National Cancer Institute®
Last Modified: November 21, 2001
UI - 20389342
AU - Kraimps JL; Bouin-Pineau MH; Mathonnet M; De Calan L; Ronceray J; Visset
TI - J; Marechaud R; Barbier J Multicentre study of thyroid nodules in patients with Graves' disease.
SO - Br J Surg 2000 Aug;87(8):1111-3
AD - Departments of Endocrine Surgery, Jean Bernard Hospital, Poitiers, France.
BACKGROUND: The association of Graves' disease with thyroid nodules and thyroid carcinoma is rarely reported. The incidence seems to be increasing according to recent literature. The aim of this multicentre study was to review patients who had surgery for Graves' disease associated with thyroid nodules, and to evaluate the risk of thyroid carcinoma. METHODS: A retrospective study was made of 557 consecutive patients who underwent operation for Graves' disease between 1991 and 1997 in five endocrine surgery departments. Each patient underwent clinical, biochemical, ultrasonographic and scintigraphic evaluation. None of the patients had had previous radioactive iodine therapy or external irradiation. Surgery consisted of either a subtotal or total thyroidectomy. RESULTS: Nodules were observed before operation in 140 patients (25.1 per cent). Thyroid carcinoma was diagnosed in 21 patients (15.0 per cent), always inside a nodule. The incidence of thyroid carcinoma associated with Graves' disease was 3.8 per cent (21 of 557 patients): 20 papillary and one follicular carcinoma. The carcinoma was multifocal in two patients. Tumour diameter ranged from 2 to 25 mm. A nodule was palpable in four patients. CONCLUSION: This multicentre study of patients having thyroidectomy for Graves' disease showed that 3.8 per cent had a carcinoma; the rate of carcinoma in cold nodules was 15.0 per cent. Surgery should be advised in any patient with Graves' disease and a thyroid nodule; the operation should be total thyroidectomy.
UI - 21256508
AU - Goto A; Sakamoto A; Machinami R
TI - An immunohistochemical analysis of cyclin D1, p53, and p21waf1/cip1 proteins in tumors originating from the follicular epithelium of the thyroid gland.
SO - Pathol Res Pract 2001;197(4):217-22
AD - Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
This study aimed at clarifying the factors closely related to the tumor progression of thyroid neoplasms. We examined the immunoreactivity of cyclin D1, p53, and p21waf1/cip1 proteins in 179 thyroid tumors originating from the follicular epithelium using an immunohistochemical technique. Cyclin D1 positivity was frequent in well-differentiated thyroid carcinomas (39/122 cases), but it was rarely seen in follicular adenomas (1/33 cases), (p < 0.05). Positivity for p53 was more frequent in poorly differentiated carcinomas (7/19 cases) and undifferentiated carcinomas (4/5 cases) than in well-differentiated carcinomas (14/122 cases) (p < 0,05, respectively). P21waf1/cip1 positivity was more frequent in well-differentiated thyroid carcinomas (43/122 cases) than in follicular adenomas (4/33 cases) (p < 0.05). Regarding the relationships of these proteins, co-positivity for cyclin D1 and p53 was observed more often in poorly differentiated carcinomas (5/7 cases) than in well-differentiated carcinomas (7/39 cases) (p < 0.05). Most cases with cyclin D1 positivity did not show p21waf1/cip1 expression in poorly differentiated carcinomas (6/7 cases). Three cases examined showed co-positivity of p53 and p21waf1/cip1. Our results suggest that cyclin D1 is invoved in thyroid oncogenesis. Moreover, p53 might be closely related to the development of poorly differentiated carcinomas and undifferentiated carcinomas originating from well-differentiated carcinomas.
UI - 21340681
AU - Pollinger B; Duhmke E
TI - External radiotherapy of thyroid cancer.
SO - Onkologie 2001 Apr;24(2):134-8
AD - Klinik und Poliklinik fur Strahlentherapie und Radioonkologie der Ludwigs-Maximilians-Universitat Munchen.
Differentiated thyroid cancer comprises papillary, mixed papillary-follicular and follicular adenocarcinomas. They are mostly hormone-sensitive and respond to thyroid-stimulating hormone (TSH) suppression. The standard treatment is total thyroidectomy, (131)I therapy and thyroid hormone suppression therapy. Adjuvant external radiotherapy is discussed controversially. Most authors recommend adjuvant external radiotherapy for extra-capsular tumor extension. Decision on an individual basis should be made for patients with lymph node involvement. In the case of incomplete surgical resection, external radiotherapy should be applied if second surgery is not possible. For medullary thyroid cancer, external beam radiotherapy seems to be beneficial for patients with surgically inaccessible disease, with microscopic residual or gross tumor after surgery, with recurrent locoregional disease, or with surgically unmanageable metastases. Patients suffering from anaplastic thyroid cancer should receive combined treatment consisting of extensive surgery, external irradiation with total doses up to 60 Gy, and chemotherapy. The combined treatment modality leads to higher local control rates and prolongs survival. Copyright 2001 S. Karger GmbH, Freiburg
UI - 21415194
AU - Kacker A; Komisar A
TI - Unilateral versus bilateral neck exploration in parathyroid surgery: an assessment of 55 cases.
SO - Ear Nose Throat J 2001 Aug;80(8):530-2, 534
AD - Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital, 100 E. 77th St., New York, NY 10021, USA.
We retrospectively evaluated the cases of 55 patients who had undergone surgery for primary hyperparathyroidism at our institution to determine whether their parathyroid glands were abnormal on both sides. Thirty-six of these patients had undergone a bilateral neck exploration, and 19 had had a unilateral investigation. Of the 36 bilaterally explored patients, 30 had a solitary adenoma and no parathyroid pathology on the opposite side, five patients had hyperplastic glands with more than one gland involved, and one patient had two adenomas. In the unilaterally explored group, all 19 patients had a solitary adenoma. There were no failures in the way of persistent hypercalcemia in either group. Based on our findings, we conclude that a unilateral neck exploration should be performed during surgery for primary hyperparathyroidism whenever a large parathyroid adenoma and a normal parathyroid gland are found on the same side. Bilateral exploration should be reserved for patients in whom pathology cannot be found on the initially explored side during surgery and for patients who have obvious parathyroid hyperplasia.
UI - 21415702
AU - Klein I; Esik O; Homolya V; Szeri F; Varadi A
TI - Molecular genetic diagnostic program of multiple endocrine neoplasia type 2A and familial medullary thyroid carcinoma syndromes in Hungary.
SO - J Endocrinol 2001 Sep;170(3):661-6
AD - Institute of Enzymology of the Hungarian Academy of Sciences, Budapest, Hungary. firstname.lastname@example.org
Medullary thyroid carcinoma (MTC) occurs usually in sporadic form, but about a quarter of the cases are hereditary and appear as part of one of the multiple endocrine neoplasia type 2 (MEN2) syndromes. Mutations in the RET protooncogene are known to be the cause of the MEN2A and familial medullary thyroid carcinoma (FMTC) syndromes in the majority of the families. Direct DNA testing allows prophylactic thyroidectomy to be offered to individuals carrying a mutation in the above codons, and in mutation-negative cases it reduces the yearly screening-related burden on family members at risk of the disease. By DNA sequencing and PCR-restriction fragment length polymorphisms, 65 MTC probands were examined for mutations in residues 609, 611, 618, 620 of exon 10, and in residues 634, 768, 804 of exons 11, 13, and 14 respectively of the RET protooncogene. In our study, mutations in the above codons were detected in all of the 14 clinically MEN2A and FMTC families. One of these mutations, TGC609 TCC has not been reported previously. Of the 14 probands with the mutation, 25 relatives also had the identified mutation and 18 relatives proved to be non-carriers. Among the 51 probands with clinically sporadic MTC, none was found to carry a mutation in the above positions even if indirect signs of MTC, pheochromocytoma or hyperparathyroidism could be detected in some families. The frequency of the TGC634AGC mutation is unexpectedly high in our samples, which can probably be attributed to a founder effect. We conclude that screening for mutations in these codons is effective in families fulfilling the strict clinical criteria of MEN2A or FMTC.
UI - 21449447
AU - Zdon MJ; Fredland AJ; Zaret PH
TI - Follicular neoplasms of the thyroid: predictors of malignancy?
SO - Am Surg 2001 Sep;67(9):880-4
AD - Department of Surgery, Finch University of Health Sciences/The Chicago Medical School at Mount Sinai Hospital Medical Center, Illinois 60064, USA.
Follicular neoplasms of the thyroid present a therapeutic challenge. Initial limited thyroidectomy may result in some patients requiring completion thyroidectomy for malignancy. In the current study we examined age, gender, race, time from nodule discovery to operation in months, history of radiation exposure, tumor size (cm), and cell type in patients with follicular neoplasms identified at the time of thyroidectomy in two socioeconomically diverse settings from 1993 through 2000 to identify possible factors associated with a greater chance of malignancy. Of 36 follicular lesions identified in 35 patients seven (19%) were malignant on permanent section. Hurthle cell histology was present in six of 36 lesions. Mean age of patients with benign lesions was 47 +/- 13 versus 50 +/- 15 in malignant cases (P > 0.05). Benign lesions measured 2.6 +/- 1.2 cm versus 3.1 +/- 1.7 cm in malignant (P > 0.05). Other factors found not to be significant included gender and time nodule was present (12.8 +/- 19 months benign vs 11.8 +/- 20 months malignant) (P > 0.05). Hurthle cell histology was associated with a 50 per cent malignancy rate (three of six) versus 13 per cent (four of 30) with non-Hurthle cell histology (P < 0.05). Two patients with exposure to radiation fallout had malignancies in lesions of one and 2 cm (P < 0.05). Patients from a socioeconomically disadvantaged setting had a malignancy rate of 50 per cent (six of 12) compared with a malignancy rate of 3 per cent (one of 24) from a socioeconomically affluent population (P < 0.05). In conclusion Hurthle cell histology and exposure to radiation fallout were associated with significantly higher rates of malignancy in follicular neoplasms and should be taken into account when deciding on the initial extent of thyroidectomy. The difference in malignancy rates observed between socioeconomic settings while significant requires further investigation.
UI - 21452375
AU - Arda IS; Yildirim S; Demirhan B; Firat S
TI - Fine needle aspiration biopsy of thyroid nodules.
SO - Arch Dis Child 2001 Oct;85(4):313-7
AD - Baskent University Faculty of Medicine, Department of Pediatric Surgery, Fevzi Cakmak caddesi 10. sokak No: 45, 06490 Bahcelievler Ankara, Turkey.
BACKGROUND: Fine needle aspiration biopsy (FNA) is a routine diagnostic technique for evaluating thyroid nodules. Many reports in adults consider that FNA is superior to thyroid ultrasonography (USG) and radionuclide scanning (RS). Only five studies have been published on FNA of childhood thyroid nodules. AIMS: To investigate the reliability of FNA in the evaluation and management of thyroid nodules, and compare the results of FNA, USG, and RS with regard to final histopathological diagnosis. METHODS: FNA was performed in 46 children with thyroid nodules after USG and RS examination. We investigated the sensitivity, specificity, accuracy, and positive and negative predictive values of USG, RS, and FNA in their management. RESULTS: Six patients who had malignant or suspicious cells on FNA examination underwent immediate surgery. The other 40 patients received medical treatment according to their hormonal status. Fifteen of these nodules either disappeared or decreased in number and/or size. Surgery was performed in 25 patients who did not respond to therapy. Statistical analysis revealed sensitivity, specificity, accuracy, and positive and negative predictive values respectively as follows: 60%, 59%, 59%, 15%, and 92% for USG; 30%, 42%, 39%, 12%, and 68% for SC; 100%, 95%, 95%, 67%, and 100% for FNAB. CONCLUSION: FNAB is as reliable in children as in adults for definitive diagnosis of thyroid nodules. Using this technique avoids unnecessary thyroid surgery in children.
UI - 21268064
AU - Zabel M; Gebarowska E; Drag-Zalesinska M; Wysocka T; Flig K
TI - Effect of octreotide on proliferation of in vitro cultured thyroid medullary carcinoma cells.
SO - Folia Histochem Cytobiol 2001;39(2):185-6
AD - Department of Histology and Embryology, University of Medical Sciences, Wroclaw, Poland. email@example.com
In TT cells, originating from medullary carcinoma of the human thyroid, the presence of receptors for somatostatin was demonstrated at the ultrastructural level. Inhibitory effect of octreotide (a somatostatin analogue) was observed on proliferation of in vitro cultured TT cells and confirmed by evaluating levels of PCNA and Ki-67 proliferation-associated antigens and examining the extent of DNA damage using the comet assay. Our studies indicate a potential for application of somatostatin analogues to diagnosis and adjunct treatment in thyroid medullary carcinomas.
UI - 21268065
AU - Dadan J; Wolczynski S; Sawicki B; Chyczewski L; Azzadin A; Dzieciol J;
TI - Puchalski Z Preliminary evaluation of influence of gemcitabine (Gemzar) on proliferation and neuroendocrine activity of human TT cell line: immunocytochemical investigations.
SO - Folia Histochem Cytobiol 2001;39(2):187-8
AD - 1st Department of General Surgery, Medical Academy, Bialystok, Poland. firstname.lastname@example.org
The choice treatment of medullary thyroid carcinoma (MTC) is total thyroidectomy. It is difficult to evaluate effectiveness of chemotherapy due to the rare incidence of MTC. Gemcitabine is a new drug of antimetabolite nucleoside group used in treatment of cancers since 1996. The aim of this study was to evaluate the influence of gemcitabine on proliferation and neuroendocrine activity of human TT cell line derived from MTC. The cells were exposed to gemcitabine in the concentration of 10, 25 and 50 microg/ml for 24 hours. Immunocytochemical examinations were carried out by the method of avidin-biotin peroxidase complex (ABC) according to Hsu et al. to detect calcitonin, chromogranin A, synaptophysin and neuron-specific enolase in TT cells. A concentration-dependent inhibitory influence of gemcitabine on proliferative activity of TT cells was observed. It was also shown that the immunostaining was reduced, especially in case of neuron-specific enolase. Only the reaction detecting calcitonin was enhanced in persistin
UI - 21300311
AU - Tancredi M; Foppiani L; Giordano GD; Ansaldo GL; Torre GC; Ceppa P;
TI - Giusti M Magnetic resonance imaging: a complementary tool in the evaluation of thyroid nodules?
SO - J Endocrinol Invest 2001 May;24(5):384-5
UI - 21366972
AU - Komisarenko IV; Rybakov SI; Bahirov MM; Bondarenko IuH; Sheptukha AI
TI - [Urgent interventions for invasive thyroidal carcinoma]
SO - Klin Khir 2000 Sep;(9):40-2
There was summarized the experience of treatment of the thyroid gland cancer, invading trachea (larynx) and other neighboring structures of the neck in 42 patients, whose state was estimated as severe one and neoplastic process--as nonoperable. Optimal surgical methods were applied depending on clinical signs of thyroidal carcinoma. In 36 patients the palliative resection of thyroid gland (in 6--with tracheostomy addition) was done, in 6--intervention was restricted by tracheostomy formation. The method of tracheostomy formation in cases of massive spreading of tumor along trachea is adduced.
UI - 21332880
AU - Nutting CM; Convery DJ; Cosgrove VP; Rowbottom C; Vini L; Harmer C;
TI - Dearnaley DP; Webb S Improvements in target coverage and reduced spinal cord irradiation using intensity-modulated radiotherapy (IMRT) in patients with carcinoma of the thyroid gland.
SO - Radiother Oncol 2001 Aug;60(2):173-80
AD - Academic Department of Radiotherapy, Institute of Cancer Research, Surrey, SM2 5PT, Sutton, UK.
BACKGROUND AND PURPOSE: External beam radiotherapy for thyroid carcinoma poses a significant technical challenge as the target volume lies close to or surrounds the spinal cord. The potential of intensity-modulated radiotherapy (IMRT) to improve the dose distributions was investigated. MATERIALS AND METHODS: A planning study was performed on patients with thyroid carcinoma. Plans were generated to irradiate the thyroid bed alone or to treat the thyroid bed and the loco-regional lymph nodes in two phases. Conventional plans with minimal beam shaping were compared to three-dimensional conformal radiotherapy (3DCRT) and inverse-planned IMRT plans to assess target coverage and normal tissue sparing. IMRT techniques were optimized to find the minimum number of equispaced beams required to achieve the clinical benefit and a concomitant boost technique was explored. RESULTS: For the thyroid bed alone and the thyroid bed plus loco-regional lymph nodes, conventional and conformal techniques produced low minimum doses to the planning target volume (PTV) if spinal cord tolerance was respected. 3DCRT reduced the irradiated volume of normal tissue (P=0.01). IMRT plans achieved the goal dose to the PTV (P<0.01) and also reduced the spinal cord maximum dose (P<0.01). IMRT, using a concomitant boost technique, produced better target coverage than a two-phase technique. For both the two-phase and concomitant boost techniques, IMRT plans with seven and five equispaced fields produced similar dose distributions to nine fields, but three fields were significantly worse. CONCLUSIONS: 3DCRT reduced normal tissue irradiation compared to conventional techniques, but did not improve PTV or spinal cord doses. IMRT improved the PTV coverage and reduced the spinal cord dose. A simultaneous integrated boost technique with five equispaced fields produced the best dose distribution. IMRT should reduce the risk of myelopathy or may allow dose escalation in patients with thyroid cancer.
UI - 21344931
AU - Arslan N; Ilgan S; Yuksel D; Serdengecti M; Bulakbasi N; Ugur O; Ozguven
TI - MA Comparison of In-111 octreotide and Tc-99m (V) DMSA scintigraphy in the detection of medullary thyroid tumor foci in patients with elevated levels of tumor markers after surgery.
SO - Clin Nucl Med 2001 Aug;26(8):683-8
AD - Department of Nuclear Medicine, Gulhane Military Medical Academy and Medical Faculty, Ankara, Turkey. email@example.com
PURPOSE: In this retrospective study, the authors evaluated the utility of In-111 octreotide (OctreoScan) and Tc-99m (V) DMSA scintigraphy for the localization of recurrent metastatic tumor foci in patients with medullary thyroid cancer (MTC) and compared the findings with those of conventional radiologic imaging methods. METHODS: The scintigraphic images were compared with computed tomography (CT) and magnetic resonance imaging (MRI) and ultrasonography (US) in 14 patients (8 men, 6 women; age range, 22 to 74 years) with elevated calcitonin and carcinoembryonic antigen levels after total thyroidectomy. All scintigraphic image findings were evaluated qualitatively as mild uptake (+) and moderate to marked uptake (++). RESULTS: In-111 octreotide may be superior to Tc-99m (V) DMSA for the detection of tumor foci of patients with MTC on a patient basis (78.5% versus 57.1%) and on a lesion basis (44.1% versus 30.2%). The sensitivity rate for In-111 octreotide (78.5%) was also similar to that of CT and MRI on a patient basis. Conversely, the combined use of Tc-99m (V) DMSA and In-111 octreotide revealed the best sensitivity rate (85.7%) on a patient basis, whereas the combined use of CT and MRI showed the best sensitivity rate (81.3%) on a lesion basis. CONCLUSIONS: These findings suggest that In-111 octreotide is superior to Tc-99m (V) DMSA and has a similar sensitivity rate to CT and MRI for the diagnosis of recurrent or metastatic MTC. Although the combined use of In-111 octreotide and Tc-99m (V) DMSA was most sensitive, the combined use of CT and MRI with radionuclide imaging methods may better detect more metastatic tumor foci.
UI - 21366175
AU - Bal CS; Padhy AK; Kumar A
TI - Clinical features of differentiated thyroid carcinoma in children and adolescents from a sub-Himalayan iodine-deficient endemic zone.
SO - Nucl Med Commun 2001 Aug;22(8):881-7
AD - Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India. firstname.lastname@example.org
Northern India is an identified sub-Himalayan iodine-deficient endemic zone. We retrospectively analysed the case files of children with differentiated thyroid carcinoma from this endemic zone and attempted to define the disease in terms of its presentation, clinical course and patients with thyroid cancer were treated in our centre and 80 (7%) were less than 20 years of age. There were 45 females and 35 males. Histologically, 85% of patients had papillary carcinoma and the rest follicular carcinoma. Cervical lymph node involvement was seen in 66% of patients, and distant metastasis, mainly pulmonary, in 29%. In children less than 10 years of age, 75% of patients had distant metastasis at the time of presentation. The post-surgery 48 h radioiodine neck uptake was 12.2+/-9.6%. Ninety-six per cent of the residual thyroid, 90% of nodal metastases and 57% of pulmonary metastases were ablated. Although nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter, and three disease-related deaths (all in children less than 10 years of age) were seen in the mean follow-up of 6 years. We conclude that, except for the relatively higher incidence of follicular thyroid cancer and the higher mortality in the less than 10 year age group, the course and outcome of differentiated thyroid carcinoma in children from iodine-deficient areas is no different from that in children in iodine-sufficient areas.
UI - 21369699
AU - Kjellman P; Lagercrantz S; Hoog A; Wallin G; Larsson C; Zedenius J
TI - Gain of 1q and loss of 9q21.3-q32 are associated with a less favorable prognosis in papillary thyroid carcinoma.
SO - Genes Chromosomes Cancer 2001 Sep;32(1):43-9
AD - Department of Molecular Medicine, Endocrine Tumour Unit, Karolinska Hospital, Stockholm, Sweden. email@example.com
In order to approach the genetic mechanisms behind initiation and progression of papillary thyroid carcinoma (PTC) tumorigenesis, we characterized numerical chromosomal imbalances in a panel of 25 PTCs with varying histopathological and clinical features using comparative genomic hybridization (CGH). The most frequently detected imbalance was gain of 9q33-qter, which was seen in close to 30% of the cases. The commonly occurring regions of loss were assigned to 22q (12%) and 9q21.3-q32 (12%), while gains preferentially involved the entire X chromosome (20%), 1q (16%), 17q (16%), and 22q (12%). The distribution of CGH alterations supports the idea of a progression of genetic events in the development of PTC, where gain of 9q33-qter would represent a relatively early event that is followed by loss of 22q and gain of X, 1q, 17q, and 22q. When the detected CGH alterations were compared with the clinical outcome and the histopathological features of the 25 PTC cases, several statistically significant correlations were revealed. The total number of genetic alterations was higher in tumors from patients with aggressive disease as compared to those without signs of aggressiveness. Gain of 1q and loss of 9q21.3-q32 were exclusively seen in tumors from patients with aggressive disease, and the presence of distant metastases was associated with gain of 1q. A sex-dependent distribution was also evident for one of the common alterations, with gain of X exclusively seen in male cases. Taken together, the findings identify several candidate locations for tumor suppressor genes and oncogenes that are potentially involved in the establishment and progression of papillary thyroid carcinogenesis. Copyright 2001 Wiley-Liss, Inc.
UI - 21423319
AU - Krohn K; Reske A; Ackermann F; Muller A; Paschke R
TI - Ras mutations are rare in solitary cold and toxic thyroid nodules.
SO - Clin Endocrinol (Oxf) 2001 Aug;55(2):241-8
AD - III Medical Department, University of Leipzig, Leipzig, Germany.
OBJECTIVE: Activation of ras proto-oncogenes as a result of point mutations is detectable in a significant percentage of most types of tumour. Similar to neoplasms of other organs, mutations of all three ras genes can be found in thyroid tumours. H-, K- and N-ras mutations have been detected in up to 20% of follicular adenomas and adenomatous nodules which were not functionally characterized. This raises the question as to whether ras mutations are specific for hypofunctional nodules and TSH receptor mutations for hyperfunctioning nodules. DESIGN: To investigate ras and TSH receptor mutations with respect to functional differentiation we studied 41 scintigraphically cold nodules and 47 toxic thyroid nodules. To address the likelihood of a somatic mutation we also studied the clonal origin of these tumours. MEASUREMENTS: Genomic DNA was extracted from nodular and surrounding tissue. Mutational hot spots in exons 1 and 2 of the H- and K-ras gene were PCR amplified and sequenced using big dye terminator chemistry. Denaturing gradient gel electrophoresis (DGGE) was used to verify sequencing results for the H-ras gene and to analyse the N-ras gene because its greater sensitivity in detecting somatic mutations. Clonality of nodular thyroid tissue was evaluated using X-Chromosome inactivation based on PCR amplification of the human androgen receptor locus. RESULTS: Monoclonal origin was detectable in 14 of 23 informative samples from cold thyroid nodules. In toxic thyroid nodules the frequency of clonal tissue was 20 in 30 informative cases. Only one point mutation could be found in the N-ras gene codon 61 (Gly to Arg) in a cold adenomatous nodule which was monoclonal. In toxic thyroid nodules no ras mutation was detectable. CONCLUSION: Our study suggests that ras mutations are rare in solitary cold and toxic thyroid nodules and that the frequent monoclonal origin of these tumours implies somatic mutations in genes other than H-, K- and N-ras.
UI - 21434012
AU - Braga M; Cavalcanti TC; Collaco LM; Graf H
TI - Efficacy of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of complex thyroid nodules.
SO - J Clin Endocrinol Metab 2001 Sep;86(9):4089-91
AD - Servico de Endocrinologia e Metabologia do Parana do Hospital de Clinicas, Universidade Federal do Parana, Curitiba 80.060-240, Brazil. firstname.lastname@example.org
Cystic thyroid nodules are considered to be one of the major causes of nondiagnostic and false-negative results on conventional fine-needle aspiration biopsy, thus limiting the potential of this method for the evaluation of complex (solid-cystic) thyroid nodules. Although ultrasound-guided fine-needle aspiration biopsy has emerged as a highly effective diagnostic method for the assessment of nonpalpable and difficult to palpate nodules, its role in complex nodules has not yet been carefully evaluated. In this study, we report the efficacy of ultrasound-guided fine-needle aspiration biopsy in 124 complex nodules in 113 patients. This method proved to be highly effective, yielding a satisfactory specimen for cytological evaluation in 94% of the nodules, suggesting that it is an excellent modality for the evaluation of complex nodules and also for the reevaluation of those nodules with a nondiagnostic result on conventional fine-needle aspiration biopsy.
UI - 21434013
AU - Pacini F; Agate L; Elisei R; Capezzone M; Ceccarelli C; Lippi F;
TI - Molinaro E; Pinchera A Outcome of differentiated thyroid cancer with detectable serum Tg and negative diagnostic (131)I whole body scan: comparison of patients treated with high (131)I activities versus untreated patients.
SO - J Clin Endocrinol Metab 2001 Sep;86(9):4092-7
AD - Department of Endocrinology and Metabolism, Section of Endocrinology, University of Pisa, 56124 Pisa, Italy.
Detectable serum Tg levels associated with negative diagnostic (131)I whole body scan are not infrequently found in patients with differentiated thyroid cancer. Several researchers have shown that in these patients the administration of high (131)I activity (100 mCi or more) increases the sensitivity of a posttherapy diagnostic (131)I whole body scan performed a few days later and allows the detection of neoplastic foci not seen with diagnostic doses of (131)I. Empirical radioiodine treatment has also been advocated by some researchers, but its therapeutic effect is controversial. In our institute, positive serum Tg/negative diagnostic (131)I whole body scan patients were not treated with high (131)I activities before 1984; afterward, almost all patients with positive serum Tg/negative diagnostic (131)I whole body scan patients were treated with radioiodine, and a posttherapy diagnostic (131)I whole body scan was performed. In the present retrospective study we compared the outcome of these two groups of patients, 42 treated and 28 untreated, followed for mean periods of 6.7 +/- 3.8 and 11.9 +/- 4.4 yr, respectively. In the treated group the first posttherapy diagnostic (131)I whole body scan was negative in 12 patients and positive in 30 patients. (131)I treatment was further administered only in the latter group. At the end of follow-up in treated patients a complete remission (normalization of serum Tg off L-thyroxine and negative diagnostic (131)I whole body scan) was observed in 10 patients (33.3%). In 9 cases (30%) posttherapy diagnostic (131)I whole body scan became negative, and serum Tg was reduced but still detectable; in 11 patients (36.6%) serum Tg was detectable, and posttherapy diagnostic (131)I whole body scan was positive. The resolution of (131)I uptake in lung metastases was observed in 8 of 9 cases (88.8%) and in cervical node metastases in 11 of 18 cases (61.1%). In patients treated only once because the posttherapy diagnostic (131)I whole body scan was negative (n = 12), 2 patients (16.7%) were in apparent remission, 7 (58.3%) had detectable Tg values without evidence of disease, 2 (16.7%) showed lymph node metastases in the mediastinum, and 1 patient (8.3%) died because of lung metastases. Of the 28 untreated patients, none with radiological evidence of disease, serum Tg off L-thyroxine therapy became undetectable in 19 cases (67.9%), significantly reduced in 6 cases (21.4%), and unchanged or increased in 3 patients (10.7%), 1 of whom developed lung metastases 14 yr after the diagnosis. In summary, our results indicate that in patients with detectable serum Tg and negative diagnostic (131)I whole body scan, treatment with high doses of (131)I may have therapeutic utility in patients with lung metastases and, to a lesser extent, in those with lymph node metastases. However, in view of the frequent normalization of Tg values in untreated patients, we believe that treatment with (131)I should be considered according to the result of the first posttherapy scan. If positive in the lung, (131)I treatment should be continued up to total remission; surgical treatment should be preferred in patients with node metastases, and no treatment should be used in those with thyroid bed uptake or no uptake.
UI - 21434042
AU - Kitamura Y; Shimizu K; Ito K; Tanaka S; Emi M
TI - Allelotyping of follicular thyroid carcinoma: frequent allelic losses in chromosome arms 7q, 11p, and 22q.
SO - J Clin Endocrinol Metab 2001 Sep;86(9):4268-72
AD - Department of Molecular Biology, Institute of Gerontology, Nippon Medical School, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki 211-8533, Japan.
The genetic mechanisms involved in development of follicular thyroid carcinoma are poorly understood, although allelic losses (LOH) in this type of tumor have been reported in small panels of follicular thyroid carcinomas examined in earlier studies. To clarify the real frequency of allelic loss we carried out a genome-wide allelotyping study of 66 follicular thyroid carcinomas using 39 microsatellite markers representing all nonacrocentric autosomal arms. The mean frequency of LOH was 9.2%, and the mean fractional allelic loss was 0.09. The most frequent allelic losses were detected in 7q (28%), 11p (28%), and 22q (41%). When we compared these results with our previous allelotyping studies using identical markers in other types of thyroid cancers, the 9.2% mean frequency of allelic loss detected in follicular thyroid carcinomas was higher than that in papillary thyroid carcinomas (3%), but not as high as that detected in anaplastic thyroid carcinomas (20%). Frequent allelic losses of markers on chromosomes 7q, 11p, and 22q suggest locations to examine for the presence of suppressor genes associated with the development of follicular thyroid carcinoma.
UI - 21439902
AU - Li WB; Friedland W; Pomplun E; Jacob P; Paretzke HG; Lassmann M; Reiners
TI - C Track structures and dose distributions from decays of (131)I and (125)I in and around water spheres simulating micrometastases of differentiated thyroid cancer.
SO - Radiat Res 2001 Oct;156(4):419-29
AD - GSF-National Research Center for Environment and Health, Institute of Radiation Protection, 85764 Neuherberg, Germany. email@example.com
The disintegration of the radionuclides (131)I and (125)I and the subsequent charged-particle tracks left behind in water (as a model substance for a biological cell) are simulated by the Monte Carlo track structure simulation code PARTRAC, using new inelastic electron scattering cross sections for condensed water. Every photon and electron emitted was followed in detail, event by event, down to 10 eV. From the spatial information on the track structures, absorbed dose distributions per (131)I and (125)I decay were calculated in and around water spheres simulating micrometastases as well as in the tissue surrounding such metastases. These radionuclides were assumed to be distributed uniformly inside spheres of different diameters (0.01, 0.03, 0.1, 0.3, 1.0 and 3.0 mm). The respective electron degradation spectra, the nearest-neighbor distance distributions between inelastic events, and the distance distributions for all activations for both iodine radionuclides were calculated. The absorbed fractions of the initial electron energies, absorbed doses and energy depositions, and single-event distributions, F(1)(epsilon), inside the six water spheres described above and in the surrounding tissue were also calculated. The absorbed doses per decay inside the six water spheres, i.e., the calculated S values (listed from 0.01 to 3.0 mm), were 6.8 x 10(-4), 7.2 x 10(-5), 5.5 x 10(-6), 4.9 x 10(-7), 3.1 x 10(-8) and 1.8 x 10(-9) Gy Bq(-1) s(-1) for (131)I, and 3.4 x 10(-3), 1.7 x 10(-4), 5.1 x 10(-6), 2.0 x 10(-7), 5.6 x 10(-9) and 2.2 x 10(-10) Gy Bq(-1) s(-1) for (125)I. It is concluded that, in the treatment of thyroid cancer, the geometrical track structure properties of (125)I might be superior to those of (131)I in micrometastases with diameters less than 0.1 mm; however, in this medical context, many other factors also have to be considered.
UI - 21455496
AU - Lohrer HD; Braselmann H; Richter HE; Jackl G; Herbeck J; Hieber L;
TI - Kellerer AM; Bauchinger M Instability of microsatellites in radiation-associated thyroid tumours with short latency periods.
SO - Int J Radiat Biol 2001 Aug;77(8):891-9
AD - Radiobiological Institute, University of Munich (LMU), Schillerstrasse 42, D-80336 Munich, Germany. firstname.lastname@example.org
PURPOSE: To determine the instability of microsatellite sequences in post-Chernobyl thyroid tumours from children and young adults, and to ascertain whether they correlated with the age of the patient at the time of the accident and the tumour latency period. MATERIALS AND METHODS: The stability of 26 microsatellite markers was investigated in 122 radiation-associated thyroid tumours (96 children, 26 adults) from Belarus and 39 spontaneous thyroid tumours (adults) from Munich without radiation history. RESULTS: A significant correlation between patient age at the time of the accident and the instability of microsatellite sequences was established. Also, a high instability of microsatellite sequences was found in 28 early thyroid tumours from Belarus with latency periods of 6-8 years, in contrast to a low instability of microsatellites in 94 tumours emerging 9-11 years after the accident. Microsatellite instability in the reference group from Munich proved similar to the early thyroid tumours from Belarus. CONCLUSION: Early, fast-growing and aggressive post-Chernobyl thyroid tumours are characterized by an increase in microsatellite instability.
UI - 20370593
AU - Cholewinski SP; Yoo KS; Klieger PS; O'Mara RE
TI - Absence of thyroid stunning after diagnostic whole-body scanning with 185 MBq 131I.
SO - J Nucl Med 2000 Jul;41(7):1198-202
AD - Department of Radiology, University of Rochester Medical Center, New York, USA.
There has been recent controversy regarding the optimal protocol for imaging and ablation of post-thyroidectomy patients. Several authors have suggested that a scanning dose of 185-370 MBq (5-10 mCi) (131)I may be capable of producing a stunning effect on thyroid tissue that may interfere with the uptake and efficacy of the subsequent ablation dose of radioiodine. The purpose of this study was to determine whether a 185-MBq (5 mCi) diagnostic dose of (131)I produces a visually apparent stunning effect 72 h before (131)I ablation therapy. METHODS: One hundred twenty-two consecutive post-thyroidectomy patients for differentiated thyroid carcinoma received a 185-MBq (5 mCi) diagnostic dose of (131)I followed by a whole-body diagnostic scan at 72 h. On the same day the diagnostic scan was completed, the patient was admitted to the hospital and received an (131)I ablation therapy dose of 5550 MBq (150 mCi) in most cases. A postablation, whole-body scan was obtained at 72 h and compared with the previous diagnostic scan for any visual evidence of stunning. RESULTS: No cases of visually apparent thyroid stunning were observed on any of the postablation scans with regard to the number of (131)I foci identified or the relative intensity of (131)I uptake seen. CONCLUSION: Diagnostic whole-body scanning can be performed effectively with a 185-MBq (5 mCi) dose of (131)I 72 h before radioiodine ablation without concern for thyroid stunning.
UI - 21330628
AU - Kobayashi S
TI - [Appropriate extent of lymph node dissection in thyroid cancer]
SO - Nippon Geka Gakkai Zasshi 2001 Jun;102(6):459-64
AD - National Higashi-Nagano Hospital, Nagano, Japan.
Surgery is not always necessary for micro cancer (less than 1.0 cm in diameter). In surgery of micro cancer, we recommended to dissect only the central compartment (pretracheal [II]/paratracheal [III] area). In patient with cancer (more than 1.0 cm in diameter), lymph nodes in the central compartment, ispirateral supraclavicular area, and jugulocarotid chain (V and VI) should be dissected. Even in incomplete surgery, lymph node dissection of the central compartment is warranted in patients with papillary cancer, because recurrence in the central compartment results in dyspnea and/or hemosptum, lowering the quality of life.
UI - 21369212
AU - Desiaterik VI; Mikhno SP
TI - [Results of operative treatment of the thyroid gland cancer in the Krivorog region]
SO - Klin Khir 2001 Jan;(1):40-2
Results of treatment of the thyroid gland cancer in 251 patients were analyzed.
UI - 21389189
AU - Jiang S; Altmann A; Grimm D; Kleinschmidt JA; Schilling T; Germann C;
TI - Haberkorn U Tissue-specific gene expression in medullary thyroid carcinoma cells employing calcitonin regulatory elements and AAV vectors.
SO - Cancer Gene Ther 2001 Jul;8(7):469-72
AD - Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany. email@example.com
Calcitonin (CT), the major secretory product of the C cell, is also expressed in C-cell-derived neoplasia. To investigate the role of the CT gene regulatory sequence in tissue-specific gene expression, the genes coding for the herpes simplex virus thymidine kinase (HSVtk) and for the enhanced green fluorescent protein (EGFP) regulated by the CT promoter (rAAV/CT266tkneo), the CT promoter/enhancer element (rAAV/CTenhtkneo), or the cytomegalovirus (CMV) promoter (rAAV/CMVtkneo) were transduced by recombinant adenoassociated viral (AAV) vectors into the medullary thyroid carcinoma (MTC) cell lines TT and hMTC and into HeLa cells as controls. In TT cell lines and hMTC cell lines transiently infected by the rAAV/CT266tkneo viruses, a significant increase in (3)H ganciclovir uptake was observed. Upon ganciclovir treatment, TT cells infected by rAAV/CT266tkneo revealed a significant growth inhibition, which was less tissue-specific because HeLa cells were also affected by these particles (74.5%). In contrast, a minor but more tissue-specific growth inhibition (33.6%) was observed for TT cells after transient infection with the rAAV/CTenhtkneo particles. Employing EGFP controlled by CMV promoter and the individual CT regulatory sequences for transduction by rAAV particles, similar results were obtained indicating that both the CT promoter and enhancer element are required for tissue-specific gene expression in MTC.
UI - 21436736
AU - Wohllk N; Becker P; Youlton R; Cote GJ; Gagel RF
TI - [Germline mutations of the ret proto-oncogene in Chilean patients with hereditary and sporadic medullary thyroid carcinoma]
SO - Rev Med Chil 2001 Jul;129(7):713-8
AD - Seccion de Endocrinologia, Departamento de Medicina, Hospital del Salvador, Laboratorio IEMA, Santiago de Chile. firstname.lastname@example.org
BACKGROUND: Medullary thyroid carcinoma (MTC) may occur either as a sporadic or familial disease. Multiple endocrine neoplasia (MEN) type 2, inherited as an autosomal dominant disease, is characterized by MTC only (FMTC) or coexistence of MTC with other endocrine neoplasia (NEM 2A, 2B). Germline mutations of the RET proto-oncogene (cRet) are found in the inherited forms and in some apparently sporadic MTC cases. AIM: To study RET mutations in 8 families with MEN 2. MATERIAL AND METHODS: RET mutations were screened in peripheral blood DNA from 18 patients and 87 high risk carriers belonging to 8 MEN 2 families and 52 sporadic MTC. Exons 10, 11, 13, 14, 15 and 16 of the c-Ret were amplified by polymerase chain reaction (PCR) and examined by direct sequencing of PCR products and/or restriction enzyme analysis. RESULTS: Five MEN 2A and one FMTC families with a germline mutation at