The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues ...The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,展开更多
The increasing incidence of papillary thyroid microcarcinoma(PTMC)has become a global challenge.Because of its indolent nature,active surveillance(AS)has been proposed as a treatment option in selected PTMC patients t...The increasing incidence of papillary thyroid microcarcinoma(PTMC)has become a global challenge.Because of its indolent nature,active surveillance(AS)has been proposed as a treatment option in selected PTMC patients to prevent surgery-related complications.However,only a few patients with PTMC receive the AS approach because of the serious psychological burden following the“cancer”diagnosis and the uncertainty of the timing for metastatic dissemination.Ultrasound(US)-guided thermal ablation can bridge the gap in the treatment options of PTMC patients who wish for a minimally invasive management approach.However,it has acquired only marginal attention from the thyroid guideline societies because of concerns regarding incomplete elimination.The recently published guidelines from the European Thyroid Association-Cardiovascular and Interventional Radiological Society of Europe and the American Head Neck Society Endocrine Section-initiated global consensus provide the most definitive evidence and essential foundational experience to address the long-term controversy over USguided thermal ablation for low-risk PTMC patient management and facilitate the responsible global dissemination of minimally invasive strategies.展开更多
BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PT...BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PTMC are rarely seen.Here,we present a patient with coexisting liver and lung metastases from PTMC.CASE SUMMARY We describe a 26-year-old woman with PTMC with multiple concurrent metastases.After 3 d of unexplained fever,she was admitted to our hospital.Her thyroid functional tests were abnormal.Her positron emission tomography(PET)/magnetic resonance imaging(MRI)examination showed increased fluorodeoxyglucose(FDG)metabolism and space-occupying lesions in the left lobe of the thyroid.Additionally,PET/MRI images revealed multiple nodules in the lung and liver with increased FDG metabolism.Chest computer tomography(CT)showed multiple pulmonary metastases.Abdominal ultrasound and liver MRI showed multiple space-occupying lesions in the liver.The patient underwent total thyroidectomy and central lymph node dissection.Postoperative pathological analysis showed a papillary microcarcinoma multiplex in the left lobe of the thyroid.A diagnosis of hepatopulmonary metastases from papillary thyroid microcarcinoma was made.The patient was given iodine-131 treatment one year after the surgery.She recovered well after the operation,and the incision healed well.After discharge,she was treated with oral levothyroxine sodium tablets,and symptomatic and supportive treatments were also given to promote radioactive excretion and prevent bone marrow suppression by iodine-131 treatment.CONCLUSION Since patients with thyroid cancer concurrent with hepatopulmonary metastases have rarely been reported,our case will highlight the clinical and pathological profiles of these patients.展开更多
In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyro...In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas,which exhibit slow growth rates with indolent courses.A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis,as the majority of these tumors would not likely result in death if left untreated.Although surgical resection was the classical standard therapy for papillary microcarcinomas,active surveillance(AS)has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery.Despite the encouraging results of AS,its implementation in clinical practice is strongly influenced by psychosocial factors.The aim of this review is to describe the epidemiology,clinical evolution,prognostic factors,and mortality of papillary thyroid microcarcinomas.We also summarize the AS strategy according to published evidence,characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics,as well as analyze the current limitations for AS implementation.展开更多
The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, inclu...The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic thyroid carcinoma (ATC). PTC tends to have an indolent clinical course with low morbidity and mortality. However, this entity has a broad range of biological and clinical behavior that can result in disease recurrence and death, depending on patient and tumor characteristics and the initial treatment approach. PTC is the most common form of well-differentiated thyroid cancer (WDTC) and based on the most recent statistics, accounts for approximately 89.4% of all thyroid malignancies. PTC appears as an irregular solid or cystic nodule in normal thyroid parenchyma. PTC has the propensity for lymphatic invasion, but it is less likely to have hematogenous spread. Around 11% of patients with PTC present with distant metastases outside the neck and mediastinum. This manuscript with review the current understanding of the epidemiology, pathology, molecular characteristics, prognostic factors, and dynamic risk stratification of PTC centered on an evidence-based and personalized approach.展开更多
Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and rest...Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.展开更多
Background:Thyroid carcinoma(TC)accounts for almost 0.5%–1%of total malignancies.Its incidence is increasing rapidly worldwide.Several studies have drawn up the epidemiological profile of TC and its clinical and path...Background:Thyroid carcinoma(TC)accounts for almost 0.5%–1%of total malignancies.Its incidence is increasing rapidly worldwide.Several studies have drawn up the epidemiological profile of TC and its clinical and pathological features.However,to date,no similar studies have been conducted in Tunisia.Aims:To establish an epidemiological profile of TC in a Tunisian health care institute and to analyze its clinical and histopathological characteristics in our institute.Materials and Methods:We present a retrospective study reviewing the cases of TC diagnosed in our institution in a 4-year period.Results:We collected a sample of 192 cases of TC.It consisted of 31 males and 161 females(83.8%)with a sex-ratio M/F of 0.19.The mean age was 46.4 years.Papillary thyroid carcinoma was the most frequent histological subtype.The multifocality rate was 33.8%.The mean size of TC was 2.2±1.9 cm.60.9%of TC were staged pT1 and 20.3%had nodal involvement.Papillary thyroid microcarcinomas were noted in 37.5%of cases.Conclusion:Our results were consistent with those of the literature.A high proportion of pT1 and pN0 tumors were noted in our series,suggesting that TC's diagnosis and management was performed at an early stage of the disease in our institution.In addition,our study enabled us to notice the impact of the Coronavirus disease 19 crisis on the management of TC in our institution.Further studies are needed to establish the epidemiological profile of TC in Tunisia and to assess its clinical and pathological features.展开更多
文摘The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,
文摘The increasing incidence of papillary thyroid microcarcinoma(PTMC)has become a global challenge.Because of its indolent nature,active surveillance(AS)has been proposed as a treatment option in selected PTMC patients to prevent surgery-related complications.However,only a few patients with PTMC receive the AS approach because of the serious psychological burden following the“cancer”diagnosis and the uncertainty of the timing for metastatic dissemination.Ultrasound(US)-guided thermal ablation can bridge the gap in the treatment options of PTMC patients who wish for a minimally invasive management approach.However,it has acquired only marginal attention from the thyroid guideline societies because of concerns regarding incomplete elimination.The recently published guidelines from the European Thyroid Association-Cardiovascular and Interventional Radiological Society of Europe and the American Head Neck Society Endocrine Section-initiated global consensus provide the most definitive evidence and essential foundational experience to address the long-term controversy over USguided thermal ablation for low-risk PTMC patient management and facilitate the responsible global dissemination of minimally invasive strategies.
基金Supported by the Joint Funds of the Zhejiang Provincial Natural Science Foundation of China,No.LBY21H030001the Science and Technology Planning Project of Zhejiang Province,No.2020KY708.
文摘BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PTMC are rarely seen.Here,we present a patient with coexisting liver and lung metastases from PTMC.CASE SUMMARY We describe a 26-year-old woman with PTMC with multiple concurrent metastases.After 3 d of unexplained fever,she was admitted to our hospital.Her thyroid functional tests were abnormal.Her positron emission tomography(PET)/magnetic resonance imaging(MRI)examination showed increased fluorodeoxyglucose(FDG)metabolism and space-occupying lesions in the left lobe of the thyroid.Additionally,PET/MRI images revealed multiple nodules in the lung and liver with increased FDG metabolism.Chest computer tomography(CT)showed multiple pulmonary metastases.Abdominal ultrasound and liver MRI showed multiple space-occupying lesions in the liver.The patient underwent total thyroidectomy and central lymph node dissection.Postoperative pathological analysis showed a papillary microcarcinoma multiplex in the left lobe of the thyroid.A diagnosis of hepatopulmonary metastases from papillary thyroid microcarcinoma was made.The patient was given iodine-131 treatment one year after the surgery.She recovered well after the operation,and the incision healed well.After discharge,she was treated with oral levothyroxine sodium tablets,and symptomatic and supportive treatments were also given to promote radioactive excretion and prevent bone marrow suppression by iodine-131 treatment.CONCLUSION Since patients with thyroid cancer concurrent with hepatopulmonary metastases have rarely been reported,our case will highlight the clinical and pathological profiles of these patients.
文摘In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas,which exhibit slow growth rates with indolent courses.A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis,as the majority of these tumors would not likely result in death if left untreated.Although surgical resection was the classical standard therapy for papillary microcarcinomas,active surveillance(AS)has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery.Despite the encouraging results of AS,its implementation in clinical practice is strongly influenced by psychosocial factors.The aim of this review is to describe the epidemiology,clinical evolution,prognostic factors,and mortality of papillary thyroid microcarcinomas.We also summarize the AS strategy according to published evidence,characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics,as well as analyze the current limitations for AS implementation.
文摘The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic thyroid carcinoma (ATC). PTC tends to have an indolent clinical course with low morbidity and mortality. However, this entity has a broad range of biological and clinical behavior that can result in disease recurrence and death, depending on patient and tumor characteristics and the initial treatment approach. PTC is the most common form of well-differentiated thyroid cancer (WDTC) and based on the most recent statistics, accounts for approximately 89.4% of all thyroid malignancies. PTC appears as an irregular solid or cystic nodule in normal thyroid parenchyma. PTC has the propensity for lymphatic invasion, but it is less likely to have hematogenous spread. Around 11% of patients with PTC present with distant metastases outside the neck and mediastinum. This manuscript with review the current understanding of the epidemiology, pathology, molecular characteristics, prognostic factors, and dynamic risk stratification of PTC centered on an evidence-based and personalized approach.
文摘Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.
文摘Background:Thyroid carcinoma(TC)accounts for almost 0.5%–1%of total malignancies.Its incidence is increasing rapidly worldwide.Several studies have drawn up the epidemiological profile of TC and its clinical and pathological features.However,to date,no similar studies have been conducted in Tunisia.Aims:To establish an epidemiological profile of TC in a Tunisian health care institute and to analyze its clinical and histopathological characteristics in our institute.Materials and Methods:We present a retrospective study reviewing the cases of TC diagnosed in our institution in a 4-year period.Results:We collected a sample of 192 cases of TC.It consisted of 31 males and 161 females(83.8%)with a sex-ratio M/F of 0.19.The mean age was 46.4 years.Papillary thyroid carcinoma was the most frequent histological subtype.The multifocality rate was 33.8%.The mean size of TC was 2.2±1.9 cm.60.9%of TC were staged pT1 and 20.3%had nodal involvement.Papillary thyroid microcarcinomas were noted in 37.5%of cases.Conclusion:Our results were consistent with those of the literature.A high proportion of pT1 and pN0 tumors were noted in our series,suggesting that TC's diagnosis and management was performed at an early stage of the disease in our institution.In addition,our study enabled us to notice the impact of the Coronavirus disease 19 crisis on the management of TC in our institution.Further studies are needed to establish the epidemiological profile of TC in Tunisia and to assess its clinical and pathological features.
