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PubMed1989

The role of the saccomano technique in sputum cytopathologic diagnosis of lung cancer.

The Saccomanno technique of sputum preparation is widely used. This study evaluates the role of this preparation in conjunction with fresh smears in the diagnosis of lung cancer. All sputum samples from September 1973 to July 1975 showing atypia were randomized and negative controls added. The Saccomanno and fresh smears were evaluated independently and blindly and classified as negative, atypical, suspicious, or cancer. When each preparation was compared with the original diagnosis, the diagnostic accuracy for 55 squamous carcinomas was similar (fresh 95%, Saccomanno 86%) but significantly less in the Saccomanno preparations of 22 small cell carcinomas (fresh 100%, Saccomanno 24%) and 26 adenocarcinomas (fresh 96%, Saccomanno 52%). Four cases negative on fresh smears were suspicious or diagnostic of cancer on the Saccomanno slides. There were no cases of small cell carcinoma in which the Saccomanno preparations added information not available on the fresh smears. The authors conclude that in conjunction with fresh smears, the Saccomanno preparation may contribute to the diagnosis of non-small cell carcinomas but does not appear to aid in the diagnosis of small cell carcinoma.

Adenocarcinoma↗
PubMed1997

Prostate cancer: relative effects of demographic, clinical, histologic, and MR imaging variables on the accuracy of staging.

PURPOSE: To determine the effects on the accuracy of staging prostate gland cancer of diagnostic prediction rules based on demographic, clinical, histologic, and magnetic resonance (MR) image variables. MATERIALS AND METHODS: A total of 200 cases from four medical centers were evaluated by nine radiologists experienced in MR imaging. The accuracies of the four diagnostic variables (age, prostate specific antigen level, Gleason tumor grade, and MR imaging findings) were measured, both singly and combined in a particular sequence, by calculating the area index of the receiver operating characteristic curve. RESULTS: The accuracy of staging with single variables (age, 0.58; prostate specific antigen level, 0.74; Gleason grade 0.73, MR image findings, 0.74) increased as the variables were optimally merged. The first two variables combined to yield an accuracy of 0.74; the first three combined to yield an accuracy of 0.81; and all four variables resulted in an accuracy of 0.86. In a clinically important subset of 69 cases for which antigen level and Gleason grade together were inconclusive for the purposes of staging, the addition of MR imaging findings resulted in an increase in accuracy from 0.55 to 0.73. CONCLUSION: Optimal merging of diagnostic test results yields an improvement in the accuracy of prostate cancer staging.

Age Factors↗
PubMed1999

[Papillomaviruses and herpesviruses as selected risk factors in the etiopathogenesis of cervix neck cancer. I. Use of nucleic acid hybridization for diagnosing HPV infections].

HPV infections are regarded as the main etiological factor responsible for the presence of cytological abnormalities and the primary risk factor for cervical cancer development. Diagnostic materials were collected between 1995 and 1997 in the Gynecologic Cancer Prevention, Cancer Center Institute of Oncology, Memorial Hospital Maria Skłodowska-Curie, Warsaw. The patients were divided into three groups: group C--women suspected for viral infection during clinical or cytological examination and two comparative groups A and B--women invited for routine cytological examination. Cytological smears for nucleic acid hybridisation collected before cytological smear sampling with a dacron swab (groups A and C) or collected after cytological smear sampling with a cervical brush (group B) were used. Cytological and clinical data was also used in the investigation. In 52% of the 236 samples tested by nucleic acid hybridisation HPV DNA was found to be present. DNA from the high/intermediate HPV risk group was also present in 36% of the samples and in 11% of the samples from the low risk HPV group. In 5% of the samples we confirmed the presence of mixed infections from both HPV risk groups. The results obtained from nucleic acid hybridisation with pap smear results were compared. It was observed that HPV infections from the high risk group occurred more frequently in pap 3 and pap 4 test results; HPV infections from the low risk group occurred more frequently in pap 1 and pap 2 results, while mixed infections from both risk groups occurred particularly in pap 4 and pap 5 results. Women in the 35-45 age groups suffered more frequently from infections from the high/intermediate risk group. In the 25-35 and 55-65 age groups HPV infections from the low risk group occurred more frequently. In the comparative groups only 2.6% of the women were infected with HPV.

Adult↗
PubMed2000

[Expression of VEGF, KDR, p53, E6 HPV16 and HPV18 in vulvar and cervix cancer].

The aim of the study was a comparison of expression of angiogenesis genes: vascular endothelial growth factor (VEGF), KDR, suppressor gene p53, E6-HPV16 and HPV18, in tissue samples of normal, dystrophic, lymph nodes and malignant cancers of vulva and uterine cervix. The results demonstrate that molecular diagnostics of cancers using gene expression profiling indicates the definitive difference in expression profiles of aforementioned genes in tissues of the same malignancy.

Carcinoma, Squamous Cell↗
PubMed2005

[A survey on the diagnosis and treatment of biliary tract cancers in Shanghai].

OBJECTIVE: To survey the status of diagnosis and treatment of biliary tract cancer in Shanghai. METHODS: A clinical epidemiology investigation was carried out on 658 new cases of biliary duct cancers aged 35-74, that registered between June 1997 and May 2001 in urban Shanghai. Clinical findings were collected in 390 gallbladder cancer, 195 bile duct cancer and 73 ampullary cancer. RESULTS: Biliary tract cancers mainly occurred in elderly patients. Ratio of males to female was 1:2.61 in gallbladder cancer, while bile duct cancer and ampullary cancer were slightly more common in men. Association with gallstones was 68.5%, 43.1% and 22.4% for gallbladder cancer, bile duct cancer and ampullary cancer, respectively. Diagnostic accuracy rate of B-ultrasonography was 63.1% in gallbladder cancer. Incidental gallbladder cancer accounted for 20%, while stage IVA and IVB patients reached up to 43.6%. Misdiagnosis rate was still high in bile duct cancer and ampullary cancer, it was 19.1% and 47.1% respectively. In addition, most patients presented jaundice at diagnosis. 69 cases (18.2%) of gallbladder cancer, 50 cases (25.6%) of bile duct cancer and 54 cases (74%) of ampullary cancer underwent radical resection, the 1-, 3- and 5-year survival rates were 58.5%, 42.8% and 40.7%, 58%, 28.3% and 11.1%, 81.5%, 39.2% and 26.9%, respectively. 79 patients with bile duct cancer underwent palliative drainage, and most cases died within 1 year. Metal endo-prostheses or plastic stents were placed into the biliary tract in 38 patients. The median survival was about 7 months. CONCLUSIONS: It is difficult to make early diagnosis of biliary tract cancers. Standardization of the operation for gallbladder cancer must be respected. Surgical exploration should be undertaken when a bile duct cancer is suspected and there are no contraindications to surgery. Pancreatoduodenectomy should be recommended for ampullary cancer.

Biliary Tract Neoplasms↗
PubMed1990

Male breast carcinoma: review of a multicenter series of 150 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

The authors report on a consecutive retrospective series of 150 male breast cancers. Clinical, diagnostic and therapeutic features are compared over time and with respect to a large consecutive series of female breast cancers. Both age at diagnosis and tumor stage were more advanced in males than in females. Poor alertness of both men and doctors for this infrequent disease may account for such a delay in diagnosis. The use of mammography increased over time and sonography or cytology were frequently and successfully employed in the last decade. Unfortunately no improvement of tumor stage at diagnosis was observed over time in the present series. A time trend was also evident for the type of surgical and postoperative treatment. Modified radical mastectomy and adjuvant chemo- or hormone therapy were increasingly adopted, although Halsted operation and postoperative radiotherapy were still common in the last decade due to the relatively high proportion of locally advanced T3-4 cancers. Both disease-free and overall survival were worse in men than in women, even after adjustment by stage at diagnosis. This study suggests that male breast cancer has a worse prognosis with respect to female breast cancer and provides no complete explanation of this finding, except for an intrinsic higher aggressivity. No evidence was found which may justify a different diagnostic or therapeutic approach with respect to female breast cancer.

Adult↗
PubMed2002

Colorectal cancer screening with double-contrast barium enema: a national survey of diagnostic radiologists.

OBJECTIVE: This article describes diagnostic radiologists' colorectal cancer screening activities and beliefs about screening effectiveness and future capacity for screening with double-contrast barium enema, and compares radiologists' opinions about colorectal cancer screening with those of primary care physicians. MATERIALS AND METHODS: We surveyed a nationally representative sample of diagnostic radiologists. Of 381 eligible radiologists, 312 (82%) responded. Descriptive statistics and chi-square tests were used to assess radiologists' opinions about double-contrast barium enema volume and capacity and to compare radiologists' beliefs about colorectal cancer screening with those of primary care physicians. Logistic regression was used to identify characteristics of radiologists who receive referrals for or perform a higher volume of screening double-contrast barium enema and of those who expect the volume of double-contrast barium enemas to increase. RESULTS: Seventy-five percent of radiologists said that double-contrast barium enema is a "very effective" colorectal cancer screening procedure compared with 33% of primary care physicians. Although 86% of radiologists reported performing one or more screening double-contrast barium enema procedures during a typical month, only 27% indicated that they did so 11 or more times. Fifteen percent of radiologists said that their double-contrast barium enema volume had increased over the past 3 years, and 50% expect an increase over the next 3 years. Only 8% said that the capacity of facilities and personnel to meet the demand for double-contrast barium enemas in their geographic area of practice is inadequate. Geographic region and belief in double-contrast barium enema efficacy were predictors of double-contrast barium enema volume and referrals. CONCLUSION: Most diagnostic radiologists perform colorectal cancer screening with double-contrast barium enema, but procedure volumes are modest. Because primary care physicians view double-contrast barium enema less positively than do radiologists, radiologists' expectations for an increased volume of double-contrast barium enemas over the next few years may not be realized.

Adult↗
PubMed2005

Personalised medicine for cancer: from drug development into clinical practice.

Personalised management of cancer means the prescription of specific therapeutics that are best suited for an individual patient and the type of tumour. Molecular diagnostics influences cancer management in several ways that aid personalisation. These technologies are enabling the classification of cancer, using molecular profiles, as a basis for more effective personalised therapies. Using microarrays, classification of a cancer based on the gene expression profile is important for personalising cancer therapy. Molecular imaging, such as by positron emission tomography, enables determination of tumour response to drug action at the molecular level. The combination of diagnostics with therapeutics--an important feature of personalised cancer therapy--is facilitated by the use of monoclonal antibodies and nanobiotechnology. Development of drug resistance--an important problem in cancer management--varies according to the anticancer agent, type of tumour and individual patient. There are no universal strategies to overcome drug resistance in cancer. Various efforts to deal with this problem should be tailored to each patient, and examples are given in this review. A better understanding of cancer biology will facilitate rational drug discovery for cancer, by linking the various pathways involved to targeted therapies. Oncoproteomics will play an important role in the development of personalised cancer therapy. Use of pharmacogenomic technologies in early clinical trials is enabling rapid assessment of the efficacy of anticancer agents, and reducing the time of drug development. Application of pharmacogenetics will reduce the adverse effect of anticancer drugs. Cell/gene therapies, cancer vaccines and RNA interference will facilitate the development of personalised cancer therapy.

Animals↗
PubMed1985

[Lymphatic invasion of cancers of the oral cavity. A diagnostic strategy].

The diagnostic of ganglionnary invasion in oral cancer is established throughout the histological investigation practiced during the operation. This histological inquiry has to be rigorous and logical, in conformity with the anatomical particularities of the drainage tubes of the oral mucous. The accurate execution of this diagnostical strategy applied to the ganglionnary invasion improves the prognostic but requires a good logistic support.

Humans↗
PubMed2002

Performance of diagnostic mammography for women with signs or symptoms of breast cancer.

BACKGROUND: The performance of diagnostic mammography for women with signs or symptoms of breast cancer has not been well studied. We evaluated whether age, breast density, self-reported breast lump, and previous mammography influence the performance of diagnostic mammography. METHODS: From January 1996 through March 1998, prospective diagnostic mammography data from women aged 25-89 years with no previous breast cancer were linked to cancer outcomes data in six mammography registries participating in the Breast Cancer Surveillance Consortium. We used the final mammographic assessment at the end of the imaging work-up to determine abnormal mammographic examination rate, positive predictive value (PPV), sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. We used age, breast density, prior mammogram, and self-reported breast lump jointly as predictors of performance. All statistical tests were two-sided. RESULTS: Of 41 427 diagnostic mammograms, 6279 (15.2%) were judged abnormal. The overall PPV was 21.8%, sensitivity was 85.8%, and specificity was 87.7%. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased (P =.007 and P<.001, respectively), that previous mammography decreased sensitivity (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.36 to 0.74; P<.001) but increased specificity (OR = 1.43, 95% CI = 1.31 to 1.57; P<.001), and that a self-reported breast lump increased sensitivity (OR = 1.64, 95% CI = 1.13 to 2.38; P =.013) but decreased specificity (OR = 0.54, 95% CI = 0.49 to 0.59; P<.001). ROC analysis showed that higher breast density and previous mammography were negatively related to accuracy (P<.001 for both). CONCLUSIONS: Diagnostic mammography in women with signs or symptoms of breast cancer shows higher sensitivity and lower specificity than screening mammography does. Higher breast density and previous mammographic examination appear to impair performance.

Adult↗
PubMedDate not supplied

MR spectroscopy as a reliable diagnostic tool for localization of prostate cancer.

BACKGROUND: Magnetic resonance spectroscopy (MRS) is a new diagnostic tool which allows the detection of cellular metabolites. We assessed the usefulness of single- voxel MRS diagnosis for localization of prostate cancer. PATIENTS AND METHODS: The study population consisted of 10 patients with prostate cancer. We set I or 2 voxels at the peripheral zone (PZ) of the prostate where biopsy had confirmed adenocarcinoma. MRS provided metabolic information about citrate, creatine and choline levels. We calculated the ratio of these metabolites ([choline + creatine]/citrate) and judged areas where the metabolic ratio was greater than 0.86 as positive. RESULTS: Thirteen out of 19 voxels showed a cancer pattern which indicated a high choline peak and low citrate peak The accuracy, sensitivity and specificity of MRS diagnosis of tumor localization were 84.2%, 81.3% and 100%, respectively. CONCLUSION: MRS is useful for the diagnosis of prostate cancer localization.

Adenocarcinoma↗
PubMed2001

Biochip technologies in cancer research.

Development of high-throughput 'biochip' technologies has dramatically enhanced our ability to study biology and explore the molecular basis of disease. Biochips enable massively parallel molecular analyses to be carried out in a miniaturized format with a very high throughput. This review will highlight applications of the various biochip technologies in cancer research, including analysis of 1) disease predisposition by using single-nucleotide polymorphism (SNP) microarrays, 2) global gene expression patterns by cDNA microarrays, 3) concentrations, functional activities or interactions of proteins with proteomic biochips, and 4) cell types or tissues as well as clinical endpoints associated with molecular targets by using tissue microarrays. One can predict that individual cancer risks can, in the future, be estimated accurately by a microarray profile of multiple SNPs in critical genes. Diagnostics of cancer will be facilitated by biochip readout of activity levels of thousands of genes and proteins. Biochip diagnostics coupled with informatics solutions will form the basis of individualized treatment decisions for cancer patients.

Computational Biology↗
PubMed2003

Breast cancer biomarkers and molecular medicine.

The first part of this two-part review of established and emerging breast cancer biomarkers and molecular diagnostics considers breast cancer predisposition, screening tests for diagnosis, diagnosis using small specimens and metastatic lesions, micrometastatic disease and breast cancer prognosis assessment. Prognostic factors covered in this review include: cytogenetic markers, DNA ploidy and S phase determination, cell proliferation markers, cell cycle regulators and growth factor measurements including epithelial growth factor receptor, HER-2/neu and a variety of other relevant molecules controlling proliferation, differentiation and angiogenesis. The first section of part two will continue the consideration of breast cancer prognostic factors including oncogenes, tumor suppressor genes, cell adhesion molecules, invasion-associated proteins and proteases, hormone receptor proteins, drug resistance proteins, apoptosis regulators, transcription factors, telomerase, DNA repair and methylation and transcriptional profiling using high-density genomic microarrays. The second section of part two will consider the prediction of therapy response using the techniques of pharmacogenetics and pharmacogenomics.

Antibodies, Monoclonal↗
PubMed1993

Prognostic factors for local recurrence in breast conservation therapy: residual cancers after lumpectomy.

In order to evaluate the local residual cancer following breast conservation therapy (BCT) with lumpectomy, we investigated the relationships between residual cancer and age, tumor location, tumor diameter (T), mammography findings, nipple discharge findings, histopathological type, lymphatic and/or vascular invasion by tumor cells, histological grading, histological lymph node metastases (n), and estrogen receptor (ER) status, in 1494 patients with breast cancer that involved diagnostic excisional biopsy. Residual cancers were found in 581 of 1448 (40%) mastectomy specimens, after 46 (3.1%) with multicentricity had been excluded. No correlation was observed between residual cancer and age, histological grading, and ER. However, residual cancer rates were significantly higher in patients with: (1) tumor diameters of 3.1 cm or larger; (2) tumors beneath or in the vicinity of the nipple-areola; (3) malignant calcifications noted in mammography findings; (4) serous or bloody nipple discharge, particularly with positive cytologic findings; (5) papillotubular carcinoma diagnosed by biopsy, (6) lymphatic invasion by tumor cells; or (7) a high degree (n > or = 4) of lymph node metastases. The above seven clinicopathologic factors are thus considered useful prognostic indicators for local recurrence in BCT with lumpectomy.

Adult↗
PubMed1999

Total and transition zone prostate volume and age: how do they affect the utility of PSA-based diagnostic parameters for early prostate cancer detection?

OBJECTIVES: To define the role of total prostate (TP) volume, transition zone (TZ) volume, and age as determinants of the utility of prostate-specific antigen (PSA)-based diagnostic parameters for early detection of prostate cancer (PCa) in a prospective multicenter study. METHODS: The study participants were 974 consecutive men with serum total PSA (tPSA) levels of 4 to 10 ng/mL who were referred for early PCa detection or lower urinary tract symptoms. All patients underwent prostate ultrasound examination and sextant biopsy with two additional TZ biopsies. In patients with negative initial biopsies, repeated biopsies were performed at 6 weeks. tPSA, the free/total PSA ratio (f/t PSA), PSA density of the TZ (PSA-TZ), PSA density (PSAD), and PSA velocity (PSAV) were determined and compared across TP volume strata of 30 cm3 or less and greater than 30 cm3, TZ volume strata of 20 cm3 or less and greater than 20 cm3, and various age groups to evaluate the need for volume and/or age-specific reference ranges. RESULTS: PCa was found in 345 (35.4%) of 974 patients and benign prostatic tissue was found in 629 (64.6%) of 947 patients. Across TP volume strata, significantly higher values of tPSA (P <0.01), PSA-TZ, PSAD (P <0.001), and PSAV (P <0.05) and lower values of f/t PSA (P <0.001) were observed in patients with PCa than in those without PCa. Similar results were obtained with respect to TZ volume strata, except in the case of PSAV (P <0.05). tPSA, PSA-TZ, and PSAD were significantly higher (P <0.05) in patients with PCa than in those without PCa for all corresponding age ranges. In patients with PCa, f/t PSA was significantly lower (P <0.001) within the same age ranges. Within each group (PCa or benign), f/t PSA, PSAD, PSA-TZ, and PSAV values were unaffected by age strata. However, PSA parameters dependent on prostate volume (PSAD, PSA-TZ) were statistically lower (P <0.001) in prostates with a higher TP volume (greater than 30 cm3) and TZ volume (greater than 20 cm3); f/t PSA values were unaffected by TP and TZ volumes. CONCLUSIONS: f/t PSA and PSA-TZ were the most powerful parameters to differentiate between benign prostatic tissue and PCa. f/t PSA was the sole parameter unaffected by age and prostate volume. We believe new volume-specific cutpoints, as presented in the current study, should be employed when using PSAD and PSA-TZ for the early detection of PCa.

Adult↗
PubMed2002

Usefulness of prostate-specific antigen velocity in screening for prostate cancer.

BACKGROUND: The cut-off value of prostate-specific antigen velocity (PSAV) was investigated in relation to the initial prostate-specific antigen (PSA) value in subjects with initial values of 1.0-4.0 ng/mL, and the usefulness and limitations of PSAV as a screening test for prostate cancer were examined. METHODS: In this study, 4883 men who underwent mass screening for prostate cancer two or more times between 1987 and 1998 and had initial PSA levels of 1.0-4.0 ng/mL were investigated. The subjects ranged in age from 42 to 96 years (mean: 68.0 +/- 6.6 years). The cut-off value of PSAV was set at 0.1-1.5 ng/mL per year, and the sensitivity, specificity, efficiency and positive predictive value (PPV) of PSAV for detecting prostate cancer were determined according to the initial PSA value. A similar examination of the average PSAV was carried out in 2888 subjects with three or more visits for mass screening for prostate cancer. RESULTS: The diagnostic efficiency of PSAV was optimal with cut-off values of 0.3 and 0.75 ng/mL per year in those subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 1.8% in subjects with initial PSA levels of 1.0-1.9 ng/mL. When the cutoff value of PSAV was set at 1.2 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV increased to 7.3% and the sensitivity was 40%. The diagnostic efficiency of the average PSAV was optimal at the cut-off values of 0.2 and 0.4 ng/mL per year in subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 2.2% in the subjects with initial PSA values of 1.0-1.9 ng/mL. When the cut-off value of PSAV was set at 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV was 9.8% and the sensitivity was 46%. CONCLUSION: It is possible to improve the diagnostic accuracy of prostate cancer screening using the cut-off value of PSAV and average PSAV in subjects with initial PSA levels of 1.0-4.0 ng/mL. The cut-off values of PSAV should be set at 1.2 and 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively. The cut-off values of the average PSAV should be set at 0.75 and 0.4 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively.

Adult↗
PubMed1995

Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan.

Seventeen patients with papillary thyroid cancer whose serum thyroglobulin (Tg) levels were elevated when hypothyroid, but whose diagnostic whole body scans were negative, were treated with 150-300 mCi 131I. All patients had total thyroidectomy and 131I ablation for thyroid remnants. Before the study, 9 patients had 131I therapy for tumor recurrence and/or metastases, and 5 patients had excisions of nonfunctioning metastasis. Radiological studies did not reveal evidence of metastases. In the initial evaluation, Tg levels ranged from 8-480 ng/mL (24 pmol/L to 1.5 nmol/L), and posttherapy whole body scans (RxWBS) revealed undiagnosed local recurrence and/or metastases in 16 of 17 patients. Follow-up from 6 months to 5 yr is available in 16 patients. RxWBS after a second treatment was positive in 8 of 13 patients, and after a third treatment in 5 of 5 patients, although in 3 cases, uptake in distant metastasis had disappeared. In 8 patients, Tg fell to 5 ng/mL or less. In 1 patient, RxWBS became negative, but Tg remained elevated; subsequent treatment revealed local and mediastinal uptake, but previous lung uptake had disappeared. In 8 patients, RxWBS remains positive, and elevated Tg persists. A total of 35 RxWBS were performed; 29 were positive. Follow-up Tg concentrations decreased in 81% of patients after the first treatment, in 90% after the second treatment, and in 100% of the patients after the third treatment. Tg (mean +/- SE) decreased from 74 +/- 33 ng/mL in the first evaluation to 62 +/- 32 ng/mL in the second study and 32 +/- 20 ng/mL in the third study. The therapeutic effectiveness of 131I treatment in patients with elevated Tg and negative diagnostic whole body scans is indicated by the conversion to negative RxWBS, the statistically significant decrease in the mean Tg level, and the reduction of serum Tg to 5 ng/mL or less in 50% of patients. Further experience with this therapeutic approach is required to evaluate its effectiveness in improving prognosis and survival.

Adult↗
PubMed1987

[Metastatic cancers of the thyroid gland. Diagnostic difficulties].

Metastatic carcinoma of the thyroid is uncommon in surgical pathology and may masquerade as primary thyroid cancer. We studied 6 cases of biopsied and/or surgically resected metastatic carcinoma of the thyroid and their corresponding primary carcinoma, with emphasis on the differential diagnosis. There were 4 men and 2 women patients aged 44 to 77. The primary carcinoma was a breast infiltrating duct carcinoma (3 cases), a colorectal adenocarcinoma (2 cases) and a bronchial oat-cell carcinoma (1 case). The interval between primary carcinoma and secondary thyroid carcinoma was 2 to 9 years in 4 cases; 2 other cases showed simultaneous occurrence. Five patients died with widespread metastases 1 to 14 months following the diagnosis of secondary carcinoma of the thyroid; 1 patient was alive after 24 months. The histological differentiation of secondary from primary thyroid cancer may be difficult in the following situations: clear-cell, Hürthle-cell and signet ring cell changes; positivity of mucins stains; production of melanin; epidermoid differentiation; very rare miscellaneous tumours ("columnar cell carcinoma" and primary thymoma of the thyroid). Immunoperoxidase methods and mucin histochemistry may help.

Adenocarcinoma↗