scholarly journals Aggressive Differentiated Thyroid Cancer due to EML4e13-ALKe20 Fusion: A Case Presentation and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Rodhan Khthir ◽  
Zainab Shaheen ◽  
Prasanna Santhanam ◽  
Saroj Sigdel
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Differentiated Thyroid Cancer ◽  
Residual Disease ◽  
Disease Patient ◽  
Clinical Signs ◽  
Cervical Lymphadenopathy ◽  
Rapid Progression ◽  
Anaplastic Lymphoma ◽  
Aggressive Form

Background. Differentiated thyroid cancer (DTC) is an indolent malignancy. It rarely presents with aggressive local invasion and/or distant metastatic disease. Patient findings. We describe a case of a 30-year-old man with a locally aggressive form of papillary thyroid cancer with EML4e13-ALKe20 fusion (EML4: echinoderm microtubule-associated protein-like 4; ALK: anaplastic lymphoma kinase). He presented with right-side cervical lymphadenopathy with a highly suspicious right-side thyroid nodule. Total thyroidectomy and level IV lymph node resection showed extensive bilateral disease, with extrathyroidal and extranodal extension. FDG-PET CT scan following surgery confirmed the presence of significant residual disease in the neck area. He underwent bilateral lateral lymph node dissection followed by radioactive iodine treatment. Somatic mutation testing showed EML4e13-ALKe20 fusion. Summary. This case represents an aggressive form of DTC with EML4e13-ALKe20 fusion. The rapid progression of clinical signs and symptoms and the local extension beyond the thyroid and lymph nodes with the persistence of high-volume local disease after thyroidectomy highlight the aggressive nature of this mutation and the importance of performing genetic analysis to guide future treatments and determine prognosis. Conclusion. This case highlights the importance of using molecular diagnostics in patient care, especially if the presentation is unusual for DTC. A thorough evaluation of the tumor pathology and the somatic mutational profile analysis are important for obtaining vital therapeutic and prognostic guidance.

The Implication of Lymph Node Metastasis on Survival in Patients with Well-Differentiated Thyroid Cancer

2005 ◽  
Vol 71 (9) ◽  
pp. 731-734 ◽  
Author(s):  
Yale D. Podnos ◽  
David Smith ◽  
Lawrence D. Wagman ◽  
Joshua D.I. Ellenhorn
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Tumor Size ◽  
Large Scale ◽  
Differentiated Thyroid Cancer ◽  
Lymph Node Status ◽  
Large Tumor ◽  
Node Metastasis ◽  
Well Differentiated

Though survival for well-differentiated thyroid cancer is very good, specific populations suffer greater recurrence and mortality. Defining these cohorts can significantly influence prognosis and extent of treatment. This study, using a large, multi-institutional database, seeks to determine how the presence of lymph node disease in patients with well-differentiated thyroid cancer affects outcome. The Surveillance, Epidemiology, and End Results (SEER) database is a large-scale sample of 14 per cent of the U.S. population. It was used to identify patients with papillary and follicular thyroid carcinomas and identify the prognostic implications of lymph node metastasis. Additional factors, including presence of metastasis, age, and tumor size, were compared using multivariate and χ2 analyses. Of 19,918 patients identified, lymph node status was known for 9,904 (49.7%). On multivariate analysis, age >45 years, presence of distant metastasis, large tumor size, and lymph node involvement significantly predicted poor outcome. Overall survival at 14 years was 82 per cent for node negative and 79 per cent for node positive patients ( P < 0.05). This study shows that the survival of patients with well-differentiated thyroid cancer is adversely affected by lymph node metastases. The optimum treatment for this cohort needs further delineation, as particular populations are at greater risk of recurrence and death.

Role of Lymph Node Dissection in Primary Surgery for Thyroid Cancer

2007 ◽  
Vol 5 (6) ◽  
pp. 623-630 ◽  
Author(s):  
Elizabeth G. Grubbs ◽  
Douglas B. Evans
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Preoperative Evaluation ◽  
Significant Risk ◽  
Cervical Lymphadenopathy ◽  
Operative Management ◽  
Surgical Removal ◽  
Cervical Lymph Nodes ◽  
N0 Neck ◽  
Preoperative Ultrasound

The preoperative evaluation of the clinically N0 neck and the operative management of cervical lymph nodes in patients with papillary and medullary thyroid cancer remains controversial. The appreciation that even patients with low-risk disease have a significant risk for recurrence has generated interest in a more comprehensive preoperative evaluation of the neck and has renewed debate on the extent of lymphadenectomy at the time of thyroidectomy. The authors recommend using preoperative ultrasound before thyroidectomy for all patients with thyroid cancer and before any subsequent surgeries for recurrent disease to identify the extent of lymph node metastases and thereby facilitate complete surgical removal of all gross disease in the neck. The optimal surgical procedure for removing cervical lymphadenopathy is compartment-oriented neck dissection based on the findings from preoperative ultrasound.

Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy

2016 ◽  
Vol 44 (6) ◽  
pp. 926-934 ◽  
Author(s):  
Arnoldo Piccardo ◽  
Matteo Puntoni ◽  
Gianluca Bottoni ◽  
Giorgio Treglia ◽  
Luca Foppiani ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Radioactive Iodine Therapy

scholarly journals Persistent cervical lymphadenitis in a patient with prior thyroid cancer attributed to Kikuchi-Fujimoto disease

2018 ◽  
pp. bcr-2018-226457
Author(s):  
Roman Zuckerman ◽  
Louise Damiani ◽  
Hashem A Ayyad ◽  
Deborah R Alpert
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lupus Erythematosus ◽  
Cervical Lymphadenopathy ◽  
Needle Aspiration ◽  
Lymph Node Biopsy ◽  
Lymphoproliferative Disease ◽  
Low Grade ◽  
Cervical Lymphadenitis ◽  
Granulomatous Lymphadenitis

We describe a 50-year-old woman with a history of thyroid cancer who presented with bilateral cervical and submandibular lymphadenopathy, low-grade fevers, and increasing fatigue. The patient underwent lymph node fine-needle aspiration, which showed no evidence of metastatic or lymphoproliferative disease. This procedure was complicated by a parapharyngeal abscess and cellulitis. She was treated unsuccessfully with various courses of antibiotics, but briefly responded to short courses of steroids. As her cervical lymphadenopathy returned, she underwent an excisional lymph node biopsy, which demonstrated caseating granulomatous lymphadenitis. Extensive review of systems, physical examination, laboratory and imaging studies demonstrated no evidence of malignancy, infection or systemic lupus erythematosus . Our patient was clinically diagnosed with Kikuchi-Fujimoto disease and successfully treated with prednisone tapered over 3 months. She remains in clinical remission.

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