OBJECTIVE: Thyroid cancer, though relatively uncommon among all cancer types, stands as the primary form of endocrine tumor. Over the last 20 years, there has been a significant uptick in its occurrence. Papillary thyroid carcinoma (PTC), which is well-differentiated, emerges as the dominant subtype, in regions where iodine levels are deemed adequate. The study aimed to study the clinicopathological profile of patients diagnosed with thyroid malignancies at the Muslim Educational Society (MES) Medical College Perinthalmanna.
METHODS: This is a retrospective study undertaken at the MES Medical College by the Department of General Surgery and Endocrine Surgery. The study focuses on patients who have been diagnosed with thyroid cancer through a biopsy. Case sheets of all those patients diagnosed with thyroid malignancy were referred from the Medical Records Library to collect the relevant medical and sociodemographic data. This data was entered in the proforma, which was transferred to the Excel sheet and processed in IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States).
RESULTS: The study included predominantly middle-aged individuals (40-60 years), with 22 (55%) falling within this age range, followed by 14 (35%) aged between 20 and 40 years, and only four (10%) above 60 years. Female patients constituted 82.5% of the study group. Most cases presented with swelling lasting less than six months 23 (57.5%), while only four (10%) had swelling lasting more than five years. Compression symptoms were rare, with only three (7.5%) experiencing dysphagia or dyspnea. Pain was reported in two (5%) of the cases. Hypothyroidism, toxic manifestations, or hoarseness were observed in one (2.5%) of the patients. Regarding swelling characteristics, most were greater than 4 cm in size (29, 72%) and firm in consistency (25, 62.5%). Nodular surfaces were present in 19 (47.5%) of the cases, while 38 (95%) of the swellings were mobile. Palpable lymph nodes were noted in 13 (32.5%) of cases. Radiologically, hypoechoic lesions were observed in 26 (65%) of cases, with microcalcification in 29 (72.5%) and peripheral vascularity in 31 (77.5%). Papillary carcinoma was the most common histological type (34, 85%), with medullary and follicular carcinomas accounting for five (12.5%) and one (2.5%), respectively. An association was found between the duration of swelling and histological type (p = 0.05) and between the mobility of swelling and histological type (p < 0.05). However, no significant associations were observed between imaging findings and histological type (p > 0.05). The gender distribution did not show a statistically significant association with histological type.
CONCLUSIONS: The findings of the study revealed a statistically insignificant association between age, gender, clinical features, and the histological type of thyroid malignancy. Additionally, there was no statistically significant association between the histological type of thyroid malignancy and the size or type of surface or consistency of thyroid swelling or ultrasonographic findings of the swelling like echogenicity, microcalcification, increased peripheral vascularity, or loss of peripheral halo.

This article reports a case of primary thyroid diffuse large B-cell lymphoma involving the superior mediastinum with Hashimoto\'s thyroiditis admitted to the Department of Otolaryngology and Head and Neck Surgery, First Hospital of Jilin University. This patient underwent right thyroid lobectomy and was transferred to the Department of Hematology of the Oncology Center for 6 courses of chemotherapy with R-CHOP protocol. The postoperative recovery was good, and the patient was regularly followed up for 12 months after the operation. The patient\'s condition was stable, and CT showed no abnormally high metabolism in the operation area indicating the inhibition of tumor activity, superficial lymph nodes and peripheral blood cells were normal. The case encountered many difficulties in the diagnosis process, and the diagnosis was not confirmed after puncture in two Grade III Class A hospitals in China. There are few patients with primary thyroid diffuse large B-cell lymphoma complicated with Hashimoto\'s thyroiditis, and it is particularly rare to invade the mediastinum. There is no report in China and abroad in the literature we reviewed. Therefore, this article reports the case and retrospectively analyzes the etiology, clinical symptoms, diagnosis and treatment of primary thyroid lymphoma.
摘要: 本文报道了吉林大学第一医院耳鼻咽喉头颈外科收治的1例累及上纵隔的原发于甲状腺的弥漫大B细胞淋巴瘤且合并桥本甲状腺炎患者，行右侧甲状腺腺叶切除术后转入肿瘤中心血液科接受R-CHOP方案化疗6个疗程，术后恢复良好，定期随访至12个月患者病情稳定，术区未见异常高代谢灶，考虑肿瘤活性抑制，浅表淋巴结、外周血细胞未见异常。该患者在诊断过程中遇到很多困难，先后就诊于国内2家三级甲等医院行穿刺后均未能确诊。原发于甲状腺的弥漫大B细胞淋巴瘤合并桥本甲状腺炎的患者不多，且侵及纵隔者尤为罕见，笔者在所查阅的资料中未见国内外相关报道。因此，本文将该病例进行报道，并回顾分析原发于甲状腺的淋巴瘤的病因、临床症状、诊断和治疗。.

Non-Hodgkin lymphoma (NHL) of the thyroid is a very rare condition. Swelling of the neck is the usual presentation among patients. Of all thyroid malignancies, only a very small portion accounts for NHL of the thyroid. Here, we present two cases of diffuse large B-cell NHL of the thyroid. Preoperative diagnosis helps in the management of patients with chemotherapy, but in rare cases, surgical removal of the thyroid is done to reduce obstructive symptoms. The diagnosis is usually made based on fine-needle aspiration cytology and biopsy with immunohistochemistry. In these two cases, the patients presented with a history of a rapidly growing mass in the neck for three to four months, but the treatment modalities differed. In one of the cases, the patient received six cycles of chemotherapy, and in the other case, the patient underwent a total thyroidectomy, followed by six cycles of chemotherapy, though chemotherapy is the standard treatment option over surgical removal of the thyroid.

Aims We aimed to assess the incidence of the BRAF V600E mutation in thyroid neoplasms at a tertiary care center and its association with various phenotypic features. Methods and material We included all cases diagnosed as thyroid neoplasm in the past decade at the Department of Pathology of our institute and obtained their clinical details from the medical records department of the institute after obtaining permission from the authorities and due International Human Epigenome Consortium clearance. We included data on age, sex, clinical presentation, hormone status, and T and N status of the malignant neoplasms. Hematoxylin and eosin (H&E) slides of all cases were evaluated for the type of neoplasm, nuclear features, invasion into the capsule and vascular spaces, extrathyroidal extension, lymph node metastases, mitoses, necrosis, and presence/absence of amyloid. Paraffin blocks of sections with high tumor density and less normal tissue were chosen for evaluation after H&E staining. The slides showing tumors with large areas of hemorrhage, cystic change, or necrosis were excluded. Two primers were used to amplify a 339-bp fragment containing the V600E mutation in exon 15 of BRAF. Tissues were prepared from formalin-fixed paraffin-embedded (FFPE) blocks, and DNA was isolated using a standard protocol BRAF NF and BRAF NR Primer Standardized Protocol For FFPE Tissue DNA. Percentages and tables have been used for data presentation. Results Among 47 identified cases, 14 were positive for the BRAF V600E mutation and had papillary carcinoma (n = 9) or follicular neoplasms (n = 5; follicular adenoma, n = 3; follicular carcinoma, n = 2). In the BRAF-positive papillary carcinomas, five cases were aged 20-30 years, eight were female, eight (88.88%) were euthyroid, and one was hypothyroid. Furthermore, 55.55% (5/9 cases) of BRAF-positive cases were stage I, 33.3% (3/9 cases) were stage II, and 0.02% (1/9 cases) were stage III. Conclusions In our cohort, 31% of cases of papillary thyroid carcinoma (PTC) and 18.72% of follicular neoplasms expressed the BRAF V600E mutation. BRAF V600E mutation-positive papillary thyroid carcinomas consistently showed all characteristic nuclear features, such as nuclear crowding, overlapping, and grooves. Considering the greater prevalence in the younger age group, the importance of mutation surveillance in PTCs for a total thyroidectomy may be warranted in mutation-positive patients.

According to National Cancer Registry Program, Thiruvananthapuram district of Kerala, has the highest relative frequency of thyroid carcinomas; nevertheless, limited data exist regarding its socio-demographic and clinico-pathological characteristics. The aims of the study were to assess the: (1) demographic characteristics, (2) histopathological features and the relative frequency of various thyroid carcinoma cases and papillary thyroid carcinoma (PTC) subtypes, (3) rising trend of papillary microcarcinomas, and (4) associated lesions. A retrospective study wherein 170 cases of thyroid malignancies reported in our single institution over a period of 8 years period was reviewed. PTC accounted for 97% cases, followed by medullary (n = 4; 2.4%) and follicular carcinoma (n = 1; 0.6%). There was female preponderance (p = 0.0379) with a lower median age in females (p = 0.0275). Among the PTCs, conventional type constituted 53.4% cases (n = 87), followed by microcarcinomas (n = 34; 20.9%), follicular variant (n = 28; 17.2%), and others 14 cases (8.5%). Thirty-three cases (19.4%) showed multifocality, 5 cases (2.9%) extra-thyroid extension, and 19 cases (11.2%) lymph node metastasis. Two cases developed recurrences and three cases, metastasis. The associated lesions were significantly higher in females (p = 0.0059); most common being multinodular goiter (MNG; n = 67; 41.1%), followed by Hashimoto thyroiditis (n = 44; 27%) and lymphocytic thyroiditis (n = 28; 17.2%); MNG being associated with follicular (p = 0.0129), and Hashimoto thyroiditis with conventional variant (p = 0.0475). The frequency of microcarcinomas significantly increased in the past 4 years (p = 0.0291) and was associated with MNG (p = 0.0055), Hurthle cell nodule (p = 0.0315) and absent lymph node metastasis (p = 0.0147). The primary treatment modality was total thyroidectomy. Papillary microcarcinoma cases increased significantly in the past 4 years and were significantly associated with MNG and Hurthle cell nodule. It is challenging to distinguish the various PTC subtypes as recognition of these histological variants warrants better patient management.

BACKGROUND: The α-Klotho protein was discovered as a gene controlling the process of aging, but further studies indicated that it also plays the role of a tumour suppressor. Although numerous studies were performed on the role of the α-Klotho gene and protein in neoplasia, the data on α-Klotho protein expression in thyroid cancers are very scarce. Our study presents the immunohistochemical investigation of α-Klotho expression in benign and malignant thyroid tumours.
METHODS: The material included samples of benign (nodular hyperplasia, follicular adenoma), differentiated (follicular and papillary) cancers and aggressive thyroid cancers of low differentiation grade. The samples were immunostained using two different monoclonal anti-α-Klotho antibodies.
RESULTS: From the two antibodies used in this study, one (EPR6856) reacted probably with the soluble form of Klotho and immunostained mostly the colloid filling thyroid follicles and intravascular or extravascular serum deposits. The other (A-9 antibody) immunostained the follicular epithelium in benign thyroid lesions as well as the epithelial tumoural cells in differentiated thyroid (follicular and papillary cancers). In the thyroid cancers of high malignancy, the immunostaining with A-9 anti-α-Klotho antibody was (except in one case) negative or very weak.
CONCLUSIONS: Our results indicate that lowered expression of a- Klotho is involved in the process of thyroid neoplasia.

Several authors have underlined the limits of morphological analysis mostly in the diagnosis of follicular neoplasms (FN). The application of ancillary techniques, including immunocytochemistry (ICC) and molecular testing, contributes to a better definition of the risk of malignancy (ROM) and management of FN. According to literature, the application of models, including the evaluation of ICC, somatic mutations (ie, BRAFV600E ), micro RNA analysis is proposed for FNs. This study discusses the validation of a diagnostic algorithm in FN with a special focus on the role of morphology then followed by ancillary techniques.
From June 2014 to January 2016, we enrolled 37 FNs with histological follow-up. In the same reference period, 20 benign nodules and 20 positive for malignancy were selected as control. ICC, BRAFV600E mutation and miR-375 were carried out on LBC.
The 37 FNs included 14 atypia of undetermined significance/follicular lesion of undetermined significance and 23 FN. Specifically, atypia of undetermined significance/follicular lesion of undetermined significance resulted in three goitres, 10 follicular adenomas and one NIFTP whereas FN/suspicious for FN by seven follicular adenomas and 16 malignancies (nine non-invasive follicular thyroid neoplasms with papillary-like nuclear features, two invasive follicular variant of papillary thyroid carcinoma [PTC] and five PTC). The 20 positive for malignancy samples included two invasive follicular variant of PTC, 16 PTCs and two medullary carcinomas. The morphological features of BRAFV600E mutation (nuclear features of PTC and moderate/abundant eosinophilic cytoplasms) were associated with 100% ROM. In the wild type cases, ROM was 83.3% in presence of a concordant positive ICC panel whilst significantly lower (10.5%) in a negative concordant ICC. High expression values of MirR-375 provided 100% ROM.
The adoption of an algorithm might represent the best choice for the correct diagnosis of FNs. The morphological detection of BRAFV600E represents the first step for the identification of malignant FNs. A significant reduction of unnecessary thyroidectomies is the goal of this application.

Purpose/aim: To focus on current aspects of primary thyroid lymphoma (PTL), which is a rare clinical entity usually manifested by a rapidly growing mass in the neck that can cause pressure symptoms.
METHODS: Relevant papers in PubMed published through June 2017 were selected to track updated information about PTL with an emphasis on diagnosis and novel therapeutic management.
RESULTS: The most frequent cases include non-Hodgkin lymphoma derived from B-cells, mainly diffuse large B-cell lymphoma (DLBCL) followed by mucosa-associated lymphoid tissue (MALT) lymphoma or a mixed type. Other subtypes are less common. Lymphomas derived from T-cells and Hodgkin lymphomas are extremely rare. Hashimoto\'s autoimmune thyroiditis has been implicated as a risk factor for lymphoma. At the molecular level, the Wnt5a protein and its receptor Ror2 are involved in the course of the disease. Ultrasonography, fine needle aspiration (FNA) biopsy, and core or open biopsy combined with new diagnostic facilities contribute to an accurate diagnosis. An increased potential exists for a cure without the need for a radical surgical procedure. Modern chemoradiation therapy plus the monoclonal antibody rituximab, which acts against CD20, have limited the need for surgical interventions and provide an excellent outcome in most cases. However, some cases have resulted in treatment failure or recurrence.
CONCLUSIONS: A multidisciplinary approach must be used to define the management policy in each case. Future efforts by researchers are likely to be focused on the molecular level.

BACKGROUND: Differentiated thyroid carcinomas (DTCs) account for about 1% of all human malignancies. Cervical lymph nodes metastases and recurrences in the thyroid bed frequently occur. Furthermore, about 10-15% of patients develop distant metastases. Therefore, patients must undergo life-long follow-up.
OBJECTIVE: The aim of this study was to evaluate the usefulness of Thyroglobulin measurement in FNAB washout (FNAB-Tg) in the detection of local metastasis in patients affected by or evaluated for thyroid cancer.
METHODS: In a 3-year period, a total of 83 consecutive patients coming to our attention at the Ear-Nose-Throat (ENT) Outpatients Service of the National Cancer Research Center &quot;Istituto Tumori Giovanni Paolo II&quot; of Bari, Italy, because of the finding of one or more cervical lymph node(s), were enrolled in the study. After collection of the cytological specimen, the needle used for performing FNAB was then washed in 1 ml of normal saline. 89 FNAB washouts were collected from the same number of lymph nodes and subsequently investigated for Thyroglobulin levels using a sequential chemiluminescent-immunometric assay.
RESULTS: Comparing the cytological or, when performed, histological diagnoses with the results of FNAB-Tg, we found that in 24 cases of lymph node metastases from PTC (19 lymph nodes from patients at the first diagnoses and 5 lymph nodes from PTC patients in follow up) the mean level of Thyroglobulin was 1840.11 ng/ml; range: <0,2 to 11440 ng/ml. In the group of PTC patients (27 lymph nodes) with lymph nodes negative for metastatic involvement at cytology (i.e. no lymph node recurrence at follow-up), as well as in the cases of subjects without PTC and submitted to FNAB because of the appearance of lymph node(s) classified as reactive at cytology (37 lymph nodes), FNAB-Tg was lower than or equal to 0.2 ng/ml. As expected, the Thyroglobulin level was not detectable (< 0.2 ng/ml) also in a lymph node FNAB from a case of anaplastic thyroid carcinoma.
CONCLUSIONS: In our study, FNAB-Tg was not detectable in all node negative patients showing, when considering together all the lymph node metastases, a 96% sensitivity and 100% specificity.