Objectives To screen out the predictors of central cervical lymph node metastasis (CLNM) for papillary thyroid carcinoma (PTC) and establish a prediction model to guide the operation of PTC patients (cN0). Methods Data from 296 PTC patients (cN0) who underwent thyroid operation at the Second Affiliated Hospital of Chongqing Medical University were collected and retrospectively analyzed. They were divided into two groups in accordance with central CLNM or not. Their information, including ultrasound (US) features, BRAFV600E status, and other characteristics of the two groups, was analyzed and compared using univariate and multivariate logistic regression analyses, and the independent predictors were selected to construct a nomogram. The calibration plot, C-index, and decision curve analysis were used to assess the prediction model’s calibration, discrimination, and clinical usefulness. Results A total of 37.8% (112/296) of PTC patients had central CLNM, and 62.2% (184/296) did not. The two groups were compared using a univariate logistic regression analysis, and there were no significant differences between the two groups in sex, aspect ratio, boundary, morphology, hypoechoic nodule, thyroid peroxidase antibody, or tumor location (P>0.05), and there were significant differences between age, tumor size, capsule contact, microcalcifications, blood flow signal, thyroglobulin antibodies (TgAb), and BRAF gene status (P<0.05). A multivariate logistic regression analysis was performed to further clarify the correlation of these indices. However, only tumor size (OR=2.814, 95% Cl=1.634~4.848, P<0.001), microcalcifications (OR=2.839, 95% Cl=1,684~4.787, P<0.001) and TgAb (OR=1.964, 95% Cl=1.039~3,711, P=0.038) were independent predictors of central CLNM and were incorporated and used to construct the prediction nomogram. The model had good discrimination with a C-index of 0.715. An ROC curve analysis was performed to evaluate the accuracy of this model. The decision curve analysis showed that the model was clinically useful when intervention was decided in the threshold range of 16% to 80%. Conclusion In conclusion, three independent predictors of central CLNM, including tumor size (> 1.0 cm), US features (microcalcifications), and TgAb (positive), were screened out. A visualized nomogram model was established based on the three predictors in this study, which could be used as a basis of central cervical lymph node dissection (CLND) for PTC patients (cN0).

/pdf/predictors-and-a-prediction-model-for-central-cervical-lymph-34sj0vd5.pdf

Predictors and a Prediction Model for Central Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma (cN0)

The current study describes a case of adenosquamous carcinoma originating from a thyroglossal duct cyst (TGDC). A 77-year-old man presented with an asymptomatic mass in the left mid-neck, which was soft and mobile on palpation. Fine-needle aspiration was performed, but cytology did not detect any malignant cells. Computed tomography demonstrated a single cystic lesion in the left lobe of the thyroid gland; therefore, surgery was performed on the suspected thyroid cyst. However, it was identified intraoperatively that the lesion was separated from the thyroid gland and instead adhered to an additional hyoid bone; therefore, the Sistrunk procedure was performed. Histopathological examination of the resected tumor confirmed the diagnosis of adenosquamous carcinoma originating from a TGDC. Carcinoma arising from a TGDC is rare, and accounts for 1% of all TGDC cases. The most common subtype of carcinoma associated with TGDC is papillary carcinoma, whilst adenosquamous carcinoma developing from a TGDC is extremely rare, with only one case currently reported in the literature. Although a consensus for the management of this disease has not yet been established, adequate surgical excision with long-term follow-up is currently the preferred treatment.

/pdf/adenosquamous-carcinoma-arising-from-a-thyroglossal-duct-1splzcmz6a.pdf

Adenosquamous carcinoma arising from a thyroglossal duct cyst: A case report

Internal jugular vein tumor thrombus is an extremely rare condition in thyroid carcinoma, but it does exist. Correlated with greater aggressiveness with a higher incidence of distant metastases at diagnosis and a higher recurrence rate, this important prognostic element should be systematically investigated by ultrasound operators in all patients presenting with thyroid carcinoma. The patient’s follow-up must be careful. This can be a trap that surgeons must look for in their preoperative checklist. We report the case of a 58-year-old woman with an IJV thrombus associated with multiple bone metastases. She underwent successful surgical treatment, and postoperative pathology showed a poorly differentiated follicular carcinoma of the thyroid and a tumor thrombus in the internal jugular vein. 

/pdf/internal-jugular-vein-tumor-thrombus-a-tricky-question-for-1b07gdnf.pdf

Internal Jugular Vein Tumor Thrombus: A Tricky Question for the Thyroid Surgeon

An extensive tumor thrombus is an extremely rare entity in thyroid cancer. It is related to aggressive tumor behavior and a poorer prognosis. 18F-FDG PET is a useful tool for accurate staging and restaging in malignancies as well as the determination of tumor thrombus and its differential diagnosis from benign thromboembolism. We report a rare case of 66-year-old patient with an extensive tumor thrombus in superior vena cava on 18F-FDG PET/CT. Un thrombus tumoral macroscopique est une entité extrêmement rare dans le cancer de la thyroïde. Il est lié à un comportement tumoral agressif et à un pronostic plus sombre. La TEP au 18F-FDG est un outil utile pour la stadification et la reconstitution plus précises des tumeurs malignes ainsi que pour la détermination du thrombus tumoral et son diagnostic différentiel par rapport à la thromboembolie bénigne. Nous rapportons un cas rare chez un patient de 66 ans présentant un thrombus tumoral étendu dans la veine cave supérieure à la TEP/TDM au 18F-FDG. 

Poorly differentiated thyroid cancer with an extensive tumor thrombus in superior vena cava on 18F-FDG PET/CT: A case report

The incidence rate of thyroid cancer is rising rapidly in numerous parts of the world, but the mortality rate is relatively stable or even declining. The aim of the present study was to analyze the risk factors of cervical lymph node metastasis (LNM) in differentiated thyroid carcinoma (DTC). The clinical data of 846 patients with DTC were collected from the Department of General Surgery of Chifeng Municipal Hospital of Inner Mongolia Medical University (Chifeng, China) from June 2018 to June 2022. The relationship between central LNM (CLNM) and lateral LNM (LLNM) was explored in terms of sex, age, tumor diameter, multifocality, capsular invasion and Hashimoto's thyroiditis. It was revealed that male sex, age &lt;35 years, tumor size &gt;1 cm, multifocality and capsular invasion were associated with CLNM and LLNM (P&lt;0.001), while there was no relationship between Hashimoto's thyroiditis, CLNM and LLNM (P&gt;0.05). The number of positive lymph nodes in CLNM dissection, accounting for ≥50% of the total number of lymph nodes dissected, was significantly associated with LLNM (P&lt;0.0001). In conclusion, there was no correlation between Hashimoto's thyroiditis and CLNM and LLNM. The present study revealed that patients with the characteristics of sex, age &lt;35 years, tumor size &gt;1 cm, multifocality and capsular invasion were associated with cervical LNM. The proportion of the number of central lymph node metastases to the total number of lymph nodes cleared during surgery is more than or equal to 50%, indicating a susceptibility to external cervical lymph node metastasis. The results of multivariate logistic analysis showed that male sex, multifocality, capsular invasion and CLNM were risk factors for LLNM, and age was a protective factor for LLNM in DTC. 

pdf/clinical-analysis-of-cervical-lymph-node-metastasis-patterns-35olqajzkw.pdf

Clinical analysis of cervical lymph node metastasis patterns and multivariate factors in differentiated thyroid carcinoma

BACKGROUND Although papillary thyroid microcarcinoma (PTMC) is not considered a threatening tumor, in some cases, it can be aggressive. Metastatic thrombosis of papillary thyroid carcinoma, follicular thyroid carcinoma, Hürthle cell carcinoma, poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature, but there have been no reports about PTMC. CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination. She had no symptoms, and the physical examination showed no positive signs. Subsequent ultrasonography-guided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance, with some actively growing cells (TBSRTC III) and the BRAFV600E mutation not present. This patient underwent left thyroidectomy, isthmus lobectomy, prophylactic central lymph node dissection and thromboembolectomy. Postoperative pathology showed papillary microcarcinoma of the left thyroid, and the thrombus in the middle thyroid vein was a tumor thrombus. CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC, but it does exist. Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid, and we strongly suggest close follow-up of these patients.

https://doi.org/10.12998/wjcc.v10.i10.3213

Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma: A case report and review of literature

Objective To evaluate the incidence and the predictive factors for the metastasis of central compartment lymph nodes （ level Ⅵ ） in clinically node-negative （cNO） papillary thyroid carcinoma （PTC）. Methods One hundred and eight patients with cNO PTC underwent neck dissection for level Ⅵ between January 2003 and December 2006 were followed up and analyzed retrospectively. Univariate analysis with the x2 test was used to analyze the statistical correlation between central compartment lymph nodes metastasis and the other clinical factors. Multiple Logistic regression analysis was used to identify the multivariate correlates of central compartment metastasis. Kaplan-Meier method was used to calculate the accumulative survival rate, lateral neck recurrence and metastasis rate. Results Metastasis rate in level Ⅵ was 59. 2% （64/108）. Age below 45, tumor size > 3 cm and extracapsular spread were independent predictive factors for the metastasis in level Ⅵ （odds ratio were 5.514, 5.610 and 3. 122, P < 0. 05,respectively）. There were low incidence of postoperative complications, 2 cases with transient nerve palsy （1. 8%）, 5 cases with transient hypoparathyroidism （4. 6%） and 1 case with permanent hypoparathyroidism（0.9% ）. Six cases with ipsilateral neck recurrence, 1 case died. The 5-year lateral neck recurrence rate and accumulative survival rate were 4. 8% and 99. 1% respectively. Conclusion Metastasis in level Ⅵ in the patients with cNO PTC is common and selective neck dissection is necessary for the patients.

Key words: 
Thyroid neoplasms; Carcinoma, papillary; Lymphatic metastasis; Radical neckdissection

Central compartment lymph node metastasis in cN0 papillary thyroid carcinoma

Objective
To study the clinical characteristic, diagnosis, surgical treatment and prognosis of thyroglossal duct carcinoma （TDCa）. 


Methods
A total of 110 patients with thyroglossal duct remanat in our hospital between 1991 and 2011 was reviewed. Five patients of them were diagnosed with TDCa by pathological examination, including 4 cases of papillary carcinoma and 1 case of squamous cell carcinoma. 


Results
All five patients were men and the median age was 41 years （range from 17-73 years）. Pulmonary metastasis was found preoperatively in one patient with papillary carcinoma. All five patients were managed by surgical treatment. Sistrunk operation was performed with resection of the tumor, thyroglossal remanat and partial hyoid bone in 2 patients, with resection of thyroid nodule in one patient, with total thyroidectomy and central neck dissection in one patient with pulmonary metastasis, with extensive resection of invading tissues in one patient with squamous TDCa. Two patients with papillary carcinoma underwent the treatment with TSH suppression postoperatively, of them one with pulmonary metastasis received radioactive iodine therapy simultaneously. The remaining three patients did not receive any further treatment. With follow-up of 14 -45 months, local recurrence occurred in one patient with squamous TDCa after two months and caused death seven months after surgery, and the other four patients survived. 


Conclusions
TDCa is a rare malignant tumor that is usually diagnosed after surgery. The Sistrunk operation may be adequate for low-risk cases.


Key words: 
Thyroglossal Cyst; Thyroid neoplasms; Diagnosis; Therapy

[Management of thyroglossal duct carcinoma: report of five cases].

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Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma: A case report and review of literature

Central compartment lymph node metastasis in cN0 papillary thyroid carcinoma

[Management of thyroglossal duct carcinoma: report of five cases].