Thyroid Carcinoma Showing Thymus-like Differentiation (CASTLE): A Case Report

Stanciu, Mihaela; Ristea, Ruxandra Paula; Popescu, Mihaela; Vasile, Corina Maria; Popa, Florina Ligia

doi:10.3390/life12091314

Cited by 11 publications

(5 citation statements)

References 28 publications

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“…While false negative results at 99m-Tc sestamibi scintigraphy may involve small parathyroid tumours or parathyroid cysts, false positive results relate to abnormal tracer uptake at the thyroid level (in our case, only at ectopic tissue, not at normal thyroid gland). The fact that 99m-Tc MIBI is up-taken in highly metabolic lesions might imply a different cellular turnover in ectopic, not orthotopic, thyroids, as has similarly been reported (false positive results) in different types of head and neck cancers, even breast and lung neoplasia [64][65][66][67]. Hence, in this case, the incidental detection of the ectopic thyroid was globally due to the first diagnosis of PHP and associated management, while its actual recognition started during surgery from an unexpected PTH drop after the excision of the first tumour.…”

Section: Ectopic Thyroid Tissuementioning

confidence: 72%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95–99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.

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Section: Ectopic Thyroid Tissuementioning

confidence: 72%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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“…Due to the correlative nature of our study, in vitro analysis must be conducted to confirm the role of these microbes in PTC incidence and progression. Although CPTC, FVPTC, and TCPTC were the primary tumors available from TCGA, future studies should also characterize how these microbes may uniquely contribute to oncogenesis in other forms of thyroid cancer [ 62 , 63 , 64 ].…”

Section: Discussionmentioning

confidence: 99%

Transcriptomic Analysis Reveals Dysregulation of the Mycobiome and Archaeome and Distinct Oncogenic Characteristics according to Subtype and Gender in Papillary Thyroid Carcinoma

John

Yalamarty

Barakchi

et al. 2023

IJMS

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Papillary Thyroid Carcinoma (PTC) is characterized by unique tumor morphology, treatment response, and patient outcomes according to subtype and gender. While previous studies have implicated the intratumor bacterial microbiome in the incidence and progression of PTC, few studies have investigated the potential role of fungal and archaeal species in oncogenesis. In this study, we aimed to characterize the intratumor mycobiome and archaeometry in PTC with respect to its three primary subtypes: Classical (CPTC), Follicular Variant (FVPTC), and Tall Cell (TCPTC), and also with respect to gender. RNA-sequencing data were downloaded from The Cancer Genome Atlas (TCGA), including 453 primary tumor tissue samples and 54 adjacent solid tissue normal samples. The PathoScope 2.0 framework was used to extract fungal and archaeal microbial read counts from raw RNA-sequencing data. Overall, we found that the intratumor mycobiome and archaeometry share significant similarities in CPTC, FVPTC, and TCPTC, although most dysregulated species in CPTC are underabundant compared to normal. Furthermore, differences between the mycobiome and archaeometry were more significant between males and females, with a disproportionate number of fungal species overabundant in female tumor samples. Additionally, the expression of oncogenic PTC pathways was distinct across CPTC, FVPTC, and TCPTC, indicating that these microbes may uniquely contribute to PTC pathogenesis in each subtype. Furthermore, differences in the expression of these pathways were observed between males and females. Finally, we found a specific panel of fungi to be dysregulated in BRAF V600E-positive tumors. This study demonstrates the potential importance of microbial species to PTC incidence and oncogenesis.

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“…In a study conducted by Tsutsui et al, two patients without lymph node metastasis and without postoperative radiotherapy were followed up for 5 and 10 years, respectively, and no tumor recurrence was found ( 9 ). Stanciu et al performed total thyroidectomy and neck dissection for a patient with thymoid-differentiated carcinoma, and there was no local recurrence or distant metastasis after 2.5 years of follow-up ( 10 ). However, a Chinese scholar retrospectively analyzed two patients with CASTLE.…”

Section: Discussionmentioning

confidence: 99%

Case report: Thymoid differentiated carcinoma of thyroid: Two cases

Zhao

Liu

2023

Front. Surg.

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ObjectiveThymoid carcinoma of the thyroid gland is a rare thyroid tumor, which is often presented in case reports.MethodsThe clinical data of two patients with thymic carcinoma of the thyroid gland were retrospectively reviewed.ResultsCase 1: a middle-aged woman who was admitted to the hospital because of “progressive enlargement of the anterior cervical mass for 8 months.” Color Doppler ultrasound and CT showed malignant tumor with high possibility of bilateral cervical lymph node metastasis. Total thyroidectomy and bilateral central cervical lymph node dissection were performed. Lymph node biopsy showed the metastasis of small cell undifferentiated thyroid carcinoma. Because the biopsy pathological result was not consistent with the pathology of the primary lesion, immunohistochemistry was performed again, and the final diagnosis was thymic carcinoma in the thyroid gland. Case 2: the patient was an elderly man who was admitted to the hospital due to hoarseness for half a month. During the operation, the tumor invaded the trachea, esophagus, internal jugular vein, common carotid artery, and surrounding tissues. Palliative resection of the tumor was performed. The tumor postoperative pathology suggested thymoid carcinoma of the thyroid gland. It recurred and compressed the trachea 4 months after the operation, resulting in dyspnea of the patient, and finally tracheotomy was performed to alleviate the symptoms.ConclusionCase 1 showed multiple differences in pathological diagnosis, suggesting that the lack of specific imaging and clinical manifestations of thymoid-differentiated thyroid carcinoma made the diagnosis so difficult. Case 2 progressed rapidly, suggesting that thymoid-differentiated thyroid carcinoma was not always inert, and the treatment and follow-up should follow the principle of individualization.

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Thyroid Carcinoma Showing Thymus-like Differentiation (CASTLE): A Case Report

Cited by 11 publications

References 28 publications

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Transcriptomic Analysis Reveals Dysregulation of the Mycobiome and Archaeome and Distinct Oncogenic Characteristics according to Subtype and Gender in Papillary Thyroid Carcinoma

Case report: Thymoid differentiated carcinoma of thyroid: Two cases

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