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Biomedical subjects

K Shimaoka

Publications and source records attributed to K Shimaoka.

At least 55 records · Page 3Linked to original sources
PubMed1983

Adenosquamous carcinoma of the thyroid after radiotherapy for Hodgkin's disease. A case report and review.

This is a case report of a patient who had received radiation therapy for Hodgkin's disease and 48 years later developed adenosquamous carcinoma of the thyroid gland. Radiation associated thyroid carcinoma is usually of differentiated variety and carried no different prognosis than one not related to radiation. Coexisting adenocarcinoma and squamous cell carcinoma is a very rare event, but makes the prognosis of patients with thyroid carcinoma much poorer. As a result, this kind of patient requires early recognition and aggressive therapy.

Adenocarcinoma↗
PubMed1983

Association of thyroid carcinoma with malignant lymphoma.

Radiation-associated thyroid carcinoma is of clinical importance in modern radiation therapy of both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL), because anatomically the thyroid is often in the radiation field. We have reviewed the records of HD and NHL patients seen at Roswell Park Memorial Institute (RPMI) between 1910 and 1960 to determine associated occurrence of thyroid cancer. Radiation therapy was the major therapeutic modality with the occasional use of single agent chemotherapy with nitrogen mustard, triethylene melamine (TEM), chlorambucil and prednisone. There were 519 patients with HD and 863 with NHL. The thyroid glands of 439 (84%) HD and 544 (63%) NHL patients were included in the field of radiation. The mean age of patients with HD was 39 yr while for those with NHL, it was 53 yr. The mean survival in HD was 4.2 yr and in NHL 3.8 yr. There were three cases of thyroid cancer among the HD patients occurring 31, 44 and 48 yr, respectively, after radiation therapy. When compared with the number of thyroid cancers expected to develop, the incidence was significantly greater (p less than 0.005). In contrast, three NHL patients were found to have thyroid cancer at the time of surgery or postmortem examination. This number is again greater than expected in such a population (p less than 0.005); however, in only two cases could the cancer be considered as a sequela to NHL treatment. In all three cases the cancer turned out to be subclinical thyroid carcinoma, incidentally found at surgery or autopsy. One of the patients is still alive without evidence of either disease. The reason for this difference between patients with HD and NHL treated with a similar principle is unclear. Some of the factors contributing to this difference may include: the younger age of HD patients at diagnosis; the longer survival of patients with HD as compared with those with NHL; differences in the sites of radiation and type of treatment given; and possible differences in immunological status between the two groups.

Adolescent↗
PubMed1982

Squamous cell carcinoma of the thyroid gland -- transition from adenocarcinoma.

Eight autopsy cases of thyroid carcinoma, in which adenocarcinoma and squamous cell carcinoma coexisted, and presented. In these adenosquamous cell carcinoma, pathological findings suggest direct transition from papillary adenocarcinoma to squamous cell carcinoma, rather than transformation to squamous cell carcinoma via squamous metaplasia. We believe that squamous cell carcinoma arises from adenocarcinoma of the thyroid in most cases.

Adenocarcinoma, Papillary↗
PubMed1982

Association between primary hyperparathyroidism and previous irradiation.

The association between primary hyperparathyroidism and previous irradiation was investigated in two study groups. Among 36 patients with hyperparathyroidism, 4 (11%) knew of having received radiation therapy. In the second group of 323 patients with a history of radiation exposure and nodular thyroid disease, 4 (1%), thus far, were found to have hyperparathyroidism.

Acne Vulgaris↗
PubMed1982

Carcinoembryonic antigen assay in thyroid screening.

CEA assay was incorporated into a screening program in which a high risk population for thyroid diseases due to previous irradiation for benign conditions in the head and neck areas were studied. Seven hundred eleven CEA determinations were available from 735 patients screened; 22 (3.1%) were found to have an elevated level. This is compared to 31 (1.7%) from 1875 healthy control subjects. Although the difference is statistically significant, we conclude the use of CEA assay in thyroid screening is not rewarding due to its lack of activity and specificity.

Adult↗
PubMed1982

Unusual cytoplasmic inclusion bodies in medullary carcinoma of the thyroid gland.

Medullary carcinoma of the thyroid from a 43-year-old patient showed 4 types of unusual cytoplasmic inclusion bodies ultrastructurally. Type 1 inclusion is composed of rod and doughnut-shaped bodies aggregated in the cytoplasma and not enclosed by a limiting membrane. Typical neurosecretory granules are intermingled with the rod and doughnut-shaped bodies. The doughnut-shaped bodies often have an electron dense core which is similar to the neurosecretory granules. The rod-shaped bodies are bounded by trilaminar unit membrane and have a slightly electron dense matrix. A centriole is often found associated with this type of inclusion. Type 2 inclusion is composed of small secretory granules and clear vesicles. These inclusions can be found either with or without surrounding membrane. Type 3 inclusion is a large osmiophilic body, or secondary lysosome, in which some degenerated organelles are discernible. Type 4 inclusion is a fragmented nucleus with condensation and margination of the chromatin, so-called karyorrhexis. Routine hematoxylin and eosin sections did not show each type of inclusion but semithin sections stained with Paragon suggested 4 different types of inclusions. Type 3 and 4 inclusions represent forms of degeneration and cell death in the tumor cells and probably represent a remote effect of radiation. Type 1 inclusion is not commonly associated with cell death and may represent a unique organellar aberration in these tumor cells. Type 2 inclusion is simply an aggregation of secretory granules and clear vesicles.

Adult↗
PubMed1982

Combinations of methotrexate (COP or CHOP) in the treatment of previously untreated and treated lymphomas.

A regimen consisting of two courses of methotrexate (MTX) with leucovorin rescue followed 1 week later by cyclophosphamide, vincristine, and prednisone (MTX-COP) was studied in ten patients with disseminated diffuse non-Hodgkin's lymphoma who had had no prior chemotherapy. A similar regimen with the addition of doxorubicin (MTX-CHOP) was used for patients who had had previous chemotherapy: 11 with diffuse non-Hodgkin's lymphoma and two with Hodgkin's disease. The response rate to initial MTX administration was 55%, and the clinical onset of effect was usually observed within 48 hours. Responses were observed in previously treated and untreated patients. The remission rate was 100% with both regimens. There were seven complete remissions with MTX-COP and six with MTX-CHOP. The median durations of remission were 23 and 13 months, respectively; median survival was not reached in either group. MTX was well-tolerated by both groups of patients without serious toxic effects. Overall, significantly more hematologic toxicity was observed in previously treated patients; however, no life-threatening toxic effects were observed in either group. The incorporation of MTX and other antimetabolites into schedules of chemotherapy for previously treated and untreated patients with non-Hodgkin's lymphoma is well tolerated and deserved further exploration.

Adult↗
PubMed1982

Necropsy of a cadaver containing 50 mCi of sodium131 iodide.

A patient who received an oral dose of iodine-131 for the treatment of metastatic thyroid carcinoma unexpectedly died with a large total-body retention of the radioiodine. An autopsy was required and the family requested the body to be transported out of state to their home town. Since the radiation intensity near the surface of the cadaver was above 200 mR/hr, advanced planning and special precautions were necessary in order for the autopsy to proceed safely. This required the immediate cooperation of the pathologists, nuclear medicine physicians, health physicists, an endocrine oncologist, and other hospital staff. As a result of team efforts, personnel radiation exposures were kept as low as reasonably achievable, contamination of the autopsy room was minimal, and the radiation level of the cadaver was adequately reduced for safe transport and burial.

Adult↗
PubMed1981

Thyroid abnormalities associated with treatment of malignant lymphoma.

The effects on the thyroid of radiation therapy to the neck and/or chemotherapy were investigated in 54 Hodgkin's and 72 non-Hodgkin's lymphoma patients. These patients had received radiation therapy with doses ranging from 2000 to 4000 rad (median 3600 rad) to the cervical or mantle fields and/or multiple-agent chemotherapy following usual staging procedures. Palpable abnormalities of the thyroid were found in 15 patients. The patients with irradiation to the neck had a higher incidence of hypothyroidism than those patients treated with chemotherapy alone (31/74 vs. 8/52, P less than 0.001 for TSH and 10/74 vs. 1/52, P less than 0.025 for T4). A higher frequency of elevated serum TSH levels and antithyroid antibodies were also observed in patients receiving radiation therapy alone to the neck than in those receiving both radiation therapy and chemotherapy (19/33 vs. 12/41, P less than 0.025 for TSH and 16/33 vs. 7/41, p less than 0.01 for antibodies), suggesting that chemotherapy agents may reduce the thyroid dysfunction induced by irradiation. There was no difference in prevalence of elevated TSH levels following irradiation to the neck between patients in whom lymphangiogram was or was not performed (21/51 vs. 10/23).

Adult↗
PubMed1981

Prognosis of thyroid carcinoma.

With 612 cases of malignant thyroid tumor, the follow-up observations were conducted from 7 to 11 years after initial examination, and 512 cases were follow up. It was found that 46 cases died of the primary cancer, while 13 died of other causes. The prognosis proved to be favorable with adenocarcinoma but with anaplastic carcinoma or squamous cell carcinoma the disease proved to be ultimately fatal. The survival rates 5 and 10 years after diagnosis were 97.4% and 95.8% for papillary adenocarcinoma, 95.6% and 92.5% for follicular adenocarcinoma, 7.7% and 7.7% for anaplastic carcinoma, 0% for squamous cell carcinoma, and 66.9% and 66.9% for malignant lymphoma. As to the causes of death, the obstruction due to the neck tumor ranks first, indicating that respiratory deaths are numerous. However, as there are histologically many deaths due to the transformation from adenocarcinoma to squamous cell carcinoma or anaplastic carcinoma, it is desirable to perform radical surgery at an early stage.

Adenocarcinoma↗
PubMed1980

Squamous cell carcinomas and adenosquamous carcinomas originating from the thyroid gland.

Three cases of squamous cell carcinoma and 3 cases of mixed squamous and glandular carcinoma were reported. Pathologic differential diagnosis of these rare primary tumors of the thyroid gland were discussed. All except 1 case occurred in elderly patients; their clinical behavior was more aggressive than that of differentiated carcinoma. It is suggested that the tumor be treated more vigorously at its initial stage.

Adenocarcinoma↗
PubMed1980

Appraisal of aspiration cytology in management of Hodgkin's disease.

The value of aspiration cytology in the management of Hodgkin's disease is shown in this study of 228 patients and 403 aspirations; 385 from lymph nodes and 18 from extranodal masses. In all patients the initial diagnosis was established on surgical biopsy. Aspirates were helpful in staging, defining extension of unusual radiation fields, and in recognizing residual disease and relapses after therapy. Adequate material was obtained in 80% of aspirations. The diagnosis of Hodgkin's disease could not be established in the adequate cytologic sample in 9.9% of cases. In 5.5%, the diagnosis was that of benign reactive hyperplasia and in 4.4%, non-Hodgkin's lymphoma. Unsatisfactory material was usually obtained from nodes less than 1 cm in diameter or from residual lesions following radiation or chemotherapy. Only 14 of 93 such lesions proved to have active disease during follow up. There were no significant complications. Characteristics of the varied aspects of aspirated tumor cells found in Hodgkin's disease are described.

Adolescent↗
PubMed1980

Radiation-associated thyroid carcinoma.

Since February, 1977, 735 patients having a history of receiving radiation therapy for benign conditions of the head and neck areas during infancy and childhood were examined in a thyroid screening program, and 159 patients were found to have palpable thyroid nodules. These patients had thyroid function tests and indirect laryngoscopy and were followed closely on suppression therapy consisting of either Cytomel or thyroid extract. Thyroidectomy was advised in those in whom the nodules persisted or increased in size. This study documents the incidence of carcinoma and other benign pathological changes and postoperative complications in this group of patients. So far, 49 patients had either a lobectomy with isthmusectomy or a total thyroidectomy. Eleven patients were found to have carcinoma (six had papillary, four had mixed papillary and follicular, and one had follicular carcinoma). Three patients had a therapeutic modified neck dissection following the documentation of microscopic involvement of paratracheal lymph nodes. A high incidence of chronic nonspecific thyroiditis, postradiation fibrosis, and follicular adenomas were also found in these patients. Three patients had temporary hypocalcemia (two weeks) and none had wound infection, hematoma, or postoperative nerve palsy. Of patients who had surgical resection, 22.4% showed thyroid carcinoma.

Adolescent↗
PubMed1980

Adjunctive management of thyroid cancer: chemotherapy.

The majority of well-differentiated carcinoma of the thyroid can be effectively treated by surgery and thyroid hormone administration, or in combination with radioiodine therapy. Occasional patients with well-differentiated carcinoma, and patients with medullary carcinoma and anaplastic carcinoma should be considered for chemotherapy. Doxorubicin has been shown to be active in this neoplasm. In addition, there are chemotherapeutic agents shown to be active in small numbers of patients with this disease, but most of them have not received an adequate trial. Multiple-agent chemotherapy has also been tried in this disease. However, average response rate of multiple-agent chemotherapy appears to be only slightly better than that of doxorubicin single-agent chemotherapy. The importance of group approach in evaluating chemotherapy program is presented.

Antineoplastic Agents↗
PubMed1980

Clinical evaluation of 201thallium chloride scan for thyroid nodule.

Thyroid scintigraphy with Tl in the evaluation of nodules was investigated. A Tl scan was performed on 55 patients with thyroid nodules previously scanned with Tc or I. In the case of 16 carcinomas, accumulation of Tl was shown in every case. In addition, some lymph node metastases were depicted. (Accumulation was noted also in some of the metastatic lymph nodes.) Cold defect was delineated in ten cases of colloid and fetal adenoma, although accumulation was shown in four cases of Hürthle and embryonal adenoma. Six cases of degenerative cysts were delineated as cold defect. As for colloid nodular goiter, the affinity to the individual nodule was not constant. In general, degenerative and cystic nodules showed less activity and hyperplastic solid nodules showed more activity than normal tissue. We concluded that although a Tl scan cannot differentiate between benign and malignant tumors satisfactorily, it is nevertheless useful for determining surgical indication, as the case showing Tl accumulation on the scan is malignant or benign tumor with poorly differentiated solid type and possiblility of further growth and malignant change.

Adenocarcinoma, Mucinous↗