Neslihan Kurtulmuş1, Fatma Tokat2, Mete Düren1, Hakan Kaya1, Burak Ertaş3, Ümit İnce2

1Clinic of Thyroid, Acıbadem Maslak Hospital, İstanbul, Turkey
2Department of Pathology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
3Clinic of Otorhinolaryngology Head and Neck Surgery, Acıbadem Maslak Hospital, İstanbul, Turkey


Objective: Vascular endothelial growth factor (VEGF) is an angiogenic factor that plays an important role in physiological and pathological angiogenesis of the thyroid. The aim of the current study was to determine the expression characteristics of VEGF in follicular cell-derived lesions of the thyroid and to assess whether a new entity noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is precancerous.

Material and Methods: Patients diagnosed with 33 follicular adenomas (FA), 41 invasive follicular variant papillary thyroid cancer (IN-FVPTC), and 40 NIFTP in surgical resection materials were evaluated retrospectively. Immunostaining was performed on 5-μm paraffin tissue sections. The percentages of immunostaing for VEGF were evaluated on pathological materials. We used a percentage of labeled thyrocytes score (0, no labeling; 1, <30%; 2, 31-60%; 3, >60%) and an intensity score (0, no staining; 1, weak; 2, intermediate; 3, strong). The sum of two scores were accepted as the total score.

Results: Mean ages of the FA, IN-FVPTC, and NIFTP groups were 44.7 ± 11.7 years, 46.9 ± 13.6 years, 43.2 ± 15.4 years, respectively and the mean VEGF immunostaining scores were 44.7 ± 29.3, 50.2 ± 32.54, 4 ± 26.3 respectively. Although there was no statistically significant difference (p= 0.347), the total score of the NIFTPs was higher than the scores of the FA (mean= 3.9 ± 1.8) and IN-FVPTC(mean= 4.3 ± 1.9) groups with a mean value of 4.6 ± 1.7. This result was remarkable. There was no statistically significant difference between tumor diameters and staining percentages (p= 0.750).

Conclusion: Even if there were no statistical differences for VEGF immunostaining, it was high in NIFTPs. Since we know the role of VEGF in tumorigenesis, we can hypothesize that NIPTP can be precancerous. Our argue should be corroborated by a large prospective study.

Keywords: VEGF, NIFTP, thyroid follicular lesions

Cite this article as: Kurtulmuş N, Tokat F, Düren M, Kaya H, Ertaş B, İnce Ü. Expression of vascular endothelial growth factor in follicular cell-derived lesions of the thyroid: Is NIFTP benign or precancerous?. Turk J Surg 2022; 38 (1): 60-66.


Ethics Committee Approval

The ethical approval for this study was obtained from Acıbadem University, Faculty of Medicine Ethics Committee (Date: 31.12.2020, Decision No: 2020-27/26).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - N.K., M.D., F.T.; Design - N.K., M.D., F.T.; Supervision - N.K., M.D., F.T.; Materials - N.K., M.D., F.T., U.İ.; Data Collection and/or Processing - N.K., M.D., F.T., H.K., B.E.; Analysis and/or Interpretation - N.K., F.T., M.D., U.İ.; Literature Search - N.K., H.K., B.E., F.T.; Writing Manuscript - N.K., F.T., M.D., H.K.; Critical Reviews - N.K., M.D., F.T..

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.