Survival and death causes in differentiated thyroid carcinoma

BACKGROUND: Survival studies in differentiated thyroid carcinoma (DTC) may be biased because they have been performed in heterogeneous populations. In addition, specific death causes in DTC have not been documented well in the literature. AIMS: The aim of our study was to investigate survival and specific death causes in a homogeneous cohort of DTC patients. PATIENTS: Patients included 366 consecutive patients with DTC who had all been treated according to the same protocol for initial therapy and follow-up. METHODS: Prognostic factors for DTC-related death were analyzed by univariate Cox regression analysis, followed by stepwise multivariate Cox regression analysis. Standardized mortality rates (SMR) were calculated using normal mortality rates for the entire Dutch population. RESULTS: During follow-up of 8.3 +/- 4.6 yr, 82 patients (22.4%) died. At multivariate Cox-regression analysis, tumor stage T4, distant metastases, and advanced age were associated with an increased relative risk for DTC-related death. SMR for the entire group was 2.32. This could be explained by increased SMR in patients with stage T4, distant metastases, or advanced age. Death causes could be verified in 80 patients: 52 died of DTC, 28 due to other causes. Ten of the 20 patients with stage T1-3M0 died from thyroid carcinoma. CONCLUSION: Relative risk for thyroid cancer-related death and SMR are significantly increased in patients with stage T4 and M1 or advanced age. Although death risk is not increased in T1-3 M0 patients, DTC contributed significantly to mortality in all patient categories.     

A clinicopathological analysis in unsuspected gallbladder carcinoma： A report of 23 cases

AIM： To study the clinicopathological characteristics of unsuspected gallbladder carcinoma （UGC）.
METHODS： We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma （PDGC）.
RESULTS： The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC （x^2 = 13.53, P 〈 0.01）. The infection rate of hepatitis B virus was 21.74% （5/23） in UGC and 30.30% （10/33） in PDGC. Nine （39.13%） of 23 patients with UGC and 8/33 （24.24） PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% （13/23） in the patients with UGC and 42.42% （14/33） in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and 11 UGC was significantly higher than that of PDGC （x^2 = 4.44, P 〈 0.05 and 2 = 4.96, P 〈 0.05） while that of Nevin stage V UGC was significantly lower than that of PDGC （x^2 = 7.59, P 〈 0.01）. According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC （2 = 4.16, P 〈 0.05）, and that of poorlydifferentiated UGC was significantly lower than that of PDGC （x^2 = 4.48, P 〈 0.05）.
CONCLUSION： There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.     

Esophageal composite carcinoma with tripartite differentiation: clinicopathological analysis of three cases

We here report on the clinicopathological characteristics of three cases of esophageal composite tumor showing tirpartite differentiation toward distinct squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. All tumors had in situ squamous cell carcinoma components and the deeply invasive parts of adenocarcinoma and small cell carcinoma components, which showed positive immunoreactivity for neuroendocrine markers and intracytoplasmic argyrophil granules. All three patients suffered disseminated tumor recurrence soon after esophagectomy and died of the disease within 14 months after operation. The metastatic tumors were predominantly composed of small cell carcinoma, and serum levels of neuron-specific enolase (NSE) were abnormally elevated at the time of recurrence in all cases. Esophageal composite tumors with tripartite differentiation are extremely aggressive; this aggression is primarily the result of the small cell carcinoma component, indicating the necessity for clinicians to treat such tumors as small cell carcinoma.     

胰腺腺泡细胞癌八例临床病理及免疫组化分析

目的 分析胰腺腺泡细胞癌的临床病理特征及蛋白表型.方法 收集2001年1月至2011年1月收治的8例胰腺腺泡细胞癌病例,分析其临床病理特征,采用免疫组化法检测肿瘤的蛋白表型,并进行随访.结果 8例胰腺腺泡细胞癌病例均为男性,中位年龄47岁.肿瘤位于胰头部和胰体尾部各4例,大小平均为4.5 cm×4.0 cm ×3.2 cm,切面灰黄、灰红色,呈实性或囊实性,体积较大者常伴有出血、坏死.镜下见肿瘤细胞排列呈腺泡状、梁索状或实性片巢状,胞质丰富、嗜酸性,核圆形、卵圆形,轻度异型.免疫组化显示癌细胞低分子量细胞角蛋白(CAM5.2)、α1-抗胰蛋白酶(α1-AT)、抗胰糜蛋白酶(α1-ACT)蛋白表达呈弥漫阳性,CA19-9、CEA,上皮型钙粘蛋白(E-cad)、β-连环素(β-cat)和粘蛋白-1( MUC-1)呈灶性阳性,AFP、神经特异性烯醇化酶(NSE)、突触素(Syn)和铬粒素A(CgA)仅少数瘤细胞呈阳性表达.7例获得随访,1例因术后胰漏伴腹腔感染病死,发生肝转移4例,其中2例病死.结论 胰腺腺泡细胞癌是一种少见的胰腺上皮源性恶性肿瘤,有其特征性的蛋白表型.     

Gastroesophageal reflux disease as a cause of death: analysis of fatal cases under conservative treatment

BACKGROUND: Treatment of gastroesophageal reflux disease (GERD) with modern acid-suppressive agents is supposed to be effective and safe. However, there have been only a few studies on the mortality in GERD today. In the 1960s the mortality was 0.10-0.17/100,000 per year. METHODS: From 1990 to 1995, according to Statistics Finland, 78 official death certificates were issued in which GERD was stated to have been the immediate or a primary cause of death. RESULTS: On completion of analysis data on 52 patients were included in the study. The annual death rate was 0.20/100,000. The causes were hemorrhagic reflux esophagitis in 51.9%, aspiration pneumonia in 34.6%, perforation of esophageal ulcer in 9.6%, and spontaneous esophageal rupture with reflux esophagitis in 3.9%. Thirty-eight patients had been treated with omeprazole or an H2 antagonist, and 44 patients (85%) had severe concomitant disease. CONCLUSION: The mortality in conservatively treated GERD has not decreased. Patients with mental disorder, heart disease, or alcoholism constitute the group in which risk of death from conservatively treated GERD is likely to be greatest.     

Adult liver transplantation: an analysis of the early causes of death in 40 consecutive cases

One hundred twenty-nine adult patients who received an orthotopic liver transplantation and survived at least 24 hr after surgery were evaluated. During the period of follow-up, 48 of the 129 patients (37%) died. Only 40 of these 48 patients died at our institution and were included in this study. Seventeen of the 40 deaths (42.5%) occurred during the first month after orthotopic liver transplantation and 30 of the 40 deaths (75%) occurred during the first 60 days post-orthotopic liver transplantation. Death was related to infection in 21 cases (52.5%), to multiorgan failure in 8 (20%) and to uncontrollable rejection in 3 (7.6%). The remaining eight deaths (20%) were attributed to a variety of other causes. Eleven of the 21 deaths related to infection (52%) occurred during the first month after orthotopic liver transplantation. Bacterial sepsis was the leading cause of death and accounted for 17 of the 21 deaths (81%) in which infection was present at the time of death. The most frequently isolated bacteria were Pseudomonas and other enteric Gram-negative bacilli. Three patients had complete occlusion of the hepatic artery of the grafted liver. Six patients developed massive infarction of the liver despite patent vascular anastomoses. Histological signs of rejection were seen in 9 of the 31 patients autopsied (29%), but in only 3 of these (9.6%) was rejection the principal cause of death. The biliary anastomoses were patent in all 31 cases examined at autopsy.     

Applying new clinicopathological characteristics to prognostication in advanced thyroid carcinoma

In the February 2011 issue of Endocrine-Related Cancer, Deandreis et al. reported that increased FDG uptake was prognostic in patients with metastatic thyroid cancer. Fludeoxyglucose-positron emission tomography (FDG-PET) is routinely used in the staging and follow-up of patients with cancer. This study gives further evidence for the role of FDG-PET scanning in metastatic thyroid cancer, especially to identify patients with aggressive disease requiring systemic therapy.     

Association of BRAF V600E mutation with poor clinicopathological outcomes in 500 consecutive cases of papillary thyroid carcinoma

CONTEXT: Because very few studies have examined the correlation between BRAF mutations and clinicopathological features of papillary thyroid carcinoma (PTC), we analyzed here a large and homogeneous cohort of patients with PTC for the presence of the BRAF mutation. OBJECTIVE: We examined BRAF mutations in a consecutive series of 500 PTC patients who underwent surgery in the Department of Surgery of the University of Pisa, and we correlated the presence of the mutation with clinicopathological parameters of the patients: age, gender, tumor size, presence of tumor capsule, extrathyroidal invasion, multicentricity, presence of node metastases, and tumor class. DESIGN: BRAF (exon 15) mutation was examined by PCR-single strand conformational polymorphism followed by DNA sequencing in laser-capture microdissected tissue samples. RESULTS: In this study, BRAF mutation was found in 219 of 500 cases (43.8%). In particular, we found the most common BRAF V600E mutation in 214 cases (42.8%), BRAF K601E mutation in three cases (0.6%), BRAF VK600-1E (0.2%) in one case, whereas in one case we found a new 14-bp deletion with concomitant 2-bp insertion, VKSR600-3del and T599I, respectively. BRAF V600E was associated with extrathyroidal invasion (P < 0.0001), multicentricity (P = 0.0026), presence of nodal metastases (P = 0.0009), class III vs. classes I and II (P < 0.00000006), and absence of tumor capsule (P < 0.0001), in particular in follicular- and micro-PTC variants. By multivariate analysis, the absence of tumor capsule remained the only parameter associated (P = 0.0005) with BRAF V600E mutation. CONCLUSIONS: Our data suggest that BRAF V600E mutation is associated with high-risk PTC and in particular in follicular variant with invasive tumor growth.     

Adenosquamous carcinoma of the extrahepatic biliary tract: clinicopathological analysis of Japanese cases of this uncommon disease

Background We analyzed the clinicopathologic variables and postoperative outcomes in patients with extrahepatic adenosquamous carcinoma to identify important factors for predicting postresection prognosis.Methods Thirty-six patients in Japan who underwent surgical resection for adenosquamous carcinoma of the extrahepatic biliary tract, with curative intent by the end of 2003, were studied. A retrospective review, with univariate and multivariate analyses, was performed on the clinical records of patients who underwent surgical exploration for adenosquamous carcinoma of the common bile duct. The clinical and pathologic factors that influenced patient survival were analyzed.Results The operative mortality rate in the patient cohort was 3%. The overall 1-, 3-, and 5-year survival rates were 57%, 26%, and 16%, respectively, and the median survival was 13 months. Univariate and multivariate analyses revealed that independent negative prognostic factors in resected specimens were: (1) the presence of pancreatic invasion, (2) the presence of n2 and n3 lymph node metastasis, and (3) curability C status. The presence of an abnormal arrangement of the pancreato-biliary ductal system and pathological serosal invasion of the tumor tended to be associated with poor survival.Conclusions Curative surgical resection for adenosquamous carcinoma remains the only effective treat-ment, because it offers the chance of long-term survival. New adjuvant strategies are required for improvements in patient outcomes.     

Small cell carcinoma of the esophagus; clinicopathological and immunohistochemical analysis of six cases

Small cell carcinoma arising in the esophagus is a relatively rare disease. In the more common small cell carcinoma of the lung, the diagnostic significance of several new markers has been recently reported. This study used immunohistochemical techniques in addition to clinicopathological analysis, in order to clarify the utility of newer markers as biological parameters or as diagnostic tools. Six patients with small cell carcinoma of the esophagus were clinicopathologically analyzed. Immunohistochemical staining was performed using primary antibodies for bombesin, CD56 and CD57 in addition to conventional endocrine markers chromogranin A, neuron specific enolase and synaptophysin. All patients died within 2 years of surgery due to cancer recurrence, whether or not they had received adjuvant therapy. Pathological stages ranged from IIa to IVb and lymph node metastasis was observed in five cases. Of the six cases, four showed a positive reaction for bombesin and five were positive for CD57. In contrast, no cases revealed a positive reaction for CD56. The one case to survive 24 months after surgery was not shown to express bombesin, CD56 or CD57. Small cell carcinoma of the esophagus demonstrated an unfavorable prognosis. The study suggested that in this disease, bombesin and CD57 (but not CD56) were useful as biological markers, predicting clinical outcome rather than having diagnostic significance.     

Hurthle cell thyroid carcinoma: report of 13 cases

The aim of this study was to report the clinical characteristics of 13 patients with Hürthle carcinoma. In the vast majority of them, disease was suspected by a palpable thyroid nodule. The results of preoperative examination (scintigraphy, ultrasonography, thyroglobulin) are also discussed as well as the pathological aspects and follow-up characteristics after total thyroidectomy.     

分化型甲状腺癌肺转移22例临床分析

目的　了解分化型甲状腺癌肺转移的临床特点和预后。方法　收集我院1 981年至2 0 0 1年2 2例分化型甲状腺癌肺转移病例并进行回顾性分析。结果　45岁以下、仅有肺转移、术后加放疗或化疗的患者5年生存率分别为86 % (6/ 7)、67% (1 0 /1 5)、75 % (6/ 8) ,而45岁以上者、肺合并其它器官转移者、仅经手术治疗者的5年生存率分别为47% (7/ 1 5)、2 8% (2 / 7)、43 % (6/1 4 )。结论　年龄因素及是否合并其它器官转移与分化型甲状腺癌肺转移患者的预后关系密切。     

Gastroesophageal reflux disease as a cause of death is increasing: analysis of fatal cases after medical and surgical treatment

OBJECTIVES: The population impact of modern treatment on complicated gastroesophageal reflux disease (GERD) is not well understood. Our aim was to determine the current mortality from GERD in Finland and compare this with the use of health resources. METHODS: In this population-based retrospective study, Finland's administrative databases provided figures on the nationwide use of antireflux medication, rate of antireflux surgery, and mortality from GERD. Any deceased person included had classic symptoms as well as objective findings of GERD. RESULTS: After analysis of the medical records of 306 patients, 213 were included. Annual mortality from GERD increased (P < 0.001) from 0.18/100,000 in 1987 to 0.46/100,000 in 2000. During that time, use of H2-blockers and proton pump inhibitors and the annual rate of antireflux surgery increased significantly (P < 0.001). Mortality from antireflux surgery, including fundoplication and gastric and esophageal resection, remained around 1.9/1,000 operations. Of the 213 patients whose cause of death was considered to be GERD, 180 (85%) had received medical treatment, including 4 patients whose death was related to either diagnostic or therapeutic endoscopy. Early complications of antireflux surgery caused 24 (11%) deaths; 9 (4%) were late failures of antireflux surgery. Causes of death in the medical group were hemorrhagic esophagitis (82, 47%), aspiration pneumonia (41, 23%), ulcer perforation (25, 14%), rupture with esophagitis (15, 9%), and stricture (13, 7%). CONCLUSIONS: Regardless of the increased use of health resources, mortality from GERD, especially with medical treatment, rose. Surgery for GERD was also associated with early mortality and usually could not prevent the fatal outcome.     

再次肝移植22例临床病理分析

目的总结分析再次肝移植患者的临床病理特征,提高再次肝移植的临床病理诊断水平。方法回顾性分析我院施行再次肝移植患者的临床病理资料,并进行随访。结果523例接受原位肝移植患者中,共有22例患者接受了23次（4．4％）再次肝移植,再次肝移植的原因主要为胆道并发症13例（59．1％）,肝动脉血栓形成3例（13．6％）,肝细胞性肝癌复发5例（22．7％）,移植肝原发无功能1例（4．5％）。结论肝移植术后的胆道并发症是再次肝移植的最主要原因,肝内广泛胆汁淤积、小胆管增生及以中性粒细胞为主的炎细胞浸润是其重要的病理特征;早期开展计划性肝穿刺,对各种并发症进行鉴别诊断并借助于影像学检查有利于指导临床合理治疗,避免对患者施行再次肝移植。     

糖尿病住院患者1053例死亡原因分析

目的 探讨糖尿病(diabetes mellitus,DM)住院患者死亡原因,明确DM防控重点.方法 时1991-2003年大连医科大学附属第一医院1053例住院死亡DM患者的临床资料进行回顾性分析,分为1型糖尿病(Type 1 dia-betes mellitus,T1DM)组和2型糖尿病(Type 2 diabetes mellitus,T2DM)组,分别记录两组的死亡原因.结果 (1)DM患者住院比率逐年增加,而病死率则呈下降趋势.(2)T1DM患者主要死亡原因为糖尿病肾病尿毒症(4/10)T2DM患者前5位死亡原因依次是脑血管疾病(24.26%)、心血管疾病(19.27%)、感染(14.09%)、恶性肿瘤(10.64%)、糖尿病肾病尿毒症(8.15%).(3)死于糖尿病酮症酸中毒(1.92%)和非酮症高渗性昏迷(2.4%)者逐渐减少.结论 T1DM主要死亡原因是糖尿病肾病尿毒症;心脑血管疾病已经成为T2DM患者死亡的主要原因;糖尿病急性并发症得到了有效控制;慢性并发症的防治是当前工作的重点.