Argon-helium cryoablation treatment of undifferentiated pleomorphic sarcoma of the thyroid:A case report and literature review

Undifferentiated pleomorphic sarcoma is an extremely rare malignant thyroid tumor.Thyroid sarcoma differs from common malignant thyroid tumors,such as thyroid follicular cell carcinoma.It is usually highly malignant,progresses rapidly,and is prone to remote metastasis.Currently,there is no standard protocol for the treatment of thyroid sarcomas,and most treatment effects are unsatisfactory.Argon-helium cryoablation is an important method of local treatment that is widely used in patients with unresectable advanced tumors.However,owing to the low incidence of thyroid sarcomas,there are no relevant literature reports on the treatment of thyroid sarcomas using cryoablation in China.This study reports the case of a patient with undifferentiated pleomorphic sarcoma of the thyroid gland who was treated with argon-helium cryoablation,and the immediate outcome was good.Based on a review of relevant literature,we discussed the effectiveness and safety of argon-helium cryoablation treatment,to provide clinical guidance and references for the treatment of patients with thyroid sarcoma.

A Case of Medullary Thyroid Carcinoma Combined with Papillary Microcarcinoma and Literature Review

Background: The histologic type of thyroid carcinomas includes follicular, papillary carcinomas, and medullary carcinomas. The reports about the histological, immunohistochemical, and ultrastructural characteristics of each kind of thyroid carcinomas were common, but the simultaneous occurrence of a medullary and papillary carcinoma as 2 distinct tumors has been reported extremely rarely. Objects: To explore the pathogenesis, clinicopathological characteristics, immunohistochemical phenotype, and pathological diagnosis of medullary thyroid carcinoma combined with papillary thyroid microcarcinoma. Methods: The clinicopathological characteristics and immunohistochemical phenotype of a patient with left medullary thyroid carcinoma combined with right papillary thyroid microcarcinoma were retrospectively studied. Then, relevant literature was thus reviewed. Results: General appearance: The size of the left thyroid lobe was 2.5 × 2 × 1 cm, the cut surface was gray and red, and a nodule with a diameter of 1.3 cm could be observed. The cut surface of the nodule was gray and yellow, solid, and hard. The size of the right lobe of the thyroid gland was 0.7 × 0.6 × 0.5 cm, and a gray nodule with a diameter of 0.4 cm was seen on the cut surface. The cut surface of the nodule was gray, solid, and hard. Observation under the microscope: the left nodular tumor cells were round, oval, or plasma cell-like, some areas were arranged in nests, and some areas were arranged in beams. Calcification and sheet-like eosinophilic amyloid deposits could be seen in the stroma. The nodule on the right showed a branched papillary structure, the covering cells on the surface of the nipple were ground glass-like nuclei, and nuclear grooves and pseudo-inclusion bodies in the nucleus could be observed. Immunohistochemistry: left lobe tumor cells Calcitonin, CEA, TTF-1, CD56, CgA, and Syn are all (+), CK19 and TG were both (−);right lobe tumor cells CK19 and TG are both (+), Calcitonin, CD56, CgA, and Syn are all (−). Conclusions: The origin, clinicopathological manifestations, and immunophenotypes of medullary thyroid carcinoma and papillary thyroid carcinoma are different. It is relatively rare for the two to occur at the same time. The diagnosis mainly depends on the microscopic morphology and immunophenotype characteristics.

Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus

Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.

Papillary thyroid carcinoma occurring with undifferentiated pleomorphic sarcoma: A case report

BACKGROUND Papillary thyroid cancer(PTC)is the most common malignant tumor of the thyroid.However,the coexistence of PTC and sarcoma in one patient is rare.In this article,we report the case of a patient who presented with both PTC and undifferentiated pleomorphic sarcoma(UPS),which has not been previously reported in the online Medline database(PubMed).CASE SUMMARY A 71-year-old man was admitted to our hospital for a mass on the right side of his neck for one month,which rapidly enlarged within 2 wk with distending pain.The patient was diagnosed with a thyroid malignancy by fine-needle aspiration and underwent total thyroidectomy and bilateral central lymph node dissection.Histology and immunohistochemistry revealed features of both PTC and UPS.The thyroid cancer 8 gene detection kit results showed BRAF and telomerase reverse transcriptase mutations.The disease progressed rapidly,and the patient died four months after surgery from extensive lung metastasis.CONCLUSION Our report highlights the patient’s pathological characteristics and related genetic mutations.Due to the rapid development and poor prognosis of cooccurring PTC and sarcoma,it is important for clinical physicians and pathologists to raise awareness of this type of tumor.

Complete response in anaplastic lymphoma kinase–rearranged oncocytic thyroid cancer:A case report and review of literature

BACKGROUND Oncocytic carcinoma of the thyroid is a rare disease,characterized by a poor prognosis and low response rate to radioiodine therapy.Crizotinib is a specific anaplastic lymphoma kinase(ALK)inhibitor,which was initially developed in non-small cell lung cancer.Other solid tumors harboring a translocation in ALK have been described,such as renal carcinoma,thyroid,colorectal,ovarian cancers,and spitzoid melanoma.The research of ALK rearrangements in thyroid tumor is a promising therapeutic track,and treatments need to be explored.CASE SUMMARY We report the case of a 76-year-old woman with a history of multinodular goiter,who was hospitalized for impairment of her general condition.She was diagnosed with metastatic oncocytic thyroid cancer.Synchrone metastases were found:Multiple mediastinal lymphadenopathies,lytic bone lesions and bilateral mammary lumps.Fluorescence in situ hybridization analysis revealed an ALK rearrangement in 61%of cells.No other mutation was found.A tumor board discussion based on molecular characteristics of the tumor suggested initiating a daily treatment by crizotinib,a specific ALK inhibitor.A positron emission tomography scan performed 4 mo after the initiation of crizotinib showed a complete metabolic response.CONCLUSION This case highlights an unexpected efficacy of crizotinib in an ALK-rearranged thyroid tumor,and the need of further assessments.

Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain:A randomized controlled trial

Background Treatment duration of wrist-ankle acupuncture(WAA)is uncertain for post-thyroidectomy pain relief.Objective This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.Design,setting,participants and intervention This randomized controlled trial was conducted at a single research site in Guangzhou,China.A total of 132 patients receiving thyroidectomy were randomly divided into the control group(sham WAA,30 min)and three intervention groups(group 1:WAA,30 min;group 2:WAA,45 min;group 3:WAA,60 min),with group allocation ratio of 1:1:1:1.Acupuncture was administered within 1 hour of leaving the operating room.Outcomes and measures Primary outcome was patients’pain at the surgical site assessed by visual analogue scale(VAS)at the moment after acupuncture treatment(post-intervention).Secondary outcomes included the patients’pain VAS scores at 6,12,24,48 and 72 h after the thyroidectomy,the 40-item Quality of Recovery(QoR-40)score,the grade of post-operative nausea and vomiting(PONV),and the use of additional analgesic therapy.Results The adjusted mean difference(AMD)in VAS scores from baseline to post-intervention in group 1 was-0.89(95%confidence interval[CI],-1.02 to-0.76).The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group(AMD,-0.43;95%CI,-0.58 to-0.28;P<0.001),and in groups 2 and 3 compared to group 1(group 2 vs group 1:AMD,-0.65;95%CI,-0.81 to-0.48;P<0.001;group 3 vs group 1:AMD,-0.66;95%CI,-0.86 to-0.47;P<0.001).The VAS scores in the four groups converged beyond 24 h after the operation.Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation.No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.Conclusion Compared with the 30 min intervention,WAA treatment with longer needle retention time(45 or 60 min)had an advantage in pain relief within 6 h after surgery.WAA’s analgesic effect lasted for 6-12 h post-operatively.

Levels of chemical element contents in thyroid as potential biomarkers for cancer diagnosis (a preliminary study)

Aim:Thyroid cancer is an internationally important health problem.The aim of this exploratory study was to evaluate whether significantchanges in the thyroid tissue levels of Al,B,Ba,Br,Ca,Cl,Cu,Fe,I,K,Li,Mg,Mn,Na,P,S,Si,Sr,V,and Zn exist in the malignantly transformed thyroid.Methods:Thyroid tissue levels of twenty chemical elements were prospectively evaluated in 41 patients with thyroid malignant tumors and 105 healthy inhabitants.Measurements were performed using a combination of non-destructive and destructive methods:instrumental neutron activation analysis and inductively coupled plasma atomic emission spectrometry,respectively.Tissue samples were divided into two portions.One was used for morphological study while the other was intended for trace element analysis.Results:It was found that contents of Al,B,Br,Ca,Cl,Cu,K,Mg,Mn,Na,P,S,and Si were significantly higher(approximately 3.2,4.6,9.3,1.8,2.3,3.6,1.6,1.6,1.6,1.2,2.5,1.1,and 2.8 times,respectively)while content of I lower(nearly 26 times)in cancerous tissues than in normal tissues.Conclusion:There are considerable changes in chemical element contents in the malignantly transformed tissue of thyroid.