Sonographic findings of metastatic disease to the thyroid

The goal of this study was to evaluate the sonographic findings of thyroid metastases arising from non-thyroid primaries. The study over a 5-year period comprised nine patients who had histopathologically proven metastatic disease to the thyroid. Ultrasonography was available in all cases. Ultrasound-guided needle aspiration was performed on 10 suspected nodules as determined by ultrasound. The Ultrasonographic findings were analyzed in two different ways. The first analysis included only those nodules biopsed, and the second analysis included all the nodules, biopsed and non-biopsed. The primary neoplasms were breast carcinoma (n=6), uterine leiomyosarcoma (n=1), cervical carcinoma (n=1), and nasopharyngeal carcinoma (n=1). Excluding 2 nodules, the 8 remaining metastatic nodules exhibited ill-defined hypoechoic character with heterogeneous texture. The other two nodules showed relatively circumscribed iso- or hypo-echoic character with cystic portion. From the analysis of ultrasonographic findings including all thyroid nodules irrespective of pathologic proof, 7 cases - excluding the 2 cases from the 9 cases - showed unilateral or bilateral multiple nodules suspected of metastasis. There was no evidence of microcalcification in any thyroid nodules. In conclusion, the sonographic findings of the thyroid metastatic nodules were not specific, but unilateral or bilateral multiple suspected thyroid nodules without evidence of microcalcification may be suggestive of metastatic nodules among patients with a known primary non-thyroidal tumor.     

Diffuse Metastasis to the Thyroid: Unique Ultrasonographic Finding and Clinical Correlation

Cases of metastases to the thyroid gland seem to be increasing in recent years. The clinical and ultrasonographic findings of diffuse metastases have been sparsely reported. Thirteen cases of diffuse metastases to the thyroid gland were documented by thyroid ultrasonography-guided fine needle aspiration cytology between 2004 and 2013. We retrospectively reviewed the patients with diffuse thyroid metastases. The most common primary site was the lung (n=9), followed by unknown origin cancers (n=2), cholangiocarcinoma (n=1), and penile cancer (n=1). Eleven patients were incidentally found to have thyroid metastases via surveillance or staging FDG-PET. Other 2 patients were diagnosed during work-up for hypothyroidism and palpable cervical lymph nodes. On ultrasonography, the echogenicity of the enlarged thyroid gland was heterogeneously hypoechoic or isoechoic, and reticular pattern internal hypoechoic lines were observed without increased vascularity found by power Doppler ultrasonography (3 right lobe, 2 left lobe, and 8 both lobes). In the 8 patients who had involvement of both lobes, 3 had hypothyroidism. In conclusion, ultrasonographic finding of diffuse metastasis is a diffusely enlarged heterogeneous thyroid with reticular pattern internal hypoechoic lines. Thyroid function testing should be performed in all patients with diffuse thyroid metastases, especially those with bilateral lobe involvement.

Graphical Abstract

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Langerhans cell histiocytosis involving the thyroid and parathyroid glands.

Langerhans cell histiocytosis (LCH) is a rare illness, and the disease afflicting the thyroid gland is very uncommon, even in the presence of multisystem involvement. In this report, we document histologically, for the first time, concurrent involvement of the thyroid and parathyroid glands by LCH. A young Chinese woman with a history of diabetes insipidus and hypogonadism underwent a total thyroidectomy for enlarged thyroid gland secondary to LCH causing airway obstruction. Microscopic examination of the excised specimen disclosed CD1a- and S-100-positive LCH cells involving the thyroid and parathyroid glands. In a patient with LCH affecting the thyroid gland, parathyroid gland disease should be suspected when the serum calcium levels are depressed in association with an inappropriate serum parathyroid hormone level, such as a normal parathyroid hormone level in this case.     

Isolated Langerhans cell histiocytosis of the thyroid: a report of two cases with nuclear imaging-pathologic correlation

We describe two cases of isolated langerhans cell histiocytosis (LCH) of the thyroid gland, one of which was found in conjunction with an incidental papillary carcinoma. The first case was that of a 43-year-old man who presented with a 1- to 2-cm nodule within the left lobe of the thyroid. Fine-needle aspiration cytology revealed atypical cells with convoluted nuclei in a background of eosinophils and lymphocytes. The findings prompted a recommendation for excision secondary to the high suspicion of a hematologic malignancy. Histologic sections demonstrated LCH in association with a small focus of papillary carcinoma. The second case involved a 43-year-old woman who presented with a 1.8-cm nodule within the right lobe of the thyroid. Fine-needle aspiration in this case demonstrated abundant hemosiderin-laden macrophages, occasional lymphocytes, and a single benign sheet of follicular cells. No eosinophils were seen; however, a single group of atypical histiocytic cells with cleaved nuclei was noted. The nodule was subsequently resected. Histologic examination demonstrated LCH in association with follicular nodular hyperplasia with cystic degeneration. Immunohistochemical studies were performed in both cases, revealing CD1a and S100 immunoreactivity in the Langerhans' cells. Although LCH may occur as a manifestation of systemic disease, its occurrence as an isolated finding in the thyroid is rare. Its occurrence in association with papillary carcinoma of the thyroid is even more uncommon. We present two cases of isolated LCH of the thyroid, one of which was found in association with papillary carcinoma of the thyroid. The cytologic, histologic, immunohistochemical, and radiologic features are described in each case. The ultrastructural findings from the first case are also presented.     

Immunocytochemical investigation of Langerin (CD207) is a valuable adjunct in the cytological diagnosis of Langerhans cell histiocytosis of the thyroid

Langerhans cell histiocytosis (LCH) is an uncommon disease encompassing three clinically different entities: eosinophilic granuloma, Hand-Schüller-Christian disease, and Abt-Letterer-Siewe disease. Despite usually being a multisystemic disease affecting numerous different organs, involvement of the thyroid gland is extremely rare, and only a few cases in adults have been described in the literature. Herein, we present the case of a 28-year-old male patient presenting with LCH involving the skin, the skeletal system, and the thyroid gland. Fine needle aspiration (FNA) of the thyroid was performed and showed the typical Langerhans cells (LC) with foamy cytoplasm and slender nuclei with longitudinal grooves against a background of inflammatory cells with only a few eosinophilic granulocytes. Immunocytochemically, the LC showed positive staining with antibodies against CD1a and Langerin, a recently detected glycoprotein exclusively expressed in LC. Langerin is the major protein that makes up the so-called Birbeck granules, the electronmicroscopical hallmark of LC. Since LCH involvement of the thyroid is occasionally mistaken for papillary thyroid carcinoma cells, we propose that application of Langerin in combination with CD1a is a helpful diagnostic adjunct for the correct assessment of LCH affecting the thyroid gland.     

Langerhans cell histiocytosis presenting as a thyroid gland mass

We report 2 cases of Langerhans cell histiocytosis (LCH) presenting as a thyroid mass. The first case is a 45-year-old woman with a 13-year history of diabetes insipidus who presented with an enlarging thyroid mass with substernal extension. The second case is a 29-year-old man who presented with an enlarging thyroid mass and skin lesions. Histologic evaluation of the thyroid gland in both cases revealed extensive involvement by LCH, confirmed by immunohistochemical analysis showing Langerhans cells that were positive for CD1a and S-100 protein. Langerhans cell histiocytosis can rarely involve the thyroid gland in adults, and we have identified 30 cases reported in literature. Most patients had evidence of LCH involving other anatomic sites, as was true in these 2 cases, and the diagnosis was initially established by examination of other sites in a subset of patients. Affected patients frequently have diabetes insipidus, as was true in case 1. Thyroid gland involvement as the initial presentation of LCH is a rare phenomenon that can result in misdiagnosis.     

Thyroid diseases after treatment of Hodgkin's disease

BACKGROUND AND METHODS. Thyroid disease, especially hypothyroidism, is common in patients with Hodgkin's disease who have been treated with irradiation. We reviewed the records of 1787 patients (740 women and 1047 men) with Hodgkin's disease who were treated with radiation therapy alone (810 patients), radiation and chemotherapy (920 patients), or chemotherapy alone (57 patients) at Stanford University between 1961 and 1989. Among these patients, 1533 were alive at the last follow-up, and 254 had died of causes other than Hodgkin's disease. (Four other patients were excluded from the analysis because they had undergone thyroidectomy before treatment for Hodgkin's disease. The thyroid was irradiated in 1677 patients. Follow-up averaged 9.9 years. RESULTS. A total of 573 patients had clinical or biochemical evidence of thyroid disease. Among the 1677 patients whose thyroid was irradiated, the actuarial risk of thyroid disease 20 years after treatment was 52 percent, and it was 67 percent at 26 years. Hypothyroidism was found in 513 patients. A total of 486 patients received thyroxine therapy for elevated serum thyrotropin concentrations and either low free thyroxine (208 patients) or normal free thyroxine values (278 patients); 27 had transient elevations of the serum thyrotropin level that were not treated. Graves' hyperthyroidism developed in 30 patients (2 of whom had not undergone thyroid irradiation), and ophthalmopathy developed in 17 of these patients. Ophthalmopathy developed in four other patients with Graves' disease during a period of hypothyroidism (n = 3) or euthyroidism (n = 1). The risk of Graves' disease was 7.2 to 20.4 times that for normal subjects. Silent thyroiditis with thyrotoxicosis developed in six patients. Forty-four patients were found to have single or multiple thyroid nodules, 26 of whom underwent thyroidectomy. Six of the 44 had papillary or follicular cancers. Among the patients who did not undergo operation, 12 had small functioning nodules, 4 had cysts, and 2 had multinodular goiters. The actuarial risk of thyroid cancer was 1.7 percent. The risk of thyroid cancer was 15.6 times the expected risk. CONCLUSIONS. High risks of thyroid disease persist more than 25 years after patients have received radiation therapy for Hodgkin's disease, reinforcing the need for continued clinical and biochemical evaluation. Prolonged follow-up confirms an elevated risk of thyroid cancer and Graves' disease as well as hypothyroidism in these patients.     

Incidental langerhans cell histiocytosis of thyroid: case report and review of the literature

We report a case of a 42-yr-old woman with Langerhans cell histiocytosis (LCH) confined to the thyroid and associated with lymphocytic thyroiditis and a papillary microcarcinoma. This patient remains free of symptoms 14 mo after surgery. Thyroid LCH is rare. In children, it usually occurs as part of a multisystemic disease, whereas it is usually exclusive in adults. Isolated thyroid LCH is frequently associated with another thyroid disease, especially lymphocytic thyroiditis, suggesting that it is a reactive process rather than a neoplastic proliferation. The prognosis of isolated thyroid LCH is good. However, because it can rarely precede or reveal a multisystemic disease, additional investigations as well as a prolonged follow-up are justified.     

Langerhans cell sarcoma arising from Langerhans cell histiocytosis: a case report

Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells that have overtly malignant cytologic features. It is a very rare disease and theoretically, it can present de novo or progress from an antecedent Langerhans cell histiocytosis (LCH). However, to our knowledge, LCS arising from an antecedent LCH has not been reported on. We present here a case of LCS arising from a pulmonary LCH. A 34 yr-old man who was a smoker, had a fever and a chronic cough. Computed tomographic (CT) scan revealed multiple tiny nodules in both lungs. The thoracoscopic lung biopsy revealed LCH. The patient quit smoking, but he received no other specific treatment. One year later, the follow up chest CT scan showed a 4 cm-sized mass in the left lower lobe of the lung. A lobectomy was then performed. Microscopic examination of the mass revealed an infiltrative proliferation of large cells that had malignant cytologic features. Immunohistochemical stains showed a strong reactivity for S-100 and CD68, and a focal reactivity for CD1a. We think this is the first case of LCS arising from LCH.     

Preoperative serum thyroglobulin as a useful predictive marker to differentiate follicular thyroid cancer from benign nodules in indeterminate nodules

Indeterminate cytology results increase the number of repetitive procedure and unnecessary surgery. This study was designed to find useful and simple predictive tools to differentiate malignant thyroid nodules from indeterminate nodules. We retrospectively enrolled 164 patients who had undergone thyroid surgery as a result of indeterminate cytology in the National Cancer Center. We reviewed patients' age at diagnosis, sex, preoperative biochemical markers such as thyroglobulin (Tg), anti-Tg antibody, free T4 and TSH level, and sonographical and pathological findings, which were subjected to statistical analysis. We found several clinical and sonographical predictive factors that showed significant differences. Young age, male, preoperative high Tg level, and hypoechoic nodule on sonography all increased cancer probability significantly in multivariate analysis. With a cut-off value of 187.5 ng/mL Tg, sensitivity and specificity were 54.8% and 90.1%, respectively (AUC 0.748, P < 0.001). In the case of nodule size > 1.7 cm, elevated serum Tg predicts the risk of malignancy; especially Tg > 70 ng/mL (odds ratio 3.245, 95% confidence interval 1.115-9.450, P = 0.038). Preoperative Tg levels had very high specificity in predicting thyroid cancer in case of suspicious follicular neoplasm. Therefore, Tg levels may be a useful marker for differentiating thyroid cancer from benign thyroid nodules in the cytological diagnosis of indeterminate nodules.     

Role of FNA in the medical management of minimally enlarged thyroid

Fine-needle aspiration (FNA) of thyroid is a cost-effective and simple diagnostic tool in the initial screening of patients with thyroid nodules. But, its role in a clinically normal thyroid or a minimally enlarged thyroid in a symptomatic patient suspected of having thyroid dysfunction is unknown. With our 2-yr experience in a setup of a tertiary health care hospital in a developing country, we have aimed to implement a management protocol using FNA thyroid done without ultrasound guidance and TSH estimation done during the same visit in symptomatic patients suspected of having thyroid pathology but presenting with no goiter or having minimally enlarged thyroid with no palpable nodules. The thyroid enlargement in 172 cases were graded with the criteria endorsed by WHO, Pan American Health Organization, and International Council for Control of Iodine Deficiency Disorders into grade 0, 1, and 2. The cases were evaluated cytologically and correlated with TSH values according to the algorithm formulated by the authors. FNA was diagnostic in 86.6, 98, and 100% in grade 0, 1, and 2 goiters, respectively. 52.3% (n = 90), 19.8% (n = 34), 16.9% (n = 29) of cases were diagnosed as Hashimoto's thyroiditis (HT), colloid goiter (CG), and lymphocytic thyroiditis (LT). Sixteen had a combination of LT and CG (n = 6), HT and CG (n = 6), papillary carcinoma (n = 2), and diffuse hyperplasia (n = 2). No statistically significant difference (P = 0.4586) was noted between the groups of patients with grade 0 and grade 1-2 goiter, who underwent FNAC. 38.95% of patients (n = 67) with TSH values greater than 10 microIU/ml and considered hypothyroid showed features of HT/LT at FNA. 23.83% (n = 41) having TSH values between 5 and 10 microIU/ml (subclinical hypothyroidism) also showed features of HT/LT at FNA. Both groups were treated with thyroxine. 35.46% (n = 61) of cases with TSH values within normal range (0.5-5.1 microIU/ml) and considered euthyroid showed a spectrum of lesions at cytology other than HT and LT. They are being followed up to detect them at an early stage of subclinical hypothyroidism. Only 13 cases (7.5%) who were serologically euthyroid showed HT/LT and are being followed-up. Thus, the authors advocate FNA of the thyroid as a single simple cost-effective office procedure in the medical management of all nonpalpable/minimally enlarged thyroid in patients suspected of having thyroid pathology and/or in combination with TSH values. FNA helps in early detection of subclinical hypothyroidism, which is of utmost importance in pregnant women and further makes possible availability of baseline values for future reference. With the implementation of this protocol of FNA thyroid without imaging, we affirm that the practice of cytology which differs in different geographic areas and from country to country depending on economy and availability of infrastructure can be made more user-friendly.     

Should the diagnosis of benign prostatic hyperplasia be made on prostate needle biopsy?

Pathologists frequently sign out benign prostate needle biopsies as "benign prostatic hyperplasia (BPH)". There are no data indicating that a diagnosis of BPH on biopsy correlates with either gland weight or with the International Prostate Symptom Score (IPSS) used to measure urinary obstructive symptoms. We examined biopsies for average percentage of glands and average percentage of glands with papillary infolding per case, maximum percentage of glands and maximum percentage of glands with papillary infolding per core per case, and presence of any stromal nodules per case. BPH was measured in 2 ways: (1) IPSS grouped into 3 categories (mild, moderate, severe) and (2) prostate weight at radical prostatectomy in men with limited cancer. IPSS was classified as follows: mild (n = 12), moderate (n = 13), and severe (n = 10). There was no correlation with IPSS and any of the histologic features measured. For the 41 radical prostatectomy specimens, the average weight was 65.3 g (median, 56.0 g, range, 22 to 117 g). There was no correlation between gland weight and the average or maximum percentage of glands, or average or maximum percentage of glands with papillary infolding. Stromal nodules on biopsy correlated with gland weight. In the 30 cases without stromal nodules on biopsy, the mean gland weight was 51.4 g. In the 11 cases with stromal nodules on biopsy, the mean gland weight was 77.4 g (P = 0.0125). However, stromal nodules were not specific for a large prostate (i.e., a 15 g prostate had stromal nodules on biopsy). With the exception of stromal nodules found on biopsy, histologic findings on biopsy are not specific for either clinical or pathologic BPH. Thus benign prostate biopsies should be signed out merely as "benign prostate tissue."     

Do repeatedly nondiagnostic fine needle aspirations of thyroid nodules predict malignancy risk?

Fine needle aspiration biopsy (FNAB) is a common, minimally invasive, cost-effective, and rapid method to manage thyroid nodules, but nondiagnostic FNAB (ND-FNAB) is still a common problem due to high prevalence (2%-20%). Our purpose in this study is to investigate risk of malignancy of repeating ND-FNABs and correlation between clinical and ultrasound findings. Our cohort study included 75 patients who had 2 or more times ND-FNABs and, finally, undergone surgical resection. We evaluated demographic, clinical, ultasonographic, and pathologic features. Fifty-seven patients were female, and 22 patients were male. Seventy-five patients' histopathologic results were 76% (n = 57) benign and 24% (n = 18) malignant. Of malignant nodules, 94.4% (n = 17) were papillary carcinoma, whereas 5.6% (n = 1) were follicular carcinoma. We did not find any predictive factor for malignancy and any differences associated with clinical and ultrasonographic features between benign and malignant nodules. Reaspiration followed by surgery for appropriate patients is recommended.     

Metastatic breast carcinoma involving the thyroid gland diagnosed by fine-needle aspiration: a case report

Secondary involvement of the thyroid gland from a remote primary malignancy is uncommon. The distinction of metastatic carcinoma (MC) or sarcoma from a primary thyroid malignancy is important because the treatment is different. We discuss a case of a 64-yr-old female with a history of breast carcinoma, who presented with pain and swelling in her neck 5 yrs after being diagnosed with breast cancer. She had undergone mastectomy with subsequent chemotherapy and radiation for infiltrating mammary carcinoma. During the 5-yr interval, she had been free of clinically evident metastatic disease. Subsequent work-up revealed two distinct nodules in the left lobe of her thyroid gland as well as a subcutaneous mass in her right shoulder. A fine-needle aspiration (FNA) of the larger thyroid nodule showed malignant epithelial cells with features consistent with breast carcinoma in a background of benign thyroid epithelial cells and colloid. The case was signed out as metastatic breast carcinoma. Subsequent FNA and biopsy of her right shoulder lesion also revealed metastatic breast carcinoma with similar morphology to the material in the thyroid FNA.     

Primary squamous cell carcinoma of the thyroid gland: an entity with aggressive clinical behaviour and distinctive cytokeratin expression profiles

AIMS: Primary squamous cell carcinoma of the thyroid gland is uncommon. This study aims to identify the clinicopathological features and the pattern of expression of cytokeratins and oncoproteins in this tumour. METHODS AND RESULTS: Histological slides from Chinese patients with thyroid cancer treated in our institution from 1980 to 1999 were reviewed. Patients with primary squamous cell carcinoma of the thyroid were identified and their clinical records were analysed. The expression of cytokeratins (CKs), p53 and p21 in these cases were also studied by an immunohistochemical method. Four women (mean age 71 years) with squamous cell carcinoma of thyroid were found. The main presenting features were signs and symptoms of airway obstruction in three patients and neck swelling in one. The tumours were located at the right lobe (n=2), left lobe (n=1) or in both lobes of the thyroid (n=1). One patient died shortly after admission and the other three died within 4 months after thyroidectomy. The p53 protein was positive in 50% (2/4) of the tumours and p53+ tumours were poorly differentiated. The tumours were negative for p21. CK19 was expressed in all the tumours while CK7 expression was noted in 3/4 of the tumours. One carcinoma showed focal positivity to CK18. The tumours were negative for CKs 1, 4, 6, 10/13 and 20. The pattern of cytokeratin expression in squamous cell carcinoma of the thyroid gland was different from carcinoma showing thymus-like differentiation (CASTLE) of the thyroid gland and oesophageal squamous cell carcinoma. CONCLUSIONS: Squamous cell carcinoma of the thyroid has aggressive clinical behaviour and characteristic CK expression pattern. p53 over-expression in these tumours was associated with tumour differentiation.     

The effect of supraclavicular lymph node irradiation upon the thyroid gland in the post-operative breast carcinoma patients

To identify the effect of post-operative irradiation to the thyroid gland in patients with breast carcinoma. Seventy seven patients with partial or total mastectomized breast carcinoma who received routine irradiation therapy (Hockey stick method: supraclavicular, internal mammary lymph nodes, and chest wall irradiation with 5,040 rads, divided into 30 treatments) were reviewed in terms of their ipsilateral thyroid gland response. All patients had the bilateral thyroid sizes measured annually by ultrasonography before and after radiation therapy. In the one-year follow-up group (n=77), 32 patients (41.5%) demonstrated decreased ipsilateral thyroid gland size after Hockey Stick irradiation therapy (p=0.428), in the two-year follow-up group (n=37), 26 patients (70.3%) demonstrated decreased gland size after Hockey Stick irradiation (p=0.001), and in the three-year follow-up group (n=21), 15 patients (71.4%) showed a decreased thyroid gland size (p=0.005). Most the patients with breast carcinoma (32/77 at the one-year follow-up, 26/37 at the two-year follow-up, and 15/21 at the three-year follow-up) after post-operative Hockey Stick irradiation therapy showed reduced ipsilateral thyroid gland size. Routine en face treatment of the supraclavicular lymph nodes, using the Hockey Stick method, should be reconsidered.     

A case of metastatic rectal adenocarcinoma diagnosed by thyroid cytology

Fine‐needle aspiration (FNA) cytology of the thyroid gland has been widely used for the evaluation of thyroid nodules. Most of the nodules are primary thyroid lesions. However, up to 4% of thyroid FNA may harbor a metastatic neoplasm. The metastases are most commonly from lung, kidney, breast, and skin. Metastatic colorectal cancers are also seen in thyroid but less common. Here we report the cytologic features, differential diagnosis and clinical implications of a metastatic rectal adenocarcinoma to the thyroid gland diagnosed by FNA.     

Fine-needle aspiration of thyroid lesions in 57 pregnant and postpartum women

Palpable thyroid nodules are common in women. The thyroid gland may enlarge in response to hyperemia, relative iodine depletion, and slight stimulation by β Human Chorionic Gonadotrophin (HCG) during pregnancy. The presence of goiter or a discrete nodule requires investigation. Fine-needle aspiration (FNA), a reliable diagnostic tool, can be safely used during pregnancy. The tenet that a “histologic hyperplasia” accompanies the physiologic hyperplasia of pregnancy may hamper FNA interpretation. We reviewed 97 (10 previous, 46 pregnant, 13 postpartum, 1 spontaneous abortion, and 27 follow-up) aspirates of thyroid nodules from 57 patients. Cytologic diagnoses were divided into five categories: 31 benign, 7 cellular adenomatoid nodules, 5 suspicious for papillary carcinoma, 12 papillary carcinomas, and 2 follicular neoplasms. There were an unanticipated number of carcinomas. Lesions present before pregnancy did not show “progression” or significant change. No characteristic features ascribable to pregnancy were identified. Standard diagnostic criteria may be used in the evaluation of FNA of thyroid nodules from pregnant patients. Diagn. Cytopathol. 16:122–125, 1997. © 1997 Wiley-Liss, Inc.     

Thyroid tumors and thyroid function in women exposed to internal and external radiation

The frequency of tumors and other conditions of the thyroid gland were examined in 686 female radium dial workers first employed before 1930, who had a radium body-burden measurement while living (1958-76). If one assumed that the two thyroid cancers ascertained were radiation-induced and that a linear dose-response relationship existed, the estimated thyroid cancer risk was 69 (4-124, 95% confidence range) per 10(6) person-rem thyroid dose equivalent from internal and external radiation. Using data from the Connecticut tumor registry to obtain expected numbers of thyroid cancer, the estimated risk (2 observed vs. 0.67 expected cases) was 46 (95% confidence interval = -19 to 101) excess cases per 10(6) person-rem. Risk estimates were based on crude estimates of external radiation exposure and uncertain quality factors for internal radiation from alpha particles ingested. The frequencies of benign tumor (adenoma), nodules, and goiters were not significantly higher in the higher thyroid-dose groups (5-19, greater than or equal to 20 or greater than or equal to 50 rem) than in the lowest dose group (less than 5 rem). In 1237 female dial workers first employed before 1930, with or without a radium body-burden measurement, no deaths due to thyroid cancer (underlying cause of death on death certificates) were observed during 1950-76, when 0.4 deaths were expected. In a subgroup of 84 Illinois female dial workers who were long-term survivors, means for thyroid function test (T3 resin uptake and free thyroxine index) results did not differ among the thyroid-dose groups.     

Isolated Langerhans cell histiocytosis of the sublingual gland in an adult

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the proliferation of pathologic Langerhans cells. Its clinical presentation is highly variable, that range from single-system, limited disease to severe, multi-organ disease with high mortality. LCH usually affects children and young adults. The most frequent sites for LCH are the bone, skin, lung, pituitary gland, and lymph nodes. Salivary gland involvement by LCH is extremely rare, and only a few cases of LHC involving the parotid glands have been reported in the English literature. To our knowledge, the involvement of the sublingual gland as a part of single or multisystem LCH has not been previously described. Herein we reported the first case of primary LCH of the sublingual gland. A 40-year-old woman presented with a 2-month history of a painless mass on the right sublingual area. Excision of the lesion including the right sublingual gland was performed. Histopathological diagnosis of LCH was rendered. The patient remains free of symptoms 17 months after surgery.