Absence of Peritumoral Fibrosis or Inflammatory Infiltrate May Be Related to Clinical Progression of Papillary Thyroid Microcarcinoma

Ramos, Ana Maria de Oliveira; Sales, Alexandre de Oliveira; Mello, Luiz Guilherme Marchesi; Andrade, Márcia Cirino de; Paiva, Fernando Pinto; Ramos, Carlos Cesar Oliveira; Formiga, Maria Célia de Carvalho; Ramos, Carlos Cesar de Formiga; Matos, Patrícia Francisca de; Ward, Laura Sterian

doi:10.1177/1066896909333749

Cited by 12 publications

(11 citation statements)

References 18 publications

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“…Papillary microcarcinomas are frequently detected during examination of the thyroid in patients who died of unrelated causes and without a history of thyroid malignancy or in patients submitted to thyroidectomy due to benign disease of the gland. This frequency ranges from 1% to 8% in Brazil (11)(12)(13)(14). Moreover, the prevalence of papillary thyroid carcinoma (PTC) detected by ultrasonographic screening in subjects without a family history of thyroid cancer or a history of radiation exposure, who had no abnormalities upon thyroid palpation, was reported to be 1.2% (15).…”

Section: Papillary Thyroid Microcarcinomasmentioning

confidence: 99%

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Rosário¹,

Ward²,

Graf³

et al. 2019

Archives of Endocrinology and Metabolism

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The indolent evolution of low-risk papillary thyroid microcarcinoma (mPTC) in adult patients and the consequences of thyroidectomy require a revision of the management traditionally recommended. Aiming to spare patients unnecessary procedures and therapies and to optimize the health system in Brazil, we suggest some measures. Fine-needle aspiration of nodules ≤ 1 cm without extrathyroidal extension on ultrasonography should be performed only in nodules classified as "very suspicious" (i.e., high suspicion according to ATA, high risk according to AACE, TI-RADS 5) and in selected cases [age < 40 years, nodule adjacent to the trachea or recurrent laryngeal nerve (RLN), multiple suspicious nodules, presence of hypercalcitoninemia or suspicious lymph nodes]. Active surveillance (AS) rather than immediate surgery should be considered in adult patients with low-risk mPTC. Lobectomy is the best option in patients with unifocal low-risk mPTC who are not candidates for AS because of age, proximity of the tumor to the trachea or RLN, or because they opted for surgery. The same applies to patients who started AS but had a subsequent surgical indication not due to a suspicion of tumor extension beyond the gland or multicentricity. Molecular tests are not necessary to choose between AS and surgery or, in the latter case, between lobectomy and total thyroidectomy. The presence of RAS or other RAS-like mutations or BRAFV600E or other BRAF V600E-like mutations should not modify the management cited above; however, the rare cases of mPTC exhibiting high-risk mutations, like in the TERT promoter or p53, are not candidates for AS.

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Section: Papillary Thyroid Microcarcinomasmentioning

confidence: 99%

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Rosário¹,

Ward²,

Graf³

et al. 2019

Archives of Endocrinology and Metabolism

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“…Studying the glands of autopsies performed in individuals from two different Brazilian regions (Rio Grande do Norte versus São Paulo), we found a high incidence of nonencapsulated nonsclerosing papillary thyroid microcarcinomas (PTM) in Rio Grande do Norte, an area of markedly high incidence of PTC, in sharp contrast with the prevalence of small sclerosing lesions in São Paulo, where clinical thyroid cancers are much more infrequent [148]. PTMs could elicit an inflammatory lymphocytic response, fibrosis, and the formation of a capsule impeding its further growth [148]. We could speculate that these lesions may never evolve to clinical cancers, in contrast with the nonencapsulated nonsclerosing lesions that could represent early stages of clinical PTC.…”

Section: Prognostic Implication Of the Association Between Clt Andmentioning

confidence: 99%

Clinical and Pathological Implications of Concurrent Autoimmune Thyroid Disorders and Papillary Thyroid Cancer

Cunha

Ferreira

Marcello

et al. 2011

Journal of Thyroid Research

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Cooccurrences of chronic lymphocytic thyroiditis (CLT) and thyroid cancer (DTC) have been repeatedly reported. Both CLT and DTC, mainly papillary thyroid carcinoma (PTC), share some epidemiological and molecular features. In fact, thyroid lymphocytic inflammatory reaction has been observed in association with PTC at variable frequency, although the precise relationship between the two diseases is still debated. It also remains a matter of debate whether the association with a CLT or even an autoimmune disorder could influence the prognosis of PTC. A better understanding about clinical implications of autoimmunity in concurrent thyroid cancer could raise new insights of thyroid cancer immunotherapy. In addition, elucidating the molecular mechanisms involved in autoimmune disease and concurrent cancer allowed us to identify new therapeutic strategies against thyroid cancer. The objective of this article was to review recent literature on the association of these disorders and its potential significance.

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“…Previous research has suggested that a local inflammatory response may impede tumor evolution (18) and may indicate a more favorable outcome (15,16). However, a recent study found an association between the presence of Tregs and lymph node metastasis in papillary thyroid carcinomas (19).…”

Section: Introductionmentioning

confidence: 99%

Foxp3 expression is associated with aggressiveness in differentiated thyroid carcinomas

Cunha¹,

Morari²,

Nonogaki³

et al. 2012

Clinics

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OBJECTIVES:Forkhead box P3 (FoxP3) expression has been observed in human cancer cells but has not yet been reported in thyroid cells. We investigated the prognostic significance of both FoxP3 expression and intratumoral FoxP3+ lymphocyte infiltration in differentiated thyroid carcinoma cells.METHODS:We constructed a tissue microarray with 385 thyroid tissues, including 266 malignant tissues (from 253 papillary thyroid carcinomas and 13 follicular carcinomas), 114 benign lesions, and 5 normal thyroid tissues.RESULTS:We determined the expression of FoxP3 in both tumor cells and tumor-infiltrating lymphocytes using immunohistochemical techniques. Cellular expression of FoxP3 was evident in 71% of benign and 91.9% of malignant tissues. The nuclear and cytoplasmic expression patterns were quantified separately. A multivariate logistic regression analysis indicated that cytoplasmic FoxP3 expression is an independent risk factor for thyroid malignancy. Cytoplasmic FoxP3 staining was inversely correlated with patient age. Nuclear FoxP3 staining was more intense in younger patients and in tumors presenting with metastasis at diagnosis. FoxP3+ lymphocytes were more frequent in tumors smaller than 2 cm, those without extrathyroidal invasion, and in patients with concurrent chronic lymphocytic thyroiditis.CONCLUSIONS:We demonstrated FoxP3 expression in differentiated thyroid carcinoma cells and found evidence that this expression may exert an important influence on several features of tumor aggressiveness.

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Absence of Peritumoral Fibrosis or Inflammatory Infiltrate May Be Related to Clinical Progression of Papillary Thyroid Microcarcinoma

Cited by 12 publications

References 18 publications

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Thyroid nodules ≤ 1 cm and papillary thyroid microcarcinomas: Brazilian experts opinion

Clinical and Pathological Implications of Concurrent Autoimmune Thyroid Disorders and Papillary Thyroid Cancer

Foxp3 expression is associated with aggressiveness in differentiated thyroid carcinomas

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