AUCTORES
Review Article
*Corresponding Author: Anthony Kodzo-Grey Venyo, North Manchester general hospital, department of urology, delaunays road, m85rb Manchester United Kingdom
Citation: Grey Venyo AK, (2024), Primary Thyroid-Like Follicular Carcinoma of Kidney: Review and Update, J. Endocrinology and Disorders, 8(1): DOI:10.31579/2640-1045/165
Copyright: © 2024, Anthony Kodzo-Grey Venyo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 27 November 2023 | Accepted: 12 December 2023 | Published: 03 January 2024
Keywords: thyroid-like follicular carcinoma of the kidney; primary; metastatic; histopathology; immunohistochemistry; partial nephrectomy; radical nephrectomy
Thyroid-like follicular carcinoma of the kidney (TLFCK) is an exceedingly uncommon tumor which has been reported sporadically on very rare occasions that afflict individuals whose ages had tended to range between 10 years and 83 years. There are no specific manifesting symptoms for this neoplasm and TLFCK had most often been diagnosed incidentally during assessment of individuals for other conditions. Confirmation of the diagnosis of TLFCK is based upon histopathology examination and immunohistochemistry staining features of the tumor and exclusion of a primary thyroid follicular carcinoma metastasizing to the kidney with radiology imaging evidence of absence of follicular carcinoma of the thyroid gland. It also needs to be appreciated that immunohistochemistry staining features for thyroid-like follicular carcinoma of the kidney are different from the features of primary follicular carcinoma of thyroid gland. TLFCK does tend to afflict one kidney only generally. On rare occasions the kidney could be afflicted by metastasis from primary follicular carcinoma of thyroid gland but in such scenarios, there tends to be evidence of multiple metastases afflicting many other organs as disseminated tumor. TLFCK tends to portend generally a low-rate of malignancy; however, few cases had been reported associated with metastasis. Even though TLFCK is regarded to most often be a tumor that is associated with a low-rate of malignancy with no development of local recurrence or distant metastasis, because few cases of TLFCT had been ensued by the subsequent development of metastasis after a long-time, it would be recommended that all patients who had undergone treatment for a diagnosed TLFCK should be followed-up regularly over a period of a long-time. Patients who had been diagnosed as having primary TLFCK have tended to be treated by means of surgery in the form of partial nephrectomy or radical nephrectomy which could entail the undertaking of open surgery, laparoscopic surgery or robotic surgery. Other procedures including pre=operative biopsy of the tumor for pathology examination confirmation of the diagnosis followed by undertaking of less-invasive procedures including: cryotherapy of the tumor, radiofrequency ablation of the tumor, irreversible electroporation of the tumor, and selective renal artery angiography and super-selective embolization of the branch of renal artery supplying the tumor in the kidney, to the knowledge of the author has so far not been reported as treatment procedures for cases of primary TLFCK.
Thyroid-like follicular carcinoma of the kidney (TLFCK) is stated to be a very rare clinical disease. [1] TLFCK is stated to be classified as a sub-type of renal cell carcinoma and it is stated to be typified by being morphologically similar to well-differentiated follicular thyroid carcinoma but does exhibit negative immunohistochemistry staining for thyroid marker expressions [1] [2] [3]. It has been documented that the clinical biological behaviour of this tumour is not certain due to the rarity of the cases so far reported in the English-language literature [1] [4] [5]. In 2004, many cases of a unique renal epithelial tumour were reported. Microscopically, these cases had shown histopathology examination features that simulated follicular lesions in a well-differentiated thyroid gland [1] [6], but this tumour had not been included in the World Health Organization (WHO) classification of kidney tumours until 2016 [7] Considering that TLFCK had only been included in the WHO classification of renal tumours, recently in 2016, it would be envisaged that majority of clinicians all over the world including some Urologists, pathologists as well as some oncologists may not have encountered a case of TLFCT before and hence they may not be conversant with the manifestations, diagnostic features, treatment options and management outcomes of TLFCT. The ensuing review and updating article on TLFCT, is divided into two parts: (A) Overview which has discussed miscellaneous general aspects related to TLFCT and (B) Miscellaneous Narrations and Discussions from Some Case Reports, Case Series and Studies Related to TLFCT.
Aim
To review and update the literature on Primary Thyroid-Like Follicular Carcinoma of Kidney.
Internet data bases were searched including: Google; Google Scholar; Yahoo; and PUBMED. The search words that were used included: Primary Thyroid-Like Follicular Carcinoma of Kidney; Primary Renal Thyroid-Like Follicular Carcinoma; Primary Thyroid-Like Follicular Cancer of Kidney; Primary Renal Thyroid-Like Follicular Cancer. Forty-one (41) references were identified which were used to write the article which has been divided into two parts: (A) Overview which has discussed miscellaneous general aspects related to TLFCT and (B) Miscellaneous Narrations and Discussions from Some Case Reports, Case Series and Studies Related to TLFCT.
[A] Overview
Definition / general statements [8]
Essential features
The essential features of primary thyroid-like follicular carcinoma of kidney had been summated as follows: [8]
Terminology
Epidemiology
The epidemiology of primary thyroid-like follicular carcinoma of kidney has been summated as follows: [8]
Sites
Clinical features [8]
Diagnosis
Radiology description
The radiology imaging features of primary thyroid-like follicular carcinoma of kidney had been summated as follows: [8]
Prognostic factors
The ensuing summations had been made about the prognostic factors of primary thyroid-like follicular carcinoma of kidney: [8]
Treatment
The treatment of primary thyroid-like follicular carcinoma of kidney had been summated to include the ensuing: [8]
Gross description
The Macroscopy examination features of primary thyroid-like follicular carcinoma of kidney had been summated to include the ensuing: [8]
Microscopic (histologic) description
The Microscopy examination features of primary thyroid-like follicular carcinoma of kidney had been summated to include the ensuing: [8]
Cytology description
Cytology examination features of primary thyroid-like follicular carcinoma of kidney had been summated to include the ensuing: [8]
Immunohistochemistry staining studies:
It has been iterated that immunohistochemistry staining studies in cases of primary thyroid follicular-like carcinoma of the kidney does demonstrate the following features: [8]
Positive stains
The tumour cells tend to exhibit positive staining for: [8]
Negative stains
The tumour cells tend to exhibit negative staining for: [8]
Molecular / cytogenetics description
The molecular and cytogenetics features of primary thyroid follicular -like carcinoma of the kidney had been summated as follows: [8]
Differential diagnoses
Some of the differential diagnoses of primary thyroid follicular-like carcinoma of kidney had been summated as follows: [8]
[B] Miscellaneous Narrations and Discussions from Some Case Reports, Case Series and Studies Primary Thyroid-Like Follicular Carcinoma of Kidney
Dong et al. [15] stated the ensuing:
Dong et al. [15] reported a unique case of TLFCK which had manifested as a striking skull and meningeal metastasis 5 years pursuant to the initial diagnosis. Dong et al. [15] stated that their reported case was the first case of TLFCK with such a novel metastasis pattern. Dong et al. [15] reported a 68-year-old woman, who was found to have a right kidney lesion utilizing computed tomography (CT) scan during her regular clinical follow-up assessment visit for urinary bladder cancer, but at that time she did not exhibit any obvious clinical symptoms. The CT scan had demonstrated a 4.4-cm diameter, slightly lobulated soft tissue mass within the right lower kidney, the pathological findings of which had shown a TLFCK. Five years subsequently, the patient had progressed to develop skull and meningeal metastasis. Both the kidney tumour and the metastasis lesion were noted to be composed almost entirely of follicles with a dense, colloid-like material that simulated thyroid follicular carcinoma. Nevertheless, no lesion was found within her thyroid gland. The neoplastic epithelial cells had exhibited strong immunohistochemistry staining for cytokeratin 7 (and vimentin but negative immunohistochemistry staining for thyroid transcription factor-1 and thyroglobulin. Furthermore, Dong et al. [15] iterated that their reported case was the first reported case of TLFCK to consist of widespread metastases to the skull and meninges and which had provided evidence that this rare variant of renal cell carcinoma has uncertain malignant potential and could be more clinically aggressive than had been previously believed.
Dawane et al. [31] iterated the ensuing:
Dawane et al. [31] evaluated the gross, histological, immunohistochemical, and fluorescence in situ hybridization (FISH) studies of a new case and they had undertaken a comprehensive review of the literature. Dawane et al. [31] summarized the results as follows:
Dawane et al. [31] made the ensuing conclusions:
Jung et al. [23] reported an unusual kidney tumour, which to their knowledge had not been classified under a known subtype of renal cell carcinoma (RCC) and which characteristically had shown similar histology examination features to thyroid follicular carcinoma. Jung et al. [23] reported a 32-year-old asymptomatic woman who was found to have a kidney mass during her annual clinical examination. She did not have any lesions within her thyroid gland found during her clinical and ultrasound scan examinations, and she did not have any abnormal thyroid function test results. No abnormalities were found within her mediastinum and her ovaries. The resected kidney upon gross examination was demonstrated to have a well-defined nodular tumour that measured 11.8 cm x 8.0 cm x 8.0 cm. The mass was protruding into the pelvic cavity with areas of yellowish geographic necrosis. Histopathology examination of the tumour demonstrated that the tumour had shown follicular architectures with inspissated colloid-like material within their lumina. No conventional (clear cell) RCC or any other known subtypes of RCC component was found during pathology examination of the tumour. Immunohistochemistry staining studies of the tumour had demonstrated that the tumour cells had exhibited intensive staining for cytokeratin (CK) cocktail AE1/AE3 and CD10 and the tumour cells were not reactive to thyroid transcription factor-1 and thyroglobulin. The staining of the tumour for CK35betaH11 and vimentin had demonstrated focal cytoplasmic immunohistochemistry staining reaction. The tumour cells had exhibited complete negative staining for CK7, CK19, CK20, CK34betaE12, carcinoembryonic antigen, epithelial membrane antigen, and CD15. Chromosomal gains of 7q36, 8q24, 12, 16, 17p11-q11, 17q24, 19q, 20q13, 21q22.3, and Xp and losses of 1p36, 3, and 9q21-33 were identified by comparative genomic hybridization. Jung et al. [23] stated that these findings were dissimilar to previously classified kidney neoplasm. Jung et al. [23] only a report which included three cases of primary thyroid-like renal tumour had been described in the abstract form. Nevertheless, there was no fully documented case on this unusual form of RCC, which morphologically simulates that of thyroid follicular carcinoma.
Li et al. [32] in 2015 stated that thyroid-like follicular carcinoma of the kidney (TLFCK) is a provisional new entity of renal cell carcinoma (RCC). Li et al. [32] reported and compared one TLFCK case and one PRCC case with thyroid-like feature. Li et al. [32] stated the ensuing:
Zhang et al. [33] stated that thyroid follicular carcinoma-like renal tumour (TFCLRT) is an uncommon primary renal epithelial tumour that was first reported in 2006. Zhang et al. [33] reported a case diagnosed of TFCLRT by their team to observe the pathology feature and to analyse comparatively the clinical and pathology examination features with all cases documented in reviewed literatures. Zhang et al. [33] reported a 54-year-old female patient who had manifested with urinary frequency and with the symptom of right flank pain with a history of more than half a year of hypertension and who had undergone uterine fibroid resection 12 years earlier. She underwent B-mode ultrasound scan examination and renal magnetic resonance which demonstrated a right renal sinus nodule. Histopathology examination of biopsy specimens of the kidney lesion demonstrated features of thyroid follicle-like structures of different sizes, which contained a colloid-like substance, while the periodic acid-Schiff (PAS) and diastase-resistant PAS staining had confirmed that it was mucus protein. Immunohistochemical staining studies of the specimen showed that the tumour cells had expressed the transcription factor PAX-8 but had not expressed the thyroid-specific antibodies TG and TTF-1. With regard to interventions, the patient underwent a tumour enucleation of right kidney. No other treatment was undertaken after her surgery. With regard to the outcome, no metastases to lymph nodes and other organs were found, and 9-months of follow-up had not demonstrated any tumour progression. Zhang et al. [33] made the ensuing iterations:
Rao et al. [19] stated the following:
Rao et al. [19] reported an unusual case of sarcomatoid TLFCK with a low-grade spindle cell component in a 34-year-old male patient, that was associated with an indolent course following radical nephrectomy and regional node dissection.
Amin et al. [6] stated the following:
Chen et al. [34] studied the clinicopathology features of thyroid-like follicular renal cell carcinoma. Chen et al. [34] collected clinical data in 5 cases of thyroid-like follicular renal cell carcinoma. Chen et al. [34] carried out HE staining and immunohistochemistry in surgically-removed specimen to analyse the clinical and pathological features with review of the literatures. Chen et al. [34] summarized the results as follows:
Chen et al. [34] made the ensuing conclusions:
Alomar et al. [1] reported the case of a 75-year-old man who had a history of hypertension over the preceding 10 years and who had manifested with difficulty with micturition for two months. He underwent trans-urethral resection of prostate (TURP) and pathology examination of the prostatic chips revealed features of adenocarcinoma of prostate gland. About two weeks pursuant to undergoing the TURP procedure, the patient developed flank pain with visible haematuria and no other associated symptoms. He did not have any family history of abnormalities or tumours. He had only been taking medication to treat his hypertension. His general examination and abdominal examination were normal and he was noted to have voided well. The results of his laboratory blood tests were within normal ranges. He had ultrasound scan of his abdomen which demonstrated presence of a mass within his right kidney that measured about 6 cm × 6 cm with no other pathological findings in the abdomen or left kidney. He had Computed tomography (CT) of his abdomen, which revealed presence of a heterogeneous mass within his right kidney that measured 6 cm × 6 cm × 5 cm. No changes were noted in his spine or lungs (see figure 1 A-B).
Reproduced from: [1] Under Creative Commons Attribution License which allows reproduction of figures and contents of the article provided the original source is cited.
Figure 1. A: CT/cross axial view of the Abdominal showing a mass in the right kidney measuring 6 × 6 × 5 cm, heterogeneous (green arrow shows kidney, yellow arrow shows tumour area). B: CT/cross coronal view, showing the tumour in the upper pole of the right kidney without extension of the renal blood elements (green arrow shows kidney, yellow arrow shows tumour area). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.). Reproduced from: [1] Under Creative Commons Attribution License which allows reproduction of figures and contents of the article provided the original source is cited.
Based upon the previous findings, it was decided that surgery was indicated. The surgery was undertaken at the tertiary teaching hospital of the authors. The surgical procedure was undertaken via a right-sided flank incision at the posterior part of the peritoneum, where the right kidney was exposed and isolated from the encompassing area. The kidney was found to be completely sutured by mass formation, and the vessels of the kidney were connected and radically removed without any complications. Macroscopy examination demonstrated that the tumour was well-defined with a brown focus and haemorrhagic cystic formations (see figure 2 A-B).
Figure 2 A - B: Macroscopic view of the tumour (green arrow shows tumour area). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.) Reproduced from: [1] Under Creative Commons Attribution License which allows reproduction of figures and contents of the article provided the original source is cited.
Histopathology examination of the kidney tumour revealed that the tumour contained follicles of different sizes, which appeared to be follicular formations with colloid-like substances inside (see figure 3 A-B). Immunohistochemistry staining studies demonstrated that the tumour cells had exhibited Negative staining for: prostate specific antigen (PSA), (see figure 4-A) and TTF1 (see figure 4-B), while the tumour cells had exhibited positive staining for vimentin (see figure 4 -C) and CK7 (see figure 4D).
Figure 3. A-B: The follicles appear filled with a fluid like colloid in the area of tumour formation on H&E stain. Reproduced from: [1] Under Creative Commons Attribution License which allows reproduction of figures and contents of the article provided the original source is cited.
Figure 4. A: Immunohistochemical stain negative for PSA. B: Immunohistochemical stain negative for TTF1. C: Immunohistochemical stain positive for vimentine. D: Immunohistochemical stain positive for CK7. Reproduced from: [1] Under Creative Commons Attribution License which allows reproduction of figures and contents of the article provided the original source is cited.
Alomar et al. [1] made the ensuing educative discussion summations:
Alomar et al. [1] made the ensuing concluding iterations:
[A] This tumour is mainly diagnosed based upon the clinical history, histopathology examination features of the kidney tumour as well as the immunohistochemistry staining features of the tumour
[B] This tumour has tended to be associated with low rate of malignancy and development of metastases.
[C] Surgical excision is regarded essential in the treatment of this neoplasm.
[D] Surgical removal of the tumour or radical nephrectomy could be undertaken depending upon the case.
Muscara et al. [2] stated that thyroid-like follicular carcinoma of the kidney (TLFCK) is an uncommon but emerging renal tumour which morphologically simulates follicular carcinoma of the thyroid but which lacks immunohistochemistry expression of thyroid tumour markers such as TTF-1 and thyroglobulin. Muscara et al. [2] reported a case of an incidentally discovered TLFCK in a 27-year-old man. Histology examination of the tumour revealed an encapsulated proliferation of variably sized thyroid follicle-like epithelial-lined spaces which had been filled with colloid-like eosinophilic secretions. Immunohistochemistry staining studies of the tumour confirmed lack of expression of the thyroid markers TTF-1 and thyroglobulin with expression of PAX8 and CD10, which confirmed that the tumour was of renal origin, which had correlated with the clinical and radiographic absence of thyroid pathology.
Lin et al. [39] stated that there had only been a few reports of thyroid-like follicular carcinoma of the kidney (TLFCK) up to 2014. Lin et al. [39] reported two patients with TLFCK as follows:
Lin et al. [39] made ensuing concluding iterations:
de Jesus et al., [40] stated that the very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC) and that differential diagnosis with secondary thyroid tumours depends upon non-reactivity to immunohistochemical (IHC) tumour markers for TFCC (thyroglobulin - TG and TTF1). de Jesus et al. [40] reported the fourth paediatric case in the global literature and extensively reviewed the subject. de Jesus et al. [40] made the ensuing iterations:
Dhillon et al. [16] stated the following:
Dhillon et al. [16] reported a unique case in which the patient had presented with flank pain and visible haematuria. Radiology imaging studies had shown a large tumour within the right kidney and metastases to the lungs and retroperitoneal lymph nodes. Both the renal tumour and the sampled lung metastasis were found upon pathology examination to be composed almost entirely of follicles with dense, colloid-like material mimicking thyroid follicular carcinoma. Nevertheless, no lesion was found in the thyroid gland; and the patient's thyroid function test results were normal. The tumour cells upon immunohistochemistry staining studies were found to be immunoreactive for PAX2 and PAX8 but lacked reactivity for thyroglobulin and thyroid transcription factor-1. Dhillon et al. [16] stated that to their knowledge, their reported case was the first case of thyroid-like follicular carcinoma of the kidney to be initially associated with marked symptoms and widespread metastases, providing evidence that this rare variant of renal cell carcinoma could be clinically aggressive.
Ni et al. [41] stated that thyroid-like follicular renal cell carcinoma is a rare subtype of renal cell carcinoma which had only been recently recognized, as most of the cases had involved a solid tumour within one kidney. Ni et al. [41] reported a rare case of bilateral renal cell carcinoma wherein the tumour within the left kidney was diagnosed as clear cell carcinoma, while the tumour within right kidney as thyroid-like follicular renal cell carcinoma. Ni et al. [41] iterated that the difference between this case and the ones that had been described in previous reports is that thyroid-like follicular renal cell carcinoma had shown cystic changes upon radiology imaging. Ni et al. [41] also stated that this suggests that when renal cystic lesions are encountered, clinicians should consider the possibility of such rare tumours.
Jenkins et al. [7] stated the following:
Jenkins et al. [7] reported a case of a 48-year-old lady who had an aggressive TLFCK with extensive sarcomatoid differentiation and metastatic disease at manifestation. Jenkins et al. [7] undertook targeted next-generation sequencing of both the thyroid-like component and the poorly differentiated sarcomatoid component utilising their solid tumour panel to evaluate for any disease-associated mutations and to better understand the molecular profile of these tumours.
Conflict of Interest – nil
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Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner