bluuebunny/crossref_metadata_2025_split huggingface dataset:
SAT515 Searching For Markers To Identify Angioinvasion In Papillary Thyroid Cancer
Authors: Buczyńska Angelika , Kościuszko Maria , Sidorkiewicz Iwona , Wiatr Aleksandra Anna , Siewko Katarzyna , Adamska Agnieszka , Jacek Krętowski Adam , Popławska-Kita Anna 
Published: October 2023

Abstract
Disclosure: A. Buczyńska: None. M. Kościuszko: None. I. Sidorkiewicz: None. A. Wiatr: None. K. Siewko: None. A. Adamska: None. A. Krętowski: None. A. Popławska-Kita: None.
The incidence of Papillary Thyroid Cancer (PTC) has increased significantly over last decades. Despite the great progress in PTC clinical management, the association of angioinvasion with tumor aggressiveness in PTC remains as significant clinical problem, suggesting worse patients prognosis. Therefore cancer metastasis occurs through cell detachment and angioinvasion, epithelial–mesenchymal transition (EMT) and cell migration, changes in cell morphology are initiated through Rho-GTPase-dependent actin cytoskeleton polymerization. 8-hydroxydeoxyguanosine (8-OHdG) is generated accordingly to increased oxidative stress, however has been characterized by paradoxical anti-oxidative, anti-inflammatory and anti-mutagenic effects following Rho-GTPase inhibition, which were noted in various cancer models. Since oxidative stress has been recognized as one of the main risk factors for thyroid cancer development and progression, the total oxidative and antioxidant capacities may also be potentially involved in the process of angioinvasion. Regardless, the identification of angioinvasion in PTC remains controversial mainly due to loose criteria in judging vascular invasion. Thus, searching for laboratory biomarkers of angioinvasion is of paramount importance.In this study, the potential screening utility of oxidative stress-related markers, such as total oxidative capacity (TOC), total antioxidant capacity (TAC) and 8-OHdG was assessed to identify angioinvasion in PTC patients.For the purpose od this study, 50 patients diagnosed with angioinvasive PTC (study group) and 50 patients with very low risk PTC (control group) were enrolled. The TOC, TAC and 8-OHdG concentrations were evaluated using enzyme-linked immunosorbent assay (ELISA). Following the received results, the TAC and 8-OHdG concentrations were decresed among study group comparing to control group (p&lt;0.001; p&lt;0.02, respectively). However, there were no differences in TOC among studied groups (p&gt;0.05). The AUC values for TAC=0.76 and AUC for 8-OHdG= 0.70 (all, p&lt;0.05) suggest their screening utility. The results indicate that angioinvasion process is associated with decreased antioxidant defense in PTC patients which may insight new medical targets in the future.
Presentation Date: Saturday, June 17, 2023
SAT516 Impact Of The Braf V600E Gene Mutation In Patients With Papillary Thyroid Cancer From Northern Ecuadorian Andes
Authors: Solis Pazmiño Andrea Paola , Cardenas Tamara , Cucalon Jessica , Jaramillo-Koupermann Gabriela , Galvez Gabriela , Reyes Carlos , Vega Jorge Salazar- 
Published: October 2023

Abstract
Disclosure: A.P. Solis Pazmiño: None. T. Cardenas: None. J. Cucalon: None. G. Jaramillo-Koupermann: None. G. Galvez: None. C. Reyes: None. J. Salazar- Vega: None.
IntroductionThe incidence of thyroid cancer (TC) is increasing worldwide. Most new TC cases are papillary thyroid cancer (PTC). Ideally, the individualization of treatment decisions should not only be based on the context and values of the patient but also on the biology of the tumor. Among them, BRAF V600E + TERT has been associated with aggressive clinic-pathologic outcomes, including tumor recurrence and mortality. The aim of this study was to determine the prevalence of the BRAFV600E mutation in PTC patients from the northern Ecuadorian Andes.MethodsA retrospective cohort study of 193 tumors, was classified according to the TNM system (AJCC 7th edition) and the patients were managed based on the 2015 ATA guidelines from June 2016 to December 2019 in Hospital Eugenio Espejo, Quito-Ecuador. PTC genomic DNA from formalin-fixed, paraffin-embedded tissue was analyzed for exon 15 of the BRAF oncogene by Sanger Sequencing.ResultsFrom 193 patients included, 146 were positive for the mutation (75.6%), and 47 were wild type (24.4%). In the bivariate analysis, the mutation was significantly associated with the presence of distant metastasis (p = 0.02), and it was also a predictor of distant metastasis (odds ratio [OR], 4.1; 95% CI 1.5 - 10.8). There was no significant association between BRAF positivity with demographic variables (age, gender, BMI, altitude), or with tumor characteristics (tumor size, focality, aggressive/nonaggressive variant, lymph node metastases, ACJJ stage, thyroglobulin or iodotherapy values).ConclusionIt has been proposed that patients harboring the mutation be managed more aggressively in the early stages, however, we conclude that the impact of BRAF V600E on PTC is still controversial. To the best of our knowledge, this is the first report of its kind carried out in the Ecuadorian population. Studies involving massive sequencing and prospective clinical correlation are needed in the future.
KEYWORDS: Papillary thyroid carcinoma, BRAF V600E mutation, distant metastasis.
Presentation Date: Saturday, June 17, 2023
FRI204 A Rare Case Of Cushing Syndrome In Pregnancy: Diagnosis And Therapeutic Challenges
Authors: Cardona Zulma , Szmuilowicz Emily Deborah 
Published: October 2023

Abstract
Disclosure: Z. Cardona: None. E.D. Szmuilowicz: None.
Introduction: Cushing’s syndrome (CS) rarely occurs during pregnancy, and diagnosis of Cushing’s syndrome in pregnancy is challenging due to physiologic changes during gestation. CS is associated with severe maternal and fetal complications. Clinical Case: A 36-year-old woman presented at 21 weeks gestational age with a known adrenal nodule admitted for evaluation of HTN, bilateral lower extremity edema, transaminitis, hyperglycemia, and acute hypoxemic respiratory failure. Reported proximal muscle weakness, facial swelling, anxiety, depression, perspiration, and headaches associated with HTN. Physical exam notable for mild supraclavicular fat deposition, chest and neck plethora, hypertrichosis, and bruising. CT abdomen pelvis revealed a 2.3-cm left adrenal nodule measuring 30 Hounsfield units. Biochemical evaluation included a plasma renin activity of 0.719 ng/mL/h [ref range: 0.167-5.380 ng/mL/h], aldosterone &lt;1.0 ng/dL [ref range: 0.167-5.380 ng/dL], potassium 2.6 mEq/dL, free plasma metanephrines (MN) &lt; 25 pg/mL [ref range: &lt; or = 57 pg/mL], free normetanephrines (NMN) &lt; 25 pg/mL [ref range: &lt; or = 148 pg/mL, total free MN and NMN &lt; 25 [ref range: &lt; or = 205 pg/mL]. 24-hour urine free cortisol (UFC) was markedly elevated at 1854.1 mcg/24h [ref range: 3.1-50.0 mcg/24h], repeat 2186.2 mcg/24h, ACTH: 1.5 pg/mL [ref range: 7.2-63.6 pg/mL], confirming a diagnosis of ACTH-independent CS. Her case was complicated due to the adrenal nodule location. Patients with left adrenal nodules are at risk of developing inferior vena cava (IVC) syndrome during left adrenalectomies, especially in the third trimester, due to compression exerted by the uterus while lying on the right side during the procedure. She underwent an uncomplicated laparoscopic left adrenalectomy. Was started on hydrocortisone (HC) following surgery. There was concern for transient neonatal adrenal insufficiency at delivery. Measuring adrenal insufficiency in utero is challenging; however, estriol could serve as a surrogate marker of fetal adrenal function. Her estriol was normal, possibly indicating intact fetal adrenal activity. She had an uncomplicated vaginal delivery with no signs of adrenal insufficiency in her baby. Interestingly, she had a severely low alkaline phosphatase (ALP) which completely normalized soon after adrenalectomy. Clinical Lesson: This case depicts the challenges in managing CS in pregnancy and its repercussions regarding maternal, fetal, and delivery outcomes. Additionally, it highlights the importance of implementing a multidisciplinary approach, including obstetricians, endocrinologists, endocrine surgeons, and pediatricians, to ensure the optimization of therapeutic strategies.
Presentation: Friday, June 16, 2023
SAT523 Molecular Profile of Local vs. Regional Aggressive Thyroid Cancer: A Multicenter Study
Authors: Tessler Idit , Gecel Nir , Payne Rick , Avior Galit , Eran Alon 
Published: October 2023

Abstract
Disclosure: I. Tessler: None. N. Gecel: None. R. Payne: None. G. Avior: None. A. Eran: None.
Background: Genetic testing for the diagnosis of thyroid cancer has rapidly evolved in recent years. While commonly applied for diagnosis, its role in predicting genotype-phenotype correlation and guiding management is emerging. Here we evaluate differences in the molecular profile of local vs. regional aggressive disease. Methods: We performed a retrospective multicenter study of patients who underwent molecular profiling for DTC between 2018-2021, dividing them into three groups: low-risk, locally aggressive, and regional aggressive. We analyzed the patients' basic characteristics, disease aggressive features (extranodal extension, perineural invasion), lymphovascular invasion, and extrathyroidal extension), and the mutation distribution according to disease aggressiveness. Genetic variants were stratified by risk levels according to the 2015 ATA guidelines. Results: The study included a total of 652 patients, 414 in the low-risk group, 73 in the locally aggressive group, and 165 in the regional aggressive group. The regional aggressive group had the lowest age at diagnosis (mean age of 44.64±13.78 years vs. 52.52±14.53 and 53.58±14.93 for the low-risk and locally-aggressive, respectively, p&gt;0.001), the highest rate of mutation-positive nodules (86.1% vs. 6.6% and 67.1%), and the highest rate of aggressive mutation (76.4% vs. 17.6 and 39.7). On the contrary, RAS mutations were more common in the low-risk (31.4% vs. 19.2% and 6.1% in the local- and regional aggressiveness groups). Conclusion: This study showed that local and regional aggressive thyroid cancer has a distinct molecular profile, with a higher prevalence of high-risk mutations in the regional group. These findings may enhance the use of genetic testing in predicting disease aggressiveness and guiding management in thyroid cancer.
Presentation Date: Saturday, June 17, 2023
SAT533 The Case of an Ectopic Thyroid Twin
Authors: Limon Ahmad Abu , Aldasouqi Saleh A , Kachhadia Palak , Khan Shaza 
Published: October 2023

Abstract
Disclosure: A. Abu Limon: None. S.A. Aldasouqi: Consulting Fee; Self; Abbott Laboratories. P. Kachhadia: None. S. Khan: None.
Introduction: Ectopic thyroid tissue is a rare but known developmental abnormality during the descent of the thyroid tissue from the floor of the foregut to its final location Infront of the trachea. The most frequent ectopic locations are the base of the tongue and anywhere along the course of the thyroglossal duct. It is very rare to have an ectopic thyroid tissue located in the mediastinum. It’s even more rare when the patient still has an almost normal thyroid gland in its usual location in the neck, and both are sizable and functional. Case Presentation: We are reporting the case of a 38-Year-old African American Female, who was involved in a car accident with non-critical injuries to her neck and chest area. She underwent a contrasted CT scan of her neck and chest that showed an anterior mediastinal mass towards the right at the level of the great vessels and arch, right paratracheal location overall measuring 6.0 x 4.6 x 4.5 cm. She was seen by Cardiothoracic surgery group and underwent Mediastinoscopy that confirmed a large firm to hard mass just inferior to the innominate artery was firmly adherent to the trachea as well as surrounding structures. Multiple biopsies showed thyroid tissue with focal mild chronic inflammation, benign. No atypia or malignancy is noted. Then, she was referred to our clinic for further evaluation. When interviewed, the patient denies any compressive symptoms (Shortness of breath, palpitations, chest pain or dysphagia). The patient has no personal or family history of thyroid disorders, including no thyroid cancer history. She has no Goiter on exam and no Pemberton sign is elicited. Laboratory work up was unremarkable including normal thyroid functions. Neck Ultrasound confirmed presence of a thyroid gland in its expected location, with Right Lobe Measurement: 5.04 x 1.70 x 1.47 cm Vol: 6.02 ml and Left Lobe Measurement: 3.94 x 1.25 x 1.21 cm Vol: 2.87 ml. We were keen to explore this matter further and ordered a thyroid uptake scan with 0.97 uCi iodine-123, that showed a 24-hour normal uptake of 27.4% at the thyroid bed and a separate substernal and RT paratracheal location uptake. Discussion: This patient has supplementary ectopic thyroid tissue in her mediastinum along with a normal thyroid gland in her neck. From the literature review and search, This is a very rare occurrence. The discussion with the patient is about the specific concern of the malignant potential of this ectopic thyroid and if surgical intervention is needed. The probability of cancer on ectopic thyroid tissue is less than 1% and when it occurs papillary carcinoma is the most common histology. Our patient has benign biopsy results and no signs nor symptoms related to this ectopic thyroid gland. The final decision is to not undergo surgery, but rather, a follow up with CT scan in 6 months.
Presentation Date: Saturday, June 17, 2023
SAT539 Thyroid Cancer Presenting as Aspiration Pneumonia
Authors: Aslam Sadia , Asif Muhammad , Nadeem Ifrah , Khan Wahab J 
Published: October 2023

Abstract
Disclosure: S. Aslam: None. M. Asif: None. I. Nadeem: None. W.J. Khan: None.
Background Goiter, most often, is first noticed as a visible neck mass; however, some patients may present with signs and symptoms of hypothyroidism, or hyperthyroidism. Retrosternal extension can cause compression of the trachea, esophagus, and jugular veins resulting in dysfunction of these viscera. CaseA 68-year-old male presented with SOB, and weakness for 5 days. He had SaO2 79% on room air requiring oxygen, RR 28/min, HR 78/min and Temp.101.6 F, BP 94/48 mmHg. The lung exam revealed bilateral rhonchi and coarse crypts. Minimal non-tender nodularity was noted on the thyroid palpation not previously noticed by the patient or his family. Chest x-ray showed bilateral airspace opacities. CT chest revealed a large upper mediastinal mass displacing the trachea and esophagus to the right, a nodule in the left lobe of thyroid, subcarinal and right hilar lymphadenopathy and bilateral dependent consolidative opacities suggesting aspiration pneumonia but no PE. A barium esophagogram showed a 7.5 cm mediastinal mass causing 50% narrowing and displacement of esophagus and compression with left sided deviation of trachea. A barium swallow study was done, and the patient was found to have aspiration with all administered food types due to an abnormal swallowing mechanism. The patient was advised NPO and placed on NG tube feeding to prevent further aspiration. The patient underwent bronchoscopy and EBUS from station 4 lymph node, the pathology of which did not show any malignant cells. However, due to high clinical suspicion of a malignant process, the patient underwent a CT-guided biopsy of the mediastinal mass that showed bland thyroid tissue. Ultrasound of thyroid revealed multiple right and left lobe nodules. TSH and free T4, and calcitonin were WNL. The patient's hypoxia and fever resolved after completion of the antibiotics including ceftriaxone and doxycycline and being nothing per oral within 7 days. Due to persistent dysphagia, he was placed on PEG tube feeding and discharged from the hospital to a nursing home. The patient underwent ultrasound-guided fine needle biopsy of 1 right-sided and 2 left-sided thyroid nodules that resulted as papillary thyroid cancer. He underwent a successful right-sided thoracotomy and removal of large sized thyroid mass. The patient is seeing endocrinology as an outpatient for radioactive iodine and hormone replacement therapy. Conclusion We treated a patient of follicular carcinoma who presented with extrathyroidal symptoms. Retrosternal or ectopic thyroid tumors can present as euthyroid state without obvious enlargement of the normal thyroid gland. A meticulous clinical evaluation should include the differential diagnosis of retrosternal goiter or ectopic thyroid with cancer when treating patients who preset with sign and symptoms concerning for mediastinal disease.
Presentation Date: Saturday, June 17, 2023
OR32-01 Clinical Performance Of Multiplatform Molecular Diagnostic Testing Of Cytology Indeterminate Thyroid Nodules: A Blinded, Single Institution Observational Study With Surgical Pathology And Surveillance Follow Up
Authors: Cipriani Nicole A , Antic Tatjana , Banizs Anna , Finkelstein Sydney David 
Published: October 2023

Abstract
Disclosure: N.A. Cipriani: None. T. Antic: None. A. Banizs: Employee; Self; Interpace Diagnostics. S.D. Finkelstein: Employee; Self; Employee of Interpace Diagnostics.
Background: Genetic analysis of final needle aspiration biopsies (FNAB) can improve the diagnostic accuracy of cytology indeterminate thyroid nodules (ITN). A combination multiplatform molecular algorithmic testing (MPTXv1) approach with mutational analysis (ThyGeNEXT®) complemented by quantitative microRNA (miRNA) expression (ThyraMIR®) can assign nodules to three diagnostic categories: Negative (low malignancy risk), Moderate (intermediate risk), or Positive (high risk). Test performance was assessed in a blinded observational study to evaluate the potential incremental benefit of adding miRNA pairwise expression profiling (MPTXv2) to reduce the Moderate category and improve diagnostic accuracy [RR1] of ITN. Methods: An 11 miRNA marker Profiler was trained to quantify the equilibrium between miRNA pairs supporting growth promotion versus growth suppression using surgical pathology confirmed nodular disease (n=50). Performance without (MPTXv1) and with miRNA pairwise expression profiling (MPTXv2) was assessed using a test cohort of 101 FNAB of ITN (Bethesda Diagnostic Category III/IV) from a single institution. Molecular analysis was performed in blinded fashion with outcome determined based on surgical pathology and surveillance tracking of patients managed for benign disease. Results: MPTXv1 performance (3 categories) without profiler showed 91% sensitivity, 97% specificity, 97% NPV and 85% PPV of 101 patient cohort with 23% cancer prevalence. MPTXv2 performance showed significant [RR2] incremental improvement with 91% sensitivity, 99% specificity, 97% NPV and 95% PPV. Of note, Nodules classified as Moderate malignancy risk decreased from 25 to 6 patients (a 76% reduction). Conclusion: Diagnostic test performance limitations inherent in isolated mutational or isolated RNA classifier analysis to both rule-in and rule-out of thyroid cancer can be improved by a combination platform [RR5] approach (MPTX) which can delivers high sensitivity and specificity. Furthermore, blinded observational analysis of deeper analysis by incorporating miRNA pairwise expression profiling (MPTXv2) further improves performance by increasing the proportion of patients that will receive a highly accurate prediction of ITN status, reducing false positives and negatives
Presentation: Sunday, June 18, 2023
FRI211 Recurrent Hypertensive Crises In A Patient With A Large Pheochromocytoma; A Complicated Intensive Care Unit Course
Authors: Sokoloff Samantha , Iwamaye Amy 
Published: October 2023

Abstract
Disclosure: S. Sokoloff: None. A. Iwamaye: None.
Introduction: Hypertensive crisis is a well-known complication of surgery in patients with pheochromocytomas. However, as demonstrated in this case, these crises can be triggered by even routine intensive care unit procedures if sufficient alpha blockade has not been achieved. Thus, prevention of these episodes in the critical care setting presents a therapeutic challenge. Case: A 47-year-old female with a medical history of hypertension and intraductal papilloma presented for right lumpectomy for recent increase in papilloma size. General anesthesia and a laryngeal mask airway (LMA) were used. Intraoperatively, hypertensive crisis developed with systolic blood pressure of three hundred and oxygen saturation of forty percent. Hypoxia persisted after LMA was exchanged for endotracheal intubation and ECMO initiation was necessary to restore oxygenation. The patient was admitted to the Intensive Care Unit and blood pressure normalized postoperatively. Echo showed normal ejection fraction with an incidental finding of a peri-hepatic mass. This prompted evaluation for pheochromocytoma, which was biochemically confirmed with plasma free metanephrine and normetanephrine of 13,900 (&lt;= 57 pg/mL) and 2,560 (&lt;= 148 pg/mL), respectively. Abdominal CT-scan showed an 8.0 x 7.0 x 8.0 cm right adrenal mass. MIBG showed increased activity in the mass without evidence of metastatic disease. Doxazosin was initiated for alpha blockade. One week postoperatively, ECMO was weaned off and the patient was extubated. Shortly after extubation, a second hypertensive crisis occurred with an increase in systolic blood pressure to over two hundred and a decrease in oxygen saturation to forty percent. Re-intubation was unsuccessful and cricothyrotomy was required. Both nitroprusside and clevidipine failed to reduce blood pressure and a labetalol infusion was necessary to end the episode. The patient underwent surgery for cricothyrotomy to tracheostomy conversion two days later. By that point, labetalol had been weaned off and doxazosin had been titrated to three mg every twelve hours. A titratable IV phentolamine infusion was used for further alpha blockade intra-operatively and normotension was maintained. Over the next two weeks, adequate alpha blockade was achieved with titration of doxazosin dosage to thirteen mg two times daily. Uncomplicated adrenalectomy was then completed. Pathology showed a pheochromocytoma with retained SDHB, focal positivity for ACTH, and without capsular or vascular invasion. Conclusion: Routine critical care procedures such as extubation can trigger hypertensive crises in patients with pheochromocytomas. These episodes may be resistant to multiple intravenous anti-hypertensive agents. Titratable intravenous phentolamine can be used as a precautionary measure during necessary procedures if adequate alpha blockade with oral agents has not yet been achieved.
Presentation: Friday, June 16, 2023