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PubMed1992

Sonography in thyroid carcinoma in children.

This paper reviews the clinical, sonographic and pathological findings of 20 children with thyroid carcinoma in an attempt to determine the value and limitations of sonography in thyroid neoplasms in this age group. Although sonography is an excellent technique for the evaluation of thyroid disorders and masses, certain limitations must be kept in mind. Microscopic foci of tumour might be missed and sonography cannot predictably differentiate benign from malignant disease. Previous radiation exposure should increase the level of suspicion for malignancy.

Adenocarcinoma↗
PubMed1998

Variability of Ha-ras (codon 12) proto-oncogene mutations in diverse thyroid cancers.

Structural alterations to proto-oncogene sequences may be involved in the pathogenesis of human thyroid neoplasms. We studied 128 thyroid tumours (35 benign and 93 malignant) for ras gene point mutations in three different codons (12, 13 and 61) using a restriction fragment length polymorphism technique and direct sequencing of double-stranded DNA on polymerase chain-reaction-amplified tumour DNA. We found a high frequency of ras mutation for the Ha-ras codon 12 in follicular adenomas (7 of 35), particularly in atypical adenomas (5 of 17), in follicular carcinomas (6 of 19), with a high percentage for Hurthle cell carcinomas (6 of 11), and in papillary carcinomas (4 of 66). Point mutations for other ras genes in different codons studied were weak to absent. No mutation was found in undifferentiated carcinomas (n = 8). The predominant amino acid substitution both in the adenomas and in the differentiated tumours was glycine to valine (GGC to GTC) at position 12 of the Ha-ras gene. Our results obtained on a large series confirm the frequent occurrence of Ha-ras codon 12 gene mutations both in adenomas and in carcinomas. The frequency of ras mutations is linked to the geographical origin of the population studied and varies (0-85%) from one cancer type to another according to published data. Therefore, these mutations are merely an expression of cellular transformation.

Adenocarcinoma, Follicular↗
PubMed1983

Thyroglobulin in carcinoma of the thyroid: an immunohistochemical study.

To determine the value of thyroglobulin as an immunohistochemical marker for thyroid neoplasms, we studied 42 primary thyroid carcinomas, 38 metastatic carcinomas, and four sarcomas involving the thyroid gland. All follicular and papillary carcinomas, regardless of their morphologic variation, stained positively for thyroglobulin, whereas the medullary carcinomas, metastatic tumors, and sarcomas showed negative staining reactions. The only small-cell variant of follicular carcinoma and ten of 14 spindle and giant cell carcinomas showed the lowest thyroglobulin reactivity. It is concluded that immunohistochemical demonstration of thyroglobulin is a sensitive and specific method of identifying thyroid carcinomas of follicular cell origin.

Carcinoma↗
PubMed1981

Geographic pathology of thyroid diseases.

The thyroid is one of the organs which demonstrates clearly the influence of extrinsic and especially geographically determined influences in the development of diseases. Endemic goiter and cretinism are the most typical examples. The question as to whether thyroid cancer arises more frequently in goiters that in normal thyroids, cannot be answered definitely as yet. But without doubt, the relative frequency of different types of thyroid neoplasms in goiter areas is not the same as in region without endemic goiter. The most common type of thyroid carcinoma observed in a nonendemic region is papillary carcinoma. Follicular and anaplastic carcinomas, however, are more often associated with goiter. Under the influence of iodine prophylaxis, the relative frequency of the different types of thyroid carcinoma approaches that of these carcinomas in nongoiter regions. The malignant hemangioendothelioma is observed nearly exclusively in some Alpine goiter areas. Since the introduction of preventive measures in Switzerland, its occurrence has diminished progressively. In contrast to endemic goiter, focal thyroiditis and even Hashimoto's disease seem to be on the increase since institution of iodine prophylaxis of endemic goiter. As the development of malignant lymphoma may be related to thyroiditis, a possible increase of such tumors should be considered.

Congenital Hypothyroidism↗
PubMedDate not supplied

Metastatic papillary cancer of the neck: a diagnostic dilemma.

The finding of papillary carcinoma in a neck mass usually leads to the presumptive diagnosis of metastatic thyroid carcinoma, with total thyroidectomy revealing the primary tumor. We report five cases of metastatic papillary carcinoma of the neck. The primary tumor in three of the cases was found to be nonthyroidal; two being discovered only after thyroidectomy failed to reveal a primary cancer. In the two thyroidal neoplasms, pathologic examination of the thyroid demonstrated only minimal tumor in one case and no detectable tumor in the other. These cases illustrate the pitfalls of diagnosis and treatment of these tumors and the utility of antithyroglobulin immunostaining in such cases.

Adenocarcinoma↗
PubMed1998

p53 and p21(WAF1) expression in lymphocytic thyroiditis and thyroid tumors.

To clarify the roles of increased apoptosis and cell proliferation in chronic autoimmune lymphocytic thyroiditis and thyroid tumorigenesis, expression of p53 and p21(WAF1) proteins was immunohistochemically investigated in a series of 158 cases. Positive epithelial cells were quantified to give numbers per unit square and to score for distribution. They were found scattered in nontumorous thyroid tissue, their numbers increasing with the severity of thyroiditis and the correlation between expression of the two proteins, regardless of the presence or absence of thyroid neoplasms. Simultaneous expression of both proteins was occasionally found in the same cells by analysis of serial histologic sections. In thyroid tumors, increased expression was found to be diffuse, focal, or scattered for the distribution of p53- or p21(WAF1)-immunopositive cells in accordance with tumor cell dedifferentiation, showing significant correlation between expression of the two proteins. Correlated with these findings, enhanced apoptosis along with decreased Bcl-2 expression and increased Ki-67 labeling in lymphocytic thyroiditis and thyroid tumors was also confirmed in the same series, using in situ DNA nick-end labeling and immunohistochemical methods. Increased expression of p53 and/or p21(WAF1) proteins was thus suggestive of possible DNA damage and increased apoptosis in autoimmune thyroiditis. In addition, a significant correlation between protein overexpression and dedifferentiation of thyroid tumor cells was apparent.

Antibodies↗
PubMed2001

Follicular neoplasms of the thyroid: predictors of malignancy?

Follicular neoplasms of the thyroid present a therapeutic challenge. Initial limited thyroidectomy may result in some patients requiring completion thyroidectomy for malignancy. In the current study we examined age, gender, race, time from nodule discovery to operation in months, history of radiation exposure, tumor size (cm), and cell type in patients with follicular neoplasms identified at the time of thyroidectomy in two socioeconomically diverse settings from 1993 through 2000 to identify possible factors associated with a greater chance of malignancy. Of 36 follicular lesions identified in 35 patients seven (19%) were malignant on permanent section. Hurthle cell histology was present in six of 36 lesions. Mean age of patients with benign lesions was 47 +/- 13 versus 50 +/- 15 in malignant cases (P > 0.05). Benign lesions measured 2.6 +/- 1.2 cm versus 3.1 +/- 1.7 cm in malignant (P > 0.05). Other factors found not to be significant included gender and time nodule was present (12.8 +/- 19 months benign vs 11.8 +/- 20 months malignant) (P > 0.05). Hurthle cell histology was associated with a 50 per cent malignancy rate (three of six) versus 13 per cent (four of 30) with non-Hurthle cell histology (P < 0.05). Two patients with exposure to radiation fallout had malignancies in lesions of one and 2 cm (P < 0.05). Patients from a socioeconomically disadvantaged setting had a malignancy rate of 50 per cent (six of 12) compared with a malignancy rate of 3 per cent (one of 24) from a socioeconomically affluent population (P < 0.05). In conclusion Hurthle cell histology and exposure to radiation fallout were associated with significantly higher rates of malignancy in follicular neoplasms and should be taken into account when deciding on the initial extent of thyroidectomy. The difference in malignancy rates observed between socioeconomic settings while significant requires further investigation.

Adolescent↗
PubMed1998

Actinomycotic thyroiditis in a child.

The authors present a unique case of actinomycosis occurring in a 10-year-old girl who presented with a painless, noninflammatory left neck mass of 3 weeks duration. Physical examination findings showed a firm, nontender mass within the left thyroid lobe, and a presumptive diagnosis of thyroid neoplasm was made. Inflammatory changes subsequently occurred and surgical drainage was performed revealing sulphur granules. Histological examination confirmed actinomycosis of the thyroid gland.

Actinomycosis↗
PubMed1991

Immunohistochemical demonstration of epidermal growth factor receptor and ceruloplasmin in thyroid diseases.

The expression of epidermal growth factor receptors (EGFR) and ceruloplasmin (CP) in thyroid diseases was investigated by immunohistochemical methods, and the results were compared with the expression of thyroglobulin (TG). Eighty-eight surgical specimens of thyroid diseases, including follicular carcinoma (7 cases), papillary carcinoma (20 cases), follicular adenoma (29 cases), adenomatous goiter (10 cases), diffuse hyperplasia (20 cases) and chronic thyroiditis (2 cases), were studied. All cases of follicular carcinoma and 18 cases (90%) of papillary carcinoma expressed the EGFR immunoreaction in the cytoplasm with a moderate to strong staining intensity. A weak immunoreaction for EGFR was noted in some benign thyroid diseases. CP showed various degrees of positivity in all cases of follicular carcinoma and 19 cases (95%) of papillary carcinoma. The benign thyroid lesions were consistently negative for this antigen, not counting one case of Hürthle cell adenoma. There was a positive correlation between EGFR and CP immunostaining intensity in thyroid carcinomas, representing higher expression of EGFR accompanied by a stronger staining intensity of CP. Except for two cases of papillary carcinoma, all cases showed immunoreaction for TG. The results indicate the enhanced expression of EGFR and CP in thyroid carcinomas. EGFR and CP thus appear to be valuable tools for differential diagnosis between benign and malignant thyroid neoplasms.

Adenocarcinoma↗
PubMed2005

Electrical impedance scanning of thyroid nodules before thyroid surgery: a prospective study.

BACKGROUND: Electrical impedance scanning (EIS) is a novel imaging technique based on differential electrical conductivity and capacitance of malignant and normal human tissues. The aim of this study was to evaluate the accuracy of EIS in the detection of thyroid malignancies. METHODS: Patients with thyroid nodules scheduled for thyroid surgery were eligible for the study. Enrolled patients underwent EIS with a T-Scan 2000ED. Nodule location, size, and type (cystic vs. solid) measured by ultrasound, cytology results, thyroid conductivity, and capacitance calculated by EIS were recorded. EIS results were interpreted as positive or negative for malignancy and compared with final histopathology results. Study end points included EIS accuracy, sensitivity, specificity, negative and positive predictive values, and false-positive and false-negative rates. RESULTS: Sixty-four patients were enrolled onto the study, and all underwent either lobectomy-isthmusectomy (20%) or total thyroidectomy (80%). The mean tumor diameter was 2.64 +/- 14.8 mm. Thyroid cancers were identified by histology in 30 patients (46.9%). There were 11 false-positive and four false-negative cases. The overall diagnostic accuracy of EIS was 76.6% (49 of 64 correct diagnoses). The sensitivity and specificity of EIS were 86.7% (26 of 30 true positive) and 67.6% (23 of 34 true negative), respectively. The corresponding positive and negative predictive values were 70.3% and 85.2%. CONCLUSIONS: EIS is a potentially useful imaging modality for differentiating thyroid neoplasms. If these results are confirmed in large-scale trials, EIS may be an important part of the evaluation of thyroid nodules.

Adolescent↗
PubMed1999

Thyroid-specific gene expression in the multi-step process of thyroid carcinogenesis.

Thyroid-specific transcription factors TTF-1 and Pax-8 play a decisive role in the determination and maintenance of cellular phenotype activating thyroglobulin (Tg), thyroperoxidase (TPO), thyrotropin receptor (TSH-R) and the sodium/iodide symporter (NIS) gene transcription. In the present work, we have studied the expression of TTF-1 and Pax-8 and their target genes in samples derived from thyroid neoplasms of follicular origin, as well as in medullary carcinoma (MTC), obtained from surgery or from fine needle aspiration (FNA) biopsies. The results show that TTF-1 and Pax-8 are expressed in well differentiated adenomas and that their expression decreases in less differentiated papillary and follicular carcinomas and is lost in undifferentiated anaplastic carcinomas. Parallel levels of Tg, TPO and TSH-R expression were found in the same neoplasm samples. Interestingly TSH-R and TTF-1 gene expression was found in MTC samples. Furthermore, the expression of the thyroid-specific genes and their transcription factors is lost in thyroid cells derived from follicular, papillary and anaplastic human carcinomas. In these cells, Tg, TPO and TSH-R promoter activities were absent. Cotransfection with expression vectors for TTF-1 and Pax-8 resulted in the stimulation of transcription to a different extent for each promoter. These results may be clinically relevant for the evaluation and prognosis of thyroid cancer since the loss of specific markers correlates with the degree of tumor differentiation.

Carcinoma, Medullary↗
PubMed1992

Oncocytic neoplasms of the thyroid gland.

Among well differentiated thyroid tumors, oncocytic neoplasms feature a distinctive set of clinical, morphologic and biologic characteristics, some of which have been a matter of controversy. The world literature on this subject has been reviewed to show that: 1) Morphology accurately predicts the behavior of Hürthle cell tumors assuming that the specimen has been adequately sampled; 2) Capsular and/or vascular invasion is the sine qua non condition for a diagnosis of malignancy; 3) "Indeterminate" or "possibly malignant" categories are useless because in the absence of invasion these neoplasms almost invariably behave in a benign fashion; 4) Among cases histologically classified as malignant, a clinically aggressive behavior is to be expected in a high percentage of cases; 5) Size alone cannot be used as a criterion of malignancy; 6) Less than total thyroidectomy provides an adequate treatment for histologically benign tumors; aggressive surgical procedures (i.e. total thyroidectomy) do not diminish the incidence of metastasis; 7) Analysis of DNA content may be helpful in defining subsets of patients with Hürthle cell carcinomas having a particularly poor prognosis; 8) Mitochondrial and/or nuclear DNA abnormalities probably play an important role in the cellular alterations which characterize the phenotype of oncocytes.

Adenoma↗
PubMed1997

Ectopic intrathyroidal thymus diagnosed as a solid thyroid lesion: case report and review of the literature.

The authors report a case of a 6-year-old boy in whom aberrant thymic tissue was misdiagnosed as an intrathyroidal solid lesion. The patient underwent hemithyroidectomy and did well. Because cervical ectopic thymus rarely produces symptoms, the true incidence in children is unclear. Surgeons need to consider this rare entity, not to mistake it as a thyroid neoplasm, and not to perform extensive thyroid resection.

Child↗
PubMed1992

Surgical management of the thyroid nodule: patient selection based on the results of fine-needle aspiration cytology.

To determine whether the routine use of fine-needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA. Twenty-nine (85.3%) of the 34 patients who had a positive FNA were confirmed by histology to have a thyroid neoplasm; in 24 patients, the neoplasm was malignant. Two of the 17 patients who had a negative FNA but underwent thyroidectomy based on other factors were found to have thyroid cancer. Only 8 (33.3%) of the 24 surgical specimens of patients who did not have an FNA were found to be malignant. FNA had a sensitivity of 93.5% and a specificity of 75.0%. The results indicate that the routine use of FNA for patients with thyroid nodules reduces the incidence of unnecessary surgery. Furthermore, FNA alone is sufficient to identify most patients at risk and is, therefore, cost-effective. However, the presence of other findings suspicious of malignancy should preclude clinical decision making based on FNA alone.

Adolescent↗
PubMedDate not supplied

Flow-cytometric DNA ploidy analysis in primary and metastatic canine thyroid carcinomas.

DNA ploidy was measured by flow cytometry in 36 primary malignant thyroid neoplasms (including 6 bilateral tumours which were considered as separate neoplasms) from 30 dogs. In addition, DNA ploidy was determined in local recurrences in 3 dogs, and in 18 metastatic sites from 14 dogs. Aneuploidy was found in 21 of 36 (58%) primary sites. Eighteen of the 21 (86%) aneuploid tumours contained hypodiploid cell populations, with 12 having single hypodiploid peaks, and 6 being multiploid. Three other tumours had single aneuploid peaks with a DNA index (DI) greater than 1.0. The DIs in local recurrences were identical to those in the original neoplasms. Ploidy status (diploid vs. aneuploid) was identical in primary and metastatic sites in 10 out of the 14 dogs. Aneuploidy was more frequent in carcinomas from dogs with distant metastases (78%) than from dogs with less advanced stages of disease (53%), although this difference was not significant. There was no significant correlation between DNA ploidy and histopathological variables. From the strikingly high frequency of hypodiploidy in canine tumours, it is concluded that ploidy evolution in canine neoplasms may differ from that in human tumours.

Aneuploidy↗
PubMedDate not supplied

[Metastasis of kidney carcinoma to thyroid gland seventeen years after resection of primary tumor].

Renal cell carcinoma is an unpredictable tumor that can recur many years after the original diagnosis. Metastasis of this tumor to the thyroid is an uncommon occurrence that can cause clinical and pathologic problems in diagnosis. The authors report case that present clinically as a palpable thyroid nodule 17 years after the primary renal cell carcinoma had been resected. This lesion appeared a solitary "cold" nodule on iodine 131 scan and was misdiagnosed as primary thyroid neoplasm. The diagnosis was facilitated by the use of immunohistochemical study.

Aged↗
PubMed2003

[Quality assessment of intraoperative frozen sections in a teaching hospital: an analysis of 847 consecutive cases].

We evaluated the accuracy of 847 consecutive frozen section diagnoses in order to develop a quality control. We also evaluated the time needed to perform them. Frozen sections and final diagnoses agreed in 92.6% and disagreed in 1.7% (14 cases). 5.8% of the cases were deferred. The only case of false-positive frozen sections (0.1%) was due to a pathologist's misinterpretation. False-negative frozen sections were due to sampling errors: in 5 cases, diagnostic tissue was present only in permanent sections of the frozen block and in 8 cases diagnostic tissue was present only in the portion of the specimen not sampled by the frozen section. One hundred and ninety two frozen sections concerned thyroid neoplasms. Thirteen cancers were diagnosed on frozen sections, 2 cancers were considered as benign and 9 cancers had a differed diagnosis. The mean duration to perform the frozen sections was 21 minutes. In conclusion, intra operative frozen section diagnosis is rapid and reliable. Discrepancies are more often false negatives due to sampling errors. Although a high rate of differed diagnosis was observed in thyroid neoplasms, frozen sections remain useful for these lesions. Imprint cytology of thyroid nodules is advisable.

Biopsy↗
PubMed2005

Follicular neoplasms of the thyroid: what to recommend.

Follicular neoplasms of the thyroid are usually diagnosed following fine-needle aspiration (FNA) biopsy of a dominant thyroid nodule. An FNA diagnosis of a follicular neoplasm represents a heterogeneous group of lesions including benign follicular hyperplasia, follicular adenomas, follicular carcinomas, and the follicular variant of papillary carcinoma. Hürthle cell neoplasms are also often included in this group. Because the criteria for malignancy in both follicular and Hürthle cell neoplasms requires vascular or capsular invasion seen on permanent histology, the majority of these patients undergo surgical resection. Intraoperative frozen section analysis of follicular neoplasms rarely renders informative information. Approximately 20% of these lesions prove to be malignant and for lesions greater than 1.0 cm in size, the majority of surgeons and endocrinologists recommend a total thyroidectomy. Postoperative treatment generally includes therapeutic doses of 131I for follicular carcinomas.

Adenocarcinoma, Follicular↗