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Concomitant papillary thyroid carcinoma and Hashimoto's thyroiditis.
Semin Diagn Pathol. 2001 May;18(2):99-103.
An association
between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis
(HT) is well recognized. Both entities may often display overlapping
morphologic features. The aim of this study was to evaluate the
accuracy of fine needle aspiration (FNA) of concomitant PTC and HT.
Twenty nine thyroid FNAs with a diagnosis of concomitant PTC and HT on
follow-up surgical material were retrospectively reviewed (11% of all
HT cases diagnosed in the same period of time). The cytologic
specimens were evaluated for the presence of diagnostic features of
PTC and HT. In 16 of 29 cases, the diagnosis of PTC was made or
suggested; however, only in 3 cases were both entities recognized on
the FNA material. The review of the remaining cases (13 cases) showed
diagnostic features of PTC in 2 cases (interpretation errors), some
features of PTC in 8 cases (insufficient diagnostic features),
features of only HT in 2 cases, and 1 case was acellular (sampling
errors). Originally, 10 cases with features of PTC were diagnosed as
either follicular neoplasm or colloid nodule with or without HT.
Histologically, 1 of 13 cases was a cystic variant and 7 of 13 cases
were follicular variants of papillary carcinoma. It is important to be
aware of the coexistence of PTC and HT. Deliberate search for
evidences of PTC in every case of HT may be necessary to improve
diagnostic accuracy of the FNA. However, the cytologic diagnosis of
follicular variant of PTC coexisting with HT can be challenging. The
sampling error may also cause false negative results.
Total thyroidectomy
for the treatment of Hashimoto's thyroiditis coexisting with papillary
thyroid carcinoma.
Adv Ther. 2007 May-Jun;24(3):510-6.
The
coexistence of Hashimoto's thyroiditis (HT) and papillary thyroid
carcinoma (PTC) is controversial. This study was conducted to evaluate
the correlation between HT and PTC and to identify predictive factors
for the coexistence of PTC and HT. A total of 922 patients underwent
surgery for thyroid disorders between January 2001 and August 2005. In
all, 199 patients had been diagnosed with PTC, 37 of whom had
coexistent HT; in 689 patients, benign thyroid disease had been
diagnosed. Patients' age and sex, as well as histopathology, tumor
size, nodal involvement status, multicentricity, presence of
metastasis, and serum thyroglobulin levels, were retrospectively
reviewed. A significant correlation was observed between HT and PTC,
although no statistical significance was noted between PTC and HT type
(nodular or diffuse). Most patients with PTC+HT were female and
younger (<40 y old) than those with PTC only. The rate of occult tumor
in patients with PTC+HT was higher than that in patients with PTC
alone. Data indicate the coexistence of PTC and HT and suggest that
PTC may develop even in cases of diffuse HT. Total thyroidectomy is
the surgical procedure of choice, especially in young, female patients
with HT.
Ultrasonographic
findings of papillary thyroid carcinoma with Hashimoto's thyroiditis.
Intern Med. 2007;46(9):547-50.
OBJECTIVE:
Papillary thyroid carcinoma (PTC) sometimes occurs with Hashimoto's
thyroiditis (HT). It is often difficult to differentiate between
benign and malignant nodules in HT because HT varies greatly on
ultrasonography. We aimed to characterize the ultrasonographic
features of PTC with HT. PATIENTS AND METHODS: In this retrospective
study, 2167 patient records (1897 women and 270 men) were examined for
ultrasonographic features and thyroid autoantibodies between 1998 and
2002 at our university. Patients with Graves' disease, positive TSH
receptor autoantibody (TRAb) or thyroid-stimulating antibody (TSAb)
were excluded. PTC was diagnosed by pathological examination. RESULTS:
Of the 1644 patients who were autoantibody negative (MCHA, TGHA, TgAb,
TPOAb), 54 (3.3%) had PTC, while 29 (5.5%) of the 523 patients who
were autoantibody positive had PTC. On ultrasonography, the frequency
of dense calcification in patients with HT was significantly higher
(P=0.0064) and frequency of psammoma bodies was less than PTC patients
without HT (P<0.0001). On the other hand, PTC with HT had more
irregular shapes and ill-defined edges of the borders with less
hypoechogenecity and calcification than PTC without HT, but the
difference was not significant. CONCLUSION: The frequency of psammoma
bodies in PTC with HT was less, while dense calcifications were
greater than in those of PTC without HT. Any type of ultrasonographic
calcification features may represent a risk for PTC.
The many faces and
mimics of papillary thyroid carcinoma.
Endocr Pathol.
2006 Spring;17(1):1-18.
This article
provides an overview of the 15 histologic variants of papillary
thyroid carcinoma listed by the 2004 World Health Organization (WHO)
monograph on endocrine tumors. The histologic features, differential
diagnosis, and clinical course of each variant are discussed in some
detail. The follicular variants (conventional and macrofollicular)
constitute a morphologic challenge because the majority of these
tumors are encapsulated and, also, because, in many tumors, not all
neoplastic cells show the nuclear features considered to be diagnostic
of papillary carcinoma. As a result, most of these tumors are missed
even by experienced pathologists. Moreover, hyperplastic thyroid
lesions, follicular adenomas, and Hashimoto's thyroiditis may contain
cells with clear nuclei resembling those of papillary carcinoma.
Papillary carcinomas composed entirely of hyperchromatic cells have
been overlooked. The WHO monograph defines papillary carcinoma with
focal spindle and giant cell carcinoma components but its clinical
behavior is unknown. Papillary carcinoma with an insular pattern that
does not show the artifactual separation of the cell nests has been
misinterpreted as the solid variant of papillary carcinoma. Papillary
microcarcinomas include not only the conventional type and the
follicular variants but also the tall cell and columnar cell variants.
Differentiated thyroid carcinoma in previously manifested autoimmune
thyroid disease.Srp
Arh Celok Lek. 2005 Oct;133 Suppl 1:74-6.
Autoimmune
thyroid diseases are frequently associated with differentiated thyroid
carcinomas. The role of autoimmune phenomena in the origin and
clinical course of coexisting papillary and follicular carcinomas is
still controversial. In Graves' patients, the prevalence of palpable
thyroid nodules is 15.8%, and by using ultrasonography, the prevalence
increases to 33.6%. Since the malignancy rate of palpable thyroid
nodules in Graves' patients is 16.9%, approximately threefold higher
than in general population, it seems that a thyroid nodule diagnosed
in Graves' patients is at higher risk for malignancy. In addition,
radioiodine therapy for Graves' disease was found to be associated
with increased incidence of thyroid cancer in some studies. These
studies however, were not able to confirm the carcinogenic effect of
radioiodine therapy since the late growth of occult carcinomas could
not be excluded. The frequency of the association of Hashimoto's
thyroiditis and differentiated thyroid carcinomas is approximately
30%. The presence of coexistent Hashimoto's thyroiditis does not
affect the diagnostic evaluation and management of papillary thyroid
cancer. The frequent presentation of differentiated thyroid carcinomas
in Graves' disease and Hashimoto's thyroiditis opens the possibility
that some mutual pathogenethic mechanisms might be involved in the
development of these diseases.
Coexistent
Hashimoto's thyroiditis with papillary thyroid carcinoma: impact on
presentation, management, and outcome.
Surgery. 1999 Dec ;126 (6): 1070-6; discussion 1076-7.
BACKGROUND:
This study was performed to assess the relationship between
Hashimoto's thyroiditis and the development, presentation, management,
and outcome of papillary thyroid carcinoma. METHODS: Two complementary
analytic methods were used. The clinical study was a retrospective
case-control study, including patients seen with papillary thyroid
carcinoma presenting during a 12-year period. We also used a
systematic literature review to identify suitable reports and
meta-analysis to statistically combine published results. RESULTS: The
prevalence of Hashimoto's thyroiditis is significantly higher in
patients with papillary thyroid cancer (odds ratio, 1.89; 95% CI,
1.02-3.50). These patients typically have a dominant nodule, 44% of
which are discovered incidentally on routine examinations. Fine-needle
aspiration has a sensitivity of 91% for the identification of
papillary cancer. The prognostic variables at the time of a diagnosis
of papillary cancer and the approach to management are not altered by
the presence of coexistent Hashimoto's thyroiditis. In addition, the
rate of surgical complications was not higher in patients with
coexistent Hashimoto's disease. Meta-analysis suggested a positive
correlation between Hashimoto's disease and disease-free survival (r =
0.09; 95% CI, 0.05-0.12) and overall survival (r = 0.11; 95% CI,
0.07-0.15). CONCLUSIONS: There is an increased prevalence of
Hashimoto's thyroiditis in patients with papillary thyroid carcinoma.
The presence of coexistent Hashimoto's thyroiditis does not affect the
diagnostic evaluation or management of papillary thyroid cancers. The
survival of patients who have papillary thyroid cancers may be
superior in coexistent Hashimoto's thyroiditis.
Expression of the
RET/PTC fusion gene as a marker for papillary carcinoma in Hashimoto's
thyroiditis.Laryngoscope.1997
Jan;107(1):95-100.
Hashimoto's
thyroiditis is an inflammatory disease of the thyroid gland with
autoimmune etiology. Patients afflicted with Hashimoto's have a higher
risk of thyroid malignancies such as papillary thyroid carcinoma. In
the present study, we investigated the frequency of papillary thyroid
carcinoma specific genes in patients diagnosed with Hashimoto's
disease. The newly identified oncogenes RET/PTC1 and RET/PTC3 provide
useful and specific markers of the early stages of papillary carcinoma
as they are highly specific for malignant cells. Using a sensitive and
specific reverse transcriptase-polymerase chain reaction (RT-PCR)
assay, we found messenger RNA (mRNA) expression for the RET/PTC1 and
RET/PTC3 oncogenes in 95% of the Hashimoto's patients studied. All
Hashimoto's patients presenting without histopathologic evidence of
papillary thyroid cancer showed molecular genetic evidence of cancer.
These data suggest that multiple, independent occult tumors exist in
these patients at high frequency.
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