CD10在甲状腺疾病中的表达及意义

目的研究CD10在甲状腺疾病中的表达及意义。方法收集70例甲状腺良、恶性病变组织,其中15例滤泡性腺瘤、15例腺瘤性甲状腺肿、30例乳头状癌和10例滤泡性癌。采用免疫组织化学的方法检测CD10在上述病变中的表达。结果9例滤泡型乳头状癌中,7例表达CD10,CD10阳性率为77％。10例滤泡性癌中,8例表达CD10,阳性率为80％。而在滤泡性腺瘤和腺瘤性甲状腺肿及21例普通型乳头状癌组织中CD10均不表达。CD10在滤泡型乳头状癌和滤泡性癌中的阳性率显著高于滤泡性腺瘤和腺瘤性甲状腺肿中的阳性率（P〈0．01）。结论对CD10表达的检测有助于对甲状腺滤泡性癌和滤泡型乳头状癌的诊断。     

CD10表达在甲状腺滤泡性癌和滤泡型乳头状癌诊断中的作用

目的研究CD10表达在甲状腺滤泡性癌和滤泡型乳头状癌诊断中的作用。方法收集70例甲状腺良、恶性病变组织，其中包括15例滤泡性腺瘤、15例腺瘤性甲状腺肿、30例乳头状癌（包括9例滤泡型乳头状癌）和10例滤泡性癌，采用免疫组织化学方法检测CD10在上述组织中的表达。结果9例滤泡型乳头状癌中，7例表达CD10（77．8％），10例滤泡性癌中8例表达CD10（80．0％）；CD10在非滤泡型乳头状癌、滤泡性腺瘤、腺瘤性甲状腺肿和正常甲状腺组织中均不表达。结论对CD10表达的检测有助于对甲状腺滤泡性癌和滤泡型乳头状癌的诊断。     

组织蛋白酶D在甲状腺乳头状腺癌中的表达及临床意义

目的:研究组织蛋白酶D在甲状腺乳头状腺癌中的表达并探讨其能否成为甲状腺乳头状腺癌独立的预后因素。方法:应用免疫组化方法,对40例甲状腺乳头状腺癌、10例甲状腺滤泡型腺瘤及10例甲状腺正常组织进行了组织蛋白酶D表达的研究,并对可能影响甲状腺癌病人预后的有关因素进行了时序检验单因素生存分析。结果:19例(47.5％)甲状腺乳头状腺癌的组织蛋白酶D表达阳性,而甲状腺滤泡型腺瘤及正常组织的表达均为阴性,差异有显著性(P<0.05)。肿瘤大于4cm及有腺外侵犯者的甲状腺癌组织蛋白酶D阳性表达率(69.23％)明显高于肿瘤小于4cm及无腺外侵犯者(37.04％)(P<0.05)。经时序检验,组织蛋白酶D与甲状腺癌病人的预后并未表现出明显的相关关系。但组织蛋白酶D表达阳性病人的术后复发率为26.3％,表达阴性者复发率为14.3％,有一定的差异。结论:组织蛋白酶D在甲状腺乳头状腺癌中有一定的阳性表达率;当肿瘤大于4cm时,发生转移和侵袭的可能性明显增加,组织蛋白酶D表达阳性者其复发率有升高趋势。     

Evidence-based protocols for the management of well-differentiated carcinomas of the thyroid

OBJECTIVES: In recent years, well-differentiated carcinomas of the thyroid have been stratified into low-risk and high-risk groups. The pattern of thyroid cancer in India is different from that seen in the West. Moreover, patients present with more advanced stages of the disease. Our aim was to develop protocols for the management of well-differentiated thyroid cancer, based on the analysis of our data and our experience. METHODS: Cases of thyroid carcinoma, which were surgically treated at the Tata Memorial Hospital during 1970-5, were studied. The survival curves were plotted according to the Kaplan-Meier method. Univariate analysis was done using the log rank test. The prognostic factors analyzed were age, sex, tumour size, extra-thyroid extension, distant metastases and lymph node metastases. Multivariate analysis using the Cox regression model was performed. Analyses were separate for follicular and papillary carcinomas. RESULTS: Four hundred and seventeen cases were entered in the study, of which 198 were follicular and 219 were papillary. Based on the evidence derived from this study, we stratified our cases into low- and high-risk groups. The low-risk group consisted of patients below 40 years of age, nodules smaller than 5 cm, absence of extra-thyroidal spread and absence of distant metastases. For follicular carcinoma, the low-risk group had 100% survival at 15 years, compared with 40% for the high-risk group. (p < 0.001). For papillary carcinomas, the survival at 15 years was 95% for the low-risk group and 40% for the high-risk group (p < 0.001). CONCLUSIONS: We recommend lobectomy for the low-risk group, and total thyroidectomy for the high-risk group and for cases with lymph node metastases. In the latter, total thyroidectomy facilitates the use of 131I.     

Downregulation of p27KIP1 and Ki67/Mib1 labeling index support the classification of thyroid carcinoma into prognostically relevant categories.

The cyclin-dependent kinase inhibitor p27KIP1 has been proposed as a valuable prognostic indicator for a variety of human neoplasms. Immunohistochemical reactivity for p27KIP1 and the proliferation marker Ki67/Mib1 were investigated in 90 thyroid carcinomas of follicular cell origin. The neoplasms were divided into three prognostic groups on the basis of their morphologic features: group 1, well-differentiated papillary or follicular carcinomas with favorable pathologic features (43 papillary carcinomas and 4 minimally invasive follicular carcinomas); group 2, papillary or follicular carcinomas with unfavorable pathologic features (21 poorly differentiated carcinomas and 2 papillary carcinomas, tall cell variant); and group 3, undifferentiated, or anaplastic, carcinomas. p27KIP1 expression (p = 0.007) and Ki67/Mib1 labeling index (p = 0.02) showed a strong correlation with the subdivision of the thyroid carcinomas in the three prognostic groups with a significant linear trend for tumors with low p27KIP1 (p = 0.002) and high Ki67/Mib1 labeling index (p = 0.005) to segregate into the unfavorable categories (groups 2 and 3). Low p27KIP1 expression, but not cellular proliferation, was related to adverse prognostic factors, such as large tumor size (p = 0.03) and extrathyroidal extension (p = 0.01), but the correlation was not independent of the subdivision in the three groups. Low p27KIP1 expression (p = 0.03) and high proliferative rate (p = 0.02) were associated with poor survival, reflecting the close association between patient morbidity and mortality rates and tumor differentiation. No significant association could be seen between p27KIP1 or cellular proliferation and clinicopathologic parameters (e.g., age, sex, tumor size, extrathyroidal extension, vascular invasion, lymph node metastases, distant metastases, tumor stage, and survival rate) within any of the groups, or the histologic diagnosis of papillary versus follicular carcinoma irrespective of their degree of differentiation. Modulation of p27KIP1 and cellular proliferation patterns in thyroid carcinoma correlate with tumor differentiation and support the morphologic classification of thyroid carcinoma into prognostically relevant categories.     

C MET蛋白在有颈部淋巴结转移的甲状腺癌中的表达和意义

目的探讨C-MET蛋白在有或无颈部淋巴结转移的甲状腺乳头状癌、甲状腺滤泡状癌及良性甲状腺组织中的表达及其临床意义。方法采用免疫组织化学方法检测有颈部淋巴结转移的甲状腺乳头状腺癌（PTC1组）62例，无颈部淋巴结转移的甲状腺乳头状腺癌（PTC2组）50例，甲状腺滤泡状腺癌（FTC组）l0例及良性甲状腺组织（良性组）30例中的C—MET蛋白的表达。结果PTCI组的C—MET表达明显高于其它3组（P〈0．001）。两两比较C—MET表达结果：PTC1组与PTC2组比较，P〈0．001；PTC1组与FTC组比较，P〈0．001；PTC1组与良性组比较，P〈0．001；PTC2组与FTC组比较，P=0．002；PTC2组与良性组比较，P〈0．001；皆有显著性差异。结论C—MET的表达是甲状腺乳头状癌是否有淋巴结转移的预测因子，是肿瘤的囊外扩展和直接侵犯的标记。该指标对甲状腺乳头状癌淋巴结转移的术前评估，决定手术方式均有一定指导意义。     

Outcome in cervical recurrences of papillary or follicular thyroid cancer]

The aim of this study was to evaluate the treatment and outcome of patients with local recurrence (LR) of differentiated thyroid carcinoma. This retrospective study concerned patients treated between 1974 and 1990 for papillary or follicular thyroid cancer. Our patients had at least one LR. LR diagnosed within 6 months after thyroidectomy and patients with increased serum thyroglobulin levels were excluded. Thirty one patients (80% female) aged 15 to 84 years had at least one LR. LR was diagnosed 7 to 200 months after thyroidectomy (mean 63.7). There were 25 papillary and 6 follicular cancers. There were 1.5 LR per patient (range 1-6). LR were treated by radioiodine in 21 cases and by surgery in 22 cases. Among the 22 surgically treated patients, 7 had nodal recurrences, 7 had nodes and tumor, 3 had only tumor, 1 had recurrence in the remnant thyroid. After a mean follow-up of 75.8 months, 11 patients had distant metastases, 11 had died from their thyroid carcinoma (7 after metastases). Three of the 7 patients with nodal recurrence died. In one third of cases, LR announced distant metastases. Node recurrence had a poor prognosis.     

The optically clear nucleus. A reliable sign of papillary carcinoma of the thyroid?

The clear ("Orphan Annie Eye") nucleus has been accepted as one of the important microscopic features of papillary carcinoma of the thyroid. This study undertook an examination of 100 consecutive thyroid lesions exclusive of papillary, mixed, and follicular carcinomas for the presence of these nuclei. Only two lesions (2%), a follicular adenoma and diffuse hyperplasia, had such nuclear morphology but as focal changes. Thirty-seven cases of papillary, mixed, and follicular carcinoma were also studied. Clear or empty nuclei were present in 83% of papillary carcinomas. One carcinoma of follicular type had clear nuclei in a diffuse distribution. "Pseudoclear" nuclei were noted in a variety of situations ranging from normal thyroids to diffuse hyperplasia, where they were present in 65% of cases. We conclude that clear nuclei when present as a diffuse changes in a thyroid tumor are a reliable sign of papillary carcinoma but are not pathognomonic. If the character of the clear nuclei is questionable, other histologic features of papillary carcinoma should be looked for, such as papillae with overlapping nuclei, psammoma bodies and multicocality. It was also fould that frozen sections and imprints do not demonstrate the nuclei; they appear only in fixed tissues.     

Clinicopathologic significance of histologic vascular invasion in papillary and follicular thyroid carcinomas

BACKGROUND: The association of angioinvasion with tumor aggressiveness in follicular and papillary thyroid carcinoma remains unclear. This study addresses this problem focusing on clinicopathologic relevance of angioinvasion in the treatment of papillary thyroid carcinoma and follicular thyroid carcinoma. METHODS: From a university hospital database, 358 patients with papillary thyroid carcinoma or follicular thyroid carcinoma were randomly selected. Their charts were retrospectively analyzed and divided into papillary thyroid carcinoma and follicular thyroid carcinoma groups. Each group was subdivided into angioinvasive and nonangioinvasive tumor subgroups. All data were analyzed using Student's t-test, Mann-Whitney rank sum test, chi-square test, and Fisher's exact test. RESULTS: There were 289 women and 69 men, ages 18 to 89 years. Papillary thyroid carcinoma (86%) was more frequent than follicular thyroid carcinoma. Most patients had nonangioinvasive tumor (90.2%). After a mean followup of 43.6 months, there were no significant differences between papillary thyroid carcinoma subgroups for local recurrence (p = 0.69), persistent elevated serum thyroglobulin (p = 0.568), and distant metastasis rates (p = 0.422). No death related to the cancer was observed in both papillary thyroid carcinoma subgroups (p = 1), except for one death resulting from a concomitant nasopharyngeal cancer. The longterm prognosis was less favorable for angioinvasive papillary thyroid carcinoma based on AJCC (American Joint Committee on Cancer staging), AMES (age, distant metastasis, tumor extent, and size), and MACIS (distant metastasis, age, completeness of primary tumor resection, local invasion, and tumor size), but the angioinvasive papillary thyroid carcinoma were larger than nonangioinvasive papillary thyroid carcinomas. The short-term clinical outcomes in both follicular thyroid carcinoma, after a mean followup of 72.3 months, were comparable in terms of local recurrence (p = 0.34), persistent elevated serum thyroglobulin (p = 1), and distant metastasis (p = 0.597). There was no death related to cancer in both follicular thyroid carcinoma subgroups (p = 1). There were no significant differences between both follicular thyroid carcinoma subgroups for longterm prognosis. CONCLUSIONS: Our results indicate that angioinvasion does not adversely influence short-term outcomes or longterm prognosis in follicular thyroid carcinoma and short-term outcomes in papillary thyroid carcinoma. Angioinvasion is a postoperative pathologic finding that does not justify an ominous prognosis or drastic therapeutic measures.     

p14ARF、p53及脆性组氨酸三联体蛋白在甲状腺肿瘤中的表达

目的探讨p14ARF、p53及脆性组氨酸三联体(FHIT)蛋白在甲状腺肿瘤组织中的表达及其意义。方法采用免疫组织化学法检测20例甲状腺腺瘤和28例甲状腺癌组织(其中包括11例甲状腺滤泡癌(FTC)、12例乳头状癌(PTC)、4例髓样癌(MTC)以及1例未分化癌(UDTC)中p14ARF、p53及FHIT蛋白的表达。结果p14ARF、p53及FHIT蛋白在甲状腺腺瘤和甲状腺癌中阳性率分别为90%、36%;15%、75%;90%、7%,这3种蛋白在甲状腺腺瘤及甲状腺癌的表达差异均有统计学意义(P<0.05)。p14ARF、p53及FHIT蛋白的表达在FTC与腺瘤之间,PTC与腺瘤之间有统计学意义(P<0.05),p53及FHIT的表达在MTC与腺瘤间差异有统计学意义(P<0.05)。p14ARF、p53及FHIT蛋白的表达与甲状腺肿瘤的恶性进程有关,与患者年龄、性别以及淋巴结转移无关。另外p14ARF与FHIT蛋白的表达正相关,并且它们与p53均负相关。结论肿瘤抑制蛋白p14ARF和FHIT的缺失以及癌蛋白p53的高表达是甲状腺肿瘤发生的重要原因之一;联合检测p14ARF、p53及FHIT蛋白有助于区分甲状腺腺瘤和甲状腺滤泡癌。     

Thyroid papillary carcinoma. Pathological and philosophical controversies

An encapsulated thyroid tumor with a papillary architecture is statistically much more likely to be a hyperplastic follicular adenoma than a papillary carcinoma, for the latter are uncommonly encapsulated. Hyperfunction of such a tumor is diagnostic of an adenoma. Various histopathologic features are useful in the differential diagnosis, but these are more accurately termed guidelines than criteria. The presence of psammoma bodies, fibrovascular stalks of papillae and pale nuclear changes are probably the most reliable histopathologic features of a carcinoma. The value of needle biopsy as a diagnostic tool for the screening of thyroid nodules is emphasized. Encapsulated variants of papillary carcinoma are discussed, including the rare pure follicular variant and those intermixed with adenomatous components, suggesting the possibility that some papillary carcinomas might arise in a preexisting adenoma. When the histopathologic diagnosis is equivocal, a benign interpretation is favored since encapsulated papillary carcinomas are very low grade, have an unusually favorable prognosis, and need no further resection. The polarization in past years of clinicians into radical and conservative operative fractions is reviewed. This stemmed from different interpretations of the presence of lymph node metastases in a majority of cases and the high frequency of intraglandular microscopic dissemination of neoplasm. It is clear that biological behavior of this unusual cancer is more important than a literal interpretation of the pathologic findings as a determinant for patient management. The surgical pathologist should be mindful that he plays an important role in patient management, not only by providing a diagnosis but also by serving as a consultant to the surgeon in pathologic correlation.     

Follicular Histotypes of Oncocytic Thyroid Carcinomas Do Not Carry Mutations of the <Emphasis Type="Italic">BRAF</Emphasis> Hot-spot

Background The BRAF V600E mutation is the most prevalent genetic aberration in papillary thyroid carcinomas (PTCs), and it is found exclusively in RET/PTC-negative tumors. In oncocytic (Hürthle cell, oxyphilic) thyroid tumors, the presence of RET/PTC rearrangements is associated with either the conventional papillary histotype or the “solid” Hürthle cell tumors, whereas all predominantly follicular oncocytic carcinomas do not harbor RET/PTC chimeras. Although 12% of tumors of the follicular variant of PTC carry BRAF mutations, none of the few oncocytic follicular thyroid adenomas (oncoAd) or carcinomas (oncoFTC) published worldwide tested positive. An aspired molecular-based classification of oncocytic thyroid tumors is in need of additional evidence on BRAF mutations in the follicular histotype. Methods A series of 44 oncocytic thyroid tumors with well-documented clinicopathological data was subjected to BRAF mutation analysis (complete exon 15) by automated sequencing. Results The series of oncocytic thyroid tumors consisted of 21 adenomas (oncoAds: 17 females, 4 males; mean age, 54.5 years; range, 27–80 years), 20 follicular carcinomas (oncoFTCs: 14 females, 6 males; mean age, 61.4 years; range, 39–80 years), and 3 “classic” papillary carcinomas (oncoPTCs: 3 females; mean age, 58.1 years; range, 46–70 years; 3x T2 tumors). The follicular variants of oncocytic cancers are divided into 11x T2, 5x T3, and 4x T4 tumor stages (International Union Against Cancer [UICC] TNM 5th edition). None of the 44 neoplasms of the presented series demonstrated genetic alterations in the BRAF hot-spot region (exon 15, codons 599–601). Congruently, 0/10 oncoAd and 0/20 oncoFTC described in the literature so far carried BRAF V600E mutations. Conclusions Our results add to the evidence that, in contrast to follicular variants of oncoPTCs, predominantly follicular oncocytic thyroid tumors harbor neither RET/PTC rearrangements nor BRAF mutations. Furthermore, the findings support the concept that oncocytic neoplasms of the thyroid gland are oncocytic counterparts of the respective histotype (adenoma, FTC, PTC, or poorly differentiated thyroid carcinoma) rather than a separate tumor entity. Molecular characterization of oncocytic thyroid malignancies for RET/PTC or BRAF genetic alterations may help with (preoperative) classification and prognostic evaluation of these tumors.     

Analysis of ultrasound B-mode histogram in thyroid tumors

B-mode histograms of preoperative ultrasound texture were correlated to final pathological diagnoses and findings in 50 thyroid tumors (18 follicular adenomas, 6 follicular carcinomas and 26 papillary carcinomas) and 10 cases without any thyroid disease. Histograms were taken in the region of interest (ROI) and in the control area of the normal thyroid tissue. The following parameters, after subtracting the statistics of the control region from that of ROI, were evaluated; the difference of mean (D1), of standard deviation (D2), of skewness (D3), and of krutosis (D4). Likewise, Maharanobis distance (MD) was also studied. D1 was lower in papillary carcinomas than in follicular adenomas, and diminished by the relative proportion of some pathological findings, D2 and D3 of papillary carcinomas was higher than those of follicular adenomas. MD, having a significant correlation to D1 (r = -.8), revealed similar relationship with pathology as that of D1. No significant difference was observed between normal thyroid tissue and follicular adenoma, nor between follicular adenoma and follicular carcinoma in any parameter. MD showed the best correlation to malignancy. The criterion which judges the the tumor with D1 less than -2.5, or D2 more than 1 to be malignant, was expected to have sensitivity of 83% and specificity of 88%.     

Prognostic factors of insular versus papillary/follicular thyroid carcinoma

The study aims were to characterize patients with insular thyroid cancer and to provide data on patient outcome after surgical therapy. We compared nine patients with insular thyroid cancer at the Department of Surgical Science of "La Sapienza" University of Rome with 27 patients of similar age and tumor size who had follicular and papillary cancer, for a minimum follow-up period of 24 months (range, 24-72 months). All of the patients examined underwent total thyroidectomy. Vascular invasion was observed in 44.4 per cent of insular carcinomas (P < 0.05 vs papillary carcinomas). No significant differences were observed regarding diagnostic method, multifocality, tumor nodes metastases (TNM), or stage. The death rate of patients with insular carcinoma (33.3%) was found to be higher than that of patients with follicular carcinoma (P < 0.05) and papillary carcinoma (P < 0.01). Relapsing lymph-node pathologies were observed in 4 patients (44.4%) with insular carcinoma (P < 0.05 vs those with follicular and papillary carcinomas). Distant metastases were observed in 66.6 per cent of insular carcinomas (P < 0.005 vs follicular carcinoma and P < 0.001 vs papillary carcinoma). At the end of follow-up, 2 patients (22.2%) with insular carcinoma were disease-free (P < 0.001 vs those with follicular and papillary carcinomas). Our study demonstrates an unfavorable prognostic role of the insular phenotype of thyroid cancer, such that this tumor can be classified as an autonomous clinical and pathological entity.     

Thyroid cancer in children: Report of three cases and a review of the Japanese literature

We experienced three cases of thyroid cancer in children less than 15 years of age between 1982 and 1995. We herein present these three cases with a review of 141 reported cases of childhood thyroid cancer in Japan. Our patients were 6, 13, and 14 years old. The patients, all girls, were diagnosed as having thyroid cancer based on diagnostic imaging. One of them was also diagnosed by a fine-needle aspiration biopsy (FNAB). One of them underwent subtotal thyroidectomy, and the other two underwent lobectomy. Modified neck dissections were performed on all three. Pathologically, the tumors were all papillary carcinomas. Multiple lymph node metastases were present in all patients. However, the postoperative courses have been good, and there have been no signs of recurrence, 10, 8, and 2 years after their respective operations. In 144 reported cases of childhood thyroid cancer in Japan including ours, the youngest patient was a 2-year-old boy, and the female to male ratio was 2.1:1. FNAB was performed in 25 cases, and 23 (92%) of the tumors were diagnosed as malignant. Histologically, 76% were papillary carcinoma and 20% follicular carcinoma. At operation, lymph node metastases were found in 80% of the cases and lung metastases in 17%. For treatment, 88% of the patients received a more extensive operation than a lobectomy. Of the 144 patients, 8 died.     

Measurement of cellular DNA content in thyroid tumors by the flow cytometer

Cellular DNA contents measured by flow cytometer were analysed in relation to histopathological classification and clinicopathological findings in 94 patients with thyroid tumors. The DNA determination was carried out on both tumor tissues and surrounding thyroid tissues. As an indicator of tumor growth, proliferative index (PI) and DNA index were calculated from DNA histograms. The PI value (mean +/- SD) was 32.5 in medullary carcinoma, 31.3 +/- 10.2 in follicular carcinoma, 28.2 +/- 6.2 in papillary carcinoma, 21.6 +/- 4.4 in follicular adenoma, and 20.6 +/- 4.4 in adenomatous goiter, respectively, whereas the value in normal thyroid tissues was 4.1 +/- 2.2. PI values in the surrounding thyroid tissues in cases of follicular and papillary carcinomas were significantly (p less than 0.01) lower than those of the corresponding cancer tissues, but they were higher than that of the normal tissues. The DNA index and frequencies of aneuploidy were 1.15 and 50.0% in medullary carcinoma; 1.25 +/- 0.27 and 66.7% in follicular carcinoma; 1.19 +/- 0.25 and 64.2% in papillary carcinoma; 1.01 +/- 0.04 and 9.3% in follicular adenoma; and 1.00 +/- 0.00% in adenomatous goiter. The result implies that PI value and DNA index are relatively correlated with clinicopathological criteria of malignancy of individual thyroid tumors, and they may become a putative tool for determination of the biological malignancy.     

Follicular carcinoma of the thyroid

Background. Follicular carcinomas of the thyroid are less common than papillary carcinomas of the thyroid, and the available data on prognostic factors are relatively scant. A retrospective study covering four decades was undertaken to evaluate clinical and pathologic findings with regard to their effect on prognosis. Methods. In 195 cases of follicular carcinoma treated from 1954 to 1991 age, sex, histologic type (minimally invasive vs. widely invasive), tumor size, and local, regional, and distant spread as well as the contribution of treatment to survival were evaluated in relation to prognosis. Results. Age was a significant prognostic factor: there was 100% survival of patients younger than 20 years of age at diagnosis and only one death in the 20-39 year age group. Sex was not a significant prognostic factor, although there was a tendency to a better prognosis in females. Tumor size was significant, more than 6 cm having a poor prognosis. Blood vessel invasion influenced prognosis for the first 10 years. The presence of distant metastases was significant regarding survival. Lymph node involvement had a negative effect on the outcome. Conclusions. The factors of age, tumor size, invasion of blood vessels, and distant metastases are significant predictors of survival for patients with follicular carcinoma, whereas sex is not; regional spread needs to be evaluated further. © 1994 John Wiley & Sons, Inc.     

Prognostic factors in patients with differentiated thyroid carcinoma.

OBJECTIVE: To study the prognostic factors in patients with differentiated thyroid carcinoma. DESIGN: Retrospective analysis. SETTING: University hospital, Germany. PATIENTS: 139 consecutive patients who underwent surgery for follicular (n = 42) and papillary thyroid carcinoma (n = 97). MAIN OUTCOME MEASURES: Survival rate, type of operation (systematic lymphadenectomy or no lymphadenectomy). RESULTS: Median observation time was 72 months (range 1-203). The 5 and 10 year survival rates in patients with papillary carcinoma were 92% and 89% respectively, and in those with follicular carcinoma 88% and 80%, respectively. Prognostic factors for papillary carcinoma were distant metastases, age, and extrathyroidal growth, and for follicular carcinoma they were distant metastases, extrathyroidal extension, and multifocal growth. The Union International contre le Cancer and European Organisation for Research and Treatment of Cancer scores and the age, grade, extent and size score were all highly significant. The extent of lymphadenectomy, primary or secondary thyroidectomy, and partial or total thyroidectomy did not influence survival. CONCLUSION: Staging and score systems may be helpful in calculating prognosis in differentiated thyroid carcinoma, but the benefit of systematic lymphadenectomy remains controversial.     

Follicular carcinoma of the thyroid gland: trends and treatment

Pure follicular carcinoma of the thyroid gland has become a relatively uncommon type of primary thyroid neoplasm in the United States. During a 20-year period (1962 to 1982) 37 cases of pure follicular carcinoma were treated at the University of Michigan Medical Center. Cases of the follicular variant of papillary carcinoma and Hürthle cell carcinoma were excluded. There were 26 women and 11 men in the series. The mean ages were 46.9 +/- 17.5 and 45.3 +/- 11.5 years, respectively. The overall, mean age was 46.4 +/- 15.9 years. Surgical treatment included total thyroidectomy in 83.8% of the cases. Seventy-six percent of the patients were treated after operation with 131I irradiation. The mean total dose was 230.5 mCi. Three patients (8.1%) had regional lymph node involvement. Six patients (16.2%) had distant metastases to bone and/or lung at the time of diagnosis. Seven patients (18.9%) died after a mean survival of 7.7 years. Six patients (16.2%) died of their disease. Twenty-nine patients (78.4%) are alive and disease free after a mean follow-up interval of 11.8 years. Pure follicular carcinoma is decreasing in incidence and usually occurs at an older age than do other forms of differentiated thyroid cancers. It is frequently more aggressive than papillary carcinoma although lymph node metastases are less common. Total thyroidectomy and 131I therapy are the recommended treatments since metastases to bone and/or lung are the usual locations of distant spread. Bone metastases are rarely if ever cured. However, excellent long-term palliation may be achieved.