Fig. 1(A, B) Papillary thyroid carcinoma at 23 years of age. (C, D) Recurrent papillary thyroid carcinoma after 5 years. Poorly differentiated cells are seen at focal areas of the papillary thyroid carcinoma. (E, F) Recurrent anaplastic thyroid carcinoma in the pretrachea adjacent thyroid bed.
Fig. 2Immunohistochemical staining for thyroglobulin, galectin-3, thyroid transcription factor 1 (TTF-1), p53, and Ki-67. Initially diagnosed and recurred well-differentiated thyroid carcinoma (WDTC) show diffuse positivity for thyroglobulin (TG), galectin-3, and TTF-1 but is negative for p53 and less than 1% of Ki-67 expression. In the poorly differentiated tumor carcinoma (PDC) component of the first recurrent tumor, thyroglobulin, TTF-1, and galectin-3 expression are lower than in the other part of the first recurrent tumor, but p53 and Ki-67 expression are the same. Thyroglobulin, TTF-1, and galectin-3 expression is decreased in the anaplastic carcinoma of the second recurrent tumor. However, nuclear p53 and Ki-67 expression are 70% and 60% to 70%, of the anaplastic carcinoma component, respectively. PDC, poorly differentiated carcinoma; ATC, anaplastic thyroid carcinoma; H&E, hematoxylin and eosin.
Fig. 3
BRAF gene mutation analysis of each tumor tissue by pyrosequencing. The BRAF V600E (c.1799T>A) and a low level of the BRAF V600V (c.1800G>A) mutation are found in the initially diagnosed papillary thyroid carcinoma (A) and poorly differentiated carcinoma component of the recurred papillary thyroid carcinoma (B), but only a prominent BRAF V600V (c.1800G>A) mutation is found in the anaplastic carcinoma component (C). The mutant allele peak of 5% to 95% is defined as the optimal cutoff value.
Table 1.Panel of antibodies used in this study
Antibody |
Source |
Clone |
Dilution |
Thyroglobulin |
Dako (Carpinteria, CA, USA) |
A251 |
1:10,000 |
Ki-67 |
Dako (Carpinteria, CA, USA) |
M7240 |
1:150 |
TTF-1 |
Dako (Carpinteria, CA, USA) |
M3575 |
1:200 |
Galectin-3 |
NovoCastra (Newcastle Upon Tyne, UK) |
NCL-GAL3 |
1:50 |
p53 |
NovoCastra (Newcastle Upon Tyne, UK) |
D02 |
1:300 |
Table 2.Immunohistochemical staining and BRAF mutation results
|
WDTC initial diagnosis |
WDTC first recur |
PDC first recur |
Anaplastic carcinoma |
Thyroglobulin |
+ (80) |
+ (80) |
+ (30) |
+ (<5) |
Galectin-3 |
+ (95) |
+ (95) |
+ (60) |
+ (50) |
TTF-1 |
+ |
+ |
- |
- |
p53 |
- |
- |
- |
+ (70) |
Ki-67 |
+ (<1) |
+ (<1) |
+ (<1) |
+ (60-70) |
BRAF V600E (c.1799T>A) |
+ |
Not done |
+ |
- |
BRAF V600V (c.1800G>A) |
+ |
Not done |
+ |
+ |