National Cancer Institute®
Last Modified: February 1, 2002
UI - 11778561
AU - Yin Y; Xu Z; Tang P
TI - [Management of the neck for patients with thyroid papillary carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2000 Jul;22(4):321-3
AD - Department of Head and Neck Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
OBJECTIVE: To search an optimal management of the neck for patients with thyroid papillary carcinoma. METHODS: Clinical data of 424 cases with thyroid papillary carcinoma treated in our hospital from Jan, 1965 to Jan, 1987 were analyzed retrospectively. Patients with positive cervical lymph nodes (N+) were treated with radical excision of the primary tumor and neck dissection. For patients without cervical lymph node involvement (N0), neck dissection was spared. On follow-up, whenever cervical lymphatic node metastasis occurred, neck dissection was performed. All patients were followed up for more than 10 years. RESULTS: The 5- and 10-year survival rate of the 258 N+ patients was 84.3% and 80.4% respectively, and that of the 166 N0 patients was 94.1% and 91.3% respectively. Twenty-three N0 cases later developed cervical lymph node metastasis. Their 5- and 10-year survival rate was 91.4% and 82.2% respectively after neck dissection. CONCLUSION: Since only 13.9% of N0 thyroid papillary carcinoma patients who did not receive neck dissection develop cervical lymph node metastases later, and their survival rate was just as good where neck dissection is postponed until metastases occur, prophylactic neck dissection seems unnecessary.
UI - 11778562
AU - Gong J; Zhang R; Chen H
TI - [Childhood thyroid carcinoma: an analysis of 14 cases]
SO - Zhonghua Zhong Liu Za Zhi 2000 Jul;22(4):324-6
AD - Department of General Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China.
OBJECTIVE: To reveal the clinical characteristics, causes of misdiagnosis, treatment and prognosis of thyroid carcinoma in children. METHODS: Fourteen patients under 14 years of age with thyroid carcinoma were retrospectively reviewed. RESULTS: According to UICC's clinical and histopathologic classification (1989), there were 12 cases of papillary carcinomas (83.3%), 2 cases of follicular carcinomas (16.7%). All but one case were in stage I. Cervical lymph node metastasis was found in 12 cases (85.7%). Diagnosis was incorrect in 7 cases. All patients were operated, including unilateral neck dissection in 11 and bilateral neck dissection in 2. One patient received palliative subthyroidectomy and postoperative 131I treatment. In the follow-up period of 2 to 13 years (mean 6 years), no patient died. CONCLUSION: Thyroid cancer in children are mostly papillary carcinomas with good prognosis, regardless of high frequency of cervical lymph node metastases. Early cases can be picked up if misdiagnosis be avoided.
UI - 11774396
AU - Ulanovski D; Feinmesser R; Cohen M; Sulkes J; Dudkiewicz M; Shpitzer T
TI - Preoperative evaluation of patients with parathyroid adenoma: role of high-resolution ultrasonography.
SO - Head Neck 2002 Jan;24(1):1-5
AD - Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel. Ulanovski@yahoo.com
BACKGROUND: Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is a controversial surgical approach to the treatment of primary hyperparathyroidism. The aim of this study was to evaluate the ability of high-resolution ultrasonography to localize adenomas preoperatively and to assess the effect of such localization on operative time. METHODS: One hundred twenty consecutive previously non-operated patients with primary hyperparathyroidism underwent ultrasonography before surgery, which consisted of unilateral neck exploration. The procedure was changed to bilateral exploration when justified by the surgical findings. RESULTS: The sensitivity and positive predictive value of the ultrasonographic examinations were 89% and 98%, respectively. These results were obtained regardless of the size of the adenoma. No significant difference was found in the presence of thyroid multinodular disease (p =.2). A positive sonographic examination decreased the operative time to an average of 59 minutes. The average size of the adenomas was 19 mm (range, 4-55 mm). A positive and highly statistically significant correlation was found between adenoma size and both preoperative calcium level (p =.01) and parathyroid hormone level (p =.0001). CONCLUSIONS: In experienced hands, high-resolution ultrasonography can be a cost-effective means of localizing parathyroid adenomas when unilateral neck exploration is considered the acceptable surgical approach. Copyright 2002 John Wiley & Sons, Inc.
UI - 11815959
AU - Leboulleux S; Travagli JP; Caillou B; Laplanche A; Bidart JM;
TI - Schlumberger M; Baudin E Medullary thyroid carcinoma as part of a multiple endocrine neoplasia type 2B syndrome: influence of the stage on the clinical course.
SO - Cancer 2002 Jan 1;94(1):44-50
AD - Service de Cancerologie Endocrinienne et de Medecine Nucleaire, Institut Gustave-Roussy, Villejuif, France.
BACKGROUND: Multiple endocrine neoplasia type 2B (MEN 2B) is an exceptional syndrome, for which the optimal age of thyroidectomy is poorly established and the course of medullary thyroid carcinoma (MTC) is ill-defined. PATIENTS: All the 18 patients with a MEN 2B syndrome examined at the Institut Gustave Roussy were included in a single-center retrospective study. RESULTS: There were 9 men and 9 women with a mean age of 13 years (range, 2-27 years) at diagnosis. The diagnosis of MTC was based on the presence of a thyroid nodule or involved neck lymph nodes and on dysmorphic features of MEN 2B in 60% and 40% of the cases, respectively. The classic M918T mutation in exon 16 was found in the 16 patients in whom it was investigated. At diagnosis, 2 patients had Stage I MTC, 15 patients had Stage III, and 1 patient had Stage IV disease. T1 MTC was found in 4 patients aged 2.1-3.7 years. However, two of these patients already had N1 disease. One patient with Stage I MTC, aged 3.4 years and 2 patients with Stage III disease, aged 14 and 25 years, had undetectable basal calcitonin (CT) after initial surgery. During follow-up, basal CT became detectable in one of three patients. Among the 15 other patients with an elevated postoperative CT level, metastases were demonstrated in 5 patients after a mean follow-up of 2 years. Five patients died, three of MTC, one of the MEN 2B syndrome, and one of intercurrent disease. Five- and 10-year overall survival rates were 85% and 75%, respectively. CONCLUSIONS: This study confirms the need for early treatment of MTC in patients with the MEN 2B syndrome, preferably within the first 6 months of life. The phenotype of MTC occurring in the MEN 2B syndrome was not more aggressive than sporadic MTC or MTC occurring in other familial syndromes. Copyright 2002 American Cancer Society.
UI - 11747225
AU - Nguyen GK; Akin MR
TI - Cytopathology of insular carcinoma of the thyroid.
SO - Diagn Cytopathol 2001 Nov;25(5):325-30
AD - Department of Laboratory Medicine and Pathology, University of Alberta Hospitals, Edmonton, Alberta, Canada. email@example.com
Four pure insular carcinomas (IC) and one IC with focal anaplastic carcinoma (AC) of the thyroid with cytologic evaluation by fine-needle aspiration (FNA) were reviewed. The needle aspirates from the four pure ICs revealed abundant monomorphic follicular cells present singly, in small, loose aggregates, and in cohesive trabecular and acinar clusters. Tumor cells showed fragile, ill-defined, granular cytoplasm and oval nuclei with conspicuous or inconspicuous nucleoli. The case of IC with focal AC yielded, in addition to the follicular cells as seen in the FNA of the 4 cases of pure IC, large pleomorphic malignant cells with prominent nucleoli that were characteristic for an AC, giant-cell type. No intact insulae of tumor cells were identified in any of the 5 cases. Thus, a thyroid IC may be suspected if abundant cohesive and dyshesive monomorphic follicular cells are present in the tumor FNA. However, a firm diagnosis of thyroid IC can only be made by histologic examination of the excised tumor. Copyright 2001 Wiley-Liss, Inc.
UI - 10905237
AU - Bartolazzi A
TI - Improving accuracy of cytology for nodular thyroid lesions.
SO - Lancet 2000 May 13;355(9216):1661-2
AD - Cellular and Molecular Tumor Pathology, Cancer Centre Karolinska, Karolinska Hospital, Stockholm, Sweden.
UI - 11776629
AU - Li Z; Tang P; Huang Y
TI - [The role of surgery in the management of thyroid lymphoma]
SO - Zhonghua Zhong Liu Za Zhi 1999 Nov;21(6):464-6
AD - Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100021.
OBJECTIVE: To evaluate the role of surgery in the management of thyroid lymphoma. METHODS: A retrospective analysis was performed of 14 patients with thyroid lymphoma treated at the Cancer Hospital, Peking Union Medical College, Chinese Academy Medical Science from 1964 to March 1998. There were 5 males and 9 females, with a median age of 54 years (range 15-75). There were 4 cases in stage IEA, 9 in stage IIEA, 1 in stage II EB. Fine needle aspiration biopsy was performed in 1 case, excision biopsy in 4, thyroid lobectomy in 8, and total thyroidectomy in 1. Radiotherapy was used alone in 4 patients, chemotherapy alone in 2, radiotherapy combined with chemotherapy in 7, no postoperative treatment in 1. RESULTS: All but 1 patients were histopathologically diagnosed as non-Hodgkin's lymphoma. It was of B cell origin in 11 cases, T cell origin in 2. Seven patients were alive without evidence of recurrent disease at follow-up, ranging from 5 to 112 months. Three patients died of lymphoma, 1 died of treatment complication, 2 died of other diseases, and 1 lost from follow-up. The major surgical resection did not appreciably affect survival. CONCLUSION: Radiotherapy or chemotherapy, alone or in combination, is the treatment of choice for thyroid lymphoma. Surgical resection combined with radiotherapy or chemotherapy may be beneficial to survival in patients with intrathyroid lymphoma. It is otherwise limited to make a tissue diagnosis.
UI - 11802050
AU - Steurer M; Passler C; Denk DM; Schneider B; Niederle B; Bigenzahn W
TI - Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk.
SO - Laryngoscope 2002 Jan;112(1):124-33
AD - Department of Otorhinolaryngology-Head and Neck Surgery, Vienna Medical School, General Hospital Vienna, Waeringer Guertel 18-20, A-1090 Vienna, Austria. firstname.lastname@example.org
OBJECTIVES/HYPOTHESIS: Recurrent laryngeal nerve palsy (RLNP) is a major obstacle in thyroid and parathyroid surgery. Therefore, methods that reduce the number of temporary and, especially, permanent recurrent laryngeal nerve palsies are of great interest. One promising way to ensure the integrity of the recurrent laryngeal nerve (RLN) is to identify the nerve always. The first question raised in the present study was whether RLN preparation reduces the number of recurrent laryngeal nerve palsies or whether it introduces additional risks. Second, from former cases we know that the absence of postoperative hoarseness does not exclude RLNP, nor does postoperative hoarseness exclusively imply RLNP. Besides, misdiagnosis is not uncommon. Therefore, preoperative and postoperative laryngoscopic examination was given attention. STUDY DESIGN: Patients were investigated 1 to 7 days before and 3 to 7 days after surgery. When an RLNP was identified, patients were followed up in a 2-week rhythm the first few times and every 6 to 8 weeks thereafter until RLNP resolved or it was considered permanent after 2 years. METHODS: We prospectively investigated 608 surgical patients with 1080 nerves at risk. Because different diseases might have different rates of postoperative RLNP, we analyzed benign thyroid disease (680 nerves at risk), thyroid malignoma (321 nerves at risk), and hyperparathyroidism (79 nerves at risk) separately. Patients undergoing primary surgery (no prior thyroid surgery) and secondary interventions (there were one or more thyroid operations before this intervention) were evaluated separately. RESULTS: We found 3.4%, 7.2%, and 2.5% of temporary recurrent laryngeal nerve palsies per nerve in the benign thyroid disease, thyroid malignoma, and hyperparathyroidism groups, respectively. The prevalence of recurrent laryngeal nerve palsies in these groups was 0.3%, 1.2%, and 0%, respectively. Conforming with other studies, the total number of recurrent laryngeal nerve palsies (temporary and permanent) was not increased compared with cases with no RLN preparation, whereas the number of permanent recurrent laryngeal nerve palsies was markedly reduced. An RLN was always identifiable. Astonishingly, the restitution of an RLNP was up to 2 years in duration; however, most restitutions occurred within the first 6 months. Thirty cases of hoarseness appeared or were intensified after surgery and were not caused by RLNP. Eleven cases of postoperative RLNP had no detectable hoarseness. CONCLUSIONS: Besides indirect laryngoscopy, videostroboscopy should be performed in all cases with no evident bilateral normal laryngeal function or normal voice. Otherwise, the incidence of false-positive or false-negative diagnosis of RLNP is likely to be increased.
UI - 11788631
AU - Thieblemont C; Mayer A; Dumontet C; Barbier Y; Callet-Bauchu E; Felman
TI - P; Berger F; Ducottet X; Martin C; Salles G; Orgiazzi J; Coiffier B Primary thyroid lymphoma is a heterogeneous disease.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):105-11
AD - Service d'Hematologie, Centre Hospitalier Lyon-Sud, 69495 Pierre-Benite, France. email@example.com
We retrospectively analyzed 26 patients with thyroid lymphoma (TL). Patients were mostly females, with a median age of 59 yr, presenting a rapidly growing nodular goiter with or without cervical adenopathy, without symptoms related to lymphoma for 81% and hypothyroidism in 61%. A previous history of Hashimoto thyroiditis was observed in 11 patients. Six different subtypes of lymphoma were observed: 13 of 26 (50%) had diffuse large B cell lymphoma, 6 (23%) mucosa- associated lymphoid tissue (MALT) lymphoma, 3 (12%) had follicular lymphoma, 2 (7%) had Hodgkin's disease, 1 (4%) had small lymphocytic lymphoma, and 1 (4%) had Burkitt's lymphoma. Diffuse large B cell lymphoma patients presented a compressive multinodular goiter, cervical adenopathy (66%), disseminated disease (50%), and poor performance status, with a poor prognosis (5-yr survival at 44%) despite a treatment based on a multidrug regimen. MALT lymphoma arose in patients with previous history of Hashimoto disease, was localized in all but 1, and was biologically associated with hypothyroidism and a high level of serum antithyroid antibodies. With total thyroidectomy, prognosis was good (5-yr survival at 100%). We did not find any routine clinical or biological parameters that could predict the evolution from Hashimoto's thyroiditis to MALT lymphoma. In conclusion, we confirmed the histological heterogeneity of TL corresponding to different clinical presentations and different prognoses.
UI - 11788654
AU - Vella V; Pandini G; Sciacca L; Mineo R; Vigneri R; Pezzino V; Belfiore A
TI - A novel autocrine loop involving IGF-II and the insulin receptor isoform-A stimulates growth of thyroid cancer.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):245-54
AD - Istituto di Medicina Interna e di Malattie Endocrine e del Metabolismo, Cattedra di Endocrinologia, University of Catania, Ospedale Garibaldi, 95123 Catania, Italy.
The insulin receptor (IR) occurs in two isoforms (IR-A and IR-B) resulting from alternative splicing of exon 11 of the gene. The IR-A isoform is predominantly expressed in fetal tissues and malignant cells and binds IGF-II with high affinity. We previously observed that IRs are overexpressed in thyroid cancer cells; now we evaluated whether these cells preferentially express IR-A and produce IGF-II, which would activate a growth-promoting autocrine loop. The IR content ranged 6.0-52.6 ng/100 microg cell membrane protein in thyroid cancer primary cultures (n = 8) and permanent cell lines (n = 6) vs. 1.2-1.7 in normal thyroid cells (n = 11 primary cultures; P < 0.0001). IR-A isoform relative abundance ranged from 36-79% in cancer cells (with the highest values in undifferentiated cancers) vs. 27-39% in normal cells. Similar results were obtained in normal vs. cancer thyroid tissue specimens. IGF-II caused IR autophosphorylation with an ED(50) of 1.5-40.0 nM in cancer cells vs. more than 100 nM in normal cells; IGF-II affinity correlated with the relative abundance of IR-A (r = 0.628; P < 0.0001). IGF-II was expressed in all cancer cells, highly expressed in anaplastic cells, and less expressed in normal cells. In conclusion, malignant thyrocytes, especially when poorly differentiated, produce IGF-II and overexpress IR, predominantly as IGF-II-sensitive isoform A. A growth-promoting autocrine loop is activated, therefore, and may affect thyroid cancer biology.
UI - 11788662
AU - Saller B; Feldmann G; Haupt K; Broecker M; Janssen OE; Roggendorf M;
TI - Mann K; Lu M RT-PCR-based detection of circulating calcitonin-producing cells in patients with advanced medullary thyroid cancer.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):292-6
AD - Division of Endocrinology, Department of Internal Medicine, University of Essen, 45122 Essen, Germany. firstname.lastname@example.org
In patients with medullary thyroid carcinoma (MTC) the clinical course of disease ranges from rapid tumor progression to long-lasting stable disease. The purpose of the present study was to investigate whether circulating tumor cells can be detected in the peripheral blood of patients with MTC by RT-PCR targeted to calcitonin (CT) mRNA and whether the results of this method are correlated with disease manifestation and metastatic potential. Blood samples from 19 consecutive patients with MTC and elevated CT levels were analyzed. Four had newly diagnosed MTC, and 15 patients had undergone total thyroidectomy. Six of 19 patients had detectable CT mRNA by RT-PCR. CT levels in the CT mRNA-positive patients were significantly higher than those in CT mRNA-negative patients [2,239-265,313 pg/ml; median 80,921 pg/ml (n = 6) vs. 70-46,787 pg/ml; median, 932 pg/ml (n = 13); P = 0.006]. CT mRNA was detectable in 5 of 8 patients with distant metastases, in 1 of 6 patients with local/regional lymph node metastases, but in none of the patients with newly diagnosed, organ-confined MTC (n = 2) or surgically treated MTC without tumor manifestation by various imaging studies (n = 3). In peripheral blood from 10 healthy volunteers and 21 patients with benign thyroid nodules, no CT RNA could be detected. In conclusion, an RT-PCR-based procedure was established to detect circulating CT-producing cells in the peripheral blood of patients with MTC. RT-PCR results seem to reflect tumor spread and aggressiveness and thus may help with early identification of patients with disseminated and rapidly progressive disease.
UI - 11788674
AU - Tonacchera M; Viacava P; Agretti P; de Marco G; Perri A; di Cosmo C; de
TI - Servi M; Miccoli P; Lippi F; Naccarato AG; Pinchera A; Chiovato L; Vitti P Benign nonfunctioning thyroid adenomas are characterized by a defective targeting to cell membrane or a reduced expression of the sodium iodide symporter protein.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):352-7
AD - Dipartimento di Endocrinologia e Metabolismo, Univerita di Pisa, Italy. email@example.com
Nodular thyroid disease is the most common endocrine disorder. Nonfunctioning thyroid nodules are identified by their low radioiodide uptake compared with the normal extranodular tissue, which, at thyroid scintiscan, produces the typical picture of a cold thyroid nodule. Previous in vitro studies demonstrated that the majority of nonfunctioning thyroid nodules have a specific defect in iodide transport that accounts for their failure to accumulate radioactive iodide in vivo. A defect in the expression or structure of the sodium iodide symporter (NIS) gene has been hypothesized as a possible cause of the impaired iodide trapping in nonfunctioning thyroid nodules. We studied 22 patients who were submitted to surgery for a solitary nonfunctioning thyroid nodule that originated in an otherwise normal gland. Thyroid scintigraphy was performed at 1, 2, 3, 4, 6, and 24 h after the oral administration of a tracer dose of 131I (iodine). All patients showed absence of 131I uptake in the nodule, with normal uptake in the extranodular tissue and in the contralateral thyroid lobe. Eight patients with toxic adenomas who underwent lobectomy were also included in the study. We first studied the expression of human NIS (hNIS) protein by immunohistochemistry in paraffin-embedded tissue sections using a specific anti-hNIS monoclonal antibody. Subsequently, we searched for somatic mutations of hNIS gene in nonfunctioning thyroid nodules. The level of hNIS expression was determined in both the nodules and the normal tissue from the same thyroid gland. In all functioning thyroid nodules (toxic adenomas), a high expression of hNIS protein was detected with respect to normal surrounding tissue. Similar to the normal thyroid tissue, follicular cells of toxic thyroid adenomas showed an exclusive expression of hNIS protein at the cell membrane. Fifty-four percent of benign nonfunctioning thyroid nodules overexpressed hNIS protein compared with the normal surrounding tissue, but in these nodules the hNIS protein failed to target the cell membrane, being mostly localized inside the cytoplasm. hNIS protein was not detected by immunohistochemistry in 46% of nonfunctioning nodules, whereas it was expressed in the surrounding unaffected thyroid tissue. Direct sequencing of the hNIS gene in all of the nonfunctioning nodules did not reveal major genetic alterations. A silent polymorphism (GCC/GCG codon 544, exon 13) was found in one nodule. In conclusion, the results obtained in this study show that two mechanisms contribute to the reduced radioiodide uptake typical of benign nonfunctioning thyroid nodules: 1) reduced expression of the hNIS protein, and 2) defective targeting of hNIS to the cell membrane.
UI - 11788675
AU - Specht MC; Tucker ON; Hocever M; Gonzalez D; Teng L; Fahey TJ 3rd
TI - Cyclooxygenase-2 expression in thyroid nodules.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):358-63
AD - Departments of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, New York 10021, USA.
Factors contributing to the development of thyroid neoplasia remain poorly understood. Recent evidence indicates that overexpression of the inducible cyclooxygenase, COX-2, is important in the pathogenesis of epithelial carcinomas. These studies were undertaken to evaluate whether COX-2 is up-regulated in human thyroid neoplasia. Benign (n = 14), and malignant (n = 14) thyroid nodules were analyzed for expression of COX-2 mRNA by quantitative RT-PCR. Immunoblotting and immunohistochemistry were performed on representative samples. Three human thyroid cancer cell lines were similarly analyzed for COX-2 expression. Levels of COX-2 mRNA were significantly increased in thyroid nodule samples compared with adjacent thyroid tissue in the malignant specimens but not in the benign specimens. Additionally, COX-2 mRNA levels were significantly increased in malignant nodule samples compared with benign nodule samples. COX-2 protein expression was higher in 8 of 10 thyroid nodules compared with the adjacent tissue. Immunohistochemical analysis localized expression of COX-2 to the malignant epithelial cells. Immunofluorescence demonstrated COX-2 protein expression in all three thyroid cell lines. Finally, COX-2 expression could be detected by RT-PCR in fine needle aspiration specimens of thyroid nodules. These data indicate that COX-2 is up-regulated in human thyroid cancer, but not in benign thyroid nodules, and suggest that COX-2 expression may serve as a marker of malignancy in thyroid nodules.
UI - 11788677
AU - Chiappetta G; Toti P; Cetta F; Giuliano A; Pentimalli F; Amendola I;
TI - Lazzi S; Monaco M; Mazzuchelli L; Tosi P; Santoro M; Fusco A The RET/PTC oncogene is frequently activated in oncocytic thyroid tumors (Hurthle cell adenomas and carcinomas), but not in oncocytic hyperplastic lesions.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):364-9
AD - Istituto Nazionale dei Tumori di Napoli, Fondazione Senatore Pascale, 80131 Napoli, Italy.
Hurthle cell adenomas and carcinomas, characterized by the presence of oncocytic cells, are unusual thyroid neoplasms, the treatment of which is still controversial. We analyzed specimens from 49 patients with oncocytic cell nodular lesions including 20 adenomas, 19 carcinomas, and 10 hyperplasias for RET/PTC (papillary thyroid carcinoma) activation, which is the most frequent genetic alteration in PTCs. RET/PTC activation was detected in a significant number of cases of Hurthle cell adenomas and carcinomas, but in 0 of 10 patients with hyperplastic nodules. In particular, the RET/PTC1 isoform was found in 7 of 12 adenomas and 4 of 7 carcinomas. These results would indicate that RET/PTC is a genetic event common to papillary carcinomas and to Hurthle cell neoplasias.
UI - 11788678
AU - Santoro M; Papotti M; Chiappetta G; Garcia-Rostan G; Volante M; Johnson
TI - C; Camp RL; Pentimalli F; Monaco C; Herrero A; Carcangiu ML; Fusco A; Tallini G RET activation and clinicopathologic features in poorly differentiated thyroid tumors.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):370-9
AD - Centro di Endocrinologia ed Oncologia Sperimentale del Consiglio Nazionale delle Ricerche, Dipartimento di Biologia e Patologia Cellulare e Molecolare, Universita di Napoli Federico II, 80131 Naples, Italy.
Poorly differentiated carcinoma of the thyroid gland (PDC) represents an heterogeneous group of epithelial neoplasms with morphologic features and clinical characteristics intermediate between well differentiated and anaplastic (undifferentiated) carcinomas. Unlike well differentiated tumors, PDCs are associated with significant morbidity and mortality. The general prevalence of RET/PTC rearrangement in thyroid PDC and its impact on patient outcome are unknown. To address these issues and to identify prognostically relevant clinicopathologic parameters, we have investigated a series of 62 PDCs. RET/PTC rearrangement, analyzed by RT-PCR and immunohistochemistry using antibodies specific for the tyrosine kinase and juxtamembrane portions of the RET protein, was identified in 8/62 (12.9%) PDCs. RET/PTC was more common in cases with histologic evidence indicating coexistence with or possible evolution from a well differentiated papillary carcinoma (5 of 25 tumors, 20%) but did not correlate with other clinicopathologic parameters. The relatively low prevalence of RET activation in PDCs argues against a major role for RET/PTC in the progression from well to poorly differentiated thyroid tumor phenotypes. Survival analysis demonstrates that poor survival in PDC is associated with old age, male sex, invasion of extrathyroidal soft tissues, coexistence in the same tumor of oncocytic features with insular growth pattern, and distant metastases but not RET activation.
UI - 11788682
AU - Menko FH; van der Luijt RB; de Valk IA; Toorians AW; Sepers JM; van
TI - Diest PJ; Lips CJ Atypical MEN type 2B associated with two germline RET mutations on the same allele not involving codon 918.
SO - J Clin Endocrinol Metab 2002 Jan;87(1):393-7
AD - Department of Clinical Genetics and Human Genetics, Vrije Universiteit Medical Center, 1007 MB Amsterdam, The Netherlands. firstname.lastname@example.org
A kindred was diagnosed with atypical MEN type 2B characterized by medullary thyroid cancer and mucosal neurilemmomas in multiple family members. Mutation analysis revealed a double RET germline mutation, Val804Met and Ser904Cys, in affected individuals. The clinical phenotype, the functional effect of the mutations, and the clinical implications of our findings are discussed.
UI - 11801940
AU - Watanabe A; Kawabori S; Osanai H; Taniguchi M; Hosokawa M
TI - Preoperative computed tomography diagnosis of non-recurrent inferior laryngeal nerve.
SO - Laryngoscope 2001 Oct;111(10):1756-9
AD - Department of Otolaryngology, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan. email@example.com
OBJECTIVE: The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that is associated with the developmentally aberrant subclavian artery. Thus, it is possible to predict NRILN by preoperative diagnosis of an aberrant subclavian artery. Preoperative recognition of the NRILN should be advantageous in the prevention of intraoperative nerve damage. The purpose of this study was to assess the possibility of diagnosis of an aberrant subclavian artery by computed tomography (CT) of the neck, which is often performed before thyroid surgery. METHODS: We retrospectively studied the preoperative CT films from 594 thyroid or patients, and a right recurrent inferior laryngeal nerve (RILN) was observed in 588 of these patients. We evaluated whether the brachiocephalic artery could be identified on the CT scan and classified the positional relationship between the right subclavian artery and the tracheoesophagus into three types. RESULTS: The brachiocephalic artery was identified on the CT films in 158 cases, all of which were cases of RILN. The right subclavian artery was detected on the ventral side of the membranous wall of the trachea in all 588 RILN cases, whereas it was detected on the dorsal side in all 6 NRILN cases. CONCLUSIONS: It was possible to predict an aberrant subclavian artery by identifying the brachiocephalic artery and position of the right subclavian artery on the CT film of the neck. When an anomaly of the subclavian artery is thus preoperatively detected, NRILN can be preoperatively predicted, which likely will enable prevention of vocal cord paralysis.
UI - 11769392
AU - Szybinski P; Nowak W
TI - [Thyroid carcinoma--contemporary diagnostic principles and treatment]
SO - Przegl Lek 2001;58(7-8):809-13
AD - I Katedra i Klinika Chirurgii Ogolnej i Gastroenterologicznej Collegium Medicum Uniwersytetu Jagiellonskiego w Krakowie.
Thyroid cancer, which is a rare neoplasm, is still controversial issue. References approved in Poland in 1995 caused unification of the extension of thyroid surgery to total resection of thyroid gland in case of cancer. For many surgeons such a radical treatment is still doubtful. On the other hand thyroid cancer is an object of many studies because of its heterogenous clinical course and prognosis depending of histological type. This article focuses on modern principles of diagnosis, treatment and follow-up according to obligatory references in Poland. The authors show current epidemiological data, prognosis according to histological type of cancer and explain pathogenesis of the disease. Preoperative diagnostic model has been described including role of ultrasound examination, biopsy, cytology and histology examination. Special interest was taken to follow-up patients after total thyroidectomy emphasising the role of thyreglobin in early detection of cancer recurrence. It is also important to observed patients for the rest of their life because cancer recurrences have been reported even 40 years after surgery. Preoperative diagnosis and treatment is a typical example of multi-disciplinary procedure which should be held in specialistic centres with proper equipment and experience.
UI - 11575855
AU - Mai KT; Vaccani JP; Thomas J; Odell PF
TI - Immunostaining for ret oncogene proteins in papillary thyroid carcinoma: a correlation of ret immunoreactivity and potential of lymph node metastasis.
SO - Thyroid 2001 Sep;11(9):859-63
AD - Department of Pathology and Laboratory Medicine, Ottawa Hospital and University of Ottawa, Ontario, Canada. firstname.lastname@example.org
Ret oncogenes, particularly Ret/PTC, have been associated with the potential of local invasion of papillary thyroid carcinoma (PTC). The purpose of this study was to investigate the correlation between the Ret oncogene expression and the potential of lymph node metastasis of PTC. A total of 107 PTC were microscopically reviewed to identify areas of infiltrating carcinoma (IC). IC was defined as tumor cells disposed in a haphazard pattern and in lobules, nests, follicles, or single cells within a desmoplastic or sclerotic stroma. All cases were submitted to immunostaining for Ret oncogene. There were 36 noninfiltrating PTC with lymph node metastasis in 1 case and 71 infiltrating PTC with lymph node metastasis in 40 cases. For non-PTC, the positive immunoreactivity was often weak to moderate and focal. For infiltrating PTC with IC, the IC displayed strong immunoreactivity. The noninfiltrating component of PTC with IC usually showed stronger reactivity than PTC without an infiltrating component. Furthermore, 36 of 40 metastatic PTC in lymph node were immunoreactive. Three follicular adenomas with areas of scar caused by fine-needle aspiration biopsy were not immunoreactive for Ret. In view of the high potential of infiltrating PTC for lymph node metastasis, distinction of this type of carcinoma from its noninfiltrating form is clinically important. Because immunoreactivity for Ret is usually positive in areas of infiltrating PTC and is often negative or focally positive in noninfiltrating PTC, immunostaining for Ret is helpful to identify infiltrating PTC and distinguish it from changes caused by fine-needle aspiration biopsy in benign thyroid lesions.
UI - 11575858
AU - Pacini F; Elisei R; Capezzone M; Miccoli P; Molinaro E; Basolo F; Agate
TI - L; Bottici V; Raffaelli M; Pinchera A Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low- and high-risk patients.
SO - Thyroid 2001 Sep;11(9):877-81
AD - Department of Endocrinology and Metabolism, University of Pisa, Italy. email@example.com
Total (or near-total) thyroidectomy (TT) is considered by many as the most adequate treatment for papillary thyroid carcinoma (PTC). In patients who have undergone lobectomy, the necessity of performing a completion thyroidectomy (CT) is still discussed. The aim of this retrospective study was to evaluate tumor bilaterality in patients initially treated with partial thyroidectomy for PTC and who then underwent CT. We studied 182 patients treated with CT after lobectomy and/or isthmectomy for PTC diagnosed from 1969-1998. Mean age at diagnosis was 40+/-14.5 years and mean interval between partial thyroidectomy and CT was 19.8+/-56.8 months. At CT, 80 of 182 patients (44%) had one or more foci of tumor in the remaining thyroid lobe, always of the same papillary histotype, associated with ipsilateral lymph node metastases in 22 cases. In addition, 10 patients with no tumoral foci in the thyroid specimen had evidence of lymph node metastases. The rate of bilateral tumor was not different when patients were analyzed according to the classification of "low-" or "high-risk." Among several clinical features, the presence of lymph node metastases at the first surgical treatment and time interval between first treatment and CT were correlated with higher frequency of bilaterality (p = 0.033 and p = 0.044, respectively). The postsurgical 131I whole-body scan revealed the presence of persistent lymph node metastases or diffuse micronodular lung metastases in 7 and 6 patients, respectively. In conclusion, PTC was frequently bilateral in our series and this bilaterality was independent from the "low-" or "high-risk" classification. On these bases, we believe that PTC should be treated with TT when diagnosed before surgery and submitted to CT, if partial surgery was the initial intervention.
UI - 11801967
AU - Gross ND; Weissman JL; Talbot JM; Andersen PE; Wax MK; Cohen JI
TI - MRI detection of cervical metastasis from differentiated thyroid carcinoma.
SO - Laryngoscope 2001 Nov;111(11 Pt 1):1905-9
AD - Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon 97201, USA.
BACKGROUND: With the advent of the use of serum thyroglobulin as a marker for the recurrence of well-differentiated thyroid cancer (WDTC) after total thyroidectomy, clinicians are increasingly faced with the diagnostic dilemma of detecting the site of recurrence in thyroglobulin-positive patients with normal clinical examinations. The high protein content of this thyroglobulin may make it specifically detectable by magnetic resonance (MR) imaging. OBJECTIVE: To determine the ability of MR imaging to detect the presence of metastatic WDTC in cervical lymph nodes. STUDY DESIGN: Retrospective cohort. METHODS: Blinded review by two independent head and neck radiologists of 34 head and neck MR scans obtained from 26 patients with thyroid cancer (12 with primary disease and 14 with recurrent disease) all of whom subsequently underwent surgical removal of the lymph nodes considered at risk by imaging. RESULTS: The average overall percent sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MR imaging were 95%, 51%, 84%, 78%, and 83%, respectively. The concordance between the two radiologists was 69%. There was no overall difference in the ability of the MR scan to detect the presence of disease in the upper jugular, lower jugular, or paratracheal nodal stations. However, it was more useful for papillary carcinoma (PPV 86%, accuracy 85%) than for follicular carcinoma or the follicular variant of papillary carcinoma (PPV 63%, accuracy 67%). CONCLUSION: MR imaging is a sensitive and accurate technique for the detection of WDTC, particularly papillary carcinoma, metastatic to cervical lymph nodes. However, the lower specificity of this modality precludes its use as a screening tool.
UI - 11790980
AU - Weiss RE; Lado-Abeal J
TI - Thyroid nodules: diagnosis and therapy.
SO - Curr Opin Oncol 2002 Jan;14(1):46-52
AD - Department of Medicine, University of Chicago, Chicago, Illinois 60613, USA. firstname.lastname@example.org
Less than 1% of all cancers are present in the thyroid, yet thyroid nodules are found in 4 to 10% of the adult population. Because thyroid nodules are relatively common, the diagnostic dilemma is to distinguish between a more common benign nodule, which usually does not require specific treatment, and a malignant nodule, which requires thyroidectomy and further treatment. Thyroid nodules usually are an incidental finding on a routine examination by a primary care physician. When patients seek treatment for symptomatic nodules, a more serious problem may be indicated, and thyroid cancer is suggested. However, additional studies have demonstrated the use of genetic markers and immunohistochemistry in the diagnosis of thyroid nodules, which may lead to a more rational approach to the treatment. This article reviews literature published in the last 12 months pertaining to the pathogenesis, diagnosis, and treatment of thyroid nodules.
UI - 11803633
AU - Triponez F; Simon S; Robert J; Andereggen E; Ussel M; Bouchardy C; Orrit
TI - J; Meier CA; Burger A; Spiliopoulos A [Thyroid cancers: the Geneva experience]
SO - Ann Chir 2001 Dec;126(10):969-76
AD - Clinique de chirurgie thoracique, departement de chirurgie, hopitaux universitaires de Geneve, rue Micheli-du-Crest 24, 1211 Geneve 14, Suisse. email@example.com
AIM OF THE STUDY: To study the survival of patients with thyroid cancer operated in the same centre from 1978 to 1999. PATIENTS AND METHOD: This retrospective study included 218 patients operated on for thyroid carcinoma from january 1978 to december 1999. Modified neck dissection was performed only in the presence of one or more suspected lymph nodes. The stage of the cancer was defined according to the last TNM classification (1997). Survival data were taken from the Geneva Tumour Registry (168 patients = 77% of the series, 109 papillary carcinomas, 37 follicular, 14 undifferentiated and 8 medullary carcinomas). RESULTS: The overall 5, 10 and 15-year survival rates were respectively 88%, 84% and 80%. Papillary carcinoma was associated with the best survival at 5, 10 and 15 years (99%, 97% and 93%), despite a recurrence rate of 20% treated mainly by surgery often associated with radioiodine therapy. Follicular carcinoma had a survival rate of 83% at 5 years and 75% at 10 years. Undifferentiated carcinoma had a median survival rate of 56 days. None of the 8 patients with medullary carcinoma had died from that cancer in this series. CONCLUSION: Thyroid carcinoma carries such a good prognosis (except for undifferentiated carcinoma) that invasive surgery at first operation, like radical neck dissection, is not justified, despite a high rate of recurrence.
UI - 11803634
AU - Wu Y
TI - [Differentiated carcinoma of the thyroid in children and adolescents]
SO - Ann Chir 2001 Dec;126(10):977-80
AD - Service de chirurgie cervicofaciale, centre anticancereux de Shanghai, Republique populaire de Chine.
AIM OF THE STUDY: Evaluation of resection "a la demande" for differentiated thyroid carcinoma in young patients. PATIENTS AND METHODS: From 1963 to 1996, 70 differentiated thyroid carcinomas were observed in young patients (mean age: 16 years, range: 9-19 years). Three had pulmonary metastases. Resections were 39 extra-capsular lobo-isthmectomies (56%), 11 total lobo-isthmectomies with contra lateral subtotal lobectomies (16%), and 20 total thyroidectomies "de necessite" (28%). Lymph node resection was unilateral in 41 cases (58%), bilateral in 23 (33%), and more extended in 5 (7%). In tracheal (n = 8), esophageal (n = 4) or bilateral inferior laryngeal nerve involvement (n = 6), the visceral extension was preserved and surgery completed with postoperative external radiotherapy. In patients with pulmonary metastases surgery was completed with I131. Two patients were lost of follow-up. The others were evaluated from 5 years to 28 years later. RESULTS: There were no postoperative deaths, no laryngeal palsy except those existing before surgery. In 6 patients, resection was complicated by permanent hypoparathyroidism. In the follow-up, the death of two patients was not correlated with the thyroid carcinoma. Five patients who had a recurrence were reoperated and were alive without any sign of recurrence. All the patients were alive. CONCLUSION: These results suggest that in children and adolescent patients, without previous irradiation, a surgical procedure "a la demande" is justified. Preservation of tracheal, esophageal or laryngeal involvement, followed by postoperative radiotherapy was associated with good results.