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PubMed2005

Metastatic thyroid carcinoma.

Although metastases to the thyroid gland are common in autopsy studies, clinically significant metastases are rare. A 58-year-old Turkish patient, presenting with thyroid metastasis 2 years after undergoing left nephrectomy for renal cell carcinoma, is reported in this case report. Thyroid metastasis can be the initial presentation of renal cell carcinoma, or it may occur a long time after nephrectomy, which can lead to misdiagnosis of primary thyroid neoplasm. Radiographic features are not useful in making discrimination between the two, however a fine needle aspiration biopsy can be useful. The role of surgical therapy is controversial.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

[A case of primitive amyloid goiter].

Amyloid goiter is a rare pathology due to massive amyloid infiltration of thyroid tissue, which cause diffuse or localized enlargement of the gland. It can be totally asymptomatic or cause only non-specific symptoms (compression of adjacent structures, tracheal deviation). Thyroid disfunction (hypothyroidism or hyperthyroidism) is rare. It is important to differentiate primitive amyloid goiter from other kinds of amyloid infiltration of the thyroid, such as in systemic amyloidosis. The correct diagnosis can be difficult because of the common presence of amyloid in thyroid neoplasms, such as medullary thyroid carcinoma (MTC). The Authors present a case of primitive amyloid goiter, that needed immunohistochemical analysis for a correct diagnosis, and a review of the concerning literature.

Aged↗
PubMedDate not supplied

Thyroid metastasis of renal cell carcinoma. A case report.

In this article thyroid metastasis in a patient who was operated 11 years ago for renal cell carcinoma is reported with the review of the literature. That case was also the first and the only thyroid gland metastasis in 4.124 thyroidectomies during a 17-year period at our department. Because the thyroid gland may be the only and a rare metastatic site, differentiation of the metastatic lesion from the primary thyroid neoplasm could be difficult.

Carcinoma, Renal Cell↗
PubMed2004

Thyroid implants after surgery and blunt trauma.

The differential diagnosis of thyroid tissue found laterally in the neck includes several conditions: lymph node deposits of thyroid carcinoma, "benign metastatic thyroidosis," detached thyroid nodules, and true ectopic thyroid tissue. We have studied nine cases with thyroid deposits in the soft tissues of the neck that do not conform to these diagnoses. We present evidence that they represent surgical or traumatic implantation of thyroid neoplasms. Eight of the nine cases presented one to 26 years after initial surgery. Adequate information of the operative procedure was available in seven cases, one patient underwent subtotal lobectomy and six subtotal thyroidectomy for a nodular gland. The nodules occurred within the operation field with no evidence that they were within lymph nodes. In six cases, birefringent particles consistent with talc from the earlier operation were found adjacent to the nodules. Three cases showed implants of colloid nodules, three of follicular adenoma, one of oncocytic (Hürthle) cell adenoma and one of follicular carcinoma. In the ninth case, infiltrating thyroid tissue in muscle and fibrous tissue presented 3 years after major blunt trauma to the neck. The tissue resembled that in a disrupted thyroid nodule present in the gland itself and was regarded as traumatically implanted. The observation that surgery or trauma to a nodular thyroid can occasionally lead to multiple subcutaneous thyroid implants has implication for management of thyroid disease. Therapy may be difficult; recurrence followed surgical removal of the nodules in three cases, and radioiodine may be a more effective therapy. Recognition of this entity is important for accurate pathologic diagnosis. It is apparently limited to implantation of tumor. The absence of implantation of normal or hyperplastic thyroid, despite the high frequency of partial thyroidectomy in Graves' disease, has pathobiological implications. These findings also support the generally held view that lobectomy rather than nodulectomy is the operation of choice for a solitary nodule.

Adult↗
PubMed1999

Follicular adenoma with squamous metaplasia and cystic change: report of a case with fine needle aspiration cytological and histological features.

Squamous metaplasia (SM) of thyroid follicular epithelium is known to occur in a variety of non-neoplastic lesions as well in thyroid neoplasms, notably papillary carcinoma (PC). In follicular thyroid tumors, on the other hand, SM is very rare. This case describes cytological and pathological findings in a follicular adenoma (FA) that presented as a cystic lesion with extensive SM. The fine needle aspiration (FNA) cytology sample in this case yielded only necrotic material from the cystic area and squamous cells, which being mostly of immature type, were not recognised as squamous in the cytological smears. The needle missed the solid (neoplastic) component of the lesion and on the whole the cytological picture was considered to be equivocal. FA can now be added to the spectrum of thyroid lesions that can show SM. Awareness of this will enable cytopathologists to consider non-papillary lesions in the differential diagnosis of thyroid nodules that yield squamous cells.

Adenoma↗
PubMed1995

Metastatic papillary thyroid carcinoma presenting as a primary renal neoplasm.

Clinically detectable thyroid cancer metastatic to the kidney is rare, with only six cases reported in the medical literature. Four of these have been follicular carcinoma, one papillary carcinoma, and one described as a thyroid adenoma. All of these had known thyroid neoplasms prior to development of their renal metastases. We report herein a seventh case of thyroid carcinoma metastatic to the kidney, unique in that the diagnosis of the kidney metastasis preceded the knowledge of the primary thyroid neoplasm. Furthermore, the follicular variant of papillary cancer, present in this case, has not been previously described in renal metastases from thyroid cancer. Treatment of the kidney metastases led to the subsequent discovery and treatment of the primary thyroid cancer. The patient underwent nephrectomy followed by total thyroidectomy, and is alive and disease-free 3 years postoperatively. Thyroid cancer metastatic to the kidney is rare clinically, but can be amenable to treatment with good long term results.

Aged↗
PubMed1992

Detection of RET oncogene activation in human papillary thyroid carcinomas by in situ hybridisation.

We have recently reported the activation of a new oncogene in human papillary thyroid carcinomas. This oncogene, named PTC, is a novel rearranged version of the ret proto-oncogene. In fact PTC is the product of the fusion of the tyrosine kinase domain of the ret proto-oncogene with the 5'-terminal region of another gene that we have named H4. The ret proto-oncogene shows a pattern of expression restricted to neuroendocrine tissue. Its fusion with H4 allows the expression of the activated form in thyroid papillary carcinomas. Therefore the detection of ret transcripts is a tool to investigate ret activation in thyroid neoplasms. Here we show the detection by in situ hybridisation, of activated ret transcripts in human thyroid papillary neoplasms that were positive for PTC activation by Southern blot analysis. We did not find any ret transcripts in papillary carcinomas negative for PTC activation, nor in normal thyroid and in non-papillary thyroid neoplasias.

3T3 Cells↗
PubMed2000

Assessment of ret/PTC-1 rearrangements in neoplastic thyroid tissue using TaqMan RT-PCR.

Among oncogenes studied in thyroid cancers, a specific activated form of c-ret has been found in a minority of papillary thyroid carcinomas (PTCs). In these tumours, c-ret is activated when by somatic rearrangements, the intracellular domain of RET is juxtaposed with the amino-terminal portion of a different donor gene such as H4, thereby generating a chimeric transcript (ret/PTC-1). The functional effects of c-ret activation and its prognostic implications are currently unclear. This study was undertaken to assess the frequency of RET/PTC-1 expression, any distinctive features of positive tumours to which it might be related, and its prognostic importance. Archival material from 88 thyroid neoplasms [50 PTCs, eight anaplastic carcinomas (ATCs), 25 follicular thyroid carcinomas (FTCs) and five follicular adenomas (FAs)] were analysed for ret/PTC-1 and H4 expression using 5' nuclease assay (TaqMan RT-PCR). RNA from the TPC-1 cell line was included as a positive control for c-ret activation. No FTC or FA displayed activation of ret/PTC-1, though all expressed H4. c-ret activation was found in 24% of PTCs (12 of 50), in 87.5% of ATCs (7 of 8), and in 33% of the combined PTC/ATC group. The frequency of c-ret activation in the aggressive ATC variants noted here suggests that ret/PTC-1-positive PTCs might also have a similar poor prognosis and a follow-up study on this cohort is in progress. Ninety per cent of ret/PTC-1-positive tumours failed to express H4, a phenomenon that has not been described previously and which may have considerable bearing on tumour morphology. A statistically significant proportion (58%) of ret/PTC-1-positive, H4-negative PTCs was associated with chronic inflammatory cell infiltration of the tumour and/or the surrounding thyroid. This association has not been reported previously.

Biomarkers, Tumor↗
PubMed1992

Peculiar nuclear clearing composed of microfilaments in papillary carcinoma of the thyroid.

BACKGROUND: Papillary carcinoma of the thyroid frequently occurs in young women. Four cases of papillary carcinoma were found in women in their 20s, and the disease was characterized by unusual morphologic and clinical features. METHODS: Four cases were analyzed clinically, grossly, microscopically, ultrastructurally, and immunohistochemically and compared with control cases of papillary carcinoma. RESULTS: The tumors histologically showed various appearances with trabecular, solid cribriform, follicular, and papillary patterns. A striking finding was that stratified cancer cell nests with prominent nuclear clearings were scattered in the tumors. Ultrastructurally, the nuclear clearings were composed of fine thread-like fibrils, and they were bound unselectively to various antibodies against hormones and intermediate filaments. The four patients also had common clinicopathologic features as follows: they were all women in their 20s and their preoperative serum thyroglobulin levels were all normal despite the large size of their thyroid tumors. The tumors were grossly well encapsulated, and there was no lymph node metastasis, except in one patient who had only one positive node. CONCLUSIONS: The peculiar nuclear features were distinct from intranuclear cytoplasmic inclusions or ground-glass nuclei, and these have not been reported previously to the authors' knowledge in conventional thyroid neoplasms. These tumors might represent another subtype of papillary thyroid carcinoma.

Actin Cytoskeleton↗
PubMed1994

Fine-needle aspiration of anaplastic thyroid carcinoma with varied cytologic and histologic patterns: a case report.

Anaplastic carcinoma of the thyroid (ACT) is a rare subtype of thyroid neoplasm. This tumor represents approximately 5-10% of all thyroid malignancies and its poor prognosis has not changed in 25 years. ACT often arises in a long-standing thyroid nodule and has been documented to be associated with a variety of more well-differentiated thyroid carcinomas. We describe the cytologic features of a case in which the patient had a 10-yr history of a thyroid nodule. The ACT in this case had a cytologic and histologic appearance of several different subtypes of thyroid carcinomas.

Aged↗
PubMed2006

Clinicopathological significance of major histocompatibility complex class I-related chain a and B expression in thyroid cancer.

CONTEXT: Major histocompatibility complex class I-related chains A and B (MICA/B) are two stress-inducible ligands for the immunoreceptor NKG2D that is expressed on cytotoxic T cells and natural killer (NK) cells. It is not known whether MICA/B expression is up-regulated in thyroid cancer as a result of oncogene activation. OBJECTIVE: The objective of the investigation was to study MICA/B expression and regulation in thyroid cancer and its role in mediating the cytotoxicity of NK cells. METHODS: MICA/B expression in thyroid cancer was analyzed by immunohistochemical staining. Cell surface MICA/B levels in thyroid tumor cell lines and fresh tumor cells were analyzed by flow cytometric analysis. The susceptibility of thyroid tumor cells to NK cell killing was tested by using (51)Cr release assay. RESULTS: MICA/B was expressed at moderate or high levels in 18 of 39 papillary thyroid carcinomas and four of eight anaplastic thyroid carcinomas. MICA/B expression was confirmed by flow cytometric analysis in three fresh thyroid neoplasms. MICA/B expression was detected in eight of 10 thyroid tumor cell lines and correlated with their sensitivity to killing by the NKG2/D-positive NK-92 cells. Blocking of NKG2D and MICA/B interaction by specific antibodies partially led to the inhibition of NK-92 cell-mediated cytotoxicity. The MAPK inhibitors were able to block MICA/B expression in MRO87 and HeLa cells. Transient transfection of mutant BRAF and RAS oncogenes led to increased MICA/B expression in 293 cells and WRO82 cells. CONCLUSION: MICA/B expression is up-regulated in thyroid cancer, probably due to the activation of the MAPK pathway. MICA/B in thyroid cancer plays an important role in NK-92 cell-mediated cytotoxicity.

Antibodies, Monoclonal↗
PubMedDate not supplied

Control results on a sample of patients subjected to total thyroidectomy for papillary carcinoma: proposal for a personal diagnostic-therapeutic follow-up.

Well-differentiated thyroid neoplasms may be included among the most frequently occurring thyroid carcinomas. Papillary ca. is without doubt the best behaved type. The aim of the present work is to perform a retrospective case history study to assess patients with con papillary ca. who have been treated surgically over the last 17 years and have been subjected to periodic checks. A sample of patients was therefore extrapolated who had all undergone total thyroidectomy for papillary ca. of the thyroid. The incidence of local recurrence of the disease was verified, together with the results at distance. Furthermore, the assessments performed were evaluated and compared. From the sample of patients observed we inferred that papillary carcinoma of the thyroid can have a good prognosis over time provided periodic random checks are carried out.

Adolescent↗
PubMed1997

Oncogenes and antioncogenes involved in human thyroid carcinogenesis.

The development of cancer is due to the accumulation of multiple somatic mutations, in some cases following germline mutations, which occur in hereditary malignancies such as retinoblastomas or multiple endocrine neoplasia (MEN 2A and B). Genetic alterations or changes in the expression of growth regulatory genes can lead to the initiation of malignant transformation and to eventual tumor progression. Cells that have undergone these cumulative alterations in either the structure or expression of these regulatory genes generally possess a selective growth and/or metastatic advantage over other normal non-transformed cells. Thus, activation of dominantly transforming oncogenes by point mutations, gene amplification, chromosomal translocation or insertional mutagenesis can lead to uncontrolled cellular growth or to a disruption in normal differentiation or apoptosis. Equally contributory to the process of malignant progression is the inactivation of recessive tumor suppressor genes due to point mutations and/or loss of heterozygosity in one allele, which can ultimately lead to a reduction of homozygosity in both alleles. Thyroid tumors in humans represent a particularly suitable multistage model of epithelial tumorigenesis. In fact, even though most thyroid neoplasms originate from a single cell type, i.e. the thyroid follicular cell, they include a broad spectrum of tumors with different phenotypic characteristics and variable biological and clinical behaviour. Multiple degrees of malignancies have been defined: from the benign colloid adenomas through the slowly progressive differentiated papillary and follicular carcinomas to the invariably fatal anaplastic carcinomas, although these histological changes are not necessarily sequential. In this review an effort has been made to summarize and integrate new data published on genetic lesions and altered expression of genes involved in the tumorigenesis of the follicular type of thyroid cancer. We have focused our interest only on gene alterations inducing gain or loss of function, that have been studied in vivo in human thyroid tumor specimens by the use of different techniques, such as PCR mediated DNA analyses, sequencing, mRNA level evaluation and protein expression by immunohistochemical staining.

Genes, Tumor Suppressor↗