Insular carcinoma of the thyroid in a 10-year-old child

Thyroid carcinomas are relatively infrequent in the pediatric age group, the majority of which are papillary carcinomas. Poorly differentiated carcinomas are very rare in this age group. Insular carcinoma is a unique subset of poorly differentiated carcinoma of thyroid, which occurs predominantly in adults older than 50 years. In terms of prognosis, insular carcinoma of thyroid occupies a place in between that of well-differentiated papillary/follicular carcinoma and anaplastic carcinoma. The authors describe a case of insular carcinoma of thyroid in a 10-year-old girl who underwent hemithyroidectomy based on a preoperative diagnosis (by fine-needle aspiration cytology) of colloid goiter, and after histopathologic diagnosis of the specimen, a completion thyroidectomy was performed with block dissection of the neck. The authors believe this to be the youngest case of insular carcinoma of thyroid to be reported.     

Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute

PURPOSE: To compare and contrast the clinical presentation and treatment outcome of patients with papillary and follicular thyroid carcinoma and to study the pattern of practice of treatment of differentiated thyroid carcinoma in Hong Kong. METHOD: The clinical presentation and treatment outcomes were reviewed for 1057 patients with differentiated thyroid cancers who were treated at the Queen Elizabeth Hospital, Hong Kong, from 1960 to 1997. Eight hundred forty-two patients had papillary thyroid carcinomas (PTC), and 215 had follicular thyroid carcinomas (FTC). The mean follow-up was 9.2 years. RESULTS: The differences in the clinical factors of PTC to FTC were as follows: PTC had a higher incidence (3.9:1); these patients were younger at presentation (median age, 44 vs 49), showed a higher female-male ratio (4.5 vs 2.9) and smaller primary tumor size (median 2 cm vs 3.5 cm), and a higher incidence of multifocal disease (28.3% vs 18.1%), extrathyroidal extension (39.4% vs 14%), and more lymph node metastases (33.3% vs 12.1%). The incidence of distant metastases was higher for patients with FTC (28.8% vs 8.9%), and cause-specific survival rates were lower (p =.001). The locoregional control rates were not significantly different (p =.2). The 10-year cause-specific survival, freedom from distant metastasis, and locoregional failure figures for PTC compared with FTC were 92.1% vs 81%, 90.8% vs 72.3%, and 78.5% vs 83%. CONCLUSIONS: Although patients with PTC tend to have more advanced locoregional disease compared with those with FTC, the likelihood of locoregional control is similar, and the probability of cure is better.     

A comparison of the effects of hyperbaric oxygen culture on survival of murine and canine thyroid gland grafts

Abstract. Canine thyroid tissue (CTy) was subjected to hyperbaric oxygen culture (HOC) under conditions that affect immunoalteration in murine thyroid tissue (MTy). Survival of autografts and allografts implanted under the kidney capsule was determined after 21 days by ¹²⁵I uptake and histology. Unlike MTy, autograft CTy subjected to normothermic HOC (95% O₂,5% CO₂; 1.76kg/cm²) for 48 h did not survive (0/8) whereas decrease of culture duration to 24 h resulted in autograft CTy survival (3/3). Under hypothermia (5"C), HOC could be extended to 7 days with autograft CTy survival (3/3 after 4 days and 3/3 after 7 days). Allograft CTy after 24 h of normothermic HOC and 7 days of hypothermic HOC was rejected. Indicators of oxygen free radical injury were determined: catalase activity was comparable in MTy and CTy (means 14.82 and 6.3–10.8 mm/mg protein, respectively) butsuperoxide dismutase activity was low in CTy (means 0.01–0.29 and 4.75 U/mg protein, respectively). Malondialdehyde content after 48 h of normothermic HOC was higher in CTy than in MTy (means 2215 and 1275 nmol/g, respectively). The results show that CTy is injured by HOC under conditions tolerated by MTy, and that this difference is related to the greater sensitivity of CTy to oxygen free radical injury.     

A comparison of the effects of hyperbaric oxygen culture on survival of murine and canine thyroid gland grafts

Canine thyroid tissue (CTy) was subjected to hyperbaric oxygen culture (HOC) under conditions that affect immunoalteration in murine thyroid tissue (MTy). Survival of autografts and allografts implanted under the kidney capsule was determined after 21 days by ¹²⁵I uptake and histology. Unlike MTy, autograft CTy subjected to normothermic HOC (95% O₂, 5% CO₂; 1.76kg/cm²) for 48 h did not survive (0/8) whereas decrease of culture duration to 24 h resulted in autograft CTy survival (3/3). Under hypothermia (5°C), HOC could be extended to 7 days with autograft CTy survival (3/3 after 4 days and 3/3 after 7 days). Allograft CTy after 24 h of normothermic HOC and 7 days of hypothermic HOC was rejected. Indicators of oxygen free radical injury were determined: catalase activity was comparable in MTy and CTy (means 14.82 and 6.3–10.8 mm/mg protein, respectively) but superoxide dismutase activity was low in CTy (means 0.01–0.29 and 4.75 U/mg protein, respectively). Malondialdehyde content after 48 h of normothermic HOC was higher in CTy than in MTy (means 2215 and 1275 nmol/g, respectively). The results show that CTy is injured by HOC under conditions tolerated by MTy, and that this difference is related to the greater sensitivity of CTy to oxygen free radical injury.     

Risk factors contributing to the difference in prognosis for papillary versus micropapillary thyroid carcinoma

Background

The aggressiveness of papillary thyroid carcinoma (PTC) was evaluated by comparing conventional PTC with papillary thyroid microcarcinoma (PTMC). Risk factors associated with differences in clinical and pathologic features were analyzed to provide appropriate surgical management.

Methods

A total of 539 patients with papillary carcinoma who underwent total thyroidectomy were retrospectively reviewed. The median follow-up period was 32 months.

Results

Of 539 patients, 311 (57.7%) had PTMC, and 228 (42.3%) had conventional PTC. No differences between patients with PTMC and those with PTC were observed in age, gender, and multifocality. PTMC was associated with less frequent bilaterality (P = .002), lymph node metastasis (P < .001), thyroid capsule invasion (P < .001), and disease recurrence (P < .001), and a higher rate of incidental diagnosis (P = .001). There was no statistically significant difference between the prevalence of lymph node metastasis at diagnosis and disease recurrence rate between nonincidental PTMC and conventional PTC (P > .05).

Conclusions

Incidental PTMC had significantly fewer aggressive tumor features. Nonincidental PTMC presented with aggressive characteristics similar to those of conventional PTC and should be treated likewise. The authors suggest routine total thyroidectomy followed by an adequate exploration of the central neck compartment as a safe treatment.     

Recurrent laryngeal nerve paralysis in patients with papillary thyroid carcinomas: evaluation and management of resulting vocal dysfunction

BACKGROUND: Recurrent laryngeal nerve paralysis (RLNP) occurs in patients with thyroid malignancy. This study prospectively evaluated vocal function and management outcomes of patients with papillary thyroid carcinomas (PTCs) and RLNP. METHODS: Of 319 PTC patients, 256 underwent total thyroidectomy with or without neck dissection, 42 underwent lobectomy, and 21 underwent reoperation for recurrent cancers. All patients underwent laryngoscopy and vocal function measurements before and after surgery. Patients with RLNP and poor vocal function underwent voice surgery. RESULTS: Temporary and permanent RLNP rates were 2.8% and .9% at nerve-at-risk-based analysis, respectively. Of 28 patients with tumor invasion of RLN, 14 had preoperative RLNP, with 9 of 14 showing voice changes. RLNP was detected in 9 of 291 (3.1%) patients without documented nerve injury; 8 recovered. Nine of 15 patients with RLN section had poor vocal function, which improved in 8 patients after medialization of the unilateral vocal fold. CONCLUSIONS: Patients with PTC may have vocal dysfunction from cancer or surgery-related RLNP. Vocal evaluation and management may help improve their vocal function, thus enhancing their quality of life.     

Intravascular extension of papillary thyroid carcinoma to the internal jugular vein: A case report

INTRODUCTION

Papillary thyroid cancer (PTC) is the most common thyroid malignancy and usually spreads via lymphatic system. PTC can sometimes show microscopic vascular invasion, but rarely causes tumour thrombus in the internal jugular vein (IJV) or other great veins of the neck.

PRESENTATION OF CASE

We report a case of a 62-year-old female presented with symptomatic central neck mass. Clinical examination revealed a hard solitary right-sided thyroid nodule with ipsilateral cervical lymphadenopathy. Ultrasonography (US) confirmed the clinical diagnosis and visualised a dilated ipsilateral IJV. Fine-needle aspiration cytology revealed PTC cells so total thyroidectomy with right neck dissection was done. A tumour thrombus was discovered in the distended right IJV and was cleared successfully. The patient recovered well after the operation with no local or distant metastasis detected.

DISCUSSION

Tumour vascular spread is observed in tumours with angio-invasive features including follicular carcinoma of the thyroid gland where great cervical veins can be affected. PTC commonly spreads to the lymph nodes and vascular spread via direct intravascular extension is extremely rare. Neck US has an important role in the diagnosis, and operators should attempt to detect signs of tumour thrombi in all patients with thyroid masses. Aggressive surgical treatment with vascular repair is recommended whenever possible to minimise the risk of potentially fatal complications of the intraluminal masses.

CONCLUSION

Intravascular tumour extension of PTC is rare but with serious consequences. Diagnosis with neck US is possible but some cases are only discovered intraoperatively. Thrombectomy with vascular repair or reconstruction is usually possible.     

乳头状甲状腺癌中谷胱甘肽过氧化物酶3启动子区高甲基化与表达缺失

目的 探讨乳头状甲状腺癌(PTC)中谷胱甘肽过氧化物酶3(GPX3)基因启动子区域甲基化状态,分析GPX3甲基化与其基凶表达的关系.方法 应用甲基化特异性聚合酶链式反应(MSP)检测47例PTC、10例非癌组织标本和乳头状甲状腺癌细胞株TPC-1中GPX3的甲基化状态,并用逆转录-聚合酶链式反应(RT-PCR)检测TPC-1细胞中GPX3的mRNA表达.结果 48.9％( 23/47) PTC发生GPX3基因启动子区域甲基化,而10例非癌组织均未发生甲基化;TPC-1中GPX3启动子区甲基化,而且GPX3的mRNA不表达,经5-aza-2’-deoxycytidine干预96h后GPX3重新表达.结论 GPX3基因启动子区域频繁发生甲基化.,可能作为PTC的诊断标志物;GPX3启动子区的甲基化是其基因表达的重要调节机制.     

组织蛋白酶B和趋化因子受体4在乳头状甲状腺癌的表达及在侵袭转移中的作用

目的 观察组织蛋白酶B(CB)、趋化因子受体4(CXCR4)mRNA和蛋白在乳头状甲状腺癌(PTC)中的表达,探讨其在乳头状甲状腺癌侵袭和转移中的作用.方法 采用逆转录-聚合酶链反应(RT-PCR)及免疫组织化学SP法检40例PTC,10例正常甲状腺中CB、CXCR4 mRNA和蛋白的表达.结果 CB、CXCR4 mRNA和蛋白在正常甲状腺中均为阴性表达;CB、CXCR4 mRNA在PTC中阳性表达率82.5%(33/40)、80%(32/40);CB、CXCR4蛋白在PTC中阳性表达率65%(26/40)、60%(24/40);CB,CXCR4 mRNA表达与蛋白表达之间呈显著正相关(r=0.352,P＜0.05;r=0.357,P＜0.05),且均与侵润深度,淋巴结转移密切相关(P＜0.05);CB,CXCR4蛋白表达呈正相关(r=0.471,P＜0.05).结论 CB、CXCR4在乳头状甲状腺癌的侵袭和转移中发挥促进作用.     

中国人甲状腺乳头状癌中RET基因重排及类型的分析研究

目的　建立检测RET基因重排的方法 ,研究中国人甲状腺乳头状癌 (PTC)中是否存在RET基因重排及其重排类型。方法　应用RT PCR方法对 110例PTC石蜡切片标本进行RET基因重排检测 ,并对扩增结果进行测序鉴定。结果　 76例PTC标本提取RNA成功 ,其中 60 .5 % (4 6/76)发生RET重排 ,13 .2 % (10 /4 6)表达PTC1,5 .3 % (4 /76)表达PTC3 ,2 .6% (2 /76)表达PTC4,其中PTC1发生的频率最高 ,实验中仅检测到 1例PTC2与PTC3 /PTC4混合型重排 ,可能中国人中PTC与RET和H4及ELE1重排激活有关。此外 ,还发现单一标本中有多种重排形式并存 ,比例高达 3 9.5 % (3 0 /76)。结论　中国人PTC组织中存在第 1、2、3、4种重排 ,且以第 1种较为常见。病例资料分析表明 :此多种重排混合的情形与肿瘤的大小、转移等无关。     

甲状腺乳头状癌63例细胞学分析

目的探讨诊断甲状腺乳头状癌的细胞学形态特点。方法运用针吸活检（FNAB）法采集甲状腺结节标本，涂片经常规HE染色后进行细胞学观察，对甲状腺结节FNAB标本采集技术和作为细胞学诊断标准的假包涵体、乳头状片断的鉴别诊断进行探讨。结果查见核内假包涵体和乳头状片断，细胞学诊断的63例甲状腺乳头状癌，均经术后组织病理学诊断证实。结论FNAB诊断甲状腺乳头状癌正确性较高，掌握甲状腺乳头状癌的细胞学形态特点可提高诊断准确率。     

Significance of vascular endothelial growth factor and epidermal growth factor in development of papillary thyroid cancer

Background and aims Vascular endothelial growth factor (VEGF) induces proliferation of endothelial cells, stimulates angiogenesis and increases vascular permeability. Epidermal growth factor (EGF) induces proliferation of epidermal cells and stimulates epidermal migration. Increased VEGF and EGF expression have been associated with poor clinical outcome in many malignancies. Several recent reports have shown overexpression of VEGF and EGF in papillary thyroid cancer (PTC). The study aimed to determine the intensity of expression of VEGF and EGF in patients with PTC and to find any correlation between the intensity of the expression and staging of the disease at the moment of surgeryPatients and methods The study comprised a group of 48 consecutive patients with PTC who underwent radical surgery. The group consisted of 11, 25, eight and four patients at pT1N0M0, pT2N0M0, pT3N1M0 and pT4N1M0 stages, respectively. The control group was composed of 20 healthy bone marrow transplant donors, age-, gender- and BMI-matched with PTC patients. The immuno-chemiluminescence enzyme linked immunoassay (ELISA) method was used to determine the expression and level of VEGF and EGF in serum samples. Patients characteristics, serum levels of VEGF and EGF, final histology and pTNM were analysed.Results The mean serum level of VEGF and EGF was remarkably higher in PTC patients than in controls. A negative correlation between staging in pTNM classification and the mean serum VEGF level (r=–0.5168; P<0.05) as well as a positive correlation between staging in pTNM classification and the mean serum EGF level (r=0.6104; P<0.05) in PTC patients was observed.Conclusions Both VEGF and EGF play an important role in PTC growth. However, the intensity of their expression is variable, depending on the stage of the disease. The highest intensity of VEGF expression is characteristic for low-stage T1N0M0 disease, whereas the highest intensity of EGF expression is more often found at locally advanced pT3 and pT4N1M0 stages of the disease. Further long-term follow-up studies are required to demonstrate the prognostic value of VEGF and EGF in PTC, particularly in identification of patients with expected poor prognosis or shorter recurrence-free survival.The paper was presented at the First Constituent Congress of the European Society of Endocrine Surgeons, 14–15 May 2004, Pisa, Italy     

Do the prognoses of papillary and follicular thyroid carcinomas differ?

Our 44 patients with follicular thyroid carcinoma had a survival rate similar to patients of the same age and sex with papillary carcinoma. By matching our patients by age and sex, this study appears to show that the biologic behavior of differentiated thyroid carcinomas is better correlated with the age and sex of the patients than with the pathologic classification of papillary carcinoma or follicular carcinoma; therefore, it is unnecessary to distinguish between patients with papillary carcinoma and follicular carcinoma from a prognostic standpoint. A classification considering all well-differentiated thyroid carcinomas as one disease with behavioral variability due to constitutional factors such as age and sex should be adopted.