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      Two cases of thyroid gland invasion by upper mediastinal carcinoma

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          Summary

          The objective this study is to report two cases of thyroid gland invasion by upper mediastinal carcinoma. Mediastinal tumors are uncommon and represent 3% of the tumors seen within the chest. In reports on mediastinal masses, the incidence of malignant lesions ranged from 25 to 49%. The thyroid gland can be directly invaded by surrounding organ cancers. We report these cases contrasting them to the case of a thyroid cancer with mediastinal lesions. Case 1 was a 73-year-old woman who was diagnosed with papillary thyroid carcinoma, and she underwent surgery and postoperative radioactive iodine. Case 2 was a 74-year-old man who was diagnosed with non-small-cell lung carcinoma, favor squamous cell carcinoma, and he underwent chemoradiotherapy. Case 3 was a 77-year-old man who was diagnosed a thymic carcinoma based on pathological findings and referred the patient to thoracic surgeons for surgical management. The images of the three cases were similar, and the differential diagnoses were difficult and required pathological examination. Primary thyroid carcinoma and invading carcinoma originating from the adjacent organs need to be distinguished because their prognoses and treatment strategies are different. It is important to properly diagnose them by images and pathological findings.

          Learning points:
          • The thyroid gland in the anterior neck can be directly invaded by surrounding organ cancers.

          • Primary thyroid carcinoma and invading carcinoma originating from the adjacent organs need to be distinguished because their prognoses and treatment strategies are different.

          • It is important to properly diagnose by images and pathological findings.

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          Most cited references10

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          Thymic carcinoma outcomes and prognosis: results of an international analysis.

          The objectives of this collaborative study were to characterize patients with thymic carcinoma, their treatment patterns, and association with overall survival (OS) and recurrence-free survival (RFS).
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            Metastasis to the Thyroid Gland: A Critical Review

            Background Metastasis to the thyroid gland from nonthyroid sites is an uncommon clinical presentation in surgical practice. The aim of this review was to assess its incidence management and outcomes. Methods A literature review was performed to identify reports of metastases to the thyroid gland. Both clinical and autopsy series were included. Results Metastases to the gland may be discovered at the time of diagnosis of the primary tumor, after preoperative investigation of a neck mass, or on histologic examination of a thyroidectomy specimen. The most common primary tumors in autopsy studies are from the lung. In clinical series, renal cell carcinoma is most common. For patients with widespread metastases in the setting of an aggressive malignancy, surgery is rarely indicated. However, when patients present with an isolated metastasis diagnosed during follow-up of indolent disease, surgery may achieve control of the central neck and even long-term cure. Other prognosticators include features of the primary tumor, time interval between initial diagnosis and metastasis, and extrathyroid extent of disease. Conclusions In patients with thyroid metastases, communication among clinicians treating the thyroid and the index primary tumor is essential. The setting is complex, and decisions must be made considering the features of the primary tumor, overall burden of metastases, and comorbidities. Careful balancing of these factors influences individualized approaches.
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              PAX8 immunostaining of anaplastic thyroid carcinoma: a reliable means of discerning thyroid origin for undifferentiated tumors of the head and neck.

              Anaplastic thyroid carcinoma can be difficult to diagnose because it does not show thyroid differentiation morphologically or immunohistochemically. Depending on the histologic variant, anaplastic thyroid carcinoma may be confused with sarcoma or squamous cell carcinoma of the head and neck. PAX8 is a transcription factor expressed in normal and neoplastic thyroid follicular epithelium and only a few other tissues. This restricted expression suggests that PAX8 staining could be useful when dealing with spindled or squamoid tumors of the neck. The purposes of this study were to determine the frequency of PAX8 staining in anaplastic thyroid carcinoma and to evaluate PAX8 immunohistochemistry as a means of distinguishing its squamoid variant from head and neck squamous cell carcinoma. PAX8 immunohistochemical staining was performed on 34 anaplastic thyroid carcinomas and 118 head and neck squamous cell carcinomas. PAX8 staining was present in 26 (76%) anaplastic thyroid carcinomas including 16 (100%) of 16 squamoid variants, 7 (58%) of 12 giant cell/pleomorphic variants, and 3 (50%) of 6 spindled variants. All head and neck squamous cell carcinomas were negative for PAX8. PAX8 expression is often retained in anaplastic thyroid carcinomas including the squamoid variant, but it is not expressed in head and neck squamous cancers. PAX8 staining is an excellent marker for carcinomas of follicular epithelial origin, including those carcinomas that are undifferentiated in other respects. The tissue specificity of PAX8 expression may be useful in resolving the differential diagnosis of anaplastic thyroid carcinoma such as the distinction between its squamoid variant and squamous cell carcinoma of the head and neck. Copyright © 2011 Elsevier Inc. All rights reserved.

                Author and article information

                Journal
                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                EDM
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                2052-0573
                13 June 2019
                2019
                : 2019
                : 19-0028
                Affiliations
                [1 ]Department of Breast and Endocrine Surgery , Kanagawa Cancer Center, Yokohama, Japan
                [2 ]Department of Pathology , Kanagawa Cancer Center, Yokohama, Japan
                [3 ]Department of Breast and Thyroid Surgery , Yokohama City University Medical Center, Yokohama, Japan
                [4 ]Department of Surgery , Yokohama City University School of Medicine, Yokohama, Japan
                Author notes
                Correspondence should be addressed to H Yamazaki; Email: paruo0413@ 123456gmail.com
                Article
                EDM190028
                10.1530/EDM-19-0028
                6589857
                656435e9-401d-4f62-ac80-8be81ea74369
                © 2019 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                : 25 April 2019
                : 15 May 2019
                Categories
                Error in Diagnosis/Pitfalls and Caveats

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