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[Medullary carcinomas of the thyroid. General review apropos of 3 further cases].

The authors report of three cases of medullary carcinoma of the thyroid and, from a review of the literature, study the definition, frequency, embryological and etiological characteristics of this disease. The physiology of thyrocalcitonin, the concept of the APUD system the secretion of active substances by the tumour cells are considered. The macroscopic and microscopic characteristics and its mode of spread are described. The two main clinical forms, the sporadic form and the familial form are described together with the other endocrine involvements. Among the factors in positive diagnosis, accent is placed on per-operative histological examination and on biological tests of familial detection. Among the forms of treatment the essential place of surgery explains partly the relatively favourable course and prognosis of the malignant disease.

Adult↗

[Malignant apudoma (argyrophilie carcinoma) of the uterine cervix in a 24-year-old woman in pregnancy].

Report on a case of the malignant APUDOMAP (argyrophil cell carcinoma) of the uterine cervix in a 24-years old women. The tumor appeared during the third pregnancy and fatal generalization resulted cca three month after operative delivery and panhysterectomy. Histologically argyrophil cells were proved both in the primary localization and distant metastases (liver, lymph nodes, ovaries, brain, meninges, skeleton). In the electron microscope of the bioptic specimen specific granules and microfilaments were identified in some tumour cells supporting the diagnosis of a cancer of the APUD-series. Some general features of primary cervical APUDOMAS also outlined.

Adult↗

Radionuclide imaging of neuroendocrine tumours: biological basis and diagnostic results.

Neuroendocrine tumours have been defined as APUD-omas in the past by authors who identified common metabolic characteristics (amine precursor uptake and decarboxylation) in a group of tumours thought to originate from cells of the neural crest and to be able to produce biogenic amines. The identification of neuroendocrine tumours with APUD-omas was not confirmed by subsequent investigators. At present it is known that a group of neuroendocrine tumours derive from pluripotent stem cells or from differentiated neuroendocrine cells, and that they have a particular pattern of histology due to the presence of some secretory products and particular cytoplasmic proteins. Many radiopharmaceuticals have been successfully used in nuclear medicine to visualise neuroendocrine tumours; most of them are based on specific uptake mechanisms, but some are non-specific probes. This review is focussed on the clinical application of radiolabelled metaiodobenzylguanidine, indium-111 pentetreotide, radiolabelled vasointestinal peptide, radiolabelled monoclonal antibodies and positron-emitting tracers. While many different types of neuroendocrine tumours are identified today, only the most common histotypes and those tumours of major relevance for nuclear medicine are considered in this review (anterior pituitary tumours and neuroblastoma are excluded). New knowledge in molecular biology, relevant biological and histological patterns, and the physiological and clinical behaviour are described for neuroendocrine tumours of the lung, tumours of the gastroenteropancreatic tract, medullary thyroid carcinoma, tumours of sympatho-adrenal lineage, and multiple endocrine neoplasia. The nuclear medicine results in diagnostic imaging are presented, and the major comparative studies with different tracers are reported. The study of further possible diagnostic approaches addressing the biological characteristics of these tumours could open the way to various new therapeutic options.

Humans↗

[Total hip arthroplasty for metastatic Merkel cell carcinoma].

Merkel cell carcinoma is an extremely rare malignant tumor which derives from the neuroendocrine cell system with features of epithelial differentiation. It belongs to the APUD-system (amine and precursor uptake and decarboxylation) and is characterized by highly aggressive spread with a predisposition for local recurrence and local regional and distant metastases. Metastatic spread to the hip has not been described in the literature before. We report on a 76-year old male patient with metastases of the left femoral head and greater trochanter 3 1/2 years after excision of a Merkel cell carcinoma of the left thigh with consecutive radical lymph node dissection of the left inguinal area and radiation therapy. Although microscopic,immunohistological and ultrastructural characteristics of the carcinoma have been well defined, there are no established treatment guidelines and prognostic factors that may predict the behaviour of the tumor due to the limited number of cases. Elective lymph node dissection decreases the rate of local recurrence but is not associated with improved overall survival. At the time of establishing the diagnosis, about half of the patients has positive lymph nodes with a 3-year-survival rate of 60%.

Aged↗

Clinical significance of the association of the Von Hippel-Lindau disease with pheochromocytoma and pancreatic apudoma.

Von Hippel-Lindau disease (VHLD) is a rare disorder known to occur with pheochromocytoma. We report a case with this association and also with pancreatic apudoma. We believe that this is the fifth reported case of this triad, which represents an overlap in the multiple endocrine neoplasia (MEN) classification. Many recent reports of overlap of MEN syndromes challenge the validity of this classification. New understanding of the embryologic origin of cells of endocrine organs has led to the elucidation of the APUD (amine precursor uptake and decarboxylation)-neuroendocrine system. Integration of the APUD system may be important to understanding the pathogenesis of the MEN-like syndromes as well as their relationship to the neurocutaneous syndromes. Any endocrine tumor or neurocutaneous syndrome should be evaluated to exclude a spectrum of possible associations.

Adult↗

[Chronic diarrhea caused by VIP-secreting ganglioneuroblastoma in children. Apropos of a case with a review of the literature].

A literature review was conducted in relation to a case of chronic diarrhea associated with a VIP (vasoactive intestinal polypeptide) producing ganglioneuroblastoma (GNB), in an 18-month old female baby. This is a rare entity characterized by premonitory, persisting diarrhea, causing fluid and electrolyte changes typical of the WDHA syndrome, associating watery diarrhea, hypokalemia, and achlorhydia. Elevated VIP plasma levels are an indication for an echographic and/or CT-scan search for the causal secreting tumor. Although the prognosis of this condition seems favorable, the recommended treatment is surgery. The VIP substance represents an excellent biological monitoring marker. Ganglioneuroblastomas are tumors of the sympathetic nervous system, which, according to Pearse's cell and embryologic theory (1966), have to be linked to the APUD system tumors (paraneuromas). VIP-producing forms are rare in children, and only 29 case studies have been compiled in the literature since 1970, when the VIP substance was discovered. The case reported in this study illustrates the diagnostic problems raised by such lesions, and allows us to confirm VIP's imputability for the occurrence of the chronic diarrhea condition in this child.

Chronic Disease↗

The diffuse neuroendocrine system and the apud concept: related "endocrine" peptides in brain, intestine, pituitary, placenta, and anuran cutaneous glands.

A number of peptides, closely related in terms of their amino acid sequences, have been found to occur in the gastroenteropancreatic system on the one hand and in the brain on the other. A common range of peptides links the pituitary gland and the placenta and 4 groups of peptides, found in anuran cutaneous glands, are related to the brain and intestinal peptides of mammals. The cells responsible for the production of these peptides, in whatever situation they occur, belong to the APUD ("Amine Precursor Uptake and Decarboxylation") series and they share a number of cytochemical and ultrastructural characteristics which reflect their functional similarities. It was originally suggested that the production of common peptides could be explained on the basis of the origin of the cells from a common ancestor. It is now postulated rather that, being derived at different periods of time from the embryonic epiblast--or perhaps, more accurately, ectoblast--they share a common neuroendocrine programme which is manifested by their possession of the acronymous amine-handling characteristics of the series and whose final expression is determined by microenvironmental circumstances. The APUD concept thus links together a whole spectrum of peptides some of which are hormones, or local hormones, others neurotransmitters and yet others probably exotoxins. Its implications are widespread, and far reaching, affecting most disciplines in the field of medical biology.

Amino Acid Sequence↗

Dopamine effect on the mitochondria potential in B lymphocytes of schizophrenic patients and normal controls.

Brain metabolic abnormalities and aberrant dopamine (DA) metabolism have been reported in patients with schizophrenia. The authors hypothesized that mitochondria is a primary target of damage by increased free radical generation secondary to increased DA metabolism by monoamine oxidase (MAO). Epstein-Barr virus (EBV)-transformed human B-lymphocytes cell lines derived from patients with schizophrenia and normal controls were incubated in the absence or presence of DA, hydrogen peroxide (H2O2), or rotenone (Rot). The cells were then stained with rhodamine 123 (Rh 123) and analyzed for uptake using flow cytometry. Compared with untreated cells, DA significantly decreased Rh 123 uptake by the mitochondria. This effect was similar to the control cells treated with H2O2 or Rot. Nevertheless, there were no differences in Rh 123 uptake between the cells of schizophrenic patients and normal controls. This study shows that DA can impair the mitochondria membrane potential but that mechanism may not be evident in schizophrenia.

B-Lymphocytes↗

Regulatory peptides and other neuroendocrine markers in medullary carcinoma of the thyroid.

Medullary thyroid carcinoma (MTC) is an APUDoma (APUD refers to amine precursor uptake and decarboxylation) arising from the parafollicular cells. Diarrhoea has been reported in some 30% of patients, variously attributed to excess production of calcitonin (CT), serotonin (5-HT), vasoactive intestinal peptide (VIP) or other factors. The regulatory factors in MTC were examined employing immunocytochemistry and RIA to tumours and their extracts. The patients were followed up for more than 15 years. CT and calcitonin gene-related peptide were universally expressed in all the tumours. The neuroendocrine markers chromogranin A (and its fragments pancreastatin and WE-14), neurone-specific enolase, protein gene product 9.5 and carcino-embryonic antigen were found in the majority of MTCs and might be useful as immunocytochemical markers. 5-HT, substance P, neurokinin A, glucagon and VIP could not be detected, excluding them as candidates in the diarrhoea of MTC.

Apudoma↗

[Pulmonary oncocytic carcinoid--a case report].

A pulmonary oncocytic carcinoid arising from the medial basal segment of the right lung is presented. The abundant oncocytic granules in the cytoplasm were observed by light-microscope. The ultrastructure by electronmicroscope showed that these granules originated from the hyperplasia of mitochondria, and there were membrane-bordered electric dense core granules (neuro-secretive granule) in the cytoplasm of this tumor. According to the morphological features observed by light and electronmicroscope, this tumor is considered as a subtype of bronchial carcinoid and belongs to the APUD system which should be differentiated from the metastatic tumor, the granular cell myoblastoma and the chemodectoma of lung.

Carcinoid Tumor↗

[Establishment of human small cell lung carcinoma cell line (LTEP-sm 1) in nude mice and in vitro].

A serially transplatable tumor model was established by inoculating subcutaneously the surgical specimen of a patient with mixed type small cell lung carcinoma into nude mice (BALB/C nu/nu). A human small cell lung carcinoma cell line cultured in vitro was established from that tumor in nude mice. The cultured cell line gave a typical growth pattern with small round feature, cell clusters in suspension and float growth. Pathological sections of both the patient's tumor and transplantable tumor in nude mice showed the same morphological features. The typical APUD granules were observed in electron transmission microscopy. The transplantable tumor has been transferred for 9 passages in 14 months and the cell line in vitro for 71 passages in nearly one year.

Animals↗

[Histogenesis of adenomas of the parathyroid gland].

The similarity of adenomas of the parathyroid gland with other tumours of the APUD-system elements was investigated. The structure of 10 adenomas was studied. The ultrastructural characteristics were compared with the histological structure of the tumour. Various histological variants of the neoplasias were shown to have similar ultrastructure. The tumour tissue was represented by clear transitional and dark cells. In their cytoplasm, osmiophilic granules of the secrete, villae, laminar structures resembling Nissl bodies, fine granular and fine fibrous substances, and lipid inclusions were found. The structural similarity of adenomas with other endocrine-active tumours developing from cells of the neuroectodermal origin (carcinoids, paragangliomas, etc.) was noted. It is suggested that parathyroid glands belong to the APUD-system.

Adenoma↗

Carotid body tumors: a 40-year study.

A total of 44 carotid body tumors were observed for over 40 years at Memorial Sloan-Kettering Cancer Center in New York. The true nature of th paraganglioma can remain obscure in those patients without prior tissue biopsy or sophisticated diagnostic studies. Eighteen patients came to surgery without a primary working diagnosis of the conditions, 43 percent of the seris. Significant advances in the preoperative workup of a cervical mass attached to the carotid sheath are now recommended: ultrasonography, radioisotope perfusion scanning, and selective carotid arteriography. Catecholamine determination should be considered for any paraganglioma exhibiting vasomotor instability or hypertension. Prior to 1945 the carotid bifurcation was sacrificed eight times with a 50 percent mortality occurring in relatively youthful subjects. In the 35 years since then, a more sophisticated surgical technique preserving the carotid circulation has resulted in over 30 resections with but one fatality. Multicentricity, both in the sporadic and the familial form, is characteristic of this rare tumor, also called "APUDoma." (APUD is an acronym derived from three of the most important characteristics of these cells: a high amine content, amine precursor uptake, and decarboxylation. Its malignant potential is beyond debate.

Adult↗

New techniques and tumor nomenclature.

New techniques in pathology can effect tumor nomenclature by leading to new concepts which may then give rise to new terms. Pathologists generate morphological data. They are obliged to provide consistent data for those who depend on standardized terms, eg, clinical trials, tumor registries and practising physicians and surgeons. They face the dilemma of when to replace a standard term with a new term. The following are recent examples of situations in which new techniques have had an impact on tumor nomenclature but which have raised questions about the applicability of new terms in routine diagnostic reports: --tumors of the lung, particularly when studied by electron microscopy: should the ultrastructural heterogeneity of lung tumor types be expressed or ignored in routine diagnosis? --the APUD and neuroendocrine carcinoma concepts: is there a need to rename carcinoids and small cell carcinomas? --endocrine elements in carcinomas: are the following terms useful for diagnosis: amphicrine carcinoma, argentaffin cell carcinoma, biphenotypic carcinoma? The recognition that conceptual terms and descriptive terms have separate functions may help pathologists deal with terminological change.

Adenocarcinoma↗

[Nonmedullary apudoma of the thyroid gland].

Eight apudomas of the thyroid gland with nonmedullary structure are described. Their structures were of the follicular-solid, papillary cancer, B-cellular, and microfollicular adenoma types, whereas their cells were impregnated with silver salts which was the inherent property of the APUD-system elements.

Apudoma↗

An unusual clinical course of a hormone-secreting gastrointestinal tumor: a case presentation from clinical practice.

The gastrinoma was first described in 1955 by the surgeons Zollinger and Ellison. The basic characteristic of this disease is an endocrine tumor of the gastrointestinal tract, which secretes gastrin. There is a hypersecretion of gastric juice and recurrent gastric, duodenal and jejunal ulcers. Herein, the case of a 49 year-old female is presented. In 1982, two liver tumors, sized 10 and 6 cm, were discovered in the right and left lobes of the liver, respectively. A duodenal ulcer was also found. During explorative laparotomy, a liver biopsy specimen was obtained and defined pathohistologically as a metastatic, small cell epithelial tumor with an organoid endocrine pattern, morphologically corresponding to tumors of the APUD (Amine Precursor Uptake and Decarboxylation) series. The gastrinoma was verified by immunohistochemical staining. Serum gastrin values exceeded normal values by 10 times. The patient refused further treatment at that time. In the following years, she was treated conservatively several times for sequelae of ulcer disease. For the past three years, she has been treated as an outpatient, mostly for chronic diarrhea.

Female↗