone, thyroxine and triiodothyronine, were within the normal limits, however, the histopathological findings were consistent with an angiosarcoma of the thyroid. The patient rejected the complementary surgery and chemotherapy options, and is currently disease-free (as per the 15-month follow-up). The current study describes a case of angiosarcoma that was characterized by Weibel-Palade bodies, and light microscopy and immunohistochemical findings, as well as an endothelial origin, which was demonstrated via electron microscopy. To the best of our knowledge, this is the first reported case of angiosarcoma of the thyroid in a patient from Turkey to be validated by electron microscopy. Furthermore, this case is one of the few reported thyroid angiosarcoma cases in a non-Alpine region. © Spandidos Publications 2014. All rights reserved.

McFadden D.G.,Thyroid Unit | Lubitz C.,Harvard University | Donovan S.E.,Thyroid Unit | Daniels G.H.,Thyroid Unit
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Background: The diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) is increasingly common. Recent studies have suggested that FVPTC is heterogeneous and comprises multiple tumor types with distinct biological behaviors and underlying genetics.Objectives: The purpose of this work was to identify the prevalence of mutations and gene fusions in known oncogenes in a panel representative of the common spectrum of FVPTC diagnosed at an academic medical center and correlate the clinical and pathological features obtained at the initial diagnosis with the tumor genotype.Materials and Methods: We performed SNaPshot genotyping on a panel of 129 FVPTCs of ≥1 cm for 90 point mutations or small deletions in known oncogenes and tumor suppressors and identified gene fusions using an anchored multiplex PCR assay targeting a panel of rearranged oncogenes.Results: We identified a mutation or gene fusion in 70% (89 of 127) of cases. Mutations targeting theRASfamily of oncogenes were the most frequently observed class of alterations, present in36% (46 of 127) of cases, followed by BRAF mutation, present in 30% (38 of 127). We also detected oncogenic rearrangements not previously associated with FVPTC, including TFG-ALK and CREB3L2- PPARγ. BRAF mutation was significantly associated with unencapsulated tumor status.Conclusions: These data support the hypothesis that FVPTC is composed of distinct biological entities, with one class being identified by BRAF mutation and support the use of clinical genotyping assays that detect a diverse array of rearrangements involving ALK and PPARγ. Additional studies are necessary to identify genetic drivers in the 30% of FVPTCs with no known oncogenic alteration and to better predict behavior in tumors with known genotypes. Copyright © 2014 by the Endocrine Society.

Schvartz C.,Thyroid Cancer Registry | Bonnetain F.,Institute Jean Godinot | Bonnetain F.,Biostatistics and Epidemiological Unit EA 4184 | Dabakuyo S.,Thyroid Cancer Registry | And 10 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: American Thyroid Association and European Thyroid Association guidelines cannot recommend for or against radioactive iodine (RAI) ablation after surgery in low-risk differentiated thyroid cancer (DTC) patients. Objectives: The objective of the study was to assess the survival benefit of RAI for these patients. Design: We identified 1298 DTC patients at low risk treated between 1975 and 2005. Logistic regressions were used to identify variables associated to RAI and to calculate the propensity score to receive RAI after surgery. We compared overall survival (OS) and disease-free survival (DFS) according to RAI with the log-rank tests and univariate and multivariate Cox analyses. Analyses stratified on propensity score were also performed. Results: Median follow-up was 10.3yr. Nine hundred eleven patients received RAI after surgery vs. 387 patients without RAI after surgery. Using univariate analysis, 10-yr OS was found to be 95.8% in patients without RAI after surgery vs. 94.6% in RAI after surgery (P = 0.006), and 10-yr DFS was found to be 93.1% vs. 88.7% (P = 0.001). All clinical factors except sex were significantly associated with RAI. Using multivariate Cox analyses, RAI was neither significantly nor independently associated with OS (P = 0.243) and DFS (P = 0.2659). After stratification on propensity score, Cox univariate analyses showed that OS did not differ according to RAI (P = 0.3524), with a hazard ratio for RAI of 0.75 (95% confidence interval 0.40-1.38). Similarly, DFS did not differ (P = 0.48) with a stratified univariate hazard ratio of 1.11 (95% confidence interval 0.73-1.70). Conclusion: With a long-term follow-up of 10.3 yr, we failed to prove any survival benefit of RAI after surgery in a large cohort of low-risk DTC patients. Copyright © 2012 by The Endocrine Society.

Dora J.M.,Thyroid Unit | MacHado W.E.,Thyroid Unit | Geib G.,Federal University of Rio Grande do Sul | Pegas K.L.,Federal University of Rio Grande do Sul | And 3 more authors.
Endocrinologist | Year: 2010

BACKGROUND:: Thyroid cancer associated with head and neck squamous cell carcinoma (HNSCC) is rare, and management of this condition remains a matter of debate. OBJECTIVES:: To report an incidentally discovered metastatic papillary thyroid carcinoma in a patient who had surgical resection of a HNSCC. We will discuss the therapeutic approach to thyroid tumors found in this circumstance. DESIGN:: A case study and a review of the literature were performed. RESULTS:: A case of incidental follicular variant papillary thyroid carcinoma found during resection for a HNSCC was studied. A series of studies indicate that the prognosis is ultimately determined by the HNSCC stage. CONCLUSION:: Management of thyroid cancers in patients with HNSCC should be based on balance between prognoses of both neoplasms. © 2010 by Lippincott Williams & Wilkins.

Bardet S.,Thyroid Unit | Ciappuccini R.,Thyroid Unit | Quak E.,Thyroid Unit | Rame J.-P.,Center Francois Baclesse | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: The impact of microscopic nodal involvement on the risk of persistent/recurrent disease (PRD) remains controversial in patients with papillary thyroid carcinoma (PTC). Objective: The goal of the study was to assess the risk of PRD and the 4-year outcome in PTC patients according to their initial nodal status [pNx, pN0,pN1microscopic (cN0/pN1) orpN1macroscopic (cN1/pN1)]. Design: We conducted a retrospective cohort study. Patients: The study included 305 consecutive PTC patients referred for radioiodine ablation from 2006 to 2011. Main Outcome Measure: We evaluated the risk of structural PRD and the disease status at the last follow-up. At ablation, persistent disease was consistently assessed by using post-radioiodine ablation scintigraphy combining total body scan and neck and thorax single-photon computed tomography- computed tomography (SPECT-CT) acquisition. Results: Of 305 patients, 128 (42%) were pNx, 84 (28%) pN0, 44 (14%) pN1 microscopic, and 49 (16%) pN1 macroscopic. The 4-year cumulative risk of PRD was higher in pN1 macroscopic than in pN1 microscopic patients (49% vs 24%, P = .03), and higher in pN1 microscopic than in pN0 (12%, P = .01) or pNx patients (6%, P <.001). On multivariate analysis, tumor size of 20 mm or greater [relative risk (RR) 3.4; P=.0001], extrathyroid extension (RR 2.6; P<.003), pN1 macroscopic (RR 4.5; P<.0001), and pN1 microscopic (RR 2.5; P<.02) were independent risk factors for PRD. At the last visit, the proportion of patients with no evidence of disease decreased from pNx (98%), pN0 (93%), and pN1 microscopic (89%) to pN1 macroscopic patients (70%) (P<.0001, Cochran-Armitage trend test). Extrathyroid extension (odds ratio 9.7; P <.0001) and N1 macroscopic (OR 4.9; P <.001) independently predicted persistent disease at the last visit, but N1 microscopic did not. Conclusions: Patients with microscopic lymph node involvement present an intermediate outcome between that observed in pN0-pNx patients and pN1 macroscopic patients. These data may justify modifications to the risk recurrence staging systems. © 2015 by the Endocrine Society.

Liu X.,Nanjing Medical University | Cai Y.,Nanjing Medical University | Wang Z.,Nanjing Medical University | Cui D.,Nanjing Medical University | And 14 more authors.
International Journal of Clinical and Experimental Pathology | Year: 2016

Background: Controversy exists about the diagnostic value of liquid-based cytology (LBC) compared to conventional smears (CS). Most prior studies of LBC were performed using ThinPrep system. Few studies have ever compared the adequacy rate of SurePath with conventional smears. Methods: We performed a prospective comparison of LBC using SurePath with CS in 304 thyroid nodules. Four needle sticks constituted a single nodule FNA, with 2 passes used for CS while the other 2 passes were used for SurePath. Cytopathologists separately read all samples, and all slides were reported using the Bethesda system for reporting thyroid cytology. The adequacy rate was compared between the CS and SurePath groups. Results: The adequacy rate for all solid nodules was 78.2% in CS group, significantly higher than 68.0% in the SurePath group (P=0.006). No significant difference was seen for mixed or cystic nodules. The adequacy rate using a combination of CS and SurePath in solid nodules was 86.4%, significantly higher than 78.2% in CS group (P < 0.001). When excluding nodules less than 1 cm, the adequacy rate of CS for solid nodules was 83.5%, significantly higher than 71.3% in SurePath group (P=0.02). The adequacy rate of combination of CS and SurePath was 91.3% for solid nodules, significantly higher than 83.5% in CS group (P=0.04). Conclusion: Our study showed that LBC using SurePath is not superior to conventional smears. However, a combination of both SurePath and CS may yield the most favorable adequacy rate compared to either process separately.

Flux G.D.,Royal Marsden NHS Foundation Trust | Haq M.,Thyroid Unit | Chittenden S.J.,Royal Marsden NHS Foundation Trust | Buckley S.,Royal Marsden NHS Foundation Trust | And 3 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2010

Purpose: The aim of this study was to determine the range of absorbed doses delivered to thyroid remnants, blood, and red marrow from fixed administrations of radioiodine and to ascertain whether the success of ablation is more dependent on these absorbed doses than on the administered activity. Methods: Twenty-three patients received 3,000 MBq radioiodine following near-total thyroidectomy. The maximum absorbed dose to remnants was calculated from subsequent single photon emission tomography scans. Absorbed doses delivered to blood and red marrow were calculated from blood samples and from whole-body retention measurements. The protein bound iodine (PBI) was also calculated. Results: Maximum absorbed doses to thyroid remnants ranged from 7 to 570 Gy. Eighteen of the 23 patients had a successful ablation. A significant difference was seen between the absorbed doses delivered to thyroid remnants, blood, and red marrow for those patients that had a successful ablation compared to those with a failed ablation (p=0.030, p=0.043 and p=0.048, respectively). The difference between the PBI values acquired at day 1 and day 6 were also indicative of response (p=0.074). Conclusions: A successful ablation is strongly dependent on the absorbed dose to the thyroid remnant. Dosimetry-based personalized treatment can prevent both sub-optimal administrations, which entails further radioiodine therapy, and excessive administration of radioactivity, which increases the potential for radiation toxicity. © 2009 Springer-Verlag.

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