Long-term survival of patients with intracranial metastases from thyroid cancer presenting with seizures: a case report and literature review
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Abstract:
Thyroid cancer has low incidence and mortality. While metastatic cancer is the most common type of intracranial cancer, patients with intracranial metastases from thyroid cancer very rarely present with seizures. Here, we describe a case study and review the neurological symptoms and histopathology of intracranial metastases from thyroid cancer.A 38-year-old woman was diagnosed with intracranial metastases from papillary thyroid cancer, with the chief symptom being generalized seizures. The bilateral frontal masses were completely resected in 2 operations, after which the patient was treated with whole-brain radiotherapy and tyrosine kinase inhibitors (TKIs). It has now been over 13 years since thyroid cancer resection and 51 months since she was diagnosed with intracranial metastases from papillary thyroid cancer. The long-term survival might be due to the effective and prompt treatment. Through literature review, we found the incidence of intracranial metastases from different subtypes of thyroid cancer to be inconsistent with epidemiological findings in thyroid cancer.Intracranial metastases of thyroid cancer should be considered when the patient has a history of thyroid cancer with seizures. A combination of surgery, radiation therapy, and TKI drugs may prolong survival.Follicular thyroid cancer
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Introduction: It has been identified ionizing radiation as the definitive cause of cancer in humans. One third of the tumors that develop after radiation exposure are malignant, with papillary thyroid cancer (PTC) being the most common cancer type. This study aimed to investigate the relationship between total radiation dose (TRD) received during imaging tests and thyroid cancer occurrence in patients diagnosed with PTC.
Material and Method: The study was designed to retrospectively review the data of adult patients aged ≥ 18 years who were diagnosed with PTC between 2005 and 2022. Patients diagnosed with a condition other than PTC were excluded from the study
Result: 307 patients with papillary thyroid cancer were 256 (83.4%) women, with a mean age of 44.7 ± 13.5 years. A statistically significant relationship was observed between TRD and multifocality (p = 0.02). Tumor size (r = 0,2, p = 0.07) weakly correlated with TRD. And TRD (OR: 0.9, 95% CI: 1.0-1.1, p: 0.006) according to multifocalty were found to be significant.
Discussion: This study found an association between TRD taken during imaging tests and multifocality. As a result, the authors aimed to remind clinicians that the disease may progress more aggressively and that thyroid cancer may develop in patients exposed to radiation as a result of excessive imaging tests
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Background: The incidence of thyroid cancer has increased worldwide. The country where the incidence has increased most is South Korea. The goal of this study is to understand the magnitude of association between opportunistic thyroid cancer screening and thyroid cancer incidence, thyroid cancer subtype, and disease-specific mortality. Methods: We used the 2010 Korea Community Health Survey, which queried 226,873 individuals if they had been screened for thyroid cancer in the last two years. Thyroid cancer incidence data from 2008 to 2010 were obtained from the Korea Cancer registry data, and mortality data from 2007–2010 were obtained from the Statistics Korea database. The ecological association between thyroid screening and thyroid cancer incidence and mortality by age and sex were examined across Korea's 16 administrative regions by general linear regression models. Results: Between 2008 and 2010, the incidence of thyroid cancer was 64.1 per 100,000 individuals: the incidence in females was 107.3 and in males was 21.1. There was a strong positive correlation between regional thyroid cancer screening and regional thyroid cancer incidence (r = 0.77, [95% confidence interval 0.70–0.82]). The magnitude of correlation was higher for females (r = 0.88 [CI 0.83–0.92]) than in males (r = 0.76 [CI 0.67–0.84]) in any age group. Thyroid screening was only associated with increased detection of papillary thyroid cancer (r = 0.74 [CI 0.59–0.88]); and not associated with mortality (r = −0.08 [CI −0.59–0.63]) due to thyroid cancer. Conclusions: The magnitude of association between thyroid cancer screening in South Korea and the incidence of thyroid cancer strongly suggests that screening is the most important driver of the epidemic of thyroid cancer, particularly among females. Thyroid cancer screening, however, was only associated with the increase of one tumor histology, papillary thyroid cancer, and it did not have any association with thyroid cancer mortality. The extent to which opportunistic thyroid cancer screening is converting thousands of asymptomatic persons to cancer patients without any known benefit to them needs to be examined carefully.
Thyroid disease
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Thyroid cancer is the 9th most common cancer in the world. Thus, in the year 2020, 586.000 cases of thyroid cancer were registered worldwide. The incidence rate among women is 10.1 per 100 thousand population, and among men — 3.1 per 100 thousand population. In Ukraine, in 2019, the standardized rate of incidence of thyroid cancer (world standard) was 6.9 per 100.000 population (2.8 among men, 10.5 among women). In the structure of the incidence of malignant neoplasms of the cervical spine, thyroid cancer ranks first place among women aged 18 — 29 (19.9 %), fourth among both men aged 18 — 29 (8.3 %, and women aged 30 — 54 (8.1 %). Over the past 40 years, increased incidence of thyroid cancer (in particular, papillary thyroid cancer) is observed in most countries, which can be explained by various factors, for example, overdiagnosis, a change in the prevalence of modified risk factors. In Ukraine, in the period from 1989 to 2012, the rate of incidence of papillary thyroid cancer among men increased by 115 %, among women — by 137 %, the annual increase in incidence of papillary thyroid cancer for men and women was 5 and 6 %, respectively. Multifocality in papillary thyroid cancer is a characteristic feature that is much more common in pediatric patients than in adults, but the number of studies in children is limited, which is associated with a lower prevalence of the disease in children. The results of investigations on the multifocality predictors and its role in influencing relapse, persistence, and survival in patients with papillary thyroid cancer are conflicting in both adults and pediatric population. Among the risk factors of multifocality, a smaller number of controversies concerns the links of metastasis in the lymphatic nodes, radiation in the anamnesis, childhood age, and for bilaterality — multifocality of the primary lobe and the presence of contralateral benign nodes (in adults). Other factors as predictors of multifocality have controversial significance and deserve attention in further research. The identification of reliable predictors of multifocality, especially with the help of preoperative data analysis, as well as multifocality risk stratification will facilitate the complex decision‑making process for the correct treatment tactics of children and adults with papillary thyroid cancer.
Overdiagnosis
Thyroid disease
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Thyroid cancer (TC) is the most common malignant tumor of the endocrine glands and accounts to 3% of the total structure of oncological morbidity. Papillary thyroid cancer (PTC) is the most common histological variant of thyroid malignancies. It accounts for about 85% of all cases of thyroid cancer. Despite good postoperative results and excellent survival compared to many other malignancies, tumor metastases to the paratracheal lymph nodes are quite common. This review of the literature considers the current personalized approach to patients with papillary thyroid cancer and current aspects influencing the management of patients with PTC.Рак щитовидной железы (РЩЖ) является наиболее частой злокачественной опухолью эндокринных желез и составляет до 3% в общей структуре онкологической заболеваемости. Папиллярный рак щитовидной железы (ПРЩЖ) является наиболее частым гистологическим вариантом злокачественных новообразований щитовидной железы, на его долю приходится около 85% всех случаев РЩЖ. Несмотря на благоприятные послеоперационные результаты и высокую выживаемость по сравнению со многими другими злокачественными заболеваниями, метастазы опухоли в паратрахеальные лимфатические узлы встречаются довольно часто. В обзоре литературы рассмотрен современный персонализированный подход к пациентам с ПРЩЖ и аспекты, влияющие на тактику ведения.
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Background: Thyroid cancer is the most common endocrine tumor and is increasing in incidence. The aim of this study was to review mouse models of differentiated thyroid cancer and how they elucidate human thyroid cancer biology. Summary: Differentiated thyroid cancer, primarily papillary and follicular, comprises the majority of thyroid cancers. There has been tremendous growth in the cross-talk between basic science and clinical practice for thyroid cancer management. Insight into the framework of genes responsible for differentiated thyroid cancer has been gained through the use of mouse models. Common genetic alterations found in human papillary thyroid cancer such as RET/PTC rearrangements or the BRAFV600E mutation have genetically modified mouse counterparts. These and other preclinical mouse models have validated the importance of the cyclic adenosine monophosphate (cAMP)/protein kinase A and mitogen-activated protein kinase (MAPK) signaling pathways in papillary thyroid cancer (PTC). RAS mutations have a role in both papillary and follicular thyroid cancer development. Mice with overactivation of the phosphatidylinol-3-kinase (PI3K)–AKT and/or thyrotropin-regulated signaling pathways have been found to develop follicular thyroid cancer. Additional mouse models of thyroid cancer that utilize inducible expression systems are in development or are being characterized and will better reflect the majority of human thyroid cancers which are non-hereditary. Advances in in vivo imaging of mice allow for earlier detection of metastasis and the ability to follow tumor growth or regression which may be used in evaluation of pharmaceutical agents. Conclusions: Mouse models have expanded our understanding of the altered signaling pathways that contribute to thyroid cancer tumorigenesis and provide a powerful tool to develop novel diagnostic approaches and therapies.
Follicular thyroid cancer
Anaplastic thyroid cancer
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Background: CDK12 is a potential therapeutic target in papillary thyroid cancer that regulates the c-myc/β-catenin pathway. Objective: We aimed to explore the specific mechanism of CDK12 in papillary thyroid cancer and provide a new target of cancer therapy. Methods: RT-qPCR was used to determine the CDK12 mRNA expression level. An IHC assay was performed to detect the tissue expression of CDK12. Then, we downregulated CDK12 expression in the thyroid cancer cell lines TPC-1-shCDK12 and KAT-5-shCDK12. CCK8 assays, colony formation assays, and animal xenograft models were used to evaluate the effect of CDK12 on tumorigenesis. Transwell assays and in vivo metastasis models were used to observe whether CDK12 can promote cancer metastasis. Western blotting further confirmed the mechanism of CDK12 in papillary thyroid cancer through the c-myc/β-catenin pathway. Results: Upregulated CDK12 expression in papillary thyroid cancer promoted papillary thyroid cancer carcinogenesis in vivo, and in vitro CDK12 strengthened papillary thyroid cancer (PTC) cell migration and tumor metastasis. CDK12 promoted tumor progression by regulating c-myc/β-catenin pathway activation. Conclusions: CDK12 affects the c-myc/β-catenin pathway to stimulate papillary thyroid cancer proliferation and metastasis. Inhibiting CDK12 might be a new method in papillary thyroid cancer therapy.
Tumor progression
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Thyroid cancer (TC) includes tumors of follicular cells; it ranges from well differentiated TC (WDTC) with generally favorable prognosis to clinically aggressive poorly differentiated TC (PDTC) and undifferentiated TC (UTC). Papillary thyroid cancer (PTC) is a WDTC and the most common type of thyroid cancer that comprises almost 70-80% of all TC. PTC can present as a solid, cystic, or uneven mass that originates from normal thyroid tissue. Prognosis of PTC is excellent, with an overall 10-year survival rate >90%. However, more than 30% of patients with PTC advance to recurrence or metastasis despite anti-cancer therapy; consequently, systemic therapy is limited, which necessitates expansion of improved clinical approaches. We strived to elucidate genetic distinctions due to patient-derived anti-cancer drug-sensitive or -resistant PTC, which can support in progress novel therapies. Patients with histologically proven PTC were evaluated. PTC cells were gained from drug-sensitive and -resistant patients and were compared using mRNA-Seq. We aimed to assess the in vitro and in vivo synergistic anti-cancer effects of a novel combination therapy in patient-derived refractory PTC. This combination therapy acts synergistically to promote tumor suppression compared with either agent alone. Therefore, genetically altered combination therapy might be a novel therapeutic approach for refractory PTC.
Follicular thyroid cancer
Refractory (planetary science)
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Thyroid cancer incidence has increased substantially in the United States over the last 4 decades, driven largely by increases in papillary thyroid cancer. It is unclear whether the increasing incidence of papillary thyroid cancer has been related to thyroid cancer mortality trends.To compare trends in thyroid cancer incidence and mortality by tumor characteristics at diagnosis.Trends in thyroid cancer incidence and incidence-based mortality rates were evaluated using data from the Surveillance, Epidemiology, and End Results-9 (SEER-9) cancer registry program, and annual percent change in rates was calculated using log-linear regression.Tumor characteristics.Annual percent changes in age-adjusted thyroid cancer incidence and incidence-based mortality rates by histologic type and SEER stage for cases diagnosed during 1974-2013.Among 77 276 patients (mean [SD] age at diagnosis, 48 [16] years; 58 213 [75%] women) diagnosed with thyroid cancer from 1974-2013, papillary thyroid cancer was the most common histologic type (64 625 cases), and 2371 deaths from thyroid cancer occurred during 1994-2013. Thyroid cancer incidence increased, on average, 3.6% per year (95% CI, 3.2%-3.9%) during 1974-2013 (from 4.56 per 100 000 person-years in 1974-1977 to 14.42 per 100 000 person-years in 2010-2013), primarily related to increases in papillary thyroid cancer (annual percent change, 4.4% [95% CI, 4.0%-4.7%]). Papillary thyroid cancer incidence increased for all SEER stages at diagnosis (4.6% per year for localized, 4.3% per year for regional, 2.4% per year for distant, 1.8% per year for unknown). During 1994-2013, incidence-based mortality increased 1.1% per year (95% CI, 0.6%-1.6%) (from 0.40 per 100 000 person-years in 1994-1997 to 0.46 per 100 000 person-years in 2010-2013) overall and 2.9% per year (95% CI, 1.1%-4.7%) for SEER distant stage papillary thyroid cancer.Among patients in the United States diagnosed with thyroid cancer from 1974-2013, the overall incidence of thyroid cancer increased 3% annually, with increases in the incidence rate and thyroid cancer mortality rate for advanced-stage papillary thyroid cancer. These findings are consistent with a true increase in the occurrence of thyroid cancer in the United States.
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AIMS OF THE STUDY: Thyroid cancer incidence rates have been increasing globally over past decades. However, no study examining those trends in the canton of Zurich, Switzerland exists. In this study, we describe the incidence and mortality trends of thyroid cancer in the canton of Zurich during a 37-year period (1980–2016) including factors such as sex, histological subtypes and age at diagnosis. METHODS: We analysed population-based cancer registry data from 1980-2016 for the canton of Zurich, Switzerland. We estimated the age-standardised incidence and mortality rates using the European standard population. Joinpoint regression was used to detect average annual percentage changes (AAPCs) and their corresponding 95% confidence intervals (CIs). RESULTS: We included 2972 primary cases of thyroid cancer (72.3% in women). The papillary cases accounted for the majority of incident cases (65.8%). In 2016, women had a higher age-standardised incidence rate than men for both papillary (10.4 and 3.3, respectively, per 100,000) and non-papillary (1.6 and 0.7, respectively, per 100,000) thyroid cancer. In both men and women, the incidence rates of thyroid cancer increased significantly over the study period with AAPCs of 1.4% (95% CI 0.6–2.2%) and 2.6% (95% CI 2–3.1%), respectively. These increasing incidence trends are mainly driven by papillary thyroid cancer with AAPCs of 3.4% in men (95% CI 2.3% to 4.4%) and 4.3% in women (95% CI 3.7% to 5%). Mortality rates significantly decreased in both sexes (men AAPC –3.6%, 95% CI –4.7% to –2.4%; women AAPC –3.7%, 95% CI –4.8% to –2.6%). CONCLUSIONS: Our results show significantly increasing age-standardised incidence rates of thyroid cancer over time in both sexes, mainly due to papillary thyroid cancer, the most frequent histological subtype, and the only subtype for which a significant increase was observed. It is possible that many indolent thyroid cancers, and more specifically papillary microcarcinomas, are increasingly diagnosed, which may not lead to symptoms if undetected. Therefore, targeted diagnostic strategies are necessary to avoid overdiagnosis of thyroid cancer. Nevertheless, we cannot completely exclude a partly true increase.
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