Prognostic significance of nuclear DNA content in highly malignant thyroid tumors

The nuclear DNA content of tumour cells is correlated with the clinical outcome of a wide range of malignant disorders, among them thyroid neoplasia. The authors performed DNA determinations by means of the Feulgen cytofluorimetric method and demonstrate the connection between ploidy and biological aggressivity in cases of highly malignant thyroid tumours. The nuclear DNA content was measured in fresh surgical specimens from 53 patients suffering from malignancy, 13 of which proved pathohistologically to be highly malignant: 8 were anaplastic giant cell carcinomas, 3 squamous cell carcinomas and 2 were malignant lymphomas. 4 of the 8 giant cell carcinomas contained co-existent well-differentiated areas, namely follicular carcinomas in 3 patients and a papillary carcinoma in the 4th patient. 11 of the patients died of cancer, 9 within the 1st year. A different DNA distribution was found in the two survivors over a 10-year follow-up period. One of them showed a diploid cell population and the other facultative polyploidy, as opposed to the aneuploid pattern found in the 11 deceased patients. Both patterns confirm the correlation with a favourable outcome.     

冰冻切片诊断甲状腺滤泡性癌的探讨

冰冻切片诊断甲状腺滤泡性癌是病理诊断工作的难点之一。我们对３６例有包膜浸润的甲状腺滤泡性癌的术中冰冻切片标本和术后石蜡切片，与随机找５０例甲状腺腺瘤的术中冰冻切片标本和术后石蜡切片标本进行了观察比较，总结出３个方面滤泡性癌不同于甲状腺腺瘤的组织学表现，作为除浸润标准外冰冻切片诊断甲状腺滤泡性癌的综合考虑依据，供进一步探讨此问题参考。     

电镜在甲状腺髓样癌诊断中的应用价值

目的 了解电镜在甲状腺髓样癌诊断中的应用价值。方法 通过对6例甲状腺髓样癌的光镜和电镜研究，结合文献分析甲状腺髓样癌的电镜诊断特点。结果 甲状腺髓样癌电镜观察要点为胞质内有大小不一的神经内分泌颗粒。结论 所观察到的结果在腺样型髓样癌与滤泡肿瘤、嗜酸细胞型髓样癌与嗜酸细胞腺瘤(癌)、玻璃样变梁状腺瘤样型髓样癌与玻璃样变梁状腺瘤的鉴别诊断中有重要价值。     

甲状腺及乳腺多原发癌临床及超声特征简

目的分析甲状腺及乳腺多原发癌的临床和超声特征。方法回顾性分析1990年1月至2013年3月在北京协和医院接受诊治且手术病理证实的甲状腺及乳腺多原发癌24例,比较这些患者的甲状腺癌及乳腺癌临床和超声特征。结果24例患者中9例（37．5％）以甲状腺癌首发,其中2例（22．2％）在1年内出现乳腺癌;15例（62．5％）以乳腺癌首发,其中6例（40．0％）在1年内出现甲状腺癌。甲状腺癌和乳腺癌超声表现均多为实性（86．4％和84．2％）、形态不规则（63．6％和94．7％）、纵横比大于1（50．0％和57．9％）、边界不清（63．6％和78．9％）、低回声或极低回声（90．9％和100％）、点状钙化（50．0％和47．4％）、局部丰富血流（50．0％和68．4％）。结论甲状腺及乳腺多原发癌的临床和超声特征与单发甲状腺癌及乳腺癌人群相近,超声可有效地筛查甲状腺及乳腺多原发癌,尤其在首发乳腺癌后1年内。     

The biological classifications of malignant thyroid tumours (author's transl)]

Carcinomas of the thyroid gland display large pathological and clinical variation. Favourable prognostic factors accompary well-differentiated tumours, whereas poorly differentiated or anaplastic carcinomas tend to invade early and are usually rapidly fatal. Experience has demonstrated the difference in rate of growth, subsequent recurrence and late spread even in identically well-differentiated thyroid carcinomas. Biological difference must be the underlying reason for the clinical difference in behaviour of histologically similar cancers. This report demonstrates the correlation between in vivo radioactive iodine uptake, tumour staging and recurrence-free interval in 30 thyroid carcinomas. The uptake by well-differentiated carcinomas staged T2N0M0 is significantly higher than that by tumours staged T3N1M0, whereas the latter show a higher uptake than those tumours staged T3N1M0. A high tumour uptake rate is correlated with long recurrence-free interval (up to 24 months) within all groups of staging and vice versa.     

Management of Thyroid Follicular Proliferation: An Ultrasound-Based Malignancy Score to Opt for Surgical or Conservative Treatment

This study was conducted to evaluate whether ultrasound characteristics of thyroid nodules with a known cytologic diagnosis of “follicular pattern” (indicative of follicular hyperplasia, follicular adenoma or follicular carcinoma) can be used to define a nodule malignancy score to limit surgery to selected, higher-risk cases. In pre-operative ultrasound results of patients diagnosed with a “follicular pattern” on cytology who subsequently underwent surgery, each nodule feature was given a score from 0 (most likely benign) to 2 (most likely malignant), resulting in a total score ranging from 0 to 11. The total nodule score (total malignancy score) was then compared with the definitive histologic diagnosis. According to our results, surgery is advisable in patients with score ≥4 (79% of carcinomas), ultrasound follow-up seems to be appropriate for patients with a score of 3 (21% of carcinomas) and no action is recommended for patients with score <3 (only benign nodules).     

Diagnosis of follicular carcinoma of the thyroid: role of sonography in preoperative diagnosis of follicular nodules

The purpose of this study was to evaluate sonographic examination, as well as other clinical tests, for clarifying the parameters for predicting follicular carcinoma in follicular nodules of the thyroid. Nine hundred and ten consecutive patients with follicular nodules were pathologically classified as having follicular carcinoma (109 patients) or benign tumor (811 patients). Benign tumors included follicular adenoma (237 patients) and adenomatous thyroid nodules (574 patients). A case-control study was performed for follicular carcinomas and benign tumors. “Thyroglobulin 1000 ng/ml≦”, “cytology class 3≦”, and a “solid pattern”, “low-echoic level of internal echo”, and “jagged borders” of follicular carcinomas were found to be significantly higher than those of benign tumors. The sensitivities of a solid pattern (79.8%) and a low-echoic level (75.2%) were found to be relatively higher than those of other features and findings. The specificities of thyroglobulin 1000 ng/ml≦(84.0%), cytology class 3≦, and jagged borders (86.2%) were found to be relatively higher than those of other features and findings. We concluded that thyroglobulin 1000 ng/ml≦ and cytology class 3≦ in clinical features, and a solid pattern, low-echoic level, and jagged borders on sonography, indicated an increased risk of follicular carcinoma of the thyroid in follicular nodules.     

低分化甲状腺癌的临床病理

  目的  观察低分化甲状腺癌(poorly differentiated thyroid carcinoma, PDTC)的临床病理特点。  方法  回顾性分析北京协和医院12例符合都灵诊断共识的PDTC临床、影像和病理学资料, 并采用EnVision法进行免疫组织化学标记。  结果  12例PDTC病例中11例为女性, 1例为男性, 平均发病年龄53.6岁。临床均表现为前颈部肿块, B超示肿物为低回声实性结节。5例患者肿瘤主要呈粱状生长, 4例主要呈岛状生长, 3例主要呈实性生长。免疫组化, 11例阳性表达TTF1;10例阳性表达甲状腺球蛋白; 4例P53弥漫阳性表达, 3例局灶阳性表达; Ki67增殖指数3%~25%不等。随访期间, 2例患者分别于术后4年及术后7.5年死于肿瘤播散。  结论  PDTC是一种独特的且较少见的甲状腺恶性肿瘤, 其临床病理特点介于高分化甲状腺癌与未分化甲状腺癌之间。     

Tall Cell Variant of Papillary Thyroid Carcinoma

We retrospectively reviewed the clinical and sonographic features of 8 patients with 10 tall cell variants of papillary thyroid carcinoma. The mean age of the patients was 57 years (range, 34–72 years). The tumor sizes varied. Of the 8 patients, 5 had symptomatic masses, and 3 had incidentalomas. Three patients had recurrences and 1 died of pulmonary metastasis within a mean time of 30 months. The tall cell variants often appeared as microlobulated markedly hypoechoic nodules with microcalcifications and extrathyroidal extension on sonography and were always associated with lymph node metastasis. The tall cell variant of papillary thyroid carcinoma should be included in the differential diagnosis of an aggressive thyroid tumor with symptoms and cervical nodal metastasis.     

Telomerase activity in fine needle aspiration biopsy samples: application to diagnosis of human thyroid carcinoma

BACKGROUND: The diagnosis of thyroid follicular carcinoma by fine needle aspiration biopsy is a well known problem in thyroid pathology. METHODS: We evaluated telomerase activity (TA) in 85 fine needle aspiration biopsy (FNAB) samples from patients with thyroid nodules. Surgery samples from patients with tumor or follicular adenomas were also analyzed. RESULTS: Twenty of the FNAB samples corresponded to carcinomas and were positive to telomerase assay (TA >10 Units). Among them, 4 follicular carcinomas and 1 papillary carcinoma were labeled as indeterminate by FNAB cytological examination. Four percent false positive cases and no false negative cases for TA in FNABs were reported. FNAB samples from follicular adenomas were diagnosed as indeterminate by cytological examination, but they showed no detectable TA. Tumor tissues from patients with follicular or papillary thyroid carcinomas presented TA >10 Units, whereas follicular adenoma tissues (benign nodules) showed no TA. CONCLUSION: Our results showed a good correlation between TA in FNAB samples and tumor/nodule thyroid tissue. This suggested that use of TA as a biological marker of malignancy might be a useful tool in the diagnosis of follicular thyroid carcinomas or follicular thyroid adenomas using FNAB samples.     

Extensive laryngeal infiltration from a neglected papillary thyroid carcinoma: A case report

Papillary carcinoma of the thyroid is the commonest type of thyroid cancer. Laryngeal infiltration from papillary thyroid carcinoma is extremely rare, with only a few cases of partial invasion described in the literature. We present a very unusual case of complete infiltration of both thyroid and cricoid cartilages from a neglected papillary thyroid carcinoma in a 59-year-old male. This sequel resulted from refusal of the patient to undergo treatment when initially diagnosed. An invasion to such an extent has not been described in the literature before, and in this case warranted a total laryngectomy followed by radioactive iodine. Prompt management of papillary carcinomas is crucial for avoiding such complications. Future guidelines should include management options for the patients who deny treatment initially.     

Sonographic Features of Follicular Variant Papillary Thyroid Carcinomas in Comparison With Conventional Papillary Thyroid Carcinomas

Objective. The purpose of this study was to compare the sonographic features as well as the results of fine-needle aspiration biopsy (FNAB) of follicular variant papillary thyroid carcinoma (FVPTCs) and conventional papillary thyroid carcinoma (PTCs). Methods. Forty patients with 44 FVPTCs and 59 patients with 74 conventional PTCs were enrolled in this study. The sonographic features, sonographic gradings, and FNAB results were compared between the two groups. Results. The mean nodule size of FVPTCs was larger than that of conventional PTCs (17.70 versus 10.53 mm; P < .001). Sonographic features of an ovoid-to-round shape (95% versus 73%), isoechogenicity (52% versus 8%), and a hypoechoic halo (25% versus 3%) were more frequent in FVPTCs than conventional PTCs (P < .001). Sonographic features of a taller-than-wide shape (5% versus 22%), a spiculated margin (7% versus 32%), marked hypoechogenicity (5% versus 38%), and microcalcification (7% versus 24%) were rarer in FVPTCs than conventional PTCs (P < .05). The incidence of a sonographically malignant grade was also lower in FVPTCs (48%) than conventional PTCs (81%; P < .001). A diagnosis of PTC on FNAB of FVPTCs was less common than that of conventional PTCs (28% versus 56%; P = .0393); however, a diagnosis of an indeterminate cytologic type such as atypical cells or follicular lesions in FVPTCs was higher than that in conventional PTCs (46% versus 19%; P = .0418). Conclusions. Follicular variant papillary thyroid carcinomas show a relatively larger size, more benign sonographic features, a lower incidence of a sonographically malignant grade, and a lower diagnostic rate of PTC on FNAB compared with conventional PTCs.     

Thyroid cancer

Thyroid cancers are especially common in patients who have received irradiation to the head and neck region for benign diseases. Well-differentiated papillary and/or follicular carcinomas are the most common types of thyroid cancer. They grow slowly and have a very good prognosis when managed with an appropriate combination of surgical and medical therapy. Other types of thyroid cancer often require more intensive therapy and follow-up. It is especially important to evaluate relatives of patients with medullary thyroid cancer.     

核素显像随访诊断甲状腺结节癌变（附19例报告）

目的：探讨核素显像在随访诊断甲状腺结节癌变中的价值。方法：回顾性分析19例经手术病理证实为甲状腺结节癌变患者的临床资料和核素显像表现。结果：19例患者，手术前核素显像表现为单发或多发的“冷”结节或“凉”结节，考虑恶变可能性大，手术病理结果显示：19例甲状腺结节恶变中，13例为甲状腺乳头状癌，4例为滤泡癌及2例未分化癌。结论：核素显像随访诊断甲状腺结节癌变具有重要的意义和价值。     

Thyroid metastasis from breast cancer presenting with diffuse microcalcifications on sonography: A case report

Microcalcifications are frequently associated with papillary thyroid cancers. Metastatic nodules from extrathyroid malignancies may mimic primary thyroid neoplasm on sonography, but do not present with microcalcifications. We report the case of a 45‐year‐old woman with a history of invasive ductal carcinomas of bilateral breasts, status post surgery and neoadjuvant chemotherapy. Four years after surgery, thyroid sonography revealed diffuse microcalcifications without nodular component. Core needle biopsy confirmed thyroid metastasis from primary breast cancer. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :430–432, 2014     

高频彩色多普勒超声对甲状腺癌的诊断价值

目的：探讨高频彩色多普勒超声对甲状腺癌的诊断价值。方法：对经手术及病理证实的35例甲状腺癌患者的灰阶及彩色多普勒声像图表现进行分析。结果。35例甲状腺癌患者中，低回声的实性结节26例，囊实混合型结节9例，结节边界不清晰27例，结节中检出有砂粒样钙化灶22例，颈部淋巴结转移14例，超声误诊13例，诊断正确率62．9％（22／35）。结论：根据肿瘤灰阶及彩色多普勒声超声的特征性表现，有助于甲状腺癌的诊断。     

Clonal composition of benign and malignant human thyroid tumors.

We determined clonality of thyroid tumors from female patients who had restriction fragment length polymorphisms (RFLP) in the X chromosome genes hypoxanthine phosphoribosyltransferase (HPRT) or phosphoglycerate kinase (PGK). We screened normal thyroid tissue from 59 female patients; of the informative cases 14 were heterozygous for a Bgl I site on PGK and 4 were heterozygous for a Bam HI site on HPRT. In monoclonal tumors, one of the polymorphic alleles was selectively digested after additional digestion with Hpa II, a methylation sensitive enzyme, whereas in polyclonal tissue both were decreased to a similar extent. Normal thyroid tissue from all patients showed a polyclonal pattern. Of the 18 tumors studied, 12 were solitary thyroid nodules, and 6 were obtained from multinodular goiters (MNG). The following were monoclonal: 6/6 follicular adenomas, 2/2 follicular carcinomas, and 1/1 anaplastic carcinoma. Two of the three papillary carcinomas showed intermediate patterns, possibly due to contaminating effects of stromal tissue present in most of these neoplasms. Of the six nodules from MNG, four were polyclonal. The two largest gave a distinct monoclonal pattern. Most solitary thyroid tumors are monoclonal, supporting a somatic cell mutation model of thyroid neoplasm formation. Nodules from MNG are largely hyperplastic, although monoclonal neoplasms do occasionally arise within these glands. The specific somatic mutations leading to clonal expansion and determination of tumor phenotype are presently unknown.     

甲状腺癌的磁共振成像诊断

目的：分析甲状腺癌的磁共振成像（MRI）表现,提高甲状腺癌的诊断水平。方法：27例经手术和病理证实的甲状腺癌患者（乳头状癌23例,滤泡状癌2例,未分化癌和转移癌各1例）行MRI检查,男性7例,女性20例,年龄26-68岁,平均年龄48岁。观察癌结节的大小、数量、形态、边缘、信号类型、强化方式。结果：27例甲状腺癌共33个癌结节,其中单发结节23例（85％）,多发结节4例（15％）。形态不规则30个,类圆形3个。T1wI呈等或略低信号32个,不规则等和高信号1个;T2wI呈均匀或不均匀高信号31个,等信号2个;结节边缘见不完整低信号环9个。增强后结节均有不同程度强化;边缘明显环形强化、中央强化稍低8个,其中“残圈征”6个,表现为结节周边强化环连续性中断、不完整;均匀强化6个;不均匀强化19个,其中乳头样强化3个,半岛样强化3个。颈部淋巴结转移7例,其中5例信号和强化不均匀。结论：甲状腺癌具有一定的形态学特征,了解其MRI表现有助于明确诊断。     

774例甲状腺癌的临床及护理分析

目的研究甲状腺癌的临床特点及护理对策。方法分析1992～2008年甲状腺癌检出率、构成比、碘营养、健康体检频率的变化及护理方法。结果17年外检总量122900例,甲状腺癌774例,总外检率0．63％,2000年后甲状腺癌发病率、检出率、甲状腺乳头状癌在甲状腺癌中的构成、微小癌占PTC比例增高（P〈0．05）。所有甲状腺癌手术患者通过整体观个性化护理恢复良好,顺利出院。结论随着健康体检观念增强、诊断水平提高及碘饮食增多,甲状腺微小癌检出率增加。整体观个性化护理是甲状腺癌手术护理的关键。     

Management of differentiated thyroid cancer of the follicular epithelium

Abstract

The incidence of thyroid cancer has been increasing in many countries over the last 30 years (from 3.6/100,000 people in 1973 to 8.7/100,000 people in 2002) while mortality has been slowly decreasing (). The increase is mainly represented by papillary thyroid cancer, while follicular and anaplastic histotypes remained stable. It is a general opinion that the increase is attributable to better detection of small papillary carcinomas as a result of improved diagnostic accuracy (neck ultrasound and fine-needle aspiration cytology). Consequently, it is common experience in thyroid cancer referral centers that nearly 60%–80% of thyroid carcinomas detected nowadays are micropapillary thyroid carcinomas (less than 1 cm in size) carrying an excellent long-term prognosis. In view of this change in the presentation of the disease, the objective of thyroid cancer management should be aimed at achieving complete cure using the less aggressive diagnostic and therapeutic procedures.