Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma

Broome, David T.; Gadre, Gauri B; Fayazzadeh, Ehsan; Bena, James; Nasr, Christian

doi:10.1530/ec-20-0193

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…As expected, the presence of a malignant pleural effusion in a patient with differentiated thyroid carcinoma denotes an extremely poor prognosis, 14 and patients usually die within a year of the onset of pleural effusion. In our patient cohort, the median survival was approximately 8.5 months.…”

Section: Discussionsupporting

confidence: 57%

Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases

Mustafa

Malenie

Mir³

et al. 2022

Cancer Cytopathology

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Background: Malignant effusions secondary to thyroid carcinomas are rare, and publications on this topic are limited. This study presents a large cohort of thyroid carcinomas involving effusion cytology. Methods: A 20-year computerized search for fluid cytology diagnosed with thyroid malignancy was performed. The following data were collected: patients' demographics, clinical findings, and histologic diagnoses. The cytology slides and ancillary tests were reviewed. Results: Among 47,593 specimens, 15 thyroid carcinomas involving the pleural fluid from 11 patients were found. There were six males and five females with a mean age of 72 years. Ten patients with available follow-up died of their disease. Papillary thyroid carcinoma (PTC) was the only histologic type. Ten cytology cases were available for review. The cytologic findings common to all cases were nonspecific (clusters/three-dimensional architecture, enlarged irregular nuclei, and scant to abundant to vacuolated cytoplasm). The classic PTC features were not present in all cases (fine/powdery chromatin [80%], micronucleoli [70%], nuclear grooves [50%], papillary-like architecture [40%], psammoma bodies [40%], and pseudo-nuclear inclusions [20%; present on the cell block only]). In 11 of the 15 cases, the diagnosis was rendered with immunohistochemical stains performed on the cell block (paired box 8, thyroid transcription factor 1, and thyroglobulin). In four of the 15 cases, the cytologic diagnosis was made after a comparison with prior surgical pathology or fluid cytology. Conclusions: PTC is the most common histologic type of thyroid malignancy involving pleural effusion. Because the cytologic findings are nonspecific and classic PTC features are not always present, the clinical history in conjunction with immunohistochemical stains is helpful in arriving at the correct diagnosis.

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Section: Discussionsupporting

confidence: 57%

Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases

Mustafa

Malenie

Mir³

et al. 2022

Cancer Cytopathology

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“…A previous study reported that patients with a pleural effusion survived a duration of 0.1-82.8 months and pleural effusion was the prognostic factor among patients with metastatic thyroid cancer [20]. Furthermore, the events of pleural effusion may predict bad prognosis during lenvatinib treatment [21].…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of lung metastasis-related finding in lenvatinib treatment for differentiated thyroid cancer

et al. 2022

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This study aimed to analyze the clinical course of patients with differentiated thyroid cancer (DTC) who were treated by lenvatinib and investigate the speci c criteria for the initiation of lenvatinib treatment in lung metastasis. MethodsA total of 111 patients with DTC treated by lenvatinib were included in the study. Patients were divided into two groups based on the target lesion for the initiation of lenvatinib treatment: lung metastasis group and other metastases group. ResultsIn the univariate analysis, the tumor size for the target lesion (p = 0.002) and target lesion (p < 0.001) were signi cantly associated with overall survival (OS). Multivariate analysis revealed that the target lesion [hazard ratio, 0.408; 95% con dence interval (CI), 0.206-0.810; p = 0.010] was the only independent prognostic factor of OS. Of the 53 patients in the lung metastasis group, 12 (23%) had lung metastasis-related nding such as pleural effusion (n = 12), hemoptysis (n = 2), and dyspnea (n = 1) at the initiation of lenvatinib treatment. The median OS in patients with or without lung metastasis-related ndings were 41.0 [95% CI, 10.4-not available (NA)] months and 62.9 (95% CI, 53.0-NA) months, respectively (p = 0.022). ConclusionPatients with lung metastasis-related nding at the initiation of lenvatinib treatment had a poorer prognosis among the lung metastasis group. It is important to consider not only the tumor size but also the presence of lung metastasis-related ndings when initiating lenvatinib treatment for DTC patients with lung metastasis.

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“…Ten months later, after discovering the metastasis, the patient’s medical condition progressed and he passed away, thus authenticating that such presentation of PTC was found to be correlated with poor prognosis and shortened overall survival [ 31 , 43 ]. A retrospective report of patients with cancer with metastatic follicular-cell-derived thyroid carcinoma from 1990 to 2010 displayed that involvement of metastatic pleural effusion was identified as a poor and an unfavorable prognostic factor in these patients [ 44 ]. The previously reported cases of similar presentation of metastatic pleural effusion, either secondary to primary PTC [ 31 , 32 ], or anaplastic transformation of a well-differentiated PTC [ 33 ] are very limited worldwide and mostly were detected in the Japanese population, which demonstrated a similar aggressive course of the disease terminated by patient death.…”

Section: Discussionmentioning

confidence: 99%

Metastatic papillary thyroid carcinoma in pleural effusion: a case report and review of the literature

Abutalib,

Shams,

Tamur

et al. 2023

J Med Case Reports

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Introduction Papillary thyroid carcinoma accounts for the most common type of thyroid cancer of well-differentiated type. Papillary thyroid carcinoma is featured by biologically low-grade and less aggressive tumors with a survival rate of 10 years in most of the diagnosed cases. Papillary thyroid carcinoma can be presented with the involvement of cervical lymph nodes in about 50% of the patients, yet distant spread is very uncommon. Case presentation Herein, we discuss a Saudi male patient in his early 50s with a history of papillary thyroid carcinoma who presented to the emergency department complaining of shortness of breath and a radiological finding of hydrothorax. Cytologic examination together with immune-histochemical staining and molecular studies of pleural effusion aspiration concluded the definitive diagnosis of metastatic papillary thyroid carcinoma in the pleural space. Conclusions Papillary thyroid carcinoma seldom causes metastatic niches in the pleural space; this is a rare clinical presentation, nevertheless, a differential diagnosis of thyroid metastasis needs to be excluded. A definitive diagnosis of metastatic papillary thyroid carcinoma can be made using clinical presentation, cytologic examination, immunohistochemical investigation, and molecular testing. The most common mutation found in papillary thyroid carcinoma cases is the V600E mutation found in the BRAF gene, yet these patients have a relatively low probability of cancer recurrence. Patients with papillary thyroid carcinoma who have the BRAF mutation frequently experience metastases and relapses of the disease after the cancer has progressed aggressively. To help with therapy planning and the introduction of BRAF inhibitors, genetic testing for BRAF mutation may therefore prove to be a useful tool, especially in cases of aggressive subtypes of TC.

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Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma

Cited by 4 publications

References 26 publications

Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases

Malignant effusions secondary to metastatic thyroid carcinomas: A review of 15 cases

Prognostic significance of lung metastasis-related finding in lenvatinib treatment for differentiated thyroid cancer

Metastatic papillary thyroid carcinoma in pleural effusion: a case report and review of the literature

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