Morphological and molecular characteristics of subcutaneous implantation of nodules after endoscopic thyroidectomy in 3 cases

doi:10.16139/j.1007-9610.2025.03.009

Abstract

Abstract:

Objective To investigate the pathological and molecular characteristics of subcutaneous implanted thyroid lesions after endoscopic thyroid surgery. Methods A retrospective analysis was conducted on three postoperative implantation cases diagnosed in the Department of Pathology of our hospital from 2017 to 2024. Morphological evaluation, immunohistochemical staining, and next generation sequencing (NGS) targeting 66 cancer-related genes and 177 fusion loci were performed to compare features between primary and implanted lesions. Results All three implanted lesions exhibited morphological similarity to their primary counterparts, but displayed enriched mutational profiles. Case 1: a 13-year-old female. The primary lesion was an atypical follicular adenoma progressing to follicular carcinoma, while the implanted lesion was follicular carcinoma. Both lesions harbored MEN1 mutations, with an additional PTPRT mutation detected in the implanted lesion. Case 2: a 45-year-old male. The primary lesion was bilateral nodular goiter, and the implanted lesion showed follicular epithelial hyperplasia with a 0.3 cm papillary carcinoma focus. No mutations were identified in the primary lesion, whereas the implanted lesion exhibited MEN1, GLIS3, EZH1, and KMT2C mutations. Case 3: a 42-year-old female. The primary lesion included a left thyroid adenoma with cystic degeneration and right nodular goiter. A nodular goiter-like implanted lesion was detected in the right breast 5 years postoperatively. The primary lesion harbored TERT, GLIS3, and SPOP mutations, while the implanted lesion showed TERT, GLIS3, EIF1AX, and KMT2C mutations. Conclusions Endoscopic thyroid surgery is widely applied in clinical practice, however, implantation dissemination of thyroid lesions along surgical pathways may occur, encompassing both benign and malignant entities. Implanted lesions exhibit pathological similarities to their primary counterparts, but demonstrate mutational enrichment.

Key words: Endoscopic thyroid surgery, Pathological morphology, Next generation sequencing (NGS), Gene mutation

CLC Number:

R653

JIA Jingdan, WANG Liangyuan, FEI Xiaochun, YU Teng, WANG Zhongyu, XIE Jing. Morphological and molecular characteristics of subcutaneous implantation of nodules after endoscopic thyroidectomy in 3 cases[J]. Journal of Surgery Concepts & Practice, 2025, 30(03): 234-240.

Figures/Tables 4

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References 33

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Case	1			2		3
Age	13			45		42
Gender	Female			Male		Female
Lesion	Primary lesions	Implanted lesions		Primary lesions	Implanted lesions	Primary lesions	Implanted lesions
Location	Left thyroid	Left cervical region and pre-axillary subcutaneous tissue	Left sternocleidomastoid muscle	Thyroid	Subcutaneous tissue of neck	Thyroid	Breast
Number of nodules	2	2	1	2	6	2	1
Pathological diagnosis	Atypical follicular adenoma of thyroid thyroid follicular carcinoma	Thyroid follicular carcinoma	Thyroid follicular carcinoma	Follicular nodular disease	Follicular nodular disease Papillary thyroid carcinoma	Left thyroid adenoma with cystic degeneration, Right thyroid nodular goiter	Nodular goiter
Immunohistochemistry	Thyroid follicular carcinoma Ki-67（10%+）	Ki-67（30%+）	Ki-67（15%+）	/	Papillary thyroid carcinoma area HBME-1（+），TPO（-）	/	HBME-1（-）
Mutated gene	MEN1	MEN1	PTPRT （p.G855R）	-	MEN1（p.G512=） GLIS3（p.G904R） EZH1（p.Q571R） KMT2C（p.V1264A）	TERT（p.L837=） GLIS3（p.L901=） SPOP（p.P94R）	TERT（p.L837=） GLIS3（p.L901=） EIF1AX（p.P2R） KMT2C（p.R4533*）
Mutation type	Non-coding mutation	Non-coding mutation	Missense mutation	-	Synonymous mutation Missense mutation Missense mutation Missense mutation	Synonymous mutation Synonymous mutation Missense mutation	Synonymous mutation Synonymous mutation Missense mutation Nonsense mutation
Mutation frequency	47.77%	49.53%	19.21%	-	59.52% 51.67% 29.61% 5.24%	47.95% 48.79% 31.05%	47.82% 50.99% 11.46% 2.01%
Classification	Ⅳ	Ⅳ	Ⅲ	-	Ⅲ Ⅳ Ⅱ Ⅲ	Ⅳ Ⅲ Ⅱ	Ⅳ Ⅲ Ⅲ Ⅱ