Anaplastic thyroid carcinoma: diagnostic challenges,histopathologic features and ancillary testing

Anaplastic thyroid carcinoma (ATC) is an aggressive thyroid malignancy with high mortality rate. This malignancy arises in thyroid follicular cells either denovo or with an associated differentiated thyroid carcinoma component. Clinically, it usually presents as a rapidly enlarging mass, pain and locally compressive symptoms. Histopathologic variability and heterogeneity often pose diagnostic challenges, especially in scant and paucicellular specimens. This article describes the clinical, histopathologic and molecular features of ATC and also addresses the associated diagnostic limitations and challenges.     

Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients

PurposeTo investigate the safety and efficacy of thyroid artery embolization (TAE) in the treatment of nodular goiter (NG).MethodsDuring a 5.5-year period, 56 consecutive patients with a NG underwent TAE. In Group A, there were 20 patients with a solitary/dominant 5–11-cm nodule, and in Group B, there were 36 patients with numerous nodules. Of the 56 patients, 47 (84%) had a retrosternal goiter and 25 had hyperthyroidism. In all patients, clinical and radiological evaluations were made at baseline and 6 months after TAE, and these parameters were statistically compared.ResultsIn 56 patients, 145 of the 146 thyroid arteries were successfully embolized. The 30-day mortality rate was 1.8%. Minor and major complications occurred in 25 and 2 patients, respectively. Six months after the TAE, the mean nodule volume was reduced from 80.2 mL to 25.0 mL, the mean thyroid volume was reduced from 147.0 mL to 62.6 mL, and the mean intrathoracic extension was reduced from 31.7 mm to 15.9 mm (P < .001). Of the 22 patients with non–Graves hyperthyroidism, 19 (86%) became euthyroid. The mean thyroid-related patient-reported outcome scores improved from 155.4 to 70.4 (P < .001). Of the 51 patients, 50 (98%) declared that they would recommend TAE to other patients with NG.ConclusionsTAE is safe and effective for the treatment of NG, with a significant volume reduction of the nodule(s) and thyroid gland.     

Papillary thyroid carcinoma with a high tumor mutation burden has a poor prognosis

BackgroundTumor mutation burden (TMB) as a prognostic marker for immunotherapy has shown prognostic value in many cancers. However, there is no systematic investigation on TMB in papillary thyroid carcinoma (PTC).MethodsBased on the somatic mutation data of 487 PTC patients from The Cancer Genome Atlas (TCGA), TMB was calculated, and we classified the samples into high-TMB (H-TMB) and low-TMB (L-TMB) groups. Bioinformatics methods were used to explore the characteristics and potential mechanism of TMB in PTC.ResultsHigh TMB predicts shorter progression-free survival (PFS) (P < 0.001). TMB was positively correlated with age, stage, tumor size, metastasis, the male sex and tall cell PTC. Compared to the L-TMB group, the H-TMB group presented with lower immune cell infiltration, a higher proportion of tumor-promoting immune cells (M0 macrophages, activated dendritic cells and monocytes) and a lower proportion of antitumor immune cells (M1 macrophages, CD8⁺ T cells and B cells). Additionally, the characteristics displayed by different TMB groups were not driven by critical driver mutations such as BRAF and RAS.ConclusionsPTC patients with high TMB have a worse prognosis. By stratifying PTC patients according to their TMB, advanced PTC patients who are candidates for immunotherapy could be selected.     

Bilateral optic nerve edema presenting as initial manifestation of thyroid eye disease

A 48-year-old smoker with a history of hyperthyroidism treated 10 years prior to presentation with radioactive iodine ablation of the thyroid gland presented to his ophthalmologist with a 2-week history of transient loss of vision in the right eye occurring for 1 to 2 hours each morning. He denied ocular pain, diplopia or change in the prominence of one or both eyes. Examination revealed 2 mm of relative proptosis on the right, bilateral temporal flare and lower lid retraction. There was minimal upper lid retraction and no evidence of lid lag. Ocular motility was full. Dilated fundoscopic examination revealed bilateral optic nerve edema, right more than left. CT of the orbit demonstrated enlargement of the extraocular muscles bilaterally with marked enlargement of the right medial rectus and left inferior rectus muscles resulting in crowding at the orbital apex bilaterally. Laboratory testing revealed the patient to be hyperthyroid. The patient was treated with high dose oral steroids followed by orbital radiation. Hyperthyroidism was managed by the patient’s primary care physician. Visual symptoms rapidly improved with oral steroids and orbital radiation. Optic nerve edema completely resolved. Repeat CT imaging demonstrated a reduction in the enlargement of the extraocular muscles with relief of bilateral optic nerve compression.     

妊娠期甲状腺癌多学科综合治疗

妊娠期甲状腺癌的诊治是目前甲状腺疾病诊治的热点和难点问题之一。妊娠期发现甲状腺癌对临床医生和孕妇都是一个极大的挑战，应通过多学科协作，尽快明确诊断，全面、合理的评估孕妇和胎儿的情况，选择最合适的治疗和随诊方式，避免对孕妇和胎儿产生副反应，维持正常孕期，获得最佳的治疗效果。     

2010年-2018年甲状腺结节相关SCI论文知识图谱及数据可视化分析

目的:分析2010年至2018年甲状腺结节相关SCI论文，并建模进行定性与定量分析。方法:利用文献计量学中的引文分析、共被引分析、数据可视化、聚类分析等方法，使用CiteSpace分析工具，分析来源于Web of ScienceTM核心合集数据库中有关论文的出版情况、国家、机构、作者、知识基础与研究热点。结果:到2018年10月31日截止，研究了4 618篇论文。发表论文数:美国在国家/地区中排名第一，延世大学在研究机构中排名第一，Kwak JY在所有作者中排名第一。从2010年开始，每年发表的论文数量都在稳步增长，有相当多的论文发表在如《新英格兰杂志》、《THYROID》、《JAMA》、《CELL》等高影响因子的期刊上。甲状腺结节的SCI论文参考文献聚类为6类，分别是papillary-like nuclear feature、current statu、radiofrequency ablation、ultrasound elastography、goiter area、data system。代表研究前沿的关键词是meta-analysis、recommendation、thyroid carcinoma、shear wave elastography与bethesda system。结论:本文通过对国际上甲状腺结节的研究基础、研究热点的分析，阐述了甲状腺结节的研究趋势，为我国医学工作者的研究提供参考。     

甲状腺手术患者围术期优质护理干预效果探讨

目的观察分析在甲状腺手术患者护理中予以围术期优质护理干预的应用价值。方法此研究从本院甲状腺手术患者中选取样本,总例数为80例,研究时间始于2017年4月,止于2019年4月,依据护理方案的异同对患者进行分组,试验组予以围术期优质护理干预,对照组予以常规性护理干预,对比两组护理结果。结果研究可得,试验组护理满意率相对较高,组间数据对比得知与对照组相比统计值合理(P<0.05)。研究可得,试验组并发症发生率相对较低,组建数据对比得知与对照组相比统计值合理(P<0.05);研究可得,试验组预后生活质量相对较高,组建数据对比得知与对照组相比统计值合理(P<0.05)。结论此研究得知,在甲状腺手术患者护理中予以围术期优质护理干预,能提高患者护理效果,降低其并发症发生情况,并进一步改善患者预后效果。     

Video-Assisted Thoracoscopic Surgery after Preoperative CT-Guided Lipiodol Marking of Small or Impalpable Pulmonary Nodules

Purpose: Small pulmonary lesions that include ground-glass attenuation have been increasingly discovered because of progressive imaging diagnostic technologies. Despite the detection of such small lesions, sometimes it is quite difficult to localize them because of their size or considerable depth from the visceral pleura. In the present study, we examined the usefulness of computed tomography-guided lipiodol marking for thoracoscopic resection of impalpable pulmonary nodules.Methods: Fifty-six patients with an undiagnosed peripheral lesion(s) of the lung who had undergone preoperative computed tomography-guided lipiodol marking followed by video-assisted thoracoscopic surgery were studied.Results: All of the nodules were successfully marked by computed tomography-guided lipiodol marking, and all except for one case were localized by means of intraoperative fluoroscopy as clear spots. With regard to complications, pneumothorax occurred in 21 patients (37.5%), and only one patient required transient drainage. Although hemorrhaging in the lung parenchyma and hemosputum occurred in nine patients (16.1%) and one patient (1.8%), respectively, no patients were in serious condition. No intra- or postoperative mortality or morbidity was observed.Conclusion: Preoperative computed tomography-guided lipiodol marking of small or impalpable pulmonary nodules is a safe and useful procedure for thoracoscopic resection of the lung.