Complications associated with thermal treatments are shown in Supplemental Table 3 and vary by patient selection and operator experience (71,72). Careers. Raposo L, Freitas C, Martins R, Saraiva C, Manita I, Oliveira MJ, Marques AP, Marques B, Rocha G, Martins T, Azevedo T, Rodrigues F. BMC Med Imaging. A newly diagnosed TN should be evaluated to ascertain whether it is benign or malignant and, for symptomatic benign TN, to establish the indications for intervention to alleviate associated local symptoms. In case of cancer diagnosis, most are small, intrathyroidal and indolen Received: 26 February 2023; Accepted: 05 June 2023;Published: 27 June 2023. In instances in which mutation such as BRAF is noted, thyroid cancer rate is effectively 100%, whereas other mutationssuch as RAShave 60%80% cancer risk and alterations in molecular expression are associated with various levels of risk for malignancy. WebOf the 155 patients who underwent thyroid surgery for a dominant thyroid nodule 4 cm or larger, 132 (85.2%) were found to have benign final pathologic test results and 21 patients (13.6%) had a final histopathologic diagnosis of clinically significant thyroid carcinoma. While most thyroid nodules are benign, rarely they can be cancerous. Thyroid The overall prevalence of (D) immunohistochemical PAX-8 nuclei, Positive expression. The risk of malignancy can be assessed by means of US characteristics using available grading systems to assess malignancy risk and determine the indications for FNAB sampling. Cystic thyroid nodules - UpToDate Solitary Thyroid Nodule Scintigraphic imaging has a more limited role, being reserved for specific clinical scenarios. official website and that any information you provide is encrypted Sample adequacy represents an important issue with FNAB sampling of subcentimeter nodules and has been reported to be as low as 72.2% for 3- to 6-mm nodules, 84.9% for 7- to 10-mm nodules, and 63% in the presence of macrocalcifications (60). Synchronous primary sigmoid colon cancer and primary thyroid cancer followed by a malignant tumor of the kidney: case report of multiple primary cancer and review of the literature. Zaorsky NG, Lehrer EJ, Kothari G, Louie AV, Siva S. Stereotactic ablative radiation therapy for oligometastatic renal cell carcinoma (SABR ORCA): a meta-analysis of 28 studies. Results: The increase in frequency of imaging has led to a rise in the incidence of incidentally diagnosed TN. For advanced kidney cancer (high-risk group), targeted combination immunotherapy is the first-line recommended treatment option according to NCCN guideline recommendations (13). As medical treatment technology has improved, the incidence of MPMN has increased (2). You may also develop a goiter, which is an enlargement of the thyroid. According to the predictive model analysis of the International Metastatic Kidney Cancer Database Consortium (IMDC), our patient belongs to the high-risk group (12). Depending on the time interval between the diagnosis of the different malignancies, they are classified as either simultaneous or metachronous MPMNs, with simultaneous being rarer in MPMNs. (D) Immunohistochemistry TTF-1 positive expression, (E) Immunohistochemistry NapsinA positive expression positive expression of TTF-1 and NapsinA revealed a high probability that the tumor originated from the lung. We considered kidney cancer combined with bleeding. Unable to load your collection due to an error, Unable to load your delegates due to an error. -, J Otolaryngol Head Neck Surg. There is no complete agreement regarding the surveillance of subcentimeter TN. We focus on managing multidisciplinary teams and selecting individualized treatment options to deliver valuable treatment strategies to patients. J Natl Cancer Inst (2000) 92(3):20516. QUESTION: Thyroid nodules are a common complaint in clinical practice and the vast majority are benign. Bethesda categories III and IV include nodules with indeterminate cytology and associated malignancy risks of 10%30% and 25%40%, respectively (45). The manuscript and the specific recommendations were developed by reconciling the best available research evidence with the knowledge and clinical experience of the panellists and updates aspects of a number of previous European Thyroid association guidelines. However, core needle biopsy has been associated with a higher rate of complications, including postbiopsy hematomas, bleeding from the incision site, pain, infections, transient hemoptysis, and nerve injuries (43,44). doi:10.1016/j.euo.2019.05.007, Keywords: papillary thyroid carcinoma, multiple primary malignancies, multidisciplinary, case report, clear cell renal cell carcinoma with sarcomatoid, Citation: Tan Y, Chen X, Ye M, Li X, Liu W, Liao S, Xie Z and Zuo Y (2023) Synchronous multiple primary malignancies of clear cell renal cell carcinoma with sarcomatoid, thyroid carcinoma: a case report. All authors contributed to the article and approved the submitted version. The timeline of the patient's entire treatment process was depicted in Figure4. Our oncology department later consulted with the patient, and we carried out a thorough examination and pre-treatment imaging evaluation. 2 Case presentation 2.1 Case report However, the report did not mention specific treatment options for the three primary tumors, which differs from ours. J Clin Oncol (2020) 38(15_suppl):65122. thyroid nodule In contradistinction, hot hyperfunctioning nodules are rarely malignant (Fig. Patient with Graves disease and left midlobe cold nodule with concerning US appearance and cytology consistent with papillary thyroid cancer. Studies have shown that about 3% to 5% of all thyroid nodules are malignant. Discordant recommendations included a US-based referral for FNAB for functional nodules (3.8%) and a 123I-based recommendation for FNAB (7.9%) when either there was no TN on US or the nodule did not meet US-guided FNAB criteria (30). Risk of Malignancy in Thyroid Nodules 4 cm or Larger - PMC YZ, ZX, YT, XC, XL, and WL analysis of data for the work YZ, ZX, YT, XC, MY, XL, WL, and SL completed the revision work. However, the number needed to treat was 8:1, and TSH suppression therapy exposed patients to the risk of bone and cardiac complications from chronic iatrogenic hyperthyroidism. Influence factors and nomogram for volume reduction rate in Efficacy of thyroid hormone suppression for benign thyroid nodules: meta-analysis of randomized trials, American Thyroid Association statement on optimal surgical management of goiter, Impact of thyroid nodule size on prevalence and post-test probability of malignancy: a systematic review, An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid, Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance, Surgical considerations for papillary thyroid microcarcinomas, The importance of surgeon experience for clinical and economic outcomes from thyroidectomy, Hypothyroidism following hemithyroidectomy for benign nontoxic thyroid disease, Detection and management of hypothyroidism following thyroid lobectomy: evaluation of a clinical algorithm, Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian Minimally-Invasive Treatments of the Thyroid (MITT) Group, Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation, Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers, Treatment of autonomous thyroid nodules with percutaneous ethanol injection: 4-year experience, Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy, Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection, How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation, Comparative efficacy of radiofrequency and laser ablation for the treatment of benign thyroid nodules: systematic review including traditional pooling and bayesian network meta-analysis, Efficacy of thermal ablation in benign non-functioning solid thyroid nodule: a systematic review and meta-analysis, Ultrasound guided percutaneous microwave ablation of benign thyroid nodules: safety and imaging follow-up in 222 patients, Benign solid thyroid nodules: US-guided high-intensity focused US ablationinitial clinical outcomes, CXCR4-Directed Imaging and Endoradiotherapy in Desmoplastic Small Round Cell Tumors, https://www.uabmedicine.org/-/tessler-heads-international-effort-to-standardize-thyroid-nodule-guidelines. Although the incidence of thyroid cancer has increased in recent decades, most TN are benign, with a rate of malignancy of less than 5% (8,9). These sharing sensitive information, make sure youre on a federal 1]). 3). In case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms that can safely be managed conservatively. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. The patient later developed lower extremity thrombosis, new metastases in the liver, and larger than before retroperitoneal lymph nodes, suggesting tumor progression. In a frequently cited postmortem series, nodules were found in 50% of the study population. Update on the Evaluation of Thyroid Nodules, DOI: https://doi.org/10.2967/jnumed.120.246025, 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer, The diagnosis and management of thyroid nodules: a review, Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination, Incidental thyroid nodules on chest CT: review of the literature and management suggestions, Imaging-detected incidental thyroid nodules that undergo surgery: a single-center experience over 1 year, Thyroid nodules detected by contrast-enhanced magnetic resonance angiography: prevalence and clinical significance, The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography, Trends in thyroid cancer incidence and mortality in the United States, 1974-2013, Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging, Screening for thyroid cancer: US Preventive Services Task Force Recommendation Statement, The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis, Thyroid ultrasound reporting lexicon: white paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee, ACR Thyroid Imaging, Reporting and Data System (TI-RADS): white paper of the ACR TI-RADS Committee, Thyroid nodule doubling time is not a reliable indicator of benign or malignant nature, Ultrasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology Consensus Statement and Recommendations, European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: the EU-TIRADS, American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules2016 Update, Incidental thyroid nodules at non-FDG PET nuclear medicine imaging: evaluation of prevalence and malignancy rate, Risk of malignancy in FDG-avid thyroid incidentalomas on PET/CT: a prospective study, A risk-adapted approach using US features and FNA results in the management of thyroid incidentalomas identified by, Risk of malignancy in thyroid incidentalomas detected by, Systematic review: prevalence of malignant incidental thyroid nodules identified on fluorine-18 fluorodeoxyglucose positron emission tomography, Management of simple nodular goiter: current status and future perspectives, Management of the solitary thyroid nodule: results of a North American survey, Diagnosis and treatment of the solitary thyroid nodule: results of a European survey. Accuracy of Fine-Needle Aspiration Biopsy for Predicting Figure3 (A) under 400x microscope Thyroid cytology: Pap stained tumor cells were arranged in solid sheets with medium cytoplasm under 400x Pap staining, irregular nucleus morphology, vacuolated, chromatin border set, thickened nuclear membrane, and deviated nucleoli were seen, which are morphological features of typical papillary thyroid carcinoma. On 23 April 2022, the patient was started on oral lenvatinib. MeSH Nodule 99mTc uptake was noted, whereas with 131I imaging, the nodules appeared cold (29). Lenvatinib plus pembrolizumab combination therapy in patients with radioiodine-refractory (RAIR), progressive differentiated thyroid cancer (DTC): results of a multicenter phase II international thyroid oncology group trial. Thyroid Nodule - StatPearls - NCBI Bookshelf sharing sensitive information, make sure youre on a federal Pichler R, Comprat E, Klatte T, Pichler M, Loidl W, Lusuardi L, et al. The combination of pathology and immunohistochemical analysis aids in differentiating metastatic or primary tumors. A combination of nodule size and appearance is used to recommend when FNAB should be considered, similar to TI-RADS. MeSH Some benign thyroid nodules can start producing Registration is free. Background Current guidelines recommend the use of conventional US for risk stratification and management of thyroid nodules. Thyroid nodules (TNs) are among the common diseases of the endocrine system [].According to the autopsy and ultrasound reports, roughly 4050% of the worlds Am Soc Clin Oncol Educ B (2018) 38):33041. Thermal ablation techniques appear to be more effective for the shrinkage of solid nodules, with radiofrequency ablation achieving a more significant volume reduction than laser ablation (77,78). Methods: PubMed and Medline were searched for articles with a focus on the epidemiology, diagnosis, and management of TN over the past 5 y. Thus, the present guidelines aim at providing a clinical practice guide for the initial work-up and the subsequent management of adult individuals harbouring thyroid nodules. Materials Alharbi A, Aboasamh G, Shafik Y. Appendicular and breast cancers in an old lady: a case report. Thyroiditis or exogenous thyroid hormone. (C) Picture shows one HE stain 400 times for cell wax block section.The tumor cells can be seen in clusters with three-dimensional distribution, rich cytoplasm, oval or irregular-shaped nuclei, vacuolated, with one or more large red nucleoli and visible nuclear division, which is consistent with the morphological characteristics of adenocarcinoma. Growth of >2 mm/year was observed in 12% of benign nodules and 26% of cancerous nodules. National Library of Medicine Find out more about what causes thyroid nodules and how they are treated. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. In conclusion, we would like to express that the combination of tirelizumab with lenvatinib mesylate with SBRT showed good clinical efficacy in this female patient. Front Oncol (2022) 12:890587(May). FOIA doi:10.3892/ol.2018.9867, 10. This study shows that thyroid nodules 4 cm do not have a higher malignancy rate at surgery nor higher benign cytology false-negative rate than smaller nodules. Following the International Metastatic Kidney Cancer Database Consortium (IMDC) prognostic model for advanced renal cancer (5), three poor prognostic factors were identified in this patient, respectively: the interval between the diagnosis of primary renal cancer and systemic therapy was less than 1 year; hemoglobin was 85 g/L; and platelet count was 435 109/L, so there was a high risk of stratification based on prognosis. The highest-grade malignancies are treated with priority; surgery is the primary treatment option for patients who are able to undergo surgery; inoperable patients apply chemotherapy, targeted therapies, and other treatments to improve their quality of life (9). Pembrolizumab combined with lenvatinib is the first-line agent (6). On 14 April 2022, a color ultrasound scan of the thyroid gland showed a hypoechoic nodule measuring approximately 1.2 cm 0.9 cm 1.1 cm on the right lobe of the thyroid gland (2017 Thyroid nodules (TN) are commonly encountered in clinical practice, with a prevalence ranging between 20% and 60% in prospective, randomly selected patients (13). 2021 by the Society of Nuclear Medicine and Molecular Imaging. J Cytol. Thyroid nodule is a common disease with a high detection rate of approximately 5060% in healthy populations with ultrasound (US) examination [Citation 1], and approximately 95% of thyroid nodule is benign [Citation 2], including adenoma, benign follicular nodules, and nodular goiter.Most benign thyroid nodules do not Figure2 Before immune-targeted therapy: (A) Retrospective retroperitoneal parietal abdominal aorta and left iliac artery with several foci of slightly large round-like isointense nodules; the larger one is approximately 13 mm*11 mm. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid nodules emerge and demand attention. FNA cytology remains the gold standard in evaluating for the presence of malignancy, and molecular testing is a valuable tool for assessing cytologically indeterminate nodules. The chance of future cancer being found in a nodule with benign cytology is low and essentially becomes zero if another sampling yields benign cytology (13,51,5355). Treatment options should be individualized for each patients particular situation. and transmitted securely. A discrepancy between the uptake of 99mTc and the uptake of 131I by cancerous TN has been reported, particularly in follicular thyroid cancer. Register for free and gain unlimited access to: - Clinical News, with personalized daily picks for you -, Best Pract Res Clin Endocrinol Metab. As a result, risk assessment strategies were developed to determine the risk of malignancy that would justify additional assessment and intervention. Thyroid nodules (TNs) are among the common diseases of the endocrine system [].According to the autopsy and ultrasound reports, roughly 4050% of the worlds general population suffer from the abnormal overgrowths of tissue in the thyroid gland [].Such nodules can be identified in 47% of the general population through physical TSH suppression secondary to autonomous nodules can vary on the basis of local dietary iodine intake, and autonomous nodules with low reference range TSH levels have been found in populations with lower dietary iodine intake (32). We suggested a biopsy of the progressive lesion to assist with treatment, but the patient refused. Although some may cause local symptoms and are diagnosed through clinical examination, at present most are reported as incidental findings during unrelated imaging (47). Thyroid surgery is best performed by an experienced, high-volume thyroid surgeon so as to minimize surgical risks, such as transient or permanent postoperative hypoparathyroidism, hoarseness, and voice changes from recurrent laryngeal nerve damage (67). Accessibility Right panel. We hope youre enjoying the latest clinical news, full-length features, case studies, and more. (2019) 33(4):131324. In case of cancer diagnosis, most are small, intrathyroidal and indolen Harahap AS, Sari DG, Stephanie M, Siswoyo AD, Zaid LSM, Kartini D, Ham MF, Tarigan TJE. J Natl Compr Canc Netw (2022) 20(8):92551. (D) Left (LT) lateral cervical lymphadenopathy in patient with 1.9-cm isthmus nodule. Copyright 2023 Tan, Chen, Ye, Li, Liu, Liao, Xie and Zuo. In such cases, US can be considered to assess for coexistent nonfunctioning nodules, which may require additional evaluation. Purpose To compare the diagnostic performance of multimodality US (including conventional US, strain elastography, and and A: Understanding thyroid nodules MPMNs are rare. In this case, we found that the FNA cytology was consistent with the typical morphological features of papillary thyroid carcinoma. Does tumor size influence the diagnostic accuracy of ultrasound-guided fine-needle aspiration cytology for thyroid nodules? We reviewed 135 articles, including their reference lists, for additional pertinent articles. The patient was treated with stereotactic radiotherapy as well as PD-1 inhibitors without an increase in overlapping toxicities. WebThe optimal duration of monitoring for a patient with a thyroid nodule with a benign FNA is unknown, but perhaps it is reasonable to perform clinical, laboratory and radiologic assessment approximately 1 to 2 years, after the initial evaluations and first reevaluation at 6 to 18 months, for 4 to 5 years and less frequently thereafter. Patient education: Thyroid nodules (Beyond the Basics) - UpToDate TN below the threshold for FNAB but with high-risk features represent a challenging category and are subject to debate. Haugen B, French J, Worden FP, Konda B, Sherman E, Dadu R, et al. The efficacy of the treatment needs to be verified in more clinical trials. This patient had clear cell renal cell carcinoma with sarcomatoid, implying a poor prognosis. Would you like email updates of new search results. Surgery is not usually recommended, and a benign nodule can be monitored with ultrasound over time. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Keywords: False-negative rate; Size; Thyroid carcinoma; Thyroid nodule; 4 cm. TSH suppression therapy to shrink TN in euthyroid individuals was in vogue for many years, and a metaanalysis published in 2005 found an 88% likelihood of achieving a reduction in nodule volume of greater than 50% compared with placebo or no treatment (61). Then, we had a consultation with the Cancer Center of Sun Yat-sen University and added KS-cad (), Oct-4 (), SALL-4 (), and FH (+), which confirmed clear cell renal cell carcinoma grade 4, combined with sarcomatosis (10%) and necrosis (15%). What Size Thyroid Nodule Should You Worry About? Frontiers | Synchronous multiple primary malignancies of clear cell Thyroid Nodule We do not capture any email address. Core-needle biopsy in thyroid nodules: performance, accuracy, and complications, Comparison of diagnostic yield of core-needle and fine-needle aspiration biopsies of thyroid lesions: systematic review and meta-analysis, Recent advances in core needle biopsy for thyroid nodules, Role of ultrasound-guided core-needle biopsy in the assessment of head and neck lesions: a meta-analysis and systematic review of the literature, Effectiveness and limitations of core needle biopsy in the diagnosis of thyroid nodules: review of current literature, The 2017 Bethesda System for Reporting Thyroid Cytopathology, The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis, Indeterminate thyroid nodules in the era of molecular genomics, BRAF V600E and TERT promoter mutations cooperatively identify the most aggressive papillary thyroid cancer with highest recurrence, Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors, Molecular markers in diagnosing thyroid cancer, Value of US correlation of a thyroid nodule with initially benign cytologic results, Contemporary thyroid nodule evaluation and management, Tessler heads international effort to standardize thyroid nodule guidelines, Long- versus short-interval follow-up of cytologically benign thyroid nodules: a prospective cohort study, The natural history of benign thyroid nodules, Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology: systematic review and meta-analysis, Determining whether tumor volume doubling time and growth rate can predict malignancy after delayed diagnostic surgery of follicular neoplasm, Rapid thyroid nodule growth is not a marker for well-differentiated thyroid cancer, Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee. The multidisciplinary team discusses individualized and comprehensive treatment based on tumor size, pathological type, and clinical stage. (2018) 9(16):2795801. Thyroid What are thyroid nodules? Recommended follow-up of nodules should be individualized and based on clinical factors (Fig. Frontiers | Synchronous multiple primary malignancies of clear cell J Otolaryngol - Head Neck Surg (2017) 46(1):36. Thyroid Nodules: When to Worry | Johns Hopkins Medicine Thanks for visiting Endocrinology Advisor. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Thyroid carcinoma, version 2.2022, NCCN clinical practice guidelines in oncology. Early diagnosis and multidisciplinary treatment may be the key factors affecting MPMN. (C) Right upper femur with local bone destruction and soft tissue shadowing. Thyroid nodules may be solid, cystic (fluid filled), or a combination of both and can develop in any location within the thyroid gland. On 27 September 2022, the patient underwent fine needle aspiration of bilateral thyroid nodules and left neck IV lymph nodes. Conversely, the RAS mutation has been identified in benign nodules, follicular adenomas, the noninvasive follicular thyroid neoplasm with papillary-like nuclear features, papillary thyroid cancer (classic, follicular variant, and poorly differentiated), and anaplastic and medullary thyroid cancers (49).