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Abramson Cancer CenterNCI CANCERLIT® Search: Thyroid Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 10634383
AU - Cailleux AF; Baudin E; Travagli JP; Ricard M; Schlumberger M
TI -
Is diagnostic iodine-131 scanning useful after total thyroid ablation
for differentiated thyroid cancer?
SO - J Clin Endocrinol Metab 2000 Jan;85(1):175-8
AD - Department of Nuclear Medicine, Institut Gustave Roussy, Villejuif,
France.
A diagnostic iodine-131 (131I) total body scan (TBS) is usually
recommended 6 to 12 months after thyroid ablation for differentiated
thyroid carcinoma. Its usefulness was evaluated in 256 consecutive
patients treated and followed up at the Institut Gustave Roussy for
papillary (n = 200), well differentiated (n = 27), or poorly
differentiated (n = 29) follicular thyroid carcinomas. All patients
underwent a near-total or total thyroidectomy and 131I ablation with 3.7
GBq (100 mCi). No TBS was performed before 131I ablation. The TBS
performed after the administration of 131I to destroy the thyroid
remnants showed uptake (<2%) limited to the thyroid bed. A diagnostic
131I-TBS was obtained after withdrawal of T4 treatment, with either 74
MBq (2 mCi; n = 82) or 185 MBq (5 mCi; n = 174), 6 to 12 months after
initial treatment, with serum thyroglobulin (Tg) determination. No
interference in the Tg assay was found in these 256 patients. Uptake in
the thyroid bed was not detected (total ablation) in 236 patients, was
visible but too low to be measured in 19 patients, and attained 1% in
only 1 patient. No uptake was found outside the thyroid bed. The serum
Tg level, once thyroid hormone treatment had been withdrawn, was below 1
ng/mL in 210 patients, ranged from 1-10 ng/mL in 31 patients, and was
above 10 ng/mL in 15 patients. A 131I-TBS performed with 3.7 GBq in nine
patients with a Tg level above 10 ng/mL, showed foci of uptake outside
the thyroid bed in three patients; lung metastases were demonstrated by
a CT scan in another patient, and palpable lymph node metastases were
found in one patient. In conclusion, a diagnostic 131I-TBS with 74-185
MBq performed 1 yr after thyroid ablation demonstrated no abnormal
uptake; it did not correlate with results of Tg determination and only
confirmed the completeness of thyroid ablation. The serum Tg level
obtained after withdrawal of T4 treatment permits the selection of
patients with a Tg level exceeding 10 ng/mL, for scanning with 3.7 GBq
(100 mCi).
2
UI - 11158080
AU - Doi SA
TI -
Usefulness of the diagnostic total body scan in differentiated thyroid
cancer.
SO - J Clin Endocrinol Metab 2001 Feb;86(2):949-50
3
UI - 11383871
AU - Min JJ; Chung JK; Lee YJ; Jeong JM; Lee DS; Jang JJ; Lee MC; Cho BY
TI -
Relationship between expression of the sodium/iodide symporter and 131I
uptake in recurrent lesions of differentiated thyroid carcinoma.
SO - Eur J Nucl Med 2001 May;28(5):639-45
AD - Department of Nuclear Medicine, Seoul National University College of
Medicine, Korea.
The sodium/iodide symporter (NIS) is known to be responsible for the
active accumulation of iodide within the thyroid gland. We evaluated the
relationship between the expression of NIS in primary or lymph node
lesions and iodine-131 uptake in recurrent lesions of differentiated
thyroid cancer. In 67 patients with differentiated thyroid cancer (5
follicular and 62 papillary carcinomas), the expression of NIS was
analysed by immunohistochemical staining using polyclonal antibodies
against human NIS. We used paraffin block tissues of primary tumours or
metastatic lesions, and also assessed 131I uptake in recurrent lesions
of thyroid cancer on post-operative 131I whole-body scan.
Immunohistochemical staining was positive in 22 patients (32.8%),
including 2 of 5 follicular and 20 of 62 papillary carcinomas.
Recurrence was confirmed in 40 patients pathologically or clinically by
serum thyroglobulin, 131I scan, fluorine-18 fluorodeoxyglucose positron
emission tomography and/or computed tomography. Among these 40 patients,
28 showed positive uptake on 131I scan. Fourteen tumour specimens out of
28 (50%) were positive by NIS immunohistochemical staining. The
remaining 12 patients with recurrent cancer showed negative 131I scans,
and all specimens were negative by NIS immunohistochemical staining.
Thus, NIS immunohistochemical staining predicted 131I uptake in
recurrent cancer with a 100% positive predictive value and a 46.2%
negative predictive value. There was no difference in the positivity of
NIS according to the site of recurrence on 131I scan. Outcome of 131I
therapy could be assessed in 22 of the 28 patients who showed 131I
uptake in recurrent lesions. Patients with positive NIS immunostaining
responded to 131I therapy better than did patients with negative
immunostaining (P<0.05). In conclusion, NIS immunohistochemical staining
showed a high positive predictive value in predicting iodine uptake.
Positive immunohistochemical staining of human NIS in primary or lymph
node lesions may predict 131I accumulation and effectiveness of 131I
therapy in recurrent lesions.
4
UI - 11403258
AU - Nayar R; Frost AR
TI -
Thyroid aspiration cytology: a "cell pattern" approach to
interpretation.
SO - Semin Diagn Pathol 2001 May;18(2):81-98
AD - Department of Pathology, Northwestern University and The Robert H. Lurie
Comprehensive Cancer Center, Chicago, IL 60611, USA.
The key to the interpretation of thyroid fine needle aspiration is
largely dependent on the recognition of various morphologic patterns of
epithelial cells, usually follicular cells, and background elements,
such as colloid. These morphologic patterns consist of 3 parts: 1) The
arrangement of cells with respect to one another, 2) The cytologic
features of individual cells, and 3) The presence of background
elements. The cellular arrangements generally encountered in fine needle
aspiration of the thyroid include the follicular patterns
(macro-/normo-follicular and micro-follicular), the papillary pattern,
the syncytial pattern, the dispersed cell pattern, and the cystic
pattern. This article approaches some of the differential diagnostic
challenges encountered while interpreting thyroid aspiration cytology by
focusing first on the overall cellular arrangement to generate a
differential diagnosis and then narrowing that differential by assessing
cellular features of individual cells and the presence of background
elements.
5
UI - 11403259
AU - Liu LH; Bakhos R; Wojcik EM
TI -
Concomitant papillary thyroid carcinoma and Hashimoto's thyroiditis.
SO - Semin Diagn Pathol 2001 May;18(2):99-103
AD - Department of Pathology, Loyola University Medical Center, Maywood, IL
60153, USA.
An association between papillary thyroid carcinoma (PTC) and Hashimoto's
thyroiditis (HT) is well recognized. Both entities may often display
overlapping morphologic features. The aim of this study was to evaluate
the accuracy of fine needle aspiration (FNA) of concomitant PTC and HT.
Twenty nine thyroid FNAs with a diagnosis of concomitant PTC and HT on
follow-up surgical material were retrospectively reviewed (11% of all HT
cases diagnosed in the same period of time). The cytologic specimens
were evaluated for the presence of diagnostic features of PTC and HT. In
16 of 29 cases, the diagnosis of PTC was made or suggested; however,
only in 3 cases were both entities recognized on the FNA material. The
review of the remaining cases (13 cases) showed diagnostic features of
PTC in 2 cases (interpretation errors), some features of PTC in 8 cases
(insufficient diagnostic features), features of only HT in 2 cases, and
1 case was acellular (sampling errors). Originally, 10 cases with
features of PTC were diagnosed as either follicular neoplasm or colloid
nodule with or without HT. Histologically, 1 of 13 cases was a cystic
variant and 7 of 13 cases were follicular variants of papillary
carcinoma. It is important to be aware of the coexistence of PTC and HT.
Deliberate search for evidences of PTC in every case of HT may be
necessary to improve diagnostic accuracy of the FNA. However, the
cytologic diagnosis of follicular variant of PTC coexisting with HT can
be challenging. The sampling error may also cause false negative
results.
6
UI - 11416889
AU - Gemsenjager E; Heitz PU; Seifert B; Martina B; Schweizer I
TI -
Differentiated thyroid carcinoma. Follow-up of 264 patients from one
institution for up to 25 years.
SO - Swiss Med Wkly 2001 Mar 24;131(11-12):157-63
AD - Surgical Clinic, Spital Zollikerberg, Zollikerberg/Zurich, Switzerland.
The optimum treatment for differentiated thyroid carcinoma (DTC) is
still debated. Results obtained using a selective treatment strategy for
papillary (PTC) and follicular (FTC) thyroid carcinoma over 25 years in
one institution are reported. 149 patients (mean age 46 yrs) had PTC in
TNM stages I-IV in 58%, 26%, 15% and 1% respectively. Total
thyroidectomy and remnant 131I ablation (43%) were carried out in TNM
high-risk patients (stages III and IV) and in low-risk patients (I and
II) at risk for a (curable) recurrence (stages pN1 and/or pT4). Hemi- or
total thyroidectomy, without radioiodine, was used in 76% of pT1-3 N0
tumours (68%). Central and/or lateral lymphadenectomy was performed in
42% of patients (electively in the last 4 years). The mean follow-up was
7 years. RESULTS: 6 patients died of PTC and 8/143 patients treated for
cure had a recurrence (6 nodal, 1 contralateral, 1 local). In low-risk
patients--including 68% of patients aged > or = 45 yrs--the cause
specific 25-year survival rate was 100%, vs. 62% (at 15 years) (p <
0.0001) in high-risk patients. In stage I and stage II the
recurrence-free survival rates at 25 years were 95% and 100%
respectively. Risk factors for recurrence were macroscopic (p < 0.0001)
but not microscopic local invasion (pT4); stage pN1 (p = 0.0004). Only
1/107 patients initially judged node-negative had a nodal recurrence.
FTC (n = 115; mean age 56 yrs; mean follow-up 8 yrs): Cause-related
death (n = 8) or serious recurrence (n = 3) occurred in 10/53 grossly
invasive FTC, in 1/45 minimally invasive FTC with vascular invasion, and
in none of 17 FTC with capsular invasion (CI) alone, under radical
treatment (131I) in 75%, 33%, and 12% respectively. 20-year disease-free
survival in grossly and in minimally invasive FTC was 78% and 95.5%
respectively (p = 0.0007). Patients aged < 45 yrs and patients with
minimally invasive FTC with CI alone (all ages) had 100% 20-year
disease-free survival vs. 80% (p = 0.013) in the remainder. There was no
curable recurrence in FTC. The ratio of grossly invasive FTC decreased
(p < 0.0001) during the study period. CONCLUSIONS: Risk-0 groups may be
defined and selected for a reduced extent of treatment (PTC pT1-3 N0;
FTC < 45 yrs, or CI alone). Older (> or = 45 yrs) patients with PTC in
stages I and II have an excellent prognosis (risk 0). With selective
(therapeutic) lymphadenectomy the risk of nodal recurrence may be very
low in node negative tumours, without use of radioiodine. Meticulous
lymphadenectomy is indicated in pN1 tumours with nodal recurrences
despite 131I (5/36 patients). The technique of capsular dissection for
extracapsular total uni- or bilateral thyroidectomy provides excellent
oncological and surgical results. A decrease in the incidence of FTC
parallels a decrease in endemic goitre in Switzerland.
7
UI - 11425213
AU - Pelizzo MR; Boschin IM; Toniato A; Bernante P; Piotto A; Rinaldo A;
TI -
Ferlito A
The sentinel node procedure with Patent Blue V dye in the surgical
treatment of papillary thyroid carcinoma.
SO - Acta Otolaryngol 2001 Apr;121(3):421-4
AD - Department of Medical and Surgical Science, 3rd Clinic of General
Surgery, University of Padua, Italy.
How far to extend the surgical treatment of papillary thyroid carcinoma
(PTC) is still an open question. A contribution may come from
intra-operative lymphatic mapping because, in other malignancies, the
procedure has become an important aid in defining lymph node status. To
assess the feasibility of using the sentinel lymph node (SLN) technique
with the intratumoral injection of Patent Blue V dye to guide nodal
dissection in PTC, 29 patients with a preoperative diagnosis of PTC and
no clinical or ultrasonographic evidence of nodal involvement underwent
cervicotomy and exposure of the thyroid gland, followed by Patent Blue V
dye injection into the thyroid nodule. Total thyroidectomy was
subsequently performed, resecting the lymph nodes at levels III, IV, VI
and VII. The thyroid, SLN and the other lymph nodes were snap-frozen and
submitted for both intra-operative and subsequent definitive
pathological evaluation. Intra-operative lymphatic mapping located the
SLN in 22/29 patients (75.9%) and the SLN revealed neoplastic
involvement in 4/22 (18.2%); other lymph nodes were also positive in 2
cases. In the 18 patients whose SLNs were not metastatic, the other
nodes were also disease-free. The SLN technique thus seems helpful in
avoiding unnecessary lymph node dissection in PTC without spread to the
SLN.
8
UI - 11434717
AU - Luft FC
TI -
Toxic thyroid adenoma and toxic multinodular goiter.
SO - J Mol Med 2001;78(12):657-60
AD - Franz-Volhard-Klinik, Humboldt University of Berlin, Berlin-Buch,
Germany. luft@fvk-berlin.de
9
UI - 11434721
AU - Trulzsch B; Krohn K; Wonerow P; Chey S; Holzapfel HP; Ackermann F;
TI -
Fuhrer D; Paschke R
Detection of thyroid-stimulating hormone receptor and Gsalpha mutations:
in 75 toxic thyroid nodules by denaturing gradient gel electrophoresis.
SO - J Mol Med 2001;78(12):684-91
AD - Department of Internal Medicine III, University of Leipzig, Germany.
The actual frequency of constitutively activating thyrotropin receptor
or Gsalpha mutations in toxic thyroid nodules (TTNs) remains
controversial as considerable variation in the prevalence of these
mutations has been reported. We studied a series of 75 consecutive TTNs
and performed mutation screening by the more sensitive method of
denaturing gradient gel electrophoresis (DGGE) in addition to direct
sequencing. Furthermore, the likelihood of somatic mutations occurring
in genes other than that for the thyroid-stimulating hormone receptor
(TSHR) and exons 7-9 of the Gsalpha protein gene was determined by
clonality analysis of TTNs, which did not harbor mutations in the
investigated genes. In 43 of 75 TTNs (57%) constitutively active TSHR
mutations were identified. Six TSHR mutations were detected only by
DGGE, underlining the importance of a sensitive screening method. Novel,
constitutively activating mutations were identified at positions 425
(Ser-->Leu) and 512 (Leu-->Glu/Arg). Furthermore, a new base
substitution was detected at position Pro639Ala (CCA-->GCA). Ten of 20
TSHR or Gsalpha mutation negative cases (50%) showed nonrandom
X-chromosome inactivation, indicating clonal origin. In conclusion,
somatic, constitutively activating TSHR mutations appear to be a major
cause of TTNs (57%), while mutations in Gsalpha play a minor role (3%).
The mutation negative but clonal cases indicate a probable involvement
of somatic mutations other than in the TSH receptor or Gsalpha genes as
the molecular cause of these hot nodules.
10
UI - 11434665
AU - Haslinghuis LM; Krenning EP; De Herder WW; Reijs AE; Kwekkeboom DJ
TI -
Somatostatin receptor scintigraphy in the follow-up of patients with
differentiated thyroid cancer.
SO - J Endocrinol Invest 2001 Jun;24(6):415-22
AD - Department of Nuclear Medicine, University Hospital Rotterdam, The
Netherlands.
The aim of this study was to compare the results of somatostatin
receptor scintigraphy (SRS) and of radioiodine scintigraphy in patients
with metastatic differentiated thyroid carcinoma during L-thyroxine
suppression therapy and after withdrawal. Twenty-five patients were
studied: 16 patients had papillary cancer and 12 of them had metastatic
disease; 9 patients had follicular cancer and 7 of these had known
metastases. In 7 patients SRS was performed during thyroxine withdrawal,
in 12 during thyroxine therapy within 9 months from radioiodine
scintigraphy, in 6 others both during suppression therapy and after
withdrawal. SRS was positive in 18 of 25 (72%) patients. It demonstrated
lesions in 11 of 13 (85%) patients after thyroxine withdrawal and in 12
of 18 (67%) patients during thyroxine suppression. In 6 patients in whom
a direct comparison was made before and after withdrawal, essentially
the same information was obtained. Six of 8 (75%) patients with lesions
that did not concentrate radioiodine showed uptake of labeled octreotide
in these lesions. In 5 of 17 (29%) patients whose tumors concentrated
radioiodine, no uptake was found during SRS. Conclusions: 1) in patients
with metastatic differentiated thyroid carcinoma, tumor sites can be
visualized using SRS; 2) there is no need to withdraw patients from
suppression therapy in order to perform SRS; 3) in some patients whose
lesions do concentrate labeled octreotide but not radioiodine, the use
of somatostatin analogues labeled with (111)In or [90Y] can provide new
therapeutic options.
11
UI - 11434669
AU - Oliynyk V; Epshtein O; Sovenko T; Tronko M; Elisei R; Pacini F; Pinchera
TI -
A
Post-surgical ablation of thyroid residues with radioiodine in Ukrainian
children and adolescents affected by post-Chernobyl differentiated
thyroid cancer.
SO - J Endocrinol Invest 2001 Jun;24(6):445-7
AD - Institute of Endocrinology and Metabolism, Kiev, Ukraine.
Post-surgical ablation of thyroid residues with 131-iodine (131-I) is
usually recommended after near-total thyroidectomy in high-risk
patients, including children, with differentiated thyroid cancer (DTC).
We report here the results of post-surgical radioiodine thyroid ablation
in 249 children and adolescents of Ukraine with post-Chernobyl DTC
initially treated with near-total thyroidectomy at the Institute of
Endocrinology and Metabolism in Kiev, during a 2-year period. The
patients' age at the time of the Chernobyl accident (1986), ranged from
<1 to 14 yr in 223 subjects (children) and from 15 to 18 yr in 26
subjects (adolescents). Six weeks after surgery a diagnostic 131-I whole
body scan revealed the presence of residual thyroid tissue in all cases.
All patients received one or more courses of radioiodine therapy, for a
total of 468 courses. One hundred and twenty-nine out of 249 patients
(51.8%) were successfully ablated. The total number of treatment courses
needed in these patients was 219. Most patients required multiple doses
of radioiodine, only 63 required a single dose. One hundred and twenty
patients (48.2%) treated with radioiodine were not ablated and are still
under treatment program. The clinical features and the amount of thyroid
residue were not different in ablated or not-ablated patients. Our
results indicate that in this particular population of post-Chernobyl
thyroid carcinomas, thyroid ablation is a rather difficult task. Only
51.8% were successfully ablated. Possible explanation for this finding
may be the young age of the patients, other particular features of
post-Chernobyl thyroid carcinoma or technical aspects, such as less
radical surgical procedures.
12
UI - 11444171
AU - Haugen BR; Lin EC
TI -
Isotope imaging for metastatic thyroid cancer.
SO - Endocrinol Metab Clin North Am 2001 Jun;30(2):469-92
AD - Division of Endocrinology, Metabolism and Diabetes, Thyroid Tumor
Center, University of Colorado Health Sciences Center, Denver, Colorado,
USA.
Many isotopes are available for imaging patients with suspected thyroid
cancer recurrence and metastases. TSH-stimulated low-dose 131I
whole-body scanning with serum thyroglobulin either by standard LT4
withdrawal or rhTSH stimulation is the preferred test for monitoring
patients without palpable disease or elevated serum thyroglobulin on LT4
therapy (Fig. 5). This approach has the advantage of finding disease
that may be amenable to 131I therapy, although low-dose 131I scans are
less sensitive than are scans with other imaging agents. 123I has better
imaging characteristics than 131I and has been shown to be equivalent or
superior to low-dose 131I in recent studies. As the availability of 123I
increases and the cost decreases, this agent may replace 131I in imaging
for recurrent or metastatic thyroid cancer. Patients who have an
elevated serum thyroglobulin on LT4 therapy or after TSH stimulation but
have a negative low-dose 131I scan require other imaging procedures to
find the suspected disease. The authors currently perform a sensitive
neck ultrasound to look for surgically remediable disease and consider a
noncontrast CT scan of the chest to look for small pulmonary metastases
that poorly concentrate low doses of 131I (Fig. 5).
Fluoro-18-deoxyglucose PET, 99mTc MIBI, 201Tl, and 99mTc tetrofosmin are
primarily useful in the setting of a negative whole-body 131I scan and
elevated serum thyroglobulin. 18FDG-PET seems to have the highest
sensitivity in this setting and would be the preferred imaging agent,
but availability and cost are major issues (Fig. 5). Although some
researchers have advocated these radiopharmaceuticals as first-line
agents replacing 131I, there is little support for this position. This
approach to imaging is not cost-effective because positive scans in
these patients would most likely require 131I scintigraphy to determine
whether the lesions are amenable to radioiodine therapy. 99mTc
pertechnetate, 99mTc furifosmin, and somatostatin receptor scintigraphy
have a limited role in imaging for recurrent or metastatic
differentiated thyroid carcinoma. In choosing among 99mTc MIBI, 201Tl,
and 99mTc tetrofosmin, the technetium label of sestamibi and tetrofosmin
results in better image quality and faster imaging than 201Tl. Although
99mTc sestamibi and 99mTc tetrofosmin have not been compared in a large
series, the higher tumor-to-background ratio and consistently high
sensitivities of 99mTc tetrofosmin suggest that it could potentially
have additional value over 99mTc sestamibi, but there is still limited
experience with 99mTc tetrofosmin.
13
UI - 11444172
AU - Puxeddu E; Fagin JA
TI -
Genetic markers in thyroid neoplasia.
SO - Endocrinol Metab Clin North Am 2001 Jun;30(2):493-513, x
AD - Division of Endocrinology and Metabolism, University of Cincinnati
College of Medicine, Cincinnati, Ohio, USA.
Cancer is a disease of genes. Detection of genetic abnormalities
associated with cancers of various cell types can now be used for
genetic counseling, diagnosis or treatment selection. In the case of
thyroid cancer, genetic testing for mutations of the RET oncogene has
had a profound effect on the management of medullary thyroid carcinomas.
There is also considerable information on the genetic changes associated
with development and progression of cancers of thyroid follicular cells,
although these have not yet proven to be of practical value for clinical
diagnosis or to guide prognosis and therapy.
14
UI - 11443849
AU - Gimm O
TI -
Multiple endocrine neoplasia type 2: clinical aspects.
SO - Front Horm Res 2001;28():103-30
AD - Department of General Surgery, Martin-Luther-University,
Halle-Wittenberg, Germany. oliver.gimm@medizin.uni-halle.de
15
UI - 11442006
AU - Yang GC; Liebeskind D; Messina AV
TI -
Ultrasound-guided fine-needle aspiration of the thyroid assessed by
Ultrafast Papanicolaou stain: data from 1135 biopsies with a two- to
six-year follow-up.
SO - Thyroid 2001 Jun;11(6):581-9
AD - Department of Pathology, New York University School of Medicine, New
York, USA. grace.yang@nyu.edu
One of the limitations of fine-needle aspiration (FNA) of the thyroid is
difficulty in distinguishing the follicular variant (FV) of papillary
thyroid carcinomas (PTC) from follicular neoplasms. By highlighting the
"Orphan Annie-eyed" clear nuclei of the former, the Ultrafast
Papanicolaou stain (UFP) easily separates these two entities. One
thousand one hundred thirty-five ultrasound-guided FNAs of the thyroid
were assessed by UFP with immediate biopsy results reported to the
were microcarcinomas (1 medullary carcinoma, 16 PTC). The rates of
"unsatisfactory," "cancer," "suspicious for cancer," "follicular
neoplasm," and "benign" cytology were 0.7%, 4.4%, 2.6%, 10.2%, and
82.1%, respectively and the cancer yields at surgery were 98%, 81.8%,
15.8%, and 0% respectively. Of the 1127 satisfactory FNAs in the series
with a 2- to -6 years of clinical follow-up, a false-negative rate of 0%
and a false-positive rate of 1.5% were obtained. Of the 169 surgical
follow-ups with satisfactory FNAs, a sensitivity of 100%, specificity of
66.7%, positive predictive value of 87.4%, negative predictive value of
100%, and global accuracy of 89.9% were achieved. The paradoxical
combination of low unsatisfactory rate and low false-negative rate is
attributed to (1) the use of needle puncture without syringe to obtain
enough microfollicles from the exceedingly bloody aspirates from
follicular neoplasms for a diagnosis, (2) eliciting history of neck
trauma to confirm hematomas, (3) using UFP to highlight the grape-like
watery clear nuclei of FVPTC evident with a 4x objective, and (4) the
precise guidance by ultrasound in sampling microcarcinomas.
16
UI - 11453525
AU - Al-Fifi S; Rodd C
TI -
Multinodular goiter in children.
SO - J Pediatr Endocrinol Metab 2001 Jun;14(6):749-56
AD - Department of Child Health, College of Medicine, King Khalid University,
Abha, Saudi Arabia.
OBJECTIVE: As multinodular goiter (MNG) is an uncommon pediatric
disorder, we decided to evaluate the children with this diagnosis at our
center to try to delineate better its etiology, the risk of malignancy
and appropriate management strategies. METHODS AND RESULTS: Eighteen
patients (12 girls and 6 boys) were the subject of this retrospective
review spanning a period of 20 years. All were previously well, except
one, and none had had head or neck irradiation. Average age at diagnosis
was 12.8 years. Four children belonged to two previously identified
kindreds diagnosed with familial MNG. These families had members
affected with multiple cases of non-medullary thyroid carcinoma (NMTC).
All were euthyroid and had no symptoms. In eight of 18 patients, the
clinical examination missed the presence of multiple nodules which were
subsequently detected by ultrasound. Twelve patients had tissue
diagnosis by fine needle aspirate cytology (FNAC) or surgery. Five of
eight patients undergoing surgery had nodular hyperplasia, one had a
follicular adenoma and one had a normal thyroid gland on histology.
There was one patient with papillary carcinoma combined with nodular
hyperplasia. Seven of the patients had evidence of antithyroid
autoimmunity. CONCLUSION: The etiology of pediatric MNG appears
multifactorial including autoimmune and familial factors. We believe
that previously healthy children can usually be managed conservatively.
Ultrasound at the time of diagnosis and in follow up seems beneficial.
Familial forms appear to warrant close follow up, given the apparent
increased risk of malignancy. The risk of malignancy while low remains
real.
17
UI - 11456270
AU - Hara H; Igarashi A; Yano Y; Yashiro T; Ueno E; Aiyoshi Y; Ito K; Obara T
TI -
Ultrasonographic features of parathyroid carcinoma.
SO - Endocr J 2001 Apr;48(2):213-7
AD - Department of Surgery, Institute of Clinical Medicine, University of
Tsukuba, Japan.
Although several authors have reported single cases illustrative of some
ultrasonographic characteristic of parathyroid carcinoma, the value of
ultrasonography for diagnosing this entity remains to be determined. The
purpose of our study was to investigate the ultrasonographic features of
parathyroid carcinoma in a large number of cases. We assessed the shape,
contour, echogenicity, and depth-width (DW) ratio of 16 parathyroid
carcinomas and 61 parathyroid adenomas. Ultrasonography showed that
parathyroid carcinomas tend to be large, inhomogeneous, hypoechoic
masses with lobulated contours. In contrast, parathyroid adenomas were
small, homogeneous, hypoechoic masses with smooth borders. The mean
(range) DW ratios for parathyroid carcinomas were 1.21 (0.91-2.5) and
0.64 (0.33-1.47) for adenomas; the difference was statistically
significant (p<0.0001). The DW ratio was > or =1 in 15 (94%) of the 16
cases of carcinoma, whereas only 3 (5%) of the 61 adenomas had a similar
ratio. Ultrasonographic examination is useful not only for preoperative
localization but also for differentiating parathyroid carcinoma from
adenoma. Parathyroid tumors with irregular margins, inhomogeneous
echogenicity, and a DW ratio > or =1 are likely to be malignant.
18
UI - 11475109
AU - Ardito G; Pintus C; Revelli L; Grottesi A; Modugno R; Vincenzoni C;
TI -
Fadda G; Perrelli L
Thyroid tumors in children and adolescents: preoperative study.
SO - Eur J Pediatr Surg 2001 Jun;11(3):154-7
AD - Istituto di Semeiotica Chirurgica, Catholic University of the Sacred
Heart, Policlinico A. Gemelli, Rome, Italy.
Several studies indicate that in young patients (less than 21 years of
age at the time of diagnosis), the prognosis of thyroid carcinoma (TC)
is more favorable than in older patients. However, a more radical
treatment approach is recommended in children and adolescents due to the
higher prevalence of local lymph-node involvement in these cases. Since
the extent of primary surgical treatment is closely related to the
overall prognosis, preoperative diagnosis becomes essential in the
management of thyroid neoplasms in young patients. In this retrospective
study (1987-1998), we analyzed a surgical series of 50 children and
adolescents with thyroid nodules in an attempt to establish the role of
diagnostic studies in detecting malignant lesions prior to surgery. Our
diagnostic protocol for evaluating thyroid nodules was based on clinical
evaluation, measurement of thyroid-hormone and thyroglobulin (TG)
levels, anti-TG and anti-TPO antibody titers, calcitonin, CEA, and TPA
levels, sonography, scintigraphy, and fine-needle aspiration cytology
(FNAC) of the thyroid nodules and any enlarged lymph nodes. Eleven of
the 15 cases of histologically confirmed carcinoma were preoperatively
identified as malignant lesions with the aid of FNAC. The authors
conclude that the preoperative work-up of children and adolescents with
thyroid nodules requires the collaboration of an experienced team of
professionals, and recommend FNAC as the initial test.
19
UI - 11471663
AU - Ortiz S; Rodriguez JM; Parrilla P; Perez D; Moreno-Gallego A; Rios A;
TI -
Soria T
Recurrent papillary thyroid cancer: analysis of prognostic factors
including the histological variant.
SO - Eur J Surg 2001 Jun;167(6):406-12
AD - Hospital Universitario Virgen de la Arrixaca (Murcia), Servicio de
Cirugia General y Aparato Digestivo (I), El Palmar, Spain.
OBJECTIVE: To analyse the factors that influence the development of
recurrent papillary thyroid carcinoma, including the histological
variant. DESIGN: Retrospective study. SETTING: Teaching hospital, Spain.
SUBJECTS: 200 patients who had papillary thyroid cancers resected
between 1970 and 1995. MAIN OUTCOME MEASURES: Prognostic factors and
disease-free interval assessed by univariate and multivariate analysis.
RESULTS: All patients were followed up for a mean of 9 years (range
4-29). 54 patients presented with recurrent disease (27%) of whom 19
(35%) died of their disease. 5-year, 10-year, and 15-year survival for
those with recurrent disease were 75%, 68%, and 60%, respectively. The
corresponding figures for the whole series were 93%, 90%, and 84%. The
significant variables on multivariate analysis were completeness of
resection (p = 0.002), extrathyroid involvement (p < 0.002), presence of
lymph node metastases (p = 0.002), and histological variant of the
carcinoma (P < 0.001). CONCLUSION: Using these risk factors it is
possible to draw up a prognostic index and classify patients as being at
low, medium, or high risk of recurrence.
20
UI - 11478264
AU - Lin JD; Hsueh C; Chao TC; Weng HF
TI -
Expression of sodium iodide symporter in benign and malignant human
thyroid tissues.
SO - Endocr Pathol 2001 Spring;12(1):15-21
AD - Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan,
Taiwan, R.O.C. einjd@adm.cgmh.org.tw
The extent of human sodium iodide symporter (hNIS) expression in
different kinds of human thyroid cancer tissues and cell lines remains
controversial. In this study, polyclonal antibodies to hNIS were used to
analyze the expression of symporter protein in benign and malignant
human thyroid tissues. Formalin-fixed, paraffin wax-embedded tissue
sections were used. Staining was performed using primary polyclonal
antibody of rabbit anti-human hNIS diluted in PBS (1:500). Results
showed that 2 of 3 normal tissue, 3 of 6 nodular hyperplasia, one
follicular adenoma, 3 of 11 papillary thyroid carcinoma, 1 of 5
follicular carcinoma and none of 3 metastatic thyroid epithelial tissue
specimens stained positively for hNIS. A higher percentage of positive
staining for symporter protein was found in benign thyroid tissues
including normal thyroid tissue, nodular hyperplasia, and adenoma (60%).
In contrast, papillary and follicular thyroid carcinomas demonstrated
low
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