여포성 종양의 진단과 치료에 있어서의 문제점들

김원배 대한갑상선학회 2012 International Journal of Thyroidology Vol.5 No.2

Thyroid follicular adenoma and hyperplastic adenomatoid nodule may show overlapping cytologic pattern with thyroid follicular carcinoma and follicular variant of thyroid papillary carcinoma. Fine-needle aspiration cytology (FNAC) has limited role in differential diagnosis of those lesions showing high cellularity and absence of colloid. Those lesions are conventionally termed ‘follicular neoplasm’. As diagnostic hallmarks of follicular carcinoma (vascular- and capsular invasion) cannot be detected by cytology, verification by histology after surgery is mandatory. However, only 20% of patients with thyroid nodules diagnosed cytologically as ‘follicular neoplasm’are finally diagnosed as carcinoma after surgery. Therefore, there have been many trials to differentiate follicular adenoma (FA) from follicular carcinoma (FTC) in preoperative setting. Among those trials are 1) cell morphometry analysis by computer graphics, analysis of telomerase expression level, quantitation of specific protein markers, or intensive cytological analysis using FNAC specimens, 2) ultrasonographic evaluation,dynamic MRI, or MR spectroscopy for thyroid nodules and 3) gene expression profile analysis for thyroid nodules by microarray technique, all showing limited success or limitations hampering clinical application. Similarly,intra-operative frozen section analysis of thyroid nodule had been known to be of no diagnostic utility in a prospective, randomized trial. Current management strategy for ‘follicular neoplasm’ is initial surgery for diagnostic purpose to get pathologic diagnosis. If the nodule is diagnosed finally as FTC, completion thyroidectomy with or without radioactive iodine therapy is recommended in most cases. Minimally invasive FTC (without vascular invasion) is known to have excellent prognosis in most cases, so traditionally those patients had undergone unilateral operation without completion thyroidectomy. But, there had been reported cases showing distant metastasis and/or recurrence in patients with ‘minimally invasive FTC’. One of problems in diagnosis of ‘minimally invasive FTC’ is lack of international standardization for pathologic diagnosis. Optimal surgical extent for cases with FTC is not known yet. It might have been due to lack of risk stratification of patients which is unique to FTC (not well differentiated thyroid cancer as a whole), lack of biomarker predicting prognosis of FTC, and lack of controlled trial for management of patients with FTC. In near future, application of molecular diagnostic markers is expected to improve our management strategy for thyroid nodules diagnosed as ‘follicular neoplasm’, if molecular pathogenesis of FA and of FTC are comprehensively understood.

갑상선 결절에서 악성 종양의 선별 검사로서 Skp2와 p27 단백 발현의 의의

이석홍 외 중앙대학교 의과대학 의학연구소 2006 中央醫大誌 Vol.31 No.1·2·3

the G1 to the S phase of the cell cycle, and is regulated through either degradation mediated by the S phase kinase associated protein 2 (Skp2), or sequestration via D3 cyclin. The overexpression of Skp2 or the underexpression of p27 has been seen in various neoplasms, but their role in thyroid tumor genesis has not yet been well established. We analyzed a series of thyroid specimens to determine whether expression of these cell cycle proteins may be useful in distinguishing among thyroid neoplasms. Formalin-fixed, paraffinembedded tissues from 69 patients with thyroid neoplasms (14 nodular hyperplasias, 17 follicular adenomas, 8 follicular carcinomas, and 30 papillary carcinomas) were analyzed for expression of p27 and Skp2 by immunostaining. The distribution of immunoreactivity was analyzed by quantifying the percentage of positive nuclei. When more or equal to 5% of the tumor cells showed positive nuclear staining for Skp2, staining was considered positive. When less or equal to 10% of the tumor cells showed positive nuclear staining for p27, staining was considered low expressor. Skp2 expression was seen in 0 (0%) nodular hyperplasia, 6 (20%) papillary carcinoma, 3 (17.6%) follicular adenoma and 3 (37.5%) follicular carcinoma. No significant difference in expression of Skp2 between nodular hyperplasia and papillary carcinoma (P = 0.084), but a significant difference between follicular adenoma and follicular carcinoma (P = 0.021) was found. Loss of p27 was seen in 3 (21. 4%) nodular hyperplasia, 29 (96.7%) papillary carcinoma, 16 (94.1%) follicular adenoma, 8 (100%) follicular carcinoma. This difference in loss of p27 between nodular hyperplasia and papillary carcinoma (P < 0.001), between follicular adenoma and follicular carcinoma (P < 0.001) were statistically significant. Skp2 and p27 may be useful for differentiating nodular hyperplasia from follicular neoplasm or papillary carcinoma but not for follicular adenoma from follicular carcinoma.

갑상선 여포종양의 임상적 특성 및 감별진단

태경,전성하,이용섭,이형석,김동선,최웅환,안유헌,박동우 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.5

Background and Objectives:A preoperative diferential diagnosis betwen follicular adenoma and follicular carcinoma of thyroid is very dificult, and the standard basis for distinction is the presence of capsular and/or vascular invasion. In this study, the folli-cular neoplasm. Subjects and Method:A retrospective review of medical records was caried out on 104 patients who had undergone thyroid surgery and had been diagnosed with thyroid follicular adenoma or carcinoma from 195 through 204. The final pathologic diagnosis was compared to the various clinical data including the result of fine needle aspiration cytology (FNAC) and ultrasonographic findings. Results:Of total 104 cases, 82 were follicular adenoma and 22 were follicular carcinoma. The incidence of carcinoma was significantly higher in male than in female. The result of FNAC were divided into 6 cyto-diagnostic groups, namely, inadequate, colloid nodule without atypia, colloid nodule with atypia, follicular neoplasm without atypia, folicular neoplasm with atypia, or highly suspicious malignancy. The incidence of carcinoma was significantly higher in the groups with atypia such as colloid nodule with atypia, follicular neoplasm with atypia, and highly suspicious malignancy than ci-fication on ultrasonography also indicated the posibility of malignancy. Conclusion:The incidence of follicular carcinoma was significantly high in male patients, atypia in FNAC, and ill-defined margin and calcification on ultrasonography. (Korean J Otolaryngol 2007 ;50 :420-5)

세포검사 결과 여포성 종양으로 진단된 갑상선 결절에서 암의 위험성과 수술 후 소견

김은숙<SUP>1<,SUP>,남궁일성,공경엽<SUP>2<,SUP>,홍석준<SUP>3<,SUP>,김원배,송영기,Eun Sook Kim,M,D,<SUP>1<,SUP>,Il Sung Nam-Goong,M,D,Gyeongyub Gong,M,D,<SUP>2<,SUP>,Suck Joon Hong,M,D,<SUP>3<,SUP>,Won Bae Kim,M,D,and You 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.2

Purpose: To assess the prevalence and the risk of malignancy in thyroid nodules which were cytologically diagnosed as follicular neoplasm by fine-needle aspiration (FNA) cytology. Methods: All the patients who had undergone surgery with cytological diagnosis of follicular neoplasm from January 1996 through December 2001 in Asan Medical Center were studied retrospectively. Patients' and nodule characteristics were analyzed for factors associated with the presence of cancer. Results: Two hundreds and fifteen patients (196 females, 19 males) were included and their mean age was 39.4 years (range: 12∼76). About half of the patients (102 out of 215, 47.4%) had malignancy with 29 papillary carcinomas, 57 follicular carcinomas, 15 Hürthle cell carcinomas, and 1 medullary carcinoma. Previously suggested factors associated with risk for malignancy such as male gender, large tumor size (>4 cm), or age of patients (>45 years), were not associated with increased risk. Diagnosis of Hürthle cell neoplasia on FNA was also not associated with increased risk. Only the extreme age of the patients (below 20 or above 60 years) was associated with increased risk for malignancy. Conclusion: By our hands, prevalence of carcinoma in thyroid nodule patients with cytological diagnosis of follicular neoplasm was much higher than those reported. Clinical characteristics such as male gender, age, and nodule size, are not useful predictors for the presence of malignancy. Thyroid nodules with cytological diagnosis of follicular neoplasm warrant immediate surgery without any further work up. (Korean J Endocrine Surg 2002;2:105-108)

Clinicoradiological Characteristics in the Differential Diagnosis of Follicular-Patterned Lesions of the Thyroid: A Multicenter Cohort Study

Lee Jeong Hoon,Ha Eun Ju,Lee Da Hyun,Han Miran,Park Jung Hyun,Kim Ji-hoon 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.7

Objective: Preoperative differential diagnosis of follicular-patterned lesions is challenging. This multicenter cohort study investigated the clinicoradiological characteristics relevant to the differential diagnosis of such lesions. Materials and Methods: From June to September 2015, 4787 thyroid nodules (≥ 1.0 cm) with a final diagnosis of benign follicular nodule (BN, n = 4461), follicular adenoma (FA, n = 136), follicular carcinoma (FC, n = 62), or follicular variant of papillary thyroid carcinoma (FVPTC, n = 128) collected from 26 institutions were analyzed. The clinicoradiological characteristics of the lesions were compared among the different histological types using multivariable logistic regression analyses. The relative importance of the characteristics that distinguished histological types was determined using a random forest algorithm. Results: Compared to BN (as the control group), the distinguishing features of follicular-patterned neoplasms (FA, FC, and FVPTC) were patient’s age (odds ratio [OR], 0.969 per 1-year increase), lesion diameter (OR, 1.054 per 1-mm increase), presence of solid composition (OR, 2.255), presence of hypoechogenicity (OR, 2.181), and presence of halo (OR, 1.761) (all p < 0.05). Compared to FA (as the control), FC differed with respect to lesion diameter (OR, 1.040 per 1-mm increase) and rim calcifications (OR, 17.054), while FVPTC differed with respect to patient age (OR, 0.966 per 1-year increase), lesion diameter (OR, 0.975 per 1-mm increase), macrocalcifications (OR, 3.647), and non-smooth margins (OR, 2.538) (all p < 0.05). The five important features for the differential diagnosis of follicular-patterned neoplasms (FA, FC, and FVPTC) from BN are maximal lesion diameter, composition, echogenicity, orientation, and patient’s age. The most important features distinguishing FC and FVPTC from FA are rim calcifications and macrocalcifications, respectively. Conclusion: Although follicular-patterned lesions have overlapping clinical and radiological features, the distinguishing features identified in our large clinical cohort may provide valuable information for preoperative distinction between them and decision-making regarding their management.

한국 임상 현장에서 갑상선의 행동양식 불명 또는 미상의 신생물 이해

정찬권 대한갑상선학회 2019 International Journal of Thyroidology Vol.12 No.1

Thyroid tumors include a heterogeneous group of entities with variable clinical behavior and histology, mostly classified as benign or malignant. Neoplasm of uncertain or unknown behavior in thyroid gland was newly adopted by the 2017 edition of World Health Organization (WHO) classification of endocrine organs. The borderline thyroid tumors include a hyalinizing trabecular tumor and three encapsulated follicular-patterned thyroid tumors (follicular tumor of uncertain malignant potential, well-differentiated tumor of uncertain malignant potential, and non-invasive follicular thyroid neoplasm with papillary-like nuclear features). This review summarizes the changes in the 2017 WHO classification of thyroid tumors, highlights their implications for clinical practice in Korea, and briefly discusses National Health Insurance system, cancer insurance policies, and their associated benefits in Korea.

Thyroid nodules with Bethesda System IV Cytology: Can Ultrasonography Differentiate Malignancy from Benign?

유미리,손은주,육지현,김정아,정선양,김하나,권혜미 대한초음파의학회 2013 ULTRASONOGRAPHY Vol.32 No.2

Purpose: The purpose of this study is to identify clinical and imaging parameters that can be used in differentiation of benign versus malignancy of preoperative FNA diagnosis of Bethesda system IV nodules. Materials and Methods: We analyzed clinical, ultrasonographic, and CT findings of 28 thyroid nodules with Bethesda system IV cytology on FNA, which were proven as follicular or Hu ¨rthle cell neoplasms on surgical pathology. Results: No statistically significant differences according to age, sex, and ultrasonographic parameters, including echogenicity, margin, calcification, shape, cystic component,and degree of vascularity and enhancement on CT were observed between benign and malignant follicular neoplasms. Only the lesion size was significantly different (p<0.05). Conclusion: The size of follicular neoplasm is predictive of malignancy. If a thyroid nodule with the Bethesda IV cytology is larger than 24.5 mm, there will be a greater probability of malignancy.

갑상선에 동시에 발생한 여포암과 유두암 1예

정성훈,김영준,김영중,구수권 대한이비인후과학회 부산,울산,경남 지부회 2014 임상이비인후과 Vol.25 No.1

Four types of thyroid cancer comprise more than 98% of all thyroid malignance. Among them, two or more distinct tumors could consist of concurrent pathologies as collision tumor of the thyroid gland. A 24-year-old female presented with thyroid mass. Physical exam revealed a 2×2 cm predominantly right sided thyroid mass that was confirmed on imaging. Ultrasound-guided fine needle aspiration suggested a suspicious for a follicular neoplasm. Consequently, she underwent total thyroidectomy with central neck dissection for follicular carcinoma of the right lobe of the thyroid gland. The pathology was reported as the right lobe was follicular carcinoma and the isthmus incidentally revealed a papillary carcinoma. We report a rare case of concurrent follicular and papillary carcinoma of the thyroid gland with a review of literature.

Fine Needle Aspiration Cytology of Thyroid Follicular Neoplasm: Cytohistologic Correlation and Accuracy

유창영,최현주,임소영,정지한,민기옥,강창석,서영진 대한병리학회 2013 Journal of Pathology and Translational Medicine Vol.47 No.1

Background: This study evaluated the accuracy of fine needle aspiration cytology (FNAC) in cases of follicular neoplasm (FN) on the basis of histologic diagnosis, and reviewed the cytologic findings of FN according to the FNAC. Methods: Among the 66 cases diagnosed with thyroid FN by FNAC during the 7-year period from 2003 to 2009, 36 cases that had undergone thyroid surgery were available for review. Cytologic diagnosis was compared with the histologic diagnosis of each case. Results: Among the 36 cases with a cytologic diagnosis of thyroid FN, histologic diagnosis was as follows: 20 follicular adenomas (55.6%), 3 Hurthle cell adenomas (8.3%), 2 follicular carcinomas (5.6%), 8 nodular goiters (22.2%), 2 papillary carcinomas (5.6%), and 1 Hashimoto’s thyroiditis (2.8%), resulting in a diagnostic accuracy of FNAC for thyroid FN of 69.5%. Conclusions: This study shows that FNAC for thyroid FN is a useful primary screening method because when FN is diagnosed by FNAC, the rate of FN histologic diagnosis is relatively high, however, adequate sampling and experience is a prerequisite for this procedure.

Synchronous Bony and Soft Tissue Metastases from Follicular Carcinoma of the Thyroid

Rodrigues, Gabriel,Ghosh, Arnab Korean Academy of Medical Science 2003 Journal of Korean medical science Vol.18 No.6