PMC10205983_01
Ultrasonographic features of the thyroid nodular. (A) Irregular and ill-defined solid nodule with hypoisoechogenicity and microcalcifications (asterisks). (B) Increased vascular flow insides and around the nodular on color Doppler sonography.
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F1
Color Doppler flow imaging showed abundant blood flow to the lesion, highly suggestive of thyroid malignancy (Figure 1).
Pathological features of renal biopsy. (A-D) Light microscopy showed no apparent glomerular, tubulointerstitial or vascular alterations. (E, F) Immunofluorescence revealed weak deposits of IgM in the mesangium and focal staining for reabsorbed albumin particles in the tubules. (G, H) Electron microscopy exhibited extensive foot processes effacement, with no segmental sclerosis or electron-dense deposits, normal mesangial cellularity and matrix, and normal glomerular basement membrane thickness. PASM: periodic acid-silver methenamine, PAS: periodic acid-Schiff. (I, J) Immunohistochemistry staining for BRAF was negative.
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F2
Electron microscopy exhibited extensive podocyte injury, as evidenced by diffuse foot processes effacement, cytoplasmic vacuoles, and microvillous transformation (Figures 2A-H).
Microscopic appearance of papillary thyroid carcinoma. (A) Pathologic features reveal papillae lined by cuboidal to columnar cells with predominant nuclear changes. A magnification box on the right shows ground-glass nuclei with thick nuclear membranes, giving rise to what has been described as Orphan Annie Eye nuclei. Nuclear grooves are also noticeable (HE, x10). (B) The presence of psammoma bodies shown by red arrows (HE, x40). (C, D) Immunohistochemistry staining for BRAF was positive.
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F3
After a total thyroidectomy with a recurrent laryngeal nerve exploration, postoperative pathology confirmed the diagnosis of PTC (Figures 3A, B) with 6 level VI metastatic lymph nodes. The tumor cells were immunopositive for the BRAF (V-raf murine sarcoma viral oncogene homolog B1) protein (Roche Diagnostics) (Figures 3C, D).
Clinical course of the patient. UPCR(blue line) and serum albumin (black line) changes before and after total thyroidectomy. Both UPCR and serum albumin normalized 6 months after the surgery (There was no spot urine or 24-h urine sample test performed in January 2019).
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F4
At 6 months postoperatively, the patient achieved complete remission of MCD [proteinuria < 0.3 g/d or UPCR < 300 mg/g, serum albumin >3.5 g/dl according to the 2021 KDIGO guideline ], and no relapse occurred during a follow-up period of up to 30 months (Figure 4).