National Cancer Institute®
Last Modified: July 1, 2002
UI - 11289751
AU - Lawal O; Agbakwuru A; Olayinka OS; Adelusola K
TI - Thyroid malignancy in endemic nodular goitres: prevalence, pattern and treatment.
SO - Eur J Surg Oncol 2001 Mar;27(2):157-61
AD - Department of Surgery, College of Health Sciences, Ile-Ife, Osun State, Nigeria. email@example.com
AIMS: The epidemiology of thyroid cancers in goitre endemic zones has not been recently reviewed, and changes being currently reported have been from studies in non-endemic areas. The aims of this study were to present the clinical pattern of thyroid malignancy in a goitre endemic area and identify recent changes, if any. METHODS: The study was conducted at Obafemi Awolowo University Teaching Hospitals Complex, patients with nodular goitres treated with thyroidectomy were reviewed, and the clinical features, laboratory parameters, treatment, outcome and follow-up of histologically-proven malignant cases were studied. RESULTS: Thirty-six of 279 (12.9%) patients, aged 13-85 years (mean)=43.7+/-14.7 years), carried malignant goitres, and most (80%) were young or middle-aged women. Of the well-differentiated cancers, follicular type was the most prevalent, being six- and 12-fold as frequent as papillary and medullary cancers (69%vs 11% and 5.6%), respectively. Lymphoma accounted for 5.6%, fibrosarcoma, 5.6% and anaplastic, 2.8%. No relationship was demonstrable between cancer type, duration of goitre and age at diagnosis (r=0.06 and 0.17, respectively). CONCLUSIONS: Thyroid cancers afflict comparatively young women in our environment, and follicular cancer remains the predominant type, partly as a result of persisting dietary iodine deficiency. Copyright Harcourt Publishers Limited.
UI - 11952857
AU - Mai KT; Bokhary R; Yazdi HM; Thomas J; Commons AS
TI - Reduced HBME-1 immunoreactivity of papillary thyroid carcinoma and papillary thyroid carcinoma-related neoplastic lesions with Hurthle cell and/or apocrine-like changes.
SO - Histopathology 2002 Feb;40(2):133-42
AD - Division of Anatomical Pathology, Department of Laboratory Medicine, The Ottawa Hospital-Civic Campus, Ontario, Canada. firstname.lastname@example.org
BACKGROUND: We have recently observed that Hurthle cell tumours and papillary thyroid carcinoma with tumour cells showing decapitation of luminal portion of the cytoplasm (apocrine-like changes) display negative or decreased immunoreactivity for HBME. The purpose of this study is to correlate papillary thyroid carcinoma with positive and negative immunoreactivity for HBME with the histopathological features. METHODS AND RESULTS: Two hundred and five thyroid neoplasms including carcinoma and adenomas were grouped into Hurthle cell tumours, tumours with or without some features of Hurthle cells, tumours with apocrine-like changes and adenomas with or without limited nuclear features of papillary thyroid carcinoma but not diagnostic for papillary thyroid carcinoma. All neoplasms were submitted for immunostaining with cytokeratin 19 (CK19) and HBME. Papillary thyroid carcinoma, follicular carcinoma and follicular adenoma that have areas of limited nuclear features but not diagnostic for papillary thyroid carcinoma showed stronger immunostaining for HBME than their respective counterparts with Hurthle cell changes. All Hurthle cell tumours showed negative to focal reactivity. This decrease of reactivity for HBME was proportional to the levels of Hurthle cell changes. In addition, focal to extensive apocrine-like changes were seen in most Hurthle cell neoplasms and rarely seen in non-Hurthle cell neoplasms. Apocrine-like changes abolished or decreased HBME immunoreactivity of papillary thyroid carcinoma and tumours with limited nuclear features. Immunostaining for cytokeratin AE3 was not affected by Hurthle cell or apocrine-like changes. CONCLUSIONS: All papillary thyroid carcinomas without Hurthle cell or apocrine-like differentiation are reactive for HBME. Hurthle cell tumours and tumours with Hurthle cell or apocrine-like changes show negative or focal reactivity for HBME. Except for this limitation, HBME is a sensitive marker for papillary thyroid carcinoma and tumours with limited nuclear features.
UI - 11914470
AU - Albores-Saavedra JA; Krueger JE
TI - C-cell hyperplasia and medullary thyroid microcarcinoma.
SO - Endocr Pathol 2001 Winter;12(4):365-77
AD - Department of Pathology, UT Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390-9073, USA.
Since the discovery of the thyroid C-cell, considerable progress has been made regarding its origin, function, and pathology. In this article an attempt is made to summarize and update our knowledge about physiologic or reactive C-cell hyperplasia, neoplastic C-cell hyperplasia (medullary carcinoma in situ), and medullary microcarcinoma. Seldom recognized preoperatively, physiologic C-cell hyperplasia is associated with inflammatory, metabolic, and neoplastic thyroid disorders as well as with hypercalcemia. However, the pathogenesis is still unclear. Although physiologic C-cell hyperplasia may progress to medullary carcinoma, the full malignant potential is unknown. Problems related to the definition of physiologic C-cell hyperplasia are discussed. Immunohistochemistry and quantitative analysis are required for the diagnosis. By contrast, C-cell hyperplasia associated with MEN II syndromes or familial medullary carcinoma can be diagnosed preoperatively in asymptomatic children or adolescents by the detection of germline mutations of the RET protooncogene. Morphologic and genetic abnormalities support the idea that C-cells in the familial form of C-cell hyperplasia are neoplastic and can be recognized with conventional stains. Therefore, the number of C-cells is irrelevant for the diagnosis. Medullary microcarcinoma is a neoplasm that measures < 1 cm. The sporadic variant is usually an incidental microscopic finding, whereas the familial form can be diagnosed by genetic testing. Its morphologic features and biologic behavior differ from those of larger medullary carcinomas. The frequency of medullary microcarcinoma will probably increase with the use of genetic testing.
UI - 11914475
AU - Heffess CS; Thompson LD
TI - Minimally invasive follicular thyroid carcinoma.
SO - Endocr Pathol 2001 Winter;12(4):417-22
AD - Department of Endocrine and Otorhinolaryngic-Head & Neck Pathology, Endocrine Division, Armed Forces Institute of Pathology, Building 54, Room G066-09, 6825 16th Street NW, Washington, DC 20306-6000, USA. email@example.com
Infiltration of the capsule, vascular invasion, and/or neoplastic extension into the adjacent parenchyma are regarded as prerequisites for the diagnosis of follicular carcinoma. In modern practice, most of these tumors fall into the category of follicular carcinoma, minimally invasive (FCMI) characterized by evidence of limited capsular or vascular invasion with an excellent long-term prognosis and a good patient outcome. Notwithstanding the wide acceptance of the diagnostic criteria established by the World Health Organization for the classification of follicular carcinomas in particular, they have been difficult to apply and have led to a great deal of confusion. This confusion is compounded when applied to "low-grade" or "minimally invasive" follicular carcinoma because of the poor reproducibility of the classification and the variable results reported in the literature. Our surgical colleagues face a similar lack of a standardized treatment for low-grade follicular carcinomas, which leads to unnecessary surgical treatment. Standardization of histologic criteria is necessary to promote confidence and uniformity in the therapeutic approach of these tumors. We believe that a FCMI is defined as an encapsulated follicular tumor (not papillary), with only small to medium vessel invasion within or immediately adjacent to the tumor capsule and/or up to full-thickness capsular transgression without accompanying extension into the thyroid parenchyma with intervening fibrosis. By using these criteria, patients can be managed with conservative surgical excision to yield an excellent long-term patient outcome.
UI - 11914476
AU - Melhus H; Li Q; Nordlinder H; Farnebo LO; Grimelius L
TI - Expression of cellular retinol- and retinoic acid-binding proteins in normal and pathologic human parathyroid glands.
SO - Endocr Pathol 2001 Winter;12(4):423-7
AD - Department of Medical Sciences, Uppsala University Hospital, S-751 85 Uppsala, Sweden. Hakan.Melhus@medsci.uu.se
We have previously reported data establishing the human parathyroid gland as a target organ for vitamin A. In the present study, we identified Ito-like cells in parathyroid glands, suggesting local stores of vitamin A. Furthermore, we used immunohistochemistry to investigate the expression of the cellular retinol-binding protein type 1 and the cellular retinoic acid-binding protein type 1 (CRABP I) in histologically normal glands, in remnants of "normal" glandular tissue adjacent to adenoma, in adenomas, and in hyperplastic glands of chief cell type. All normal and abnormal glands displayed immunoreactivity to the two antibodies. CRABP I appeared in the cytoplasm, cell membranes, and nuclear membranes in normal glands, but only exceptionally in the nuclear membranes in abnormal glands. Since retinoic acid inhibits the secretion of parathyroid hormone and CRABP I is thought to play a key role in regulating the amount of retinoic acid available to interact with specific nuclear receptors, these data may suggest impaired transport of retinoic acid to cell nuclei, thus contributing to the development of hyperparathyroidism.
UI - 10740604
AU - Kumar PV; Hodjati H; Monabati A; Talei A
TI - Medullary thyroid carcinoma. Rare cytologic findings.
SO - Acta Cytol 2000 Mar-Apr;44(2):181-4
AD - Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Iran.
OBJECTIVE: To describe some rare cytologic findings in medullary thyroid carcinoma. STUDY DESIGN: Review of the fine needle aspiration smears from 15 cases of medullary thyroid carcinoma that were confirmed on histologic sections. The ages ranged between 31 and 67 years; 10 were female and 5 male. Thirteen were sporadic forms, and two were familial forms. RESULTS: Eight cases were classified as pleomorphic cell type and seven as monomorphic cell type. The smears revealed round, oval, triangular, polygonal and spindle-shaped cells, intracytoplasmic red granules, occasional intranuclear inclusions, amyloid, binucleated and multinucleated cells, and thick, granular chromatin. CONCLUSION: The rare cytologic findings in this study were grape cells, cytoplasmic nippling, elongated cytoplasmic processes, carrot-shaped nuclei, nuclear buddings, mast cell-like cells and a Burkitt's lymphoma-like appearance. These findings were rarely reported before.
UI - 11963755
AU - Mann K
TI - [Diagnosis and therapy of differentiated thyroid gland carcinomas]
SO - Internist (Berl) 2002 Feb;43(2):174-85
AD - Abteilung fur Endokrinologie, Zentrum fur Innere Medizin, Universitatsklinikum Essen, Hufelandstrasse 55, 45122 Essen. firstname.lastname@example.org
UI - 12050199
AU - Malchoff CD; Malchoff DM
TI - The genetics of hereditary nonmedullary thyroid carcinoma.
SO - J Clin Endocrinol Metab 2002 Jun;87(6):2455-9
AD - Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1850, USA. email@example.com
UI - 11114619
AU - Brink JS; van Heerden JA; McIver B; Salomao DR; Farley DR; Grant CS;
TI - Thompson GB; Zimmerman D; Hay ID Papillary thyroid cancer with pulmonary metastases in children: long-term prognosis.
SO - Surgery 2000 Dec;128(6):881-6; discussion 886-7
AD - Division of General and Gastroenterologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
BACKGROUND: Papillary thyroid cancer (PTC) in young patients may rarely be encountered with pulmonary metastases. Previous studies have suggested that, in the pediatric population, this may not portend a lethal outcome. Our present study, children with pulmonary metastases, was designed to clarify this issue. METHODS: Fourteen children and young adolescents (mean age, 13.5 years; range, 9.8-17 years) with PTC and pulmonary metastases were treated at our institution between 1937 and 1998. Surgical treatment consisted of total thyroidectomy (n = 10 patients), subtotal thyroidectomy (n = 3 patients), and a biopsy only procedure (n = 1 patient). All patients who underwent thyroidectomy also underwent a variety of cervical lymph node dissections, and all patients proved to have regional nodal disease. After the operation, 12 patients were treated with ablative doses of (131)I, 1 patient was treated with external beam irradiation, and all patients were placed on suppressive thyroid hormone therapy. The mean length of follow-up was 19.3 years (range, 1-45 years). RESULTS: Regional recurrent disease developed in 2 patients (15%). No patient experienced the development of worsening pulmonary disease or extra-pulmonary metastases. All patients with recurrent disease underwent selective nodal resections. No patient died of metastatic PTC. Seven patients (50%) remain completely free of disease and are probably cured; 7 patients (50%) are asymptomatic with residual pulmonary disease. CONCLUSIONS: A stepwise treatment approach allows long-term survival and frequent cure for young patients with PTC and concomitant pulmonary metastases.
UI - 11303892
AU - Melloul M; Paz A; Koren R; Cytron S; Feinmesser R; Gal R
TI - 99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance.
SO - Eur J Nucl Med 2001 Feb;28(2):209-13
AD - Department of Nuclear Medicine, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel. firstname.lastname@example.org
The aim of this study was to assess the correlation between technetium-99m methoxyisobutylisonitrile (MIBI) uptake by parathyroid adenomas, oxyphil cell content and volume of the lesions. Thirty-one patients with parathyroid adenomas were evaluated prospectively. Preoperative double-phase 99mTc-MIBI scintigraphy was performed in all patients and tracer uptake by parathyroid lesions was assessed semi-quantitatively employing region of interest ratios to normal adjacent neck areas. Surgical specimens underwent histological evaluation and oxyphil cell content was determined. The intensity of tracer uptake was compared with oxyphil cell content, volume of the lesions and serum levels of calcium and parathormone. 99mTc-MIBI tracer uptake was correlated with oxyphil cell content, volume of parathyroid lesions and the functional status of the parathyroid adenomas. Tracer accumulation in oxyphil cells might partially explain the preferential 99mTc-MIBI retention in parathyroid lesions.
UI - 11504097
AU - Gabriel M; Erler H; Bacher-Stier C; Kendler D; Donnemiller E;
TI - Decristoforo C; Moncayo R Methodological considerations influence the clinical value of parathyroid localisation diagnostics.
SO - Eur J Nucl Med 2001 Jul;28(7):942-3
UI - 11601131
AU - Renshaw AA
TI - Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves.
SO - Am J Clin Pathol 2001 Oct;116(4):477-82
AD - Department of Pathology, Baptist Hospital of Miami, Miami, 8900 N Kendall Dr, Miami, FL 33176, USA.
Although many large series demonstrate the effectiveness of thyroid fine-needle aspiration (FNA), measuring its accuracy has been suboptimal owing to inappropriate statistical methods. All thyroid fine-needle aspirates were correlated with corresponding histologic and cytologic follow-up for a 4-year period, and the accuracy was determined using receiver operator characteristic curves, which allow inclusion of nondiagnostic and indeterminate cases. There were 1,085 cases, 291 with follow-up. The overall accuracy was 0.90 +/- 0.02 for a single aspiration session. A nondiagnostic aspirate was associated with a significant risk of malignancy (16%). However, 70% of patients who underwent reaspiration had adequate and negative results, and reaspiration significantly increased overall accuracy. Subcategorizing the nondiagnostic category did not affect accuracy, but did define categories with a significantly different change of a negative diagnosis on repeated aspiration. Although subcategories of papillary carcinoma were associated with significantly different risks of carcinoma (40% vs 81%), they did not significantly improve overall accuracy. Receiver operator characteristic curves can be used to define the accuracy of thyroid FNA. This method demonstrates significantly increased accuracy with repeated aspiration of nondiagnostic cases and demonstrates that subcategorization does not improve the overall accuracy of the test.
UI - 12064873
AU - Pomorski L; Bartos M
TI - Histologic changes in thyroid nodules after percutaneous ethanol injection in patients subsequently operated on due to new focal thyroid lesions.
SO - APMIS 2002 Feb;110(2):172-6
AD - Clinic of Endocrinological and General Surgery, Institute of Endocrinology, Medical University of Lodz, Poland.
This paper reports macro- and microscopic changes in hyperfunctioning thyroid nodules (HTN), initially diagnosed as solitary, in patients treated with percutaneous ethanol injection (PEI). In 78 patients, benign solitary HTN were diagnosed by clinical and hormonal examination. High resolution ultrasonography confirmed the solitary nodule. The results of fine needle aspiration biopsy (FNAB), performed twice, ruled out malignancy of the nodule. The patients were referred for PEI treatment. At 1-year follow-up, newly formed thyroid nodules, whose volumes increased, were detected in five patients (6.4%) with HTN, initially diagnosed as solitary. Therefore, these patients were operated on. Subtotal thyroidectomy was performed. At the intraoperative macroscopic evaluation, a hard fibrous solid mass was found in place of three nodules (n1, n2, n3) following PEI treatment. The middle area of the cut surface of PEI-treated nodules (n4 and n5) in the other two patients was firm and haemorrhagic, surrounded by a fibrous mass. Histolopathologic examination of n1, n2 and n3 revealed fibrosis and hyalinosis. Examination of n4 and n5 showed haemorrhagic necrosis in the middle of the nodules surrounded by fibrous tissue.
UI - 12050949
AU - Zettinig G; Prager G; Kurtaran A; Kaserer K; Czerny C; Dudczak R;
TI - Niederle B [Value of a structured report for the interpretation of parathyroid scintigraphy in primary essential hyperthyroidism]
SO - Acta Med Austriaca 2002;29(2):68-71
AD - Universitatsklinik fur Nuklearmedizin, Ludwig Boltzmann Institut fur Nuklearmedizin, Universitat Wien. email@example.com
The aim of the study was to evaluate whether a four-stage report scheme increases the diagnostic accuracy of dual phase Tc-99 m sestamibi scintigraphy (MIBI-scintigraphy) in patients with primary hyperparathyroidism (pHPT). We analysed the scans of 35 patients with primary hyperparathyroidism referred for Tc-99 m sestamibi scintigraphy and compared them with the sonographic and surgical findings. All scans were interpreted following a four-stage report scheme: Group A--typical scintigraphic findings of a single gland disease, group B--scan consistent with single gland disease, group C--multiple gland disease, group D--non diagnostic scan. Twenty-three scans were ranked in group A. In all these patients, scintigraphy diagnosed both the side and the localization of the adenoma correctly. Sonography made the correct diagnosis in 21/23 individuals and showed false-positive results in 2/23 cases. Group B included 10 scans. In 7/10 individuals, both the side and the localization of the adenoma were diagnosed correctly, whereas in 2/10 patients only the side was diagnosed. The scan of a single patient with hyperplasia of all 4 parathyroid glands was falsely interpreted as "consistent with a left caudal single gland disease". Sonography made the correct diagnosis in 8/10 cases, two individuals were diagnosed as false positive and false negative, respectively. No scan was interpreted as multiple gland disease (group C) and two scans were non diagnostic (group D). Both patients of the last group were correctly diagnosed by sonography. These findings suggest that in case of typical scintigraphic findings of single gland disease, scintigraphy but not sonography should be the primary localization technique for minimally invasive parathyroidectomy.
UI - 11786411
AU - Hoos A; Stojadinovic A; Singh B; Dudas ME; Leung DH; Shaha AR; Shah JP;
TI - Brennan MF; Cordon-Cardo C; Ghossein R Clinical significance of molecular expression profiles of Hurthle cell tumors of the thyroid gland analyzed via tissue microarrays.
SO - Am J Pathol 2002 Jan;160(1):175-83
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Hurthle cell tumors are rare thyroid neoplasms for which disease biology is poorly understood and diagnosis of carcinoma can be challenging. The aim of the study was to characterize molecular expression profiles of Hurthle cell tumors and to determine the clinical significance of identified phenotypes. Paraffin-embedded tissue cores of normal thyroid (n = 18), and histopathologically well-defined Hurthle cell adenomas (n = 27), Hurthle cell tumors of unknown malignant behavior (n = 7), and minimally (n = 14) and widely (n = 21) invasive Hurthle cell carcinomas were arrayed in triplicate on tissue microarrays. Expression profiles of p53, mdm-2, p21, Bcl-2, cyclin D1, and Ki-67 were detected by immunohistochemistry and correlated with clinicopathological data and patient outcome using standard statistical methodology. Median follow-up time was 8 years. High Ki-67 proliferative index was evident only in the clinically aggressive widely invasive Hurthle cell carcinomas and was associated with significantly reduced relapse-free (P = 0.001) and disease-specific (P < 0.001) survival. The molecular phenotype of Hurthle cell tumors, independent of histopathological subtype diagnosis, was characterized by p53(-), mdm-2(+), p21(+/-), cyclin D1(-), and Bcl-2(+/-). Normal thyroid tissue demonstrated a p53(-), mdm-2(-), p21(-), cyclin D1(-), and Bcl-2(+) phenotype. The Bcl-2(+) phenotype was associated with improved relapse-free survival (P = 0.04) and disease-specific survival (P = 0.01) in widely invasive carcinomas and the Ki-67(+)/Bcl-2(-) phenotype was associated with the diagnosis of widely invasive Hurthle cell carcinoma (P < 0.001). This study demonstrates that tissue microarray-based profiling allows identification of molecular markers that are associated with patient prognosis. High Ki-67 proliferative index was associated with adverse outcome in Hurthle cell neoplasms. Together with down-regulation of Bcl-2, high Ki-67 proliferative index may be useful for diagnosing widely invasive Hurthle cell carcinomas. Molecular alterations in the p53 pathway play a role in Hurthle cell tumorigenesis, but other unidentified molecular changes seem to be required to induce the malignant phenotype.
UI - 12067803
AU - Moysich KB; Menezes RJ; Michalek AM
TI - Chernobyl-related ionising radiation exposure and cancer risk: an epidemiological review.
SO - Lancet Oncol 2002 May;3(5):269-79
AD - Department of Cancer Prevention, Epidemiology, and Biostatistics, Roswell Park Cancer Institute, Buffalo, NY 14226, USA. firstname.lastname@example.org
The Chernobyl nuclear accident on 26th April, 1986, led to a massive release of radionuclides into the environment. Although vast areas of Europe were affected by Chernobyl-related ionising radiation, the accident had the greatest impact in Belarus, Ukraine, and the Russian Federation. Epidemiological studies that have investigated the link between the Chernobyl accident and cancer have largely focused on malignant diseases in children, specifically thyroid cancer and leukaemia. There is good evidence to suggest that rates of thyroid cancer in children from the countries that were formally part of the Soviet Union have risen as a consequence of the Chernobyl accident. The findings for childhood leukaemia are less conclusive. Overall rates for this disease do not seem to have been affected by the Chernobyl-related ionising radiation, but there may be a larger risk of infant leukaemia in contaminated areas of Europe. Among adult populations, there is no strong evidence to suggest that risk of thyroid cancer, leukaemia, or other malignant disease has increased as a result of the Chernobyl accident.
UI - 12027995
AU - Caraci P; Aversa S; Mussa A; Pancani G; Ondolo C; Conticello S
TI - Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules.
SO - Br J Surg 2002 Jun;89(6):797-801
AD - Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
BACKGROUND: The role of routine frozen section (FS) in the surgical management of thyroid nodules remains uncertain. This study reviewed the role of FS in the presence of an adequate fine-needle aspiration biopsy (FNAB). METHODS: FNAB and FS were evaluated in 206 patients who had surgery for a thyroid nodule. Cytological specimens were classified as benign, malignant or suspicious. The FS diagnoses were benign, malignant or deferred. RESULTS: A cytological diagnosis was obtained in 93 nodules; the remaining 113 were classified as suspicious, of which 21 were malignant on definitive examination. The overall accuracy of FNAB was 53 per cent. FS evaluation identified 165 lesions as benign; the diagnosis was deferred until definitive histological evaluation in only eight. The overall accuracy, therefore, was 96 per cent. Routine use of FS was cost-effective; lowering the number of reoperations led to an estimated saving of about 40 per cent. CONCLUSION: These data suggest that FS remains an important tool in the surgical management of thyroid nodules and can reduce the number of patients requiring reoperation.
UI - 12027996
AU - Tan MP; Agarwal G; Reeve TS; Barraclough BH; Delbridge LW
TI - Impact of timing on completion thyroidectomy for thyroid cancer.
SO - Br J Surg 2002 Jun;89(6):802-4
AD - Endocrine Surgical Unit, Department of Surgery, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia.
BACKGROUND: It has been stated that completion thyroidectomy for thyroid malignancy should be performed either within 10 days of the primary operation or after 3 months, to reduce the incidence of complications. The aim of this study was to review the impact of timing on the rate of complications following completion thyroidectomy. METHODS: Data were obtained retrospectively from the Endocrine Surgery Thyroid Data Base, to which the records of all patients have been entered since 1957. The patients who had the last 100 consecutive completion thyroidectomies for thyroid cancer comprised the study group. RESULTS: Sixty-three patients had the second operation performed within 10 days or more than 90 days after the initial operation (group 1). Thirty-seven patients had reoperation between 10 and 90 days after the first procedure (group 2). One patient (2 per cent) in group 1 and one patient (3 per cent) in group 2 suffered a permanent complication (P not significant). CONCLUSION: There was no definite impact of the timing of surgery on the rate of complications after completion thyroidectomy.
UI - 12050333
AU - Meier DA; Brill DR; Becker DV; Clarke SE; Silberstein EB; Royal HD;
TI - Balon HR; Society of Nuclear Medicine Procedure guideline for therapy of thyroid disease with (131)iodine.
SO - J Nucl Med 2002 Jun;43(6):856-61
AD - William Beaumont Hospital, Royal Oak, Michigan, USA. email@example.com
UI - 12079713
AU - Basaria M; Graf H; Cooper DS
TI - The use of recombinant thyrotropin in the follow-up of patients with differentiated thyroid cancer.
SO - Am J Med 2002 Jun 15;112(9):721-5
AD - Division of Endocrinology and Metabolism, Sinai Hospital of Baltimore, Maryland 21215, USA.
Many clinicians care for patients who have been treated for differentiated thyroid cancer. Recombinant thyrotropin, which stimulates iodine uptake in thyroid tissue, is a safe and effective diagnostic agent for those patients who require radioiodine scanning for routine follow-up. The combination of a whole body radioiodine scan and a serum thyroglobulin measurement can identify virtually all patients with distant metastatic disease. A serum thyroglobulin >2 ng/mL and/or a positive whole body scan after recombinant thyrotropin stimulation suggest residual thyroid tissue or neoplastic disease. The use of recombinant thyrotropin has fewer adverse effects than does the alternative, which is withdrawal of thyroid hormone replacement, although nausea and headache have been reported. However, recombinant thyrotropin is expensive.
UI - 12033961
AU - Herrmann ME; LiVolsi VA; Pasha TL; Roberts SA; Wojcik EM; Baloch ZW
TI - Immunohistochemical expression of galectin-3 in benign and malignant thyroid lesions.
SO - Arch Pathol Lab Med 2002 Jun;126(6):710-3
AD - Department of Pathology, University of Pennsylvania, Philadelphia, USA. firstname.lastname@example.org
CONTEXT: The expression of galectin-3, a human lectin, has been shown to be highly associated with malignant behavior of thyroid lesions. DESIGN: We studied the immunohistochemical expression pattern of galectin-3 in a variety of follicular-derived thyroid lesions (13 benign and 62 malignant), including Hurthle cell and follicular carcinoma, papillary carcinomas and variants, and anaplastic and poorly differentiated carcinomas. RESULTS: Immunoreactivity was strongest in papillary thyroid carcinomas, whereas staining was less intense in Hurthle cell and anaplastic carcinomas, and even weaker in the follicular variant of papillary thyroid carcinoma. Staining was absent or weak in the 3 follicular thyroid carcinomas and was negative in both insular carcinomas. In several tumors, staining was stronger at the advancing invasive edge of the lesion than in the central portion of the tumor. Galectin-3 was also expressed focally and weakly in reactive follicular epithelium and entrapped follicles in chronic lymphocytic thyroiditis. A variety of thyroid lesions showed prominent endogenous, biotin-like activity, which could cause flaws in interpretation if a biotin-detection system were used. CONCLUSION: We conclude that galectin-3 immunostaining, when used in biotin-free detection systems, may be useful as an adjunct to distinguish benign from malignant thyroid lesions.
UI - 12075176
AU - Stojadinovic A; Shoup M; Ghossein RA; Nissan A; Brennan MF; Shah JP;
TI - Shaha AR The role of operations for distantly metastatic well-differentiated thyroid carcinoma.
SO - Surgery 2002 Jun;131(6):636-43
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BACKGROUND: The role of operations for distantly metastatic well-differentiated thyroid carcinoma (DTC) is poorly defined. We review the indications for operation for metastatic DTC. METHODS: This study consists of 260 patients treated between 1941 and 2000 for metastatic DTC, of which 59 (23%) underwent operations. Median follow-up was 7 years (range, 1 to 49 years). Metastases were identified clinically in 157 (60%) and radiologically in 103 (40%) patients. The disease-specific survival was estimated with the Kaplan-Meier method. RESULTS: Twenty-four patients (9%) were disease-free with resection. Palliative resection was indicated for painful bone metastasis, pathologic fracture, or symptomatic spinal cord involvement (35/260, 14%). Patients who could undergo complete metastasectomy survived longer than those having incomplete/palliative resection or nonoperative treatment for metastatic DTC (5-year disease-specific survival, 78% vs 43% vs 46%, P =.03). CONCLUSIONS: Solitary distant metastasis of DTC amenable to complete resection is infrequent. Complete metastasectomy may be associated with improved survival for localized distant disease. Palliative resection is indicated to improve quality of life for symptomatic distant metastasis.
UI - 11913107
AU - Smit JW
TI - [The initial treatment of patients with differentiated thyroid carcinoma; consensus and controversies]
SO - Ned Tijdschr Geneeskd 2002 Mar 9;146(10):454-7
AD - Leids Universitair Medisch Centrum, afd. Endocrinologie en Stofwisselingsziekten, Postbus 9600, 2300 RC Leiden. email@example.com
Differentiated thyroid carcinoma has a low incidence and a relatively good prognosis. As a consequence, treatment protocols are largely based on retrospective analyses of heterogeneous patient groups, as no randomised controlled trials with residual disease and survival as outcome measures are available. In the Netherlands, guidelines for initial therapy are based on a 1987 international consensus meeting. These guidelines involve near-total thyroidectomy with a few exceptions and routine radioiodide ablative therapy in all cases. Recent publications still support the main measures as advised in this consensus. Although randomised trials have not proven that the consensus guidelines improve the prognosis in thyroid carcinoma, the guidelines provide a base for uniform data collection and thus scientific research. They also provide tools for health-practice quality surveys.
UI - 11913113
AU - Kuijpens JL; Hoekstra OS; Hamming JF; Haak HR; Ribot JG; Coebergh JW
TI - [Surgery and referral for subsequent 131I therapy for patients with differentiated thyroid carcinoma in the south-east of the Netherlands, 1983-1996, compared to the consensus guidelines from 1987]
SO - Ned Tijdschr Geneeskd 2002 Mar 9;146(10):473-7
AD - ArboUnie Zuidoost Nederland, Eindhoven.
OBJECTIVE: To evaluate the treatment of patients with differentiated (papillary or follicular) thyroid cancer in general hospitals in the south-east of the Netherlands during the period 1983-1996, in relation to the 1987 national consensus recommendations. DESIGN: Population-based, retrospective, descriptive. METHOD: For the period 1 treatment (hospital, specialist, type of operation, referral for 131I therapy) of all 236 patients with differentiated thyroid cancer were obtained from the cancer registry of the Comprehensive Cancer Centre South, Eindhoven, the Netherlands. The treatment was compared with the recommendations from the consensus meeting in 1987. RESULTS: Data on 219 patients (137 papillary, 82 follicular thyroid carcinoma) treated in the general hospitals in the region were studied; the 17 remaining patients had been referred from outside the region. Patients were treated at all hospitals in the region; the number of specialists per hospital able to treat thyroid carcinoma (internist and/or surgeon) was limited. In total 79% of the patients underwent a (near-)total thyroidectomy, half of them in two phases, and in 12% of the cases combined with regional lymph node dissection. In the majority of cases, surgical treatment was in accordance with the consensus recommendations: 65-100% of the cases per hospital. The proportion of patients referred for 131I therapy varied from 17% to 90%; referral was more frequent in the case of larger tumours and/or metastases. Of the 24 patients with a small papillary carcinoma without metastases, 79% were not referred for 131I therapy. CONCLUSIONS: The recommendations laid down in the consensus meeting in 1987 were known and appeared to be followed for surgical treatment but for subsequent 131I therapy they appeared to be interpreted differently. A review of the consensus guidelines seems to be worthwhile.
UI - 12034964
AU - Spieth ME; Gough J; Kasner DL
TI - Role of US with supplemental CT for localization of parathyroid adenomas.
SO - Radiology 2002 Jun;223(3):878-9; discussion 879
UI - 12077916
AU - Szakall S Jr; Bajzik G; Repa I; Miklovicz T; Dabasi G; Sinkovics I; Esik
TI - O [FDG PET scan of metastases in recurrent medullary carcinoma of the thyroid gland]
SO - Orv Hetil 2002 May 26;143(21 Suppl 3):1280-3
AD - Debreceni Egyetem, Orvos- es Egeszsegtudomanyi Centrum, PET Centrum, Debrecen. firstname.lastname@example.org
Searching for metastases of medullary thyroid cancer (MTC), FDG PET was applied. PET results were compared with those of conventional diagnostic imaging procedures. After primary treatment, 52 MTC patients with elevated serum tumor marker levels and/or general symptoms (diarrhoea/flush) underwent radiological (CT/MRI), 131-iodine labeled metaiodo-benzylguanidine (MIBG) whole-body scintigraphy and FDG PET investigations. At least one pathological lesion was detected in 49 patients by PET, 35 by CT, 32 by MRI and 3 by MIBG. FDG PET was far superior to the other methods in identifying metastases in the supradiaphragmatic lymphatic regions. In the follow-up of MTC patients, FDG PET was more sensitive in localizing tumorous LN involvement, especially in the cervical, supraclavicular and mediastinal lymphatic regions, compared to other imaging modalities.
UI - 12063398
AU - Bol S; Belge G; Rippe V; Bullerdiek J
TI - Molecular cytogenetic investigations define a subgroup of thyroid adenomas with 2p21 breakpoints clustered to a region of less than 450 kb.
SO - Cytogenet Cell Genet 2001;95(3-4):189-91
AD - Center for Human Genetics, University of Bremen, Bremen, Germany.
Structural rearrangements involving chromosome band 2p21 characterize a cytogenetic subgroup of benign thyroid tumors. To narrow down the breakpoints of these aberrations, we established two cell lines from benign thyroid tumors showing translocations involving 2p21. These two cell lines and one additional primary tumor were used for FISH-studies with 18 BAC clones. All breakpoints were mapped to a cluster of about 450 kb. Copyright 2002 S. Karger AG, Basel
UI - 11849247
AU - Fugazzola L; Cerutti N; Mannavola D; Ghilardi G; Alberti L; Romoli R;
TI - Beck-Peccoz P Multigenerational familial medullary thyroid cancer (FMTC): evidence for FMTC phenocopies and association with papillary thyroid cancer.
SO - Clin Endocrinol (Oxf) 2002 Jan;56(1):53-63
AD - Istituto Clinico Humanitas and Ospedale Maggiore IRCCS, Milan, Italy.
BACKGROUND: Occurrence in a familial setting is well established for medullary thyroid carcinoma (MTC) and has been more recently reported for papillary thyroid cancer (PTC). Germline mutations or rearrangements of the RET proto-oncogene are the genetic background of the majority of hereditary MTCs and of about 25-40% of PTCs. PATIENTS: A large multigenerational familial medullary thyroid cancer (FMTC) family, comprised of four generations and a total of 60 subjects, has been fully evaluated. Studies on germline RET mutations and polymorphisms, on somatic RET activation and on haplotyping with RET-linked markers, were performed. RESULTS: RET mutational analysis revealed a rare missense point mutation in exon 15 of RET (A891S), associated with FMTC. Haplotype analysis showed a co-segregation between the allelic variant 5 of D10S578 marker (which is tightly linked to the RET locus) and the RET mutation. Two patients, from different branches of the family, did not harbour the point mutation A891S despite histological confirmation of MTC. In these cases, haplotype analysis excluded the involvement of the RET gene itself in the pathogenesis of the MTC. In three patients, the coexistence, in different foci, of medullary and papillary thyroid cancer was documented. The genetic studies did not show ret/PTC rearrangements. The microsatellite analysis excluded co-segregation of RET locus with the MTC/PTC phenotype. CONCLUSIONS: We report a full clinical and molecular analysis of a large FMTC kindred with an uncommon RET mutation. In two family members, phenotype and genotype were not concordant, representing the first evidence of FMTC phenocopies. Furthermore, the association of familial forms of medullary and papillary thyroid cancers has been found in 30% of patients undergoing thyroidectomy for MTC. In these situations, genetic analyses excluded the possible germline involvement of RET. Though FMTC phenocopies are likely to represent an exceptional finding, such a possibility should be taken into account in the genetic counselling for MEN 2 syndromes.