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Background: It is important to distinguish benign thyroid nodules from malignant thyroid nodules. Hence, this study aimed to determine the characteristics of patients with thyroid cancer using thyroid ultrasonography. Methods: We retrospectively examined the ultrasonographic findings of 327 patients with 457 thyroid nodules (age: 59.9 ± 14.3 years; sex, n (%): female 242 (74.0%)) at a single center from 2014 to 2016. Ultrasonography was used to determine the nodule size, shape, border, internal echogenicity, presence of coarse calcifications and microcalcifications within the nodule, internal blood flow and whether the nodule was solid or contained cystic structures. Thyroid fine needle aspiration cytology (FNAC) was performed in all patients. The ultrasonographic findings were compared between patients with benign nodules and those with papillary thyroid carcinoma (PTC). Furthermore, in the analysis of anti-thyroglobulin (Tg) antibody-negative patients with single nodules, values of serum Tg/nodule volume were calculated and compared between patients with benign nodules and those with PTC. Results: There were 298 (65.2%) benign nodules, 33 (7.2%) PTCs and 126 (27.6%) others (104 follicular neoplasms, 19 masses of undetermined significance and three other malignant tumors). The nodules diagnosed as PTC had significantly lower internal echogenicity (P < 0.01), more microcalcifications (P < 0.01) and comprised more nodules rich in blood flow (P < 0.05) than benign nodules. Solid nodules were found significantly more in the PTC group (P < 0.01). The serum Tg/nodule volume ratio was significantly higher in the PTC group (P < 0.05). Conclusions: Findings suggestive of PTC were found from images obtained using thyroid ultrasonography. In the diagnosis of PTC, the frequency of FNAC examinations should be reduced as this method is costly and invasive. J Clin Med Res. 2020;12(8):499-507 doi: https://doi.org/10.14740/jocmr4260

Highlights • Simultaneous occurrence of papillary and follicular thyroid carcinomas in the same lobe are very rare. • First case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. • Endocrinologists and pathologists should be aware of and vigilant to this variety. • Occurrence of both types together shifts patients from low risk to intermediate or high risk which may reflect on management., Background Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported. Presentation of cases We report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. Conclusions We present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety.

Highlights • Thyroglossal duct cyst carcinoma concurrent with another thyroid gland carcinoma as two separate tumours are rare. • Ultrasound scan and ultrasound-guided fine needle aspiration and cytology are useful for diagnosis and for follow up. • Excision of thyroglossal duct cyst carcinoma and total thyroidectomy is ideal treatment option to facilitate future radioactive iodine ablation if required., Introduction Malignancy of thyroglossal duct cyst (TGDC) is rare, usually as papillary carcinoma, and less frequently as squamous cell or follicular carcinoma. TGDC carcinoma can present as a mass arising from the neck, with or without compression symptoms. Papillary carcinoma in TGDC concomitant with another papillary carcinoma in the thyroid gland is extremely rare. Presentation of case : 31 years old female with a neck lump since 2 years, slowly increasing in size, with mild pain while drinking fluids, and no change of voice. No past history of neck irradiation or family history of thyroid cancers. Ultrasonography of the neck showed TGDC and right thyroid nodule. Ultrasound guided fine needle aspiration and cytology of the TGDC showed TGDC papillary carcinoma. The patient underwent Sistrunk’s procedure and total thyroidectomy. Discussion Rare case of classic papillary carcinoma arising in TGDC, concomitant with another papillary carcinoma in the right thyroid nodule. Preoperative work up included US and fine needle aspiration and cytology (FNAC). Post-operative histopathology showed papillary carcinoma in the TGDC; and another in the right thyroid lobe that was a papillary carcinoma with follicular patterns. Conclusions TGDC carcinoma concurrent with another carcinoma in the right thyroid lobe as two separate tumours are extremely rare. All patients should undergo Sistrunk’s procedure, and total thyroidectomy for the thyroid tumour. Follow-up requires thyroxine replacement therapy to treat hypothyroidism and to suppress TSH in order to prevent recurrence; and neck ultrasound and thyroglobulin tumour marker to detect recurrence if present.

Objective To investigate the clinical feature of the poorly differentiated thyroid papillary carcinoma. Methods We investigate retrospectively 276 thyroid papillary carcinoma patients who underwent initial treatment at our Department who underwent initial treatment at our Department during the 13-year period from 2000 to 2012. We examine the pathological samples of papillary carcinoma retrospectively to investigate the prevalence of a poorly differentiated component in the tumor. Then the disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate were compared between patients with or without a poorly differentiated component. In addition, well differentiated carcinoma and poorly differentiated carcinoma were compared in relation to the age, sex, TNM stage, and recurrent laryngeal nerve infiltration. Results It was considered appropriate to define tumors with a poorly differentiated component of 10% or more as poorly differentiated carcinoma. There was a significant difference of the T classification but not the N classification between well and poorly differentiated thyroid papillary carcinomas. The disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate of patients with poorly differentiated carcinoma was significantly lower than that of patients with well differentiated carcinoma, and we considered that this might be due to the higher frequency of local infiltration in patients with poorly differentiated tumors. Conclusion The higher relapse rate compared with well differentiated carcinoma suggests that careful postoperative follow-up of patients with poorly differentiated carcinoma is important, particularly surveillance of distant metastasis.

У 1-й частині огляду проаналізовано нові дані наукової літератури щодо молекулярно-генетичних механізмів утворення папілярної та фолікулярної карцином щитоподібної залози. Відзначено роль мутацій і перебудов генів, продукти яких формують МАРК- і РІ3К-сигнальні каскади. Аналізуються нещодавно виявлені за допомогою сучасних генетичних методів чинники, що впливають на патогенез папілярної карциноми щитоподібної залози. Особливу увагу приділено доказам впливу іонізуючої радіації на канцерогенез. Обговорюється значущість нових діагностичних і прогностичних маркерів раку щитоподібної залози.

Background Papillary thyroid carcinoma (PTC) is the most common thyroid cancer. While many patients survive, a portion of PTC cases display high aggressiveness and even develop into refractory differentiated thyroid carcinoma. This may be alleviated by developing a novel model to predict the risk of recurrence. Ferroptosis is an iron-dependent form of regulated cell death (RCD) driven by lethal accumulation of lipid peroxides, is regulated by a set of genes and shows a variety of metabolic changes. To elucidate whether ferroptosis occurs in PTC, we analyse the gene expression profiles of the disease and established a new model for the correlation. Methods The thyroid carcinoma (THCA) datasets were downloaded from The Cancer Genome Atlas (TCGA), UCSC Xena and MisgDB, and included 502 tumour samples and 56 normal samples. A total of 60 ferroptosis related genes were summarised from MisgDB database. Gene set enrichment analysis (GSEA) and Gene set variation analysis (GSVA) were used to analyse pathways potentially involving PTC subtypes. Single sample GSEA (ssGSEA) algorithm was used to analyse the proportion of 28 types of immune cells in the tumour immune infiltration microenvironment in THCA and the hclust algorithm was used to conduct immune typing according to the proportion of immune cells. Spearman correlation analysis was performed on the ferroptosis gene expression and the correlation between immune infiltrating cells proportion. We established the WGCNA to identify genes modules that are highly correlated with the microenvironment of immune invasion. DEseq2 algorithm was further used for differential analysis of sequencing data to analyse the functions and pathways potentially involving hub genes. GO and KEGG enrichment analysis was performed using Clusterprofiler to explore the clinical efficacy of hub genes. Univariate Cox analysis was performed for hub genes combined with clinical prognostic data, and the results was included for lasso regression and constructed the risk regression model. ROC curve and survival curve were used for evaluating the model. Univariate Cox analysis and multivariate Cox analysis were performed in combination with the clinical data of THCA and the risk score value, the clinical efficacy of the model was further evaluated. Results We identify two subtypes in PTC based on the expression of ferroptosis related genes, with the proportion of cluster 1 significantly higher than cluster 2 in ferroptosis signature genes that are positively associated. The mutations of Braf and Nras are detected as the major mutations of cluster 1 and 2, respectively. Subsequent analyses of TME immune cells infiltration indicated cluster 1 is remarkably richer than cluster 2. The risk score of THCA is in good performance evaluated by ROC curve and survival curve, in conjunction with univariate Cox analysis and multivariate Cox analysis results based on the clinical data shows that the risk score of the proposed model could be used as an independent prognostic indicator to predict the prognosis of patients with papillary thyroid cancer. Conclusions Our study finds seven crucial genes, including Ac008063.2, Apoe, Bcl3, Acap3, Alox5ap, Atxn2l and B2m, and regulation of apoptosis by parathyroid hormone-related proteins significantly associated with ferroptosis and immune cells in PTC, and we construct the risk score model which can be used as an independent prognostic index to predict the prognosis of patients with PTC.

Both metastatic tumors and breast cancer metastases in the thyroid gland are rare. Tumor metastasis into a primary thyroid cancer is rarer. We present a case with breast cancer metastasis into a metachronous thyroid papillary carcinoma which is the only case in literature.

Importance Thyroid cancer is more common in women than in men, but the associated causes of these differences are not fully understood. Objective To compare sex-specific thyroid cancer rates in the US to the prevalence of subclinical thyroid cancer at autopsy. Data Sources Data on thyroid cancer incidence and mortality by sex among US adults (≥18 years) were extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) data for 1975 to 2017. Embase, PubMed, and Web of Science databases were searched for studies on the prevalence of subclinical thyroid cancer at autopsy of men and women, from inception to May 31, 2021. Study Selection The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was used to perform a systematic search for articles reporting the prevalence of subclinical thyroid cancer in autopsy results of both women and men. Of 101 studies identified, 8 studies containing 12 data sets met inclusion criteria; ie, they examined the whole thyroid gland, stated the number of thyroids examined, and reported results by sex. Excluded studies reported thyroid cancer in Japan after the atomic bombs or Chernobyl after the nuclear disaster; did not examine the whole thyroid gland or had incomplete information on thyroid examination methods; or did not report rates by sex. Data Extraction and Synthesis Thyroid cancer incidence and mortality data by sex, histologic type, and tumor size were extracted from SEER. The inverse variance heterogeneity model was used to meta-analyze the prevalence and the odds ratio of subclinical thyroid cancer by sex from 8 studies (12 data sets) on thyroid cancer prevalence in autopsy results. Main Outcomes and Measures Incidence and mortality of thyroid cancer, by histologic type and tumor size; prevalence of thyroid cancer in autopsy results. Results In 2017, 90% of thyroid cancers diagnosed were papillary thyroid cancer (PTC) and in 2013 to 2017, the women to men incidence ratio for small (≤2 cm) PTC was 4.39:1. The incidence ratio approached 1:1 as cancer type lethality increased. The ratio of thyroid cancer mortality by gender was 1.02:1 and remained stable from 1992 to 2017. Results of the meta-analysis showed that the pooled autopsy prevalence of subclinical PTC was 14% in women (95% CI, 8%-20%) and 11% in men (95% CI, 5%-18%). The pooled odds ratio of subclinical PTC in women compared with men was 1.07 (95% CI, 0.80-1.42). Conclusions and Relevance This cohort study and meta-analysis found that the belief that women get thyroid cancer more often than men is an oversimplification. The gender disparity is mostly confined to the detection of small subclinical PTCs, which are equally common in both sexes at autopsy but identified during life much more often in women than men. As the lethality of the cancer type increases, the ratio of detection by gender approaches 1:1. This phenomenon may be associated with gender differences in health care utilization and patterns of clinical thinking and can harm both women, who are subject to overdetection, and men, who may be at risk of underdetection.

Various researches demonstrated that transcription factors (TFs) played a crucial role in the progression and prognosis of cancer. However, few studies indicated that TFs were independent biomarkers for the prognosis of thyroid papillary carcinoma (TPC). Our aim was to establish and validate a novel TF signature for the prediction of TPC patients’ recurrence-free survival (RFS) from The Cancer Genome Atlas (TCGA) database to improve the prediction of survival in TPC patients. The genes expression data and corresponding clinical information for TPC were obtained from TCGA database. In total, 722 TFs and 545 TPC patients with eligible clinical information were determined to build a novel TF signature. All TFs were included in a univariate Cox regression model. Then, the least absolute shrinkage and selection operator Cox regression model was employed to identify candidate TFs relevant to TPC patients’ RFS. Finally, multivariate Cox regression was conducted via the candidate TFs for the selection of the TF signatures in the RFS assessment of TPC patients. We identified 6 TFs that were related to TPC patients’ RFS. Receiver operating characteristic analysis was performed in training, validation, and whole datasets, we verified the high capacity of the 6-TF panel for predicting TPC patients’ RFS (AUC at 1, 3, and 5 years were 0.880, 0.934, and 0.868, respectively, in training dataset; 0.760, 0.737, and 0.726, respectively, in validation dataset; and 0.777, 0.776, and 0.761, respectively, in entire dataset). The result of Kaplan–Meier analysis suggested that the TPC patients with low scores had longer RFS than the TPC patients with high score (P = .003). A similar outcome was displayed in the validation dataset (P = .001) and the entire dataset (P = 2e-05). In addition, a nomogram was conducted through risk score, cancer status, C-index, receiver operating characteristic, and the calibration plots analysis implied good value and clinical utility of the nomogram. We constructed and validated a novel 6-TF signature-based nomogram for predicting the RFS of TPC patients.

An important problem in the diagnosis, treatment and prediction of papillary thyroid cancer is radioiodine-resistant metastases, early prediction of which is possible on the condition of determining their cytological and histological characteristics. The purpose of this work was to identify the histological and cytological characteristics of metastases of papillary thyroid carcinomas correlated with their iodine-accumulative capacity, on the basis of which it will be possible to predict the radio-resistance of papillary thyroid carcinomas. A cytological examination of punctates of 30 papillary carcinomas and 45 of their metastases identified in the postoperative period and analysis of the histological characteristics of 100 papillary carcinomas of the general population, 47 primary papillary carcinomas and their radio-resistant metastasis and 17 primary papillary carcinomas of patients with radioiodine-uptake metastases were conducted. Statistical analysis was performed via the non-parametric criterion χ2 in the package Statistica 11.0. It has been shown a statistically significant difference between presence of sign of follicular structures in the histological material of primary papillary canсer of patients with radioiodine-resistance metastases and between of primary papillary canсer of patients with radioiodine-uptake metastases and common population of papillary thyroid cancer. It has been shown a statistically significant difference between punctuates of radioiodine-resistance and radioiodine-uptake metastases in presence of such cytological characteristics as different subpopulations of thyrocytes. It has been shown that the cytological characteristics of radioiodine-resistant metastases differ from radioiodine-uptake metastases and primary papillary carcinomas by the presence of different subpopulations of thyrocytes, particular structures and oxyphilic changes. It is shown that such histological characteristics as lack of follicular structures in the material of primary papillary carcinomas correlate with radio-resistance and can be prognostic factors of its appearance.

Background: The aim of this study is to determine the prognostic factors which affect both disease-free survival (DFS) and overall survival (OS) in thyroid papillary carcinoma with clinical lateral lymph node metastasis. Methods: One hundred and three papillary thyroid carcinomas diagnosed in adult patients received therapeutic lateral neck dissection between December 1989 and June 2010 were analyzed retrospectively. All of the patients were classified as American Thyroid Association (ATA) intermediate risk category. Age, gender, tumor stage and size, multicentricity and bilaterality, vascular invasion and extrathyroidal invasion, ipsilateral/contralateral lymph node involvement, lymph node ratio, extranodal tumor extension, and development of recurrence were the factors which might affect disease-free and OS. Univariate and multivariate analyses were performed. ROC analysis was used to find the cutoff value for lymph node ratio. Results: One hundred and three patients were followed median 101 months. Locoregional or systemic recurrence developed in 20 patients (19.4%) while 7 patients (6.8%) had persistent disease. In multivariate analysis, lymph node ratio (P = 0.003, relative risk [RR] 5.4, 95% confident interval [CI] 1.7–16.5) and contralateral lymph node involvement (P = 0.02, RR 4.9, 95% CI 1.3–18.5) were the independent factors affecting DFS where contralateral lymph node involvement (P = 0.009, RR 44.4, 95% CI 2.5–765.2) was the only factor which affected OS. Conclusions: Lymph node ratio and contralateral metastasis affect DFS while contralateral metastases only affect OS in patients with N1b thyroid papillary carcinoma.

Background Thyroid cancer (TC) is the most common endocrine malignancy; basigin (also known as BSG) plays a crucial role in tumor cell invasion, metastasis, and angiogenesis. This study was designed to identify the change of BSG expression in TC and its possible potential mechanism. Methods The BSG expression levels in TC were demonstrated using data collected from in-house immunohistochemical (IHC), RNA-sequencing (RNA-seq), microarrays, and literatures. Integrated analysis was performed to determined BSG expression levels in TC comprehensively. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed with the integration of BSG co-expressed genes and differentially expressed genes (DEGs) in TC tissues to explore the potential mechanisms of BSG in TC. Results The protein expression level of BSG was significantly higher in TC cases based on the IHC experiments. In addition, the combined SMD for BSG expression was 0.39 (p < 0.0001), the diagnostic odds ratio was 3.69, and the AUC of the sROC curve was 0.6986 using 1182 TC cases and 437 non-cancerous cases from 17 independent datasets. Furthermore, BSG co-expressed genes tended to be enriched in gene terms of the extracellular matrix (ECM), cell adhesion, and cell-cell interactions. The expression levels of nine hub BSG co-expressed genes were markedly upregulated in TC cases. Conclusion BSG expression levels were closely correlated with the progression of TC and may affect the signals of the ECM, cell adhesion, and cell-cell interactions.

Thyroid carcinoma tissue is frequently found in cervical lymph nodes following metastasis of thyroid, and particularly, thyroid papillary carcinoma. However, thyroid follicles without any malignant characteristics also are frequently detected in cervical lymph nodes. The reasons for the existence of “benign thyroid tissue” in lymph nodes are presently not understood. We present 3 cases of benign-appearing thyroid follicles in cervical lymph nodes. All patients underwent thyroidectomy and a central neck dissection after discovery of thyroid nodules by ultrasonography. The intraoperative frozen pathology and postoperative pathology of the 3 cases demonstrated that the lymph nodes contained thyroid follicles without any malignant features, and that the thyroid glands only displayed benign diseases, such as nodular goiter and thyroiditis. The patients remained disease-free for 1 to 6 months without evidence of abnormal cervical lymph nodes at the latest follow-up. The incidence of benign-appearing thyroid follicles in cervical lymph nodes is high.

Unlike daily routine images, ultrasound images are usually monochrome and low-resolution. In ultrasound images, the cancer regions are usually blurred, vague margin and irregular in shape. Moreover, the features of cancer region are very similar to normal or benign tissues. Therefore, training ultrasound images with original Convolutional Neural Network (CNN) directly is not satisfactory. In our study, inspired by state-of-the-art object detection network Faster R-CNN, we develop a detector which is more suitable for thyroid papillary carcinoma detection in ultrasound images. In order to improve the accuracy of the detection, we add a spatial constrained layer to CNN so that the detector can extract the features of surrounding region in which the cancer regions are residing. In addition, by concatenating the shallow and deep layers of the CNN, the detector can detect blurrier or smaller cancer regions. The experiments demonstrate that the potential of this new methodology can reduce the workload for pathologists and increase the objectivity of diagnoses. We find that 93:5% of papillary thyroid carcinoma regions could be detected automatically while 81:5% of benign and normal tissue could be excluded without the use of any additional immunohistochemical markers or human intervention.

AA amyloidosis is often secondary to chronic inflammatory diseases but can rarely occur in patients with malignant neoplasms. A 33 years old woman with papillary carcinoma of thyroid was hospitalized in our department of Nephrology for nephrotic syndrome. Renal histology finds AA amyloidosis. To our knowledge, this is the first report of a patient with papillary carcinoma of thyroid and secondary (AA) amyloidosis with amyloid deposition in the kidneys causing nephrotic syndrome.

Papillary Thyroid Carcinoma (PTC) is the most common type of malignant thyroid tumors. The main diagnostic clue of PTC is the presence of its characteristic nuclear features. Yet, the focal presence of these features in other thyroid lesions causes a diagnostic dilemma.To evaluate Cytokeratin 19 (CK19) and CD56 immunostains as useful diagnostic markers in distinguishing papillary thyroid carcinoma from other mimicking thyroid lesions.Eighty cases of different thyroid lesions were submitted for immunohistochemical staining of CK19 and CD56. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were analyzed.CK19 was expressed in 87.8% and 21.2% of the PTC group and the non-papillary carcinoma (NPTC) group respectively, with significant difference (P0.001). CD56 expression was lost with 81.8% of the PTC group. However, CK19 was negative in only 12.7% of the NPTC group, with significant difference (P0.001). Comparing papillary carcinoma with papillary hyperplasia, CK19 was the most sensitive immunostain and CD56 was the most specific one, with better diagnostic accuracy in combining both immunostains. Co-expression of CK19/CD56 provided 100% sensitivity and 92% diagnostic accuracy in differentiating follicular variant of PTC from follicular adenoma. Comparing FVPTC with follicular carcinoma, sensitivity and diagnostic accuracy increased to 100% and 91.7% respectively. On distinction between papillary carcinoma (Hurthle cell variant) and Hurthle cell adenoma, sensitivity, specificity, and diagnostic accuracy were 100%, 75% and 83.3% respectively, with CK19/CD56 staining combination. Comparing papillary carcinoma on top of Hashimoto's thyroiditis with Hashimoto's thyroiditis, co-expression of both markers was associated with 100% specificity, as well as increase in PPV and diagnostic accuracy to 91%.The combined use of CK19 and CD56 is helpful in discriminating papillary thyroid carcinoma and its variants from other mimicking thyroid lesions.

Breast metastasis from thyroid papillary carcinoma is an exceptional situation. Here, we present the diagnostic approach and the management of a 19-year-old woman with single breast metastasis from thyroid carcinoma. There was no extra thyroidal extension, neoplastic emboli, or lymph node invasion. The metastasis was revealed by whole-body radioactive I scan, explored by a fine-needle aspiration, and confirmed by elevated thyroglobulin in situ.

As a critical member of the Retinal Determination Gene Network (RDGN), SIX1 has been regarded as a tumor promoter in various types of cancer. However, its role in papillary thyroid carcinoma (PTC) has never been investigated. In this study, thyroid carcinoma tissue microarray staining was employed to identify the expression patterns of SIX1 and its co-activator EYA1. Papillary thyroid cancer cell lines, BCPAP, and TPC-1 cells were used to investigate the potential mechanism of SIX1 in vitro and in vivo. Flow cytometry analysis, MTT assay, the growth curve assay, colony formation assay, EdU incorporation and xenograft assay were performed to demonstrate the role of SIX1 in the malignant change of PTC cells. Western blot and Real-time PCR were used to detect the interaction among the SIX1, EYA1, and STAT3 signaling. In comparison with normal tissue, high expressions of SIX1 and EYA1 were associated with a malignant tumor. Importantly, SIX1 strongly correlated with EYA1 in thyroid carcinoma tissue microarray. Functional assays indicated SIX1 increased EYA1 expression by stabilizing EYA1 at the post-transcriptional level. Besides, SIX1 promoted the proliferation and invasion of thyroid carcinoma via activation of STAT3 signaling and its downstream targets in an EYA1-dependent manner. SIX1 can integrate with EYA1 to contribute to PTC development via activation of the classical STAT3 signaling. These data suggested targeting the abnormal activation of the SIX1/EYA1 complex may represent a novel therapeutic strategy for advanced PTC patients.

Актуальність. Особливістю тиреоїдної патології в умовах ендемічного регіону зоба є поєднання в одного пацієнта декількох захворювань щитоподібної залози, зокрема папілярного раку та автоімунного тиреоїдиту Хашімото. Мета. Визначити частоту і морфологічні особливості папілярного раку та автоімунного тиреоїдиту Хашімото у пацієнтів, оперованих з приводу тиреоїдної патології в умовах Прикарпатського ендемічного регіону зоба. Методи. Проведено аналіз результатів патогістологічних досліджень операційного матеріалу 1348 хворих, оперованих з приводу захворювань щитоподібної залози у Львівській обласній клінічній лікарні та Військовому медичному клінічному центрі Західного регіону у 2014-2018 роках. Результати. Серед 1348 хворих, оперованих з приводу захворювань щитоподібної залози, автоімунний тиреоїдит Хашімото виявили у 61 випадку (4,5%), фокальний тиреоїдит - у 114 випадках (8,5%), папілярний рак - у 245 випадках (18,2%), зокрема папілярний рак всіх гістологічних варіантів крім «маленького» папілярного раку - у 204 випадках (15,1%) та «маленький» папілярний рак - у 41 випадках (3,0%). Серед загального числа оперованих пацієнтів у 70 випадках (5,2%) в кожного окремо взятого пацієнта виявляли одночасно автоімунний тиреоїдит Хашімото або фокальний тиреоїдит у поєднанні з папілярним раком. Висновки. У жителів Прикарпатського ендемічного регіону зоба, оперованих з приводу захворювань ЩЗ, часто зустрічаються випадки поєднання автоімунного тиреоїдиту Хашімото і фокального тиреоїдиту з папілярним раком. Такі випадки потребують подальшого вивчення з метою удосконалення їх діагностики і лікування., Background. A feature of thyroid pathology in the endemic goiter region is the combination in one patient of several diseases of the thyroid gland, in particular thyroid papillary carcinoma and Hashimoto’s autoimmune thyroiditis. Objective. To determine the frequency and morphological features of thyroid papillary carcinoma and Hashimoto's autoimmune thyroiditis in surgically treated patients with thyroid diseases in the Precarpathian endemic goiter region. Methods. The results of pathohistological examinations of 1348 patients operated on thyroid diseases at the Lviv Regional Clinical Hospital and the Military Medical Clinical Center of the Western Region in 2014-2018 were analyzed. Results. Among 1348 patients operated on for thyroid disease Hashimoto's autoimmune thyroiditis was found in 61 cases (4.5 %), focal thyroiditis - in 114 cases (8.5 %), thyroid papillary carcinoma - in 245 cases (18.2%), thyroid papillary carcinoma of all histological variants except papillary microcarcinoma - in 204 cases (15.1 %) and papillary microcarcinoma - in 41 cases (3.0 %). Among the total number of operated patients in 70 cases (5.2%), in each individual patient both Hashimoto's autoimmune thyroiditis or focal thyroiditis in association with thyroid papillary carcinoma were detected. Conclusion. Residents of the Precarpathian endemic goiter region operated on thyroid diseases often have cases of a combination of Hashimoto's autoimmune thyroiditis and focal thyroiditis with thyroid papillary carcinoma. These cases need further study to improve their diagnosis and treatment., Актуальность. Особенностью тиреоидной патологии в условиях эндемического региона зоба является сочетание у одного пациента нескольких заболеваний щитовидной железы, в частности папиллярного рака и аутоиммунного тиреоидита Хашимото. Цель. Определить частоту и морфологические особенности папиллярного рака и аутоиммунного тиреоидита Хашимото у пациентов, оперированных по поводу тиреоидной патологии в условиях Прикарпатского эндемического региона зоба. Методы. Проведен анализ результатов патогистологических исследований операционного материала 1348 больных, оперированных по поводу заболеваний щитовидной железы во Львовской областной клинической больнице и Военном медицинском клиническом центре Западного региона в 2014-2018 годах. Результаты. Среди 1348 больных, оперированных по поводу заболеваний щитовидной железы, аутоиммунный тиреоидит Хашимото обнаружили в 61 случае (4,5%), фокальный тиреоидит - в 114 случаях (8,5%), папиллярный рак - в 245 случаях (18,2%) , в частности папиллярный рак всех гистологических вариантов кроме «маленького» папиллярного рака - в 204 случаях (15,1%) и «маленький» папиллярный рака 41 случаях (3,0%). Среди общего числа оперированных пациентов в 70 случаях (5,2%) у каждого отдельно взятого пациента выявлены одновременно аутоиммунный тиреоидит Хашимото или фокальный тиреоидит в сочетании с папиллярным раком. Выводы. У жителей Прикарпатского эндемического региона зоба, оперированных по поводу заболеваний щитовидной железы, часто встречаются случаи сочетания аутоиммунного тиреоидита Хашимото и фокального тиреоидита с папиллярным раком. Такие случаи требуют дальнейшего изучения с целью усовершенствования их диагностики и лечения.

Tumour-induced osteomalacia (TIO) is a rare disease characterised by hypophosphataemia and clinical symptoms of osteomalacia. Herein we report the case of a 29-year-old man who was admitted to hospital with progressive bone pain and was diagnosed with TIO caused by maxillary sinus tumours. In the preoperative evaluation, it was found that the patient had thyroid malignant tumours at the same time. Two operations were performed separately on the left maxillary sinus tumour and thyroid tumour after complete examination. After tumour resections, the symptoms of bone pain were relieved and the level of blood phosphorus was restored, long-term replacement therapy was needed for thyroid. When a patient is diagnosed with TIO, it is necessary to screen for the presence of other malignant tumours and explore the treatment options in order to benefit patients preferably.

Background There are no data regarding the prevalence of malignancies in patients with primary immunodeficiency (PID) in Turkey. Along with the prevalence of malignancy, we aimed to present the types of malignancy and define the underlying immune deficiency of the patients. Method Between the years 1992 and 2018, from five tertiary immunology clinics, fifty-nine patients with PID who developed malignancy were included. All patients were evaluated for demographics, clinical features, and prognosis. Results The prevalence of malignancy in our cohort was detected as 0.9% (59/6392). The male-to-female ratio was 1.8 (38/21), and the median age of patients was 14 years (range: 1.5-51). The median age at diagnosis of malignancy was 10 years (range: 1.5-51). Ataxia-telangiectasia was the most frequent PID in patients with malignancy (n = 19, 32.2%), and non-Hodgkin lymphoma was the most common malignancy (n = 32, 51.6%). The rate of malignancy in DOCK8 deficiency (n = 7/43, 16.3%) was higher than AT (n = 19/193, 9.8%), Wiskott-Aldrich syndrome (n = 2/22, 9.1%), and common variable immunodeficiency (n = 11/205, 5.4%). EBV quantitative PCR was positive in 16 out of 53 patients (30.2%). Three patients had secondary malignancies. Remission was achieved in 26 patients (44.1%). However, 31 patients (52.5%) died. Two patients (3.4%) are still on chemotherapy. Conclusion This study is the largest cohort investigating the association of malignancy in patients with PID in Turkey. While lymphoid malignancies were the most common malignancy and observed more frequently in AT patients, the risk for malignancy was higher in patients with DOCK8 deficiency compared to AT.

Objective. To evaluate the risk factors for predicting lymph nodes (LN) posterior to right recurrent laryngeal nerve metastasis in thyroid papillary carcinoma. Methods. PubMed, PMC, EMBASE, and the Cochrane Library were systematically searched for articles published spanning 30/06/2009-30/8/2018 using multiple search terms. Thirteen articles involving 10,014 patients were reviewed in our meta-analysis. Stata 15.1 software was used for the meta-analysis. Results. The rate of LN posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis was 8.65%. Univariate analysis showed that age (P=0.001), gender (P<0.001), tumour size (P<0.001), lateral LN metastasis (P<0.001), extrathyroidal invasion (P<0.001), multifocality (P=0.005), capsule invasion (P<0.001), tumour location (P=0.076), lymph nodes anterior to right recurrent laryngeal nerve (LN-arRLN) metastasis (P<0.001), and central LN metastasis (P<0.001) were significantly associated with the increased incidence of LN-prRLN metastasis in thyroid papillary carcinoma. Conclusion. PTC patients aged tumours>1 cm, lateral LN metastasis, extrathyroidal invasion, multifocality, capsule invasion, LN-arRLN metastasis, or central LN metastasis were significantly correlated with lymph nodes posterior to right recurrent laryngeal nerve metastasis, indicating LN-prRLN dissection.

Horner’s syndrome encompasses miosis, ptosis of the eyelid, enophthalmos and facial anhidrosis, resulting from sympathetic cervical nerve damage. Although a well-known entity, it is rarely encountered in the setting of thyroid surgery, with only anecdotal evidence in the literature. Variations in the anatomical relationship between the thyroid gland and surrounding neural structures may increase the odds of sympathetic chain lesion occurring during surgery.

Background: Papillary tumours of the breast are diagnostically challenging lesions and represent a wide spectrum of diseases from papilloma to invasive papillary carcinoma. A rare subtype of breast papillary tumour resembling the tall cell variant of thyroid papillary carcinoma (BTRTPC) has been described. The nomenclature of this entity, its relationship to other papillary tumours, and its nature, whether in situ or invasive, remain unclear. Methods: Seventy-five papillary carcinomas (PCs) of the breast previously diagnosed in routine practice were reviewed and the presence of features (n = 10) characteristic of BTRTPC were assessed to determine whether BTRTPC comprises a distinct entity or is part of the spectrum of the previously defined PC variants. Results: Nuclear overlapping and eosinophilic granular cytoplasm were seen in 81 and 75% of the cases, whereas nuclear grooves, nuclear clearing, and tall cells were noticed in 51, 42, and 38% of the cases, respectively; 27% of the cases showed macro- and micro-follicular architecture filled with colloid-like material. Five cases (7%) lacked oestrogen receptor (ER) expression. Co-existing invasive carcinoma was seen in 25 cases (33%). Two cases displayed several features characteristic of BTRTPC, and both were ER-negative. Conclusion: Features characteristic of BTRTPC overlap with other PCs of the breast. Molecular and immunohistochemical biomarkers are needed to provide objective diagnostic criteria for the characterisation of such lesions in routine practice.

WOS: 000422772500022, PubMed ID: 29303141, Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. A 52-year-old female was diagnosed approximately 4 years ago with primary hyperparathyroidism (PHPT) on the basis of hypercalcemia and elevated serum parathyroid hormone (PTH) level. Clinically, PHPT diagnosed patient was examined with Tc-99m MIBI scintigraphy to investigate parathyroid adenoma. Early Tc-99m MIBI images showed focal focused enhanced activity retention on both thyroid left lobe upper pole and thyroid lower pole inferior neighborhood. However, late images indicated thyroid activity washout and persistence of activity on left lobe lower pole. The observed lesion on left lobe lower pole neighborhood was identified as parathyroid adenoma. One-day thyroid scintigraphy was also conducted to correlate enhanced activity retention on the left lobe upper pole. Results on thyroid scintigraphy showed hypoactivity, and thyroid fine-needle aspiration cytology process was suggested from the nodule. Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. Diagnosis and treatment of hyperparathyroidism is crucial during preoperative period. Even observed rarely, parathyrotoxicosis diagnosed patients can develop thyroid cancer along with parathyroid adenoma.

Mature cystic teratomas (MCT) are composed of a mixture of tissues derived from all three germ layers and are the most common ovarian tumor in both adolescents and women of reproductive age. Although most of these tumors are benign, malignant transformation of MCT occurs only in about 1-2% of cases. Any of the tissues within the MCT, can change malignant transformation. Struma ovarii is a rare ovarian tumor, reported as %0.5-1 of all ovarian masses and 3% of MCT’s. Less than 5% of struma ovarii present malignant transformation. We reported a 66 year-old postmenopausal woman who was admitted for routine control. We revealed solid-cystic mass in the right adnexa that suggested teratoma. We performed total abdominal hysterectomy and bilateral salpingooophorectomy and thyroid papillary carcinoma was determined in pathological assesment. It is difficult to determine the diagnosis prior to surgery, final pathological diagnosis was confirmed as struma ovarii based on the typical morphology of the thyroid follicles and the results of immunohistochemical staining.

Supplemental Digital Content is available in the text, Introduction: Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of mature peripheral T-cell lymphoma and accounts for approximately 1% to 2% of non-Hodgkin lymphomas. Although the B symptoms with generalized lymphadenopathy are the most frequent manifestations of AITL, its diagnosis remains a challenge as clinical manifestations and pathological features are frequently misleading. Patient concerns: We report herein the case of a 70-year-old man with intermittent fever, pulmonary infection, and skin rash developed for 1 month before admission. Previously, he had undergone thyroidectomy for thyroid papillary carcinoma. Fever occurred on the day of discharge and occurred again during the next month. Symptoms worsened despite treatment with antibiotics and papular rash appeared. The local hospital diagnosed it as drug fever and stopped all antibiotics. Fever and rash were controlled temporarily; however, both relapsed 2 days before admission. On the night of admission, the patient developed fever again. Blood culture showed Staphylococcus epidermidis and Staphylococcus haemolyticus infection. Interventions: Taking into account the recent history of surgery, the patient was diagnosed with septicemia and was treated with anti-infective treatment. On 13th day after admission, the patient developed fever again accompanied by generalized lymphadenopathy. However, multiple blood cultures were negative and bone marrow aspiration cytology, biopsy, immunohistochemistry, and gene rearrangement results were normal. Diagnosis: The patient was finally subjected to cervical lymph node biopsy and was diagnosed with AITL. Outcomes: The patient was transferred to the Department of Hematology for further treatment. Conclusion: This case highlights the complex diagnostic challenges of AITL. AITL accompanied by thyroid carcinoma may not be a mere coincidence and administration of antibiotics may be a rare cause of AITL.

Geographic differences have been reported to affect the morphological and molecular features of papillary thyroid carcinomas (PTCs). The area around Chernobyl is well-known to be iodine-deficient in contrast to Japan, an iodine-rich country. We reviewed histological differences in adult PTC between Ukraine and Japan. In total, 112 PTCs from age- and sex-matched adults (Ukraine 56, Japan 56) were evaluated histologically for several factors including tumor size, capsulation, tumor components (papillary, follicular, solid, trabecular), lymph node metastasis, extrathyroid invasion, lymphocytic infiltration, oxyphilic metaplasia, and MIB-1 index. We demonstrated that tumors were smaller (1.56 vs. 2.13 cm, p

Parathyroid carcinomas are rare endocrine tumors which comprise 0.3-5.6% of all causes of hyperparathyroidism. 90% of them are hormonally active, while 10% of them may be non-functional. They mostly occur in a single parathyroid gland. Concurrent involvement of both parathyroid glands is quite rare. A 57-year-old male patient was admitted to emergency department with the complaint of dyspnea. Thorax tomography revealed a retrosternal mass. The mass was thoracoscopically excised by thoracic surgeons. Histopathological examination result of the mass was reported as parathyroid carcinoma. Parathyroid scintigraphy performed and focal activity increase in the lower pole of the left lobe. Parathyroid hormone level was 118 pg/ml and calcium level was measured as 11.4 mg/dl. The patient with these findings was operated and pathological examination of excised left lower parathyroid tissue was reported as carcinoma. In addition, micropapillary carcinoma was detected in left thyroid lobectomy specimen. Our case was also unusual in that double parathyroid carcinoma, which is a rare condition, was hormonally inactive. We aimed to present our case in the light of the literature due to its rare occurrence.

INTRODUCTIONThere are only few cases reported about the role of surgery in the presence of single or multiple bulky bone metastases. The literature about treatment for bulky sternal metastases is scarce.PRESENTATION OF CASEWe present two patients treated surgically for metastatic thyroid lesions. Case 1 is a female with tumor of the thyroid right lobe, mediastinal extension and multiple pulmonary metastases. Bony infiltration was observed in the sternum and ribs. Case 2 is a female with a lesion in the cervical region of the thyroid left lobe and increase in volume on the upper sternal manubrium.DISCUSSIONPatients with well-differentiated thyroid cancer may present with extracervical metastasis in 5–10% of cases at diagnosis. Bone metastases occur in 0.4% of cases of papillary carcinoma. Management remains controversial. There are only isolated cases reported in the literature of the role surgery plays in the presence of single or multiple bulky bone metastases. The basis for initial surgical approach is keeping in mind that the surgical procedure is palliative in order to achieve optimal hypothetical ablation as a result of reduced tumor volume.CONCLUSIONSurgery is the elective treatment and can be performed safely and with adequate results, allowing proper optimization of the dose of 131I for ablative therapy.

The expression of non‑metastatic expressed/non‑metastatic 23 nucleoside diphosphate kinase 1 (nm23‑H1) and cyclooxygenase 2 (COX‑2) proteins in thyroid carcinoma have been analysed in a number of previous studies, but this requires further study. The current study focused on the expression levels of nm23‑H1 and COX‑2 in 130 human thyroid papillary carcinoma (PTC) tissues. Of the 130 PTC tissues, 55 were classified as microcarcinoma and may provide information on the development of the specific characteristics of this tumour type. Routine histopathological examination and immunohistochemical detection of nm23‑H1 and COX‑2 expression was performed on 130 PTC tissues from patients treated in the Clinical Hospital for Tumours (Zagreb, Croatia) between January 2000 and December 2007. The stain intensity of nm23‑H1 and COX‑2 proteins was compared with the characteristics of the patients and the tumour. The highest overall expression rate of nm23‑H1 and COX‑2 was 90 and 67.6%, respectively, and the joint expression of these proteins was statistically significant. The median expression level of nm23‑H1 was significantly increased in the classical and follicular histological group of the PTC tissues compared with tissues from other histological groups. The median expression level of COX‑2 was significantly increased in the follicular histological group, and reduced in the diffuse‑sclerosing group of PTC tissues. All the metastatic microcarcinoma tissues had increased expression levels of the two proteins in comparison with microcarcinoma tissues without lymph node metastases ; however, this variation was only statistically significant for COX‑2 expression levels. Therefore the results of the current study indicate that COX‑2 protein levels may be able to differentiate which thyroid papillary microcarcinoma tumours possess metastatic potential.

Existe controversia na literatura quanto a associacao entre Carcinoma Papilifero de Tireoide (CPT) e Tireoidite de Hashimoto (TH) e tambem quanto a qual seria a relacao etiologica entre ambos. OBJETIVO: Determinar a proporcao de casos de TH entre pacientes com CPT, correlacionando com aspectos histomorfologicos. METODO: Foi realizado estudo retrospectivo de pacientes consecutivos submetidos a tireoidectomia parcial ou total por CPT, entre 2007 e 2009, totalizando de 41 casos. RESULTADOS: Em relacao a associacao de TH e CPT, foram encontrados 11 casos (26,8%), sendo todos do sexo feminino, porem, sem significância estatistica. Nos casos em que havia CPT coexistente com TH a idade media foi de 44,9 anos e sem a associacao, 49,1 anos. O tamanho medio dos tumores entre os sem TH foi 20,53mm e os com TH foi de 12,72 mm - p = 0,4. Em relacao ao estadiamento anatomopatologico, as proporcoes entre os que apresentam TH e os que nao apresentam foram mantidas em T1a, T1b e T3. Em T2, nao houve casos de coexistencia entre TH e CPT. CONCLUSAO: Ha uma proporcao de 26,8% de pacientes que possuem associacao entre TH e CPT, porem, sem diferencas em relacao ao tamanho do tumor.

Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. We performed shotgun liquid chromatography (LC)/tandem mass spectrometry (MS/MS) analysis on pooled protein extracts from patients with PTC and compared the results with those from normal thyroid tissue validated by real-time (RT) PCR and immunohistochemistry (IHC). We detected 524 types of protein in PTC and 432 in normal thyroid gland. Among these proteins, 145 were specific to PTC and 53 were specific to normal thyroid gland. We have also identified two important new markers, nephronectin (NPNT) and malectin (MLEC). Reproducibility was confirmed with several known markers, but the one of two new candidate markers such as MLEC did not show large variations in expression levels. Furthermore, IHC confirmed the overexpression of both those markers in PTCs compared with normal surrounding tissues. Our protein data suggest that NPNT and MLEC could be a characteristic marker for PTC.

Systematic elective paratracheal dissection for papillary thyroid carcinoma is controversial.This study aims to analyze the pattern of locoregional recurrence (LRR) to determine the potential benefit of elective paratracheal dissection and to identify prognostic factors influencing locoregional control and disease specific survival.A cohort of 342 patients who underwent a total thyroidectomy with or without neck dissection for a papillary thyroid carcinoma was retrospectively reviewed. Clinicopathological variables predicting for survival and control were examined.All patients underwent total thyroidectomy and 84 underwent neck dissection as primary treatment. Sixty-six patients underwent a central compartment neck dissection. Twenty-eight (8.2%) patients developed LRR, of which 12 did not undergo neck dissection at initial surgery. The majority of neck recurrences were found in the lateral neck. Two patients (0.7%) without a paratracheal dissection done initially recurred only in the central compartment. On univariable analysis significant pathological predictors of locoregional control included tumor size, extrathyroidal extension (ETE), lymphovascular invasion and pathological lymph node status. Only ETE was a significant adverse prognostic variable for disease specific survival. On regression analysis, ETE and lymphovascular invasion were the only significant independent predictors of LRR. Paratracheal dissection did neither influence LRR nor central compartment control when adjusted for the effect of other variables.Strong conclusions are difficult to draw without a comparable group, but these results suggest that the absolute benefit of elective paratracheal dissection is small.

Background: The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. Methods: Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. Results: The mean age of subjects was 49.3 ± 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas (P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens (P < .05). Conclusion: Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity. © 2010 Elsevier Inc. All rights reserved.

Differentiated thyroid carcinoma is a rare malignancy in children. It represents 0.4% to 3.0% of all childhood malignancies, with greater than 70% of cases presenting between the ages of 11 to 17 years and is exceptionally rare in children under 5 years of age. The most common type of differentiated thyroid carcinoma in children is papillary thyroid carcinoma, most of which are believed to be related to radiation exposure and only approximately 5% of cases have a family history of papillary thyroid cancer. In this report, we present a papillary thyroid carcinoma in a 3-year-old American boy with a family history of thyroid cancer and no known history of radiation exposure. A literature review with discussion on the management and treatment of pediatric papillary thyroid carcinoma follows.

BackgroundLeptin has physiological roles in multiple systems, and has possible effects on several carcinogenesis steps. The aim of this study was to investigate the leptin levels in thyroid papillary carcinoma (TPC) patients.MethodsForty-three female TPC patients and 30 healthy female control subjects were recruited for the study. TPC was diagnosed by fine needle aspiration biopsy. TPC patients had a bilateral total thyroidectomy operation and their leptin levels were measured before and 20 days after the operation.ResultsSerum leptin levels of TPC patients were higher than in control group subjects (21.15 ± 14.12 ng/mL vs. 9.89 ± 0.21 ng/mL, p < 0.05). The leptin levels decreased after total thyroidectomy (13.92 ± 10.55 ng/mL) compared to prethyroidectomy levels (22.94 ± 14.67 ng/mL) in 34 patients who came to the follow-up visit (p < 0.05). However, the decreased post-thyroidectomy levels of leptin were still statistically significantly higher than the control group levels. Multivariate regression analysis showed that the leptin levels in TPC patients were not related to age, menopausal status or pathologic occult status but were directly related to the cancer group.ConclusionLeptin levels were elevated in thyroid cancer, decreased after total thyroidectomy, and might be associated with thyroid papillary carcinogenesis.

We report two cases of papillary thyroid carcinoma occurring after the successful treatment of osteosarcoma. One of the patients was administered with several alkylating agents and topoisomerase II inhibitor as part of the primary treatment of osteosarcoma. The onset of thyroid carcinoma occurred after 5 and 12 yr after cessation of the osteosarcoma therapy. All the patients involved in this study are alive and free of their malignancies. There have been eight case reports of these two malignancies occurring in the same patient. Thyroid carcinoma rarely occurs in patients with osteosarcoma; however, vigilant surveillance and long-term follow-up should be emphasized for all survivors.