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1.
Eloy C Santos J Soares P Sobrinho-Simões M 《Virchows Archiv : an international journal of pathology》2011,459(3):265-276
Prognostic factors indicative of papillary thyroid carcinoma (PTC) aggressive behaviour remain incompletely established partially
due to the different composition of the series on record regarding the relative proportion of classic PTC (CPTC) and follicular
variant PTC (FVPTC) subtypes. Several clinico-morphological features of PTC, together with the occurrence of BRAF mutations, are still not fully accepted as markers of aggressiveness. In the present clinico-pathological study of a series
of 75 CPTC and FVPTC cases, we evaluated the relative contribution of the morphological features of the tumours and their
BRAF and N-RAS status for the occurrence of nodal metastases. The morphological features most closely related to the occurrence of nodal
metastases were extra-thyroid extension and poorly circumscribed growth pattern, in both CPTC and FVPTC. Additional features
significantly associated to nodal metastases were multicentricity in the CPTC and vascular invasion in the FVPTC group. BRAF V600E mutation was detected in 29% of tumours, 41% of CPTC and 16% of FVPTC; N-RAS Q61R mutation was detected in 6% of tumours, 3% of CPTC and 10% of FVPTC. BRAF mutation was significantly more frequent in the CPTC group and in females, and it was detected only in patients older than
20 years, suggesting a late tumourigenic effect in the development of PTC. BRAF mutation was not significantly associated to any of the other studied features related to aggressiveness or nodal metastases.
These results highlight the importance of infiltrative growth pattern and invasiveness over the presence of BRAF mutation in classic and follicular variant PTC for the development of nodal metastases. 相似文献
2.
It is known that the prevalence of lymphocytic thyroiditis (LT) is higher in patients with papillary thyroid carcinoma (PTC),
that gender influences this association, and that certain features of PTC occur more frequently in patients who also have
LT. These relationships have not been studied in patients with papillary thyroid microcarcinomas (PTMC), however. Therefore,
we performed a study to compare the clinical and pathological features of patients with PTMC who did and did not have LT.
We collected the 323 consecutive patients following excision of PTMC diagnosed as papillary carcinoma on preoperative needle
aspiration cytology. We analyzed the demographic, serologic, and pathologic data of those cases with categorization into four
groups based on presence of LT and neck lymph node metastasis. In all PTMC, the presence of LT did not influence the frequency
of lymph node metastasis (27 of 105 [25.7%] vs. 48 of 218 [22.0%]). Among the patients with metastatic PTMC, LT was noted
significantly more often in female than male patients (95.2% vs. 79.8%). In metastatic PTMC, multifocality and bilaterality
was more frequent in with LT than without LT (44.4% vs. 29.2%; 29.6% vs. 14.6%). Both the presence of serum thyroglobulin
antibody (TgAb; p = 0.016) and serum microsomal antibody (p = 0.013) were highly correlated with the presence of LT. Twenty-seven of 105 patients (25.7%) with PTMC with LT had nodal
metastasis. Co-existing LT was noted predominantly in women, influenced more often multifocality and bilaterality of tumors,
and higher frequency of metastasis to lateral compartment lymph nodes. 相似文献
3.
Mariana Bonjiorno Martins Marjory Alana Marcello Elaine Cristina Morari Lucas Leite Cunha Fernando Augusto Soares José Vassallo Laura Sterian Ward 《Endocrine pathology》2013,24(2):77-82
Although there are evidences of the involvement of KAP-1 in other tumors, data on differentiated thyroid carcinomas (DTC) are still lacking. We aimed to evaluate KAP-1 clinical utility in the diagnosis and prognosis of DTC. We used both visual immunohistochemistry and a semiquantitative analysis to evaluate KAP-1 expression in 230 thyroid carcinomas and 131 noncancerous thyroid nodules. There were 43 follicular carcinomas (FC) and 187 papillary thyroid carcinomas (PTC), including 130 classic (CPTC), 4 tall cells (TCPTC), and 53 follicular variants (FVPTC). Patients were followed up for 53.8?±?41 months. They were classified as free-of-disease (142 cases) or poor outcome (25 cases—10 deaths), according to their serum Tg levels and image evidences. KAP-1 was identified in 78 % PTC, 75 % TCPTC, 74 % FC, 72 % FVPTC, 55 % FA, 44 % hyperplasia, and 11 % normal thyroid tissues. A ROC analysis identified malignant nodules with 69 % sensitivity and 75 % specificity, using a cutoff of 73.19. In addition to distinguishing benign from malignant thyroid tissues (p?<?0.0001), KAP-1 expression differentiated CPTC from nodular hyperplasia (p?<?0.0001), CPTC from FA (p?=?0.0028), FVPTC from hyperplasia (p?=?0.0039), and FC from hyperplasia (p?=?0.0025). Furthermore, KAP-1 was more expressed in larger tumors (>4 cm; p?=?0.0038) and in individuals who presented recurrences/metastases (p?=?0.0130). We suggest that KAP-1 may help diagnose thyroid nodules, characterize follicular-patterned thyroid lesions, and identify individuals with poor prognosis. 相似文献
4.
Argyrophilic nucleolar organizing region associated proteins (AgNORs) have been shown to be of interest in a variety of different
diseases including thyroid disorders. Our aim was to distinguish benign thyroid lesions from papillary thyroid carcinoma (PTC)
via AgNOR count and with a new approach, via AgNOR surface area/total nuclear surface area (NORa/TNa) proportions in the nuclei
on fine-needle aspiration (FNA) materials. Thirty patients (eight men and 22 women) whose FNA was compatible with benign lesion
and 26 patients (eight men and 18 women) whose FNA was compatible with PTC were included in the study. Fine-needle aspiration
materials were stained for AgNOR detection according to a specific protocol. One hundred nuclei per individual have been evaluated,
and AgNOR number and NORa/TNa proportions of individual cells were measured and calculated by using a computer program. Patients
with PTC had significantly (p < 0.001) higher AgNOR count (4.6 ± 1.2%) than in the patients with benign lesions (2.0 ± 0.5%). Additionally, patients with
PTC had significantly (p < 0.001) higher NORa/TNa (13.4 ± 2.4) than in the patients with benign lesion (5.7 ± 1.0). Modified method of AgNOR staining
is an easy and reliable method for evaluating proliferation activity of cells in malignant and benign thyroid lesions and
it may contribute to routine cytopathology in inconclusive situations. 相似文献
5.
Eloy C Santos J Soares P Sobrinho-Simões M 《Virchows Archiv : an international journal of pathology》2011,459(6):595-605
Papillary thyroid carcinoma (PTC) gives frequently rise to nodal metastases via lymphatic vessels while follicular thyroid
carcinoma (FTC) metastasises mainly via blood vessels to lung and bones. The follicular variant of PTC (FVPTC) encompasses
the infiltrative subtype (I-FVPTC), which shares most of the features of classic PTC (CPTC), and the encapsulated subtype
(E-FVPTC), which appears to be related to minimally invasive FTC. In an attempt to contribute to the understanding of the
aforementioned differences, we evaluated intratumoural and peritumoural lymph vessels density (LVD), using the immunomarker
D2-40 in a series of E-FVPTC, I-FVPTC, and CPTC with known BRAF and RAS status. None of the E-FVPTC cases presented extra-thyroid extension, lymph vessel invasion or nodal metastases, at variance with
I-FVPTC and CPTC cases. The BRAF V600E mutation was detected in 8.3% of E-FVPTC, 25.0% of I-FVPTC and in 40.7% of CPTC, while N-RAS Q61R mutation was detected only in 10.3% of FVPTC cases. Only one case of E-FVPTC (8.3%) had intratumoural D2-40-stained
vessels in contrast to their presence in 76.5% of the cases of I-FVPTC. Intratumoural LVD determined by D2-40 expression correlated
with the occurrence of extra-thyroid extension, lymph vessel invasion and lymph node metastases in PTC cases. At variance
with intratumoural LVD, peritumoural LVD was not associated with any clinic-pathological or molecular feature, being similar
in E-FVPTC, I-FVPTC and CPTC. Our study highlights the role of intratumoural lymph vessels in PTC nodal metastisation and
reinforces the importance of distinguishing E-FVPTC from I-FVPTC regarding invasiveness, metastatic pattern and molecular
profile. 相似文献
6.
7.
Morari EC Silva JR Guilhen AC Cunha LL Marcello MA Soares FA Vassallo J Ward LS 《Endocrine pathology》2010,21(4):242-249
Our purpose was to evaluate MUC1 clinical utility in the diagnosis and prognosis of thyroid cancer patients. We studied the protein expression of MUC1 in 289 thyroid carcinomas and 121 noncancerous thyroid nodules. There were 41 follicular carcinomas (FC) and 248 papillary thyroid carcinomas (PTC) including 149 classic (CPTC), 20 tall cell (TCPTC) and 79 follicular variants (FVPTC). In addition, we used a quantitative real-time PCR (q-PCR) method to measure MUC1 mRNA expression levels in 108 carcinomas, 23 hyperplasias, and 19 FA. According to their serum Tg levels and other evidences of recurrence/metastasis, the patients were classified as free-of-disease (185 cases) or bad outcome (56 cases, 10 deaths). MUC1 protein was identified in 80.2% PTC; 48.8% FC; 68.3% FVPTC; 70% TCPTC; 21.8% FA; 30% hyperplasias and 6% normal thyroid tissues. MUC1 distinguished benign from malignant thyroid tissues (sensitivity?=?89%; specificity?=?53%). MUC1 also differentiated FC from FA (p?=?0.0083). q-PCR mRNA expression of MUC1 also distinguished malignant from benign nodules (Mann–Whitney test, p?0.0001). However, neither IHC nor mRNA MUC1 expression was associated with any clinical or pathological feature of aggressiveness or outcome. We suggest that MUC1 expression may help differentiate follicular patterned thyroid lesions. 相似文献
8.
Adela Nechifor-Boila Angela Borda Geneviève Sassolas Zakia Hafdi-Nejjari Françoise Borson-Chazot Jean Christophe Lifante Nathalie Sturm Marie Hélène Lavérriere Nicole Berger Myriam Decaussin-Petrucci 《Pathology, research and practice》2013
We aimed to evaluate the expression and diagnostic value of five immunohistochemical markers (HBME-1, Galectin-3, CK19, CD56 and p63) in a very large series of unequivocal papillary thyroid carcinoma (PTC) cases, including both the classic (CPTC) and the follicular variant (FVPTC). 相似文献
9.
Di Cristofaro J Marcy M Vasko V Sebag F Fakhry N Wynford-Thomas D De Micco C 《Human pathology》2006,37(7):824-830
Although the follicular variant of papillary thyroid carcinoma (FVPTC) has been classified as a papillary cancer based on nuclear features, its follicular growth pattern and potential for hematogenous spread are more characteristic of follicular carcinoma. To gain insight into the biologic nature of FVPTC, we compared genetic alterations characteristic of papillary and follicular thyroid carcinomas in 24 FVPTCs and 26 classic PTC (CPTCs). In FVPTCs, we observed ras mutation in 6 of 24 cases (25%), BRAF mutation in 1 of 13 cases (7.6%), and ret rearrangement in 5 of 12 cases (41.7%). In CPTCs, we found ras mutation in no case, BRAF mutation in 3 of 10 cases (30%), and ret rearrangement in 5 of 11 cases (45%). One FVPTC exhibited simultaneous ras mutation and ret/PTC1 rearrangement, and one CPTC harbored simultaneous BRAF mutation and ret/PTC3 rearrangement. Based on these findings, we concluded that ras mutation correlates with follicular differentiation of thyroid tumors whereas ret activation is associated with papillary nuclei but not with papillary architecture. ret activation is not exclusive of ras or BRAF mutation, whereas ras and BRAF mutations are mutually exclusive. The implications of these results for follicular and papillary carcinogenesis are discussed. 相似文献
10.
Papillary thyroid carcinoma (PTC) is the most common type among thyroid cancers. The diagnosis of PTC may be challenging when follicular variant (FVPTC) of this disease is present due to the resemblance of nuclear properties of the classical type (CVPTC). However, making use of ancillary molecular markers in the diagnosis of PTC may help. In our study, we aimed to evaluate the SEPT7 protein expression in PTC. A total of 55 paraffin block tissue samples comprising encapsulated FVPTC (FVPTC(e), n = 25), and CVPTC (n = 15), and benign hyperfunctioning thyroid nodules (HypN, n = 15) were used in this study. Nuclear, cytoplasmic, and overall (total) SEPT7 protein expression levels were determined by using immunohistochemistry. Nuclear, cytoplasmic, and overall SEPT7 expressions (p = 0.02, p = 0.001, p = 0.002, respectively) were significantly lower in FVPTC(e) tissues when compared to HypN. In CVPTC group, nuclear expression was significantly lower (p = 0.004) while overall and cytoplasmic expressions were not changed (p > 0.05). In HypN group, highest nuclear (mean = 2.73), cytoplasmic (mean = 2.86), and overall (mean = 2.86) expression scores were detected. Significantly lower SEPT7 expression in all expressional categories in FVPTC(e) group may be a sign of different molecular signature in this type of tissue. 相似文献
11.
Sena Hwang Dong Yeob Shin Eun Kyung Kim Woo Ick Yang Jung Woo Byun Su Jin Lee Gyuri Kim Soo Jung Im Eun Jig Lee 《Yonsei medical journal》2015,56(5):1338-1344
Purpose
It is often difficult to discriminate focal lymphocytic thyroiditis (FLT) or adenomatous hyperplasia (AH) from thyroid cancer if they both have suspicious ultrasound (US) findings. We aimed to make a predictive model of FLT from papillary thyroid cancer (PTC) in suspicious nodules with benign cytologic results.Materials and Methods
We evaluated 214 patients who had undergone fine-needle aspiration biopsy (FNAB) and had shown thyroid nodules with suspicious US features. PTC was confirmed by surgical pathology. FLT and AH were confirmed through more than two separate FNABs. Clinical and biochemical findings, as well as US features, were evaluated.Results
Of 214 patients, 100 patients were diagnosed with PTC, 55 patients with FLT, and 59 patients with AH. The proportion of elevated thyrotropin (TSH) levels (p=0.014) and thyroglobulin antibody (Tg-Ab) or thyroid peroxidase antibody (TPO-Ab) positivity (p<0.001) in the FLT group was significantly higher than that in the PTC group. Regarding US features, absence of calcification (p=0.006) and "diffuse thyroid disease" (DTD) pattern on US (p<0.001) were frequently seen in the FLT group. On multivariate analysis, Tg-Ab positivity, presence of a DTD pattern on US, and absence of calcification in nodules were associated with FLT with the best specificity of 99% and positive predictive value of 96%. In contrast, a taller than wide shape of nodules was the only variable significant for differentiating AH from PTC.Conclusion
Suspicious thyroid nodules with cytologic benign results could be followed up with US rather than repeat FNAB, if patients exhibit Tg-Ab positivity, no calcifications in nodules, and a DTD pattern on US. 相似文献12.
Eon Ju Jeon Young Ju Jeong Sung Hwan Park Chang Ho Cho Ho Sang Shon Eui Dal Jung 《Journal of Korean medical science》2016,31(3):397-402
Follicular variant papillary thyroid cancer (FVPTC) is the second most common subtype after conventional PTC. We compared ultrasonographic (US) features of FVPTC to those of conventional PTC according to tumor size. We reviewed US findings, pathologic reports, and medical charts of 249 PTC patients with surgically proven disease (83 FVPTCs, 166 conventional PTCs) at our institution from January 2007 to December 2012. FVPTCs were divided into PTC-like and follicular neoplasm (FN)-like based on sonographic characteristics. PTC-like features were defined as having at least one malignant feature (taller-than-wide shape, infiltrative margin, marked hypoechogenicity, and micro-calcifications), whereas FN-like cancers showed oval solid features without malignant features. FVPTCs showed a higher rate of FN-like features than conventional PTCs. Of 166 conventional PTCs, 13 (7.8%) had FN-like features and 153 (92.2%) had PTC-like features, whereas of the 83 FVPTCs, 31 (37.3%) had FN-like features and 52 (62.7%) had PTC-like features. Macro-FVPTCs showed a higher rate of FN-like features than micro-FVPTCs (P < 0.001). Of 21 macro-FVPTCs, 18 (85.7%) had FN-like features and 3 (14.3%) had PTC-like features, whereas of the 62 micro-FVPTCs, 13 (21%) had FN-like features and 49 (79%) had PTC-like features. There were no differences in multifocality, extrathyroidal invasion, and lymph node metastasis between PTC-like FVPTCs and FN-like FVPTCs. FVPTCs showed fewer sonographic malignant features than conventional PTCs. In particular, FVPTCs larger than 1 cm had a more frequent benign sonographic appearance. Therefore, if fine-needle aspiration result is suspicious for PTC in a nodule larger than 1 cm with no suspicious US features, the possibility of FVPTC might be considered. 相似文献
13.
Eduardo Anselmo Garcia Kleber Simões Alda Wakamatsu Rodrigo Albergaria Ressio Venâncio Avancini Ferreira Alves Adhemar Longatto-Filho Roberto Souza Camargo 《Endocrine pathology》2010,21(2):101-107
Thyroid cancer is the most frequent endocrine neoplasia worldwide. The route for metastasis and loco-regional invasion preferentially
occurs by lymphatic vessels. For this reason, the assessment of lymphatic vessel density (LVD) is supposed to represent both
a prognostic parameter and also a potential therapeutic target. In order to evaluate the value of LVD in benign and malignant
thyroid lesions, we analyzed 110 thyroidectomy specimens using D2-40, a specific marker for lymphatic vessels and vascular
endothelial growth factor C (VEGF-C), the most potent molecule of lymphatic proliferation. LVD was significantly different
between papillary and follicular carcinomas in total (p = 0.045) and peritumoral area (p = 0.042). Follicular adenoma and follicular carcinoma showed an important difference of intra- (p = 0.019) and peritumoral (p = 0.033) LVD. VEGF-C was more markedly expressed in malignancies than in benignant lesions (p = 0.0001). Almost all cancers with high positive VEGF-C expression also exhibited increased peritumoral LVD (p = 0.049) when compared with the benignant lesions. Indeed, the high peritumoral LVD of malignant thyroid lesions is an important
finding for surgery planning and supports the practice of total thyroidectomy in malignant thyroid neoplasm’s since the lymphatic
peritumoral vessels definitely are an escape path for tumor cells. 相似文献
14.
Kristine S. Wong Kyle C. Strickland Trevor E. Angell Matthew A. Nehs Erik K. Alexander Edmund S. Cibas Jeffrey F. Krane Brooke E. Howitt Justine A. Barletta 《Endocrine pathology》2017,28(2):171-176
The term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently proposed to replace noninvasive follicular variant of papillary thyroid carcinoma (FVPTC) both to promote more conservative management of these tumors and spare patients the psychological burden of a cancer diagnosis. This reclassification will lower the incidence of papillary thyroid carcinoma (PTC). In addition, it could result in an increase in the rates of unfavorable histologic prognosticators for PTC overall because NIFTPs had previously accounted for many of the PTCs without these features. Our aim was to evaluate the potential impact of the reclassification of NIFTP on the rates of extrathyroidal extension, lymphovascular invasion, and lymph node metastases in PTC. We identified all PTCs clinically over 1 cm diagnosed on surgical resection between August 2010 and August 2012. The histopathologic characteristics, including PTC subtype, tumor size, presence of extrathyroidal extension and lymphovascular invasion, and surgical margin and lymph node status were all recorded. Based on these parameters, cases were classified according to the American Thyroid Association (ATA) risk stratification system for structural disease recurrence. Tumor slides for cases initially diagnosed as FVPTC were reviewed to identify tumors that would now be classified as NIFTPs. Our cohort included 348 cases of PTC, of which 94 (27%) would now be classified as NIFTPs. After excluding NIFTPs from the PTC category, there were increased rates of extrathyroidal extension (26% up from 19%, p = 0.046), lymphovascular invasion (37% up from 27%, p = 0.0099), and lymph node metastases (26% up from 19%, p = 0.045) among the remaining PTCs. Based on these changes in histologic features, 10% fewer cases were defined as ATA low risk (62% down from 72%, p = 0.0081). Our results indicate that the downgrading of some carcinomas to NIFTP will increase the rates of higher risk histologic parameters in the remaining PTCs by statistically significant margins. Although the overall survival for PTC is very high and would likely not be changed significantly by the introduction of NIFTP, additional studies evaluating the impact of the NIFTP shift are warranted. 相似文献
15.
Compérat E Camparo P Haus R Chartier-Kastler E Radenen B Richard F Capron F Paradis V 《Virchows Archiv : an international journal of pathology》2007,450(4):419-424
Aurora-A, a member of serine/threonine kinase, is implied in mitosis and centrosome maturation. Increasing levels of Aurora-A
have been shown to be present in several malignancies and especially in bladder cancer. No immunohistochemical marker has
shown to be able to predict the clinical outcome of patients with superficial bladder cancer, except MIB-1, as a predictive
marker of relapse and progression. The aim was to investigate the expression of Aurora-A and MIB-1 in tissue micro arrays
of superficial bladder cancer representative of pTa papillary urothelial neoplasm with different degrees of aggressiveness
(low malignant potential [PUNLMP], non-invasive papillary urothelial carcinoma low grade [NILGC], non-invasive papillary urothelial
carcinoma high grade [NIHGC] and carcinoma in situ). We analysed predictive values of both markers, their specificity and
sensitivity in tumor recurrence. Aurora-A was a sensitive marker to predict tumor recurrence especially for pTa (PUNLMP, NILGC;
PUNLMP p < 0.001, NILGC p < 0.001) with statistical significant correlation between immunohistochemical staining and clinical outcome. MIB-1 expression
displayed statistical difference p = 0.002 in the PUNLMP group and p = 0.03 in the NILGC group. Aurora-A is a more sensitive marker than MIB-1 to predict relapse in pTa bladder neoplasias. The
combination of both markers seems to have a very powerful predictive value of recurrence (p < 0.001). 相似文献
16.
Ertek S Yılmaz NC Cicero AF Vurupalmaz O Demiröz AS Erdoğan G 《Endocrine pathology》2012,23(3):157-160
We aimed to compare ratios of thyroid cancers diagnosed in our regional reference hospital Pathology Center in Sanliurfa city located in southeast Anatolia, and evaluate the characteristics related with follicular variant papillary thyroid carcinoma (FVPTC). We re-evaluated the specimens of last 5?years thyroidectomies by same five pathologists, by same criteria and immunohistochemical evaluation. Chi-square test was used to compare characteristics of classical pure papillary thyroid carcinomas and FVPTC groups. Stepwise multiple regression analysis was used to evaluate the factors related with presence of FVPTC. Among 400 thyroidectomies, there were 105 papillary thyroid carcinoma, 42 of them with pure PTC, and 56 with FVPC, also seven with other variants. There was increase in ratios of FVPTC/PTC between 2010 and 2011 (68.4 vs 76.7?%, p?0.005). Radius, vascular invasion, and extrathyroidal invasion showed statistically significant difference between pure PTC and FVPTC. In regression analysis radius (p?=?0.001, OR?=?2.611; 95?%CI, 2.010-3.391), age (p?=?0.018, OR?=?0.959; 95?%CI, 0.927-0.993), and multicentricity (p?=?0.044, OR?=?0.403; 95?%CI, 0.167-0.975) were related with presence of FVPTC. Besides, further need for studies to understand whether total prevalence of FVPTC is higher in this region, and the related factors, our study showed that the ratio of FVPTC/PTC is higher in our reference hospital. Age of the patients and the radius and multicentricity of the nodules could be alarming factors for us to suspect for FVPTC. 相似文献
17.
Berrin Ustun David Chhieng Manju L. Prasad Elizabeth Holt Lynwood Hammers Tobias Carling Robert Udelsman Adebowale J. Adeniran 《Endocrine pathology》2014,25(3):257-264
Follicular variant of papillary thyroid carcinoma (FVPTC) creates a continuous diagnostic dilemma among pathologists because of the paucity of nuclear changes of papillary carcinoma and overlapping features with benign and other neoplastic follicular lesions. Current guidelines for the management of thyroid nodules recommend surgery for confirmed PTC, suspicious for PTC, and follicular neoplasm cases, while further immediate diagnostic studies or treatment are not routinely required if the nodule is benign on cytology. This study is designed to determine the accuracy of cytology in the diagnosis of FVPTC, based on the Bethesda classification system, and determine the implications for patient management based on the current recommendation. Based on a retrospective review of cytologic diagnoses between January 2008 and December 2011, thyroid fine needle aspiration (FNA) cytology specimens with subsequent surgical intervention and a final diagnosis of FVPTC were selected. The cytologic diagnoses were compared with the final diagnoses, and the percentage of cases contributing to the final diagnosis of FVPTC was calculated for each diagnostic category. Triage efficiency and diagnostic accuracy were calculated. One hundred and fifty-two cases with histologic confirmation of FVPTC were identified (representing 128 patients—101 female, 27 male). All patients had undergone either lobectomy with completion thyroidectomy or total thyroidectomy. The cytologic diagnosis of “positive for malignancy” accounted for only 27 % of the final histologic diagnosis of FVPTC, while suspicious for carcinoma, follicular neoplasm, follicular lesion of undetermined significance, and benign accounted for 11, 23, 23, and 16 % of the final diagnosis of FVPTC, respectively. Only 18 % of the 55 cases tested were positive for BRAF mutation. The subtle nuclear features of FVPTC pose challenges for an accurate diagnosis. Therefore, a better approach is to triage these cases for surgical intervention and/or further evaluation of the particular nodule. Our triage efficacy for FVPTC was 84 %; however, the diagnostic accuracy of PTC was 38 %. A negative diagnosis on FNA has diagnostic and management implications for up to 16 % of cases because they may have no further immediate diagnostic studies or treatment. BRAF mutation analysis provides minimal effect on diagnostic accuracy. 相似文献
18.
Gamboa-Dominguez A Vieitez-Martinez I Barredo-Prieto BA Richaud-Patin Y Herrera ME Angeles-Angeles A 《Endocrine pathology》1996,7(4):303-308
The planimetric, flow cytometric, and immunohistochemical characteristics of the macrofollicular variant of papillary thyroid
carcinoma (MFVPTC) have not been reported before. The clinical, morphological, immunohistochemical, planimetric, and flow
cytometric characteristics of six cases of the MFVPTC and six of the follicular variant of papillary thyroid carcinoma (FVPTC)
were analyzed. Patients had undergone surgical treatment. The mean age was 38 (range 29–64 yr), and five were women. Tumors
had a mean size of 3.2 cm (range 0.3–4.5 cm). Half were originally diagnosed as goiter. Macrofollicles had a mean diameter
of 345.5 μm, perimeter of 1237 μm, and area of 13,779 μm2, with nuclear changes of PTC. Mean follow-up was 107 mo (range 12–277), and neither lymph node metastases nor recurrence
were seen. Differences in diameter, perimeter, and area between the macrofollicular and follicular variants were found. Follicular
neoplastic cells were thyroglobulin and S-100 protein positive in macrofollicles and normofollicles. All were negative to
cytokeratin and to high-mol-wt keratin. All tumors were diploid. There were no significant differences in follow-up, DNA content,
nor immunohistochemical reactivity. Differences in diameter (p<0.00006), perimeter (p<0.0001), and area (p<0.001) were observed. It is important to recognize this variant because it could be misdiagnosed as benign thyroidal lesions.
Part of this work was presented as a poster at the 85th Annual Meeting of the United States and Canadian Academy of Pathology
in Washington, DC, March 1996. 相似文献
19.
Ramani P Dungwa JV May MT 《Virchows Archiv : an international journal of pathology》2012,460(2):183-191
Neuroblastoma (NB) accounts for 15% of all childhood cancer deaths. The majority of patients have widespread lymphatic and/or
haematogenous metastases at diagnosis, but lymphangiogenesis has not been well documented. Sixty-seven NBs were immunostained
for the lymphatic endothelial marker, LYVE-1, and the lymphatic density (LD) and lymphatic invasion (LI), were counted in
LYVE-1-expressing lymphatics. LYVE-1-stained lymphatic vessels and LI were present in 26/67 (39%) and 14/67 (21%) of the NBs,
respectively. Central LD (CLD) and LI were higher in NBs from stage 4 (p = 0.012, p = 0.004, respectively), high-risk group (p = 0.030, p = 0.002), NBs with high mitosis karyorrhexis index (MKI) (p = 0.011, p = 0.005), unfavourable histology group (p = 0.040, p = 0.017) and distant lymph node metastasis (LNM) (p < 0.001 for each). Marginal LD (MLD) was higher in patients with LNM (p < 0.001). CLD and MLD correlated with LI (p < 0.001 each). Total LYVE-1 protein levels, quantified by a sensitive enzyme-linked immunosorbent assay (n = 55), were also higher in NBs from patients with stage 4 disease (p = 0.046), high-risk group (p = 0.028), MYCN-amplified NBs (p = 0.034) and LNM (p = 0.038). Kaplan–Meier analysis showed that the presence of CLD was associated with both worse OS at 5 years (77% [95% CI:
62–87%] versus 60% [95% CI: 32–80%], p = 0.062) and EFS (74% [95% CI: 58–85%] versus 43% [95% CI: 15–69%], p = 0.070) and LI with OS (71% [95% CI: 57–81%] versus 56% [95% CI: 26–78%], p = 0.055). Significant upregulation of LYVE-1 and the presence of LI in patients with stage 4 and high-risk disease, MYCN-amplification and LNM suggests that LYVE-1 may have value as predictors of outcome. 相似文献
20.
Ultrasound (US)-guided percutaneous laser ablation (LA) of benign thyroid nodules may be a potential alternative to surgery
in patients with compressive symptoms, at high surgical risk, or in patients who refuse to undergo surgery. We evaluated the
morphological effects of LA procedure on 22 patients and compared the cytological findings before and after LA with the histological
features on surgical specimens. Twenty-two (4.9%; 19 women, three men, mean age 53.2 years) out of 452 patients treated with
LA for benign thyroid nodules in our Hospital underwent surgery after LA procedure, either because nodule regrowth (treatment
failure, n = 17) or indeterminate cytology (Thy3) after LA (n = 5). Morphological findings varied according to the time between LA and surgical intervention. Within 2 months, the area
was occasionally cavitated and filled in with dark amorphous material. The inflammatory response was abundant and composed
of neutrophils, lymphocytes, and macrophages. After 18 months or more since LA, the expected laser-induced histologic changes
in thyroid morphology consisted of a well-defined area surrounded by a fibrous capsule and filled in by amorphous material.
No significant pathologic features were found in the thyroid tissue adjacent to the treated area. Histological evaluation
of thyroid tissues after LA shows that thermal damage is restricted to the ablated area, with no involvement of the nearby
parenchyma. Our long-term histopathological findings indicate that LA treatment of benign thyroid nodules is safe, and patients
undergoing LA may also be followed up by fine needle aspiration. 相似文献