Tracheal carcinoma presenting as a thyroid tumor

Direct invasion of the trachea by an aggressive tumor originating in the thyroid gland is an unusual but well-documented phenomenon. The reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland and presenting as a thyroid mass is apparently an even less common occurrence. A careful search of the literature has failed to reveal any recorded instances of this type of occurrence. We report a case of an adenoid cystic carcinoma arising in the trachea and invading the thyroid gland and recurrent laryngeal nerves causing vocal cord paralysis. The presentation of this lesion as a primary thyroid tumor is an unusual occurrence that serves to remind the clinician that in the differential diagnosis of thyroid masses one must include the possibilities of metastases or direct extension of a primary neoplasm from another organ.     

Two cases of malignant thymoma presenting as an anterior neck mass and misdiagnosed as thyroid carcinoma

Two cases of malignant thymoma presenting as an anterior neck mass are reported. Both tumors were initially diagnosed as thyroid carcinoma. The lesions were not ectopic thymomas and had invaded the thyroid gland from the mediastinum. Careful preoperative examination is important to distinguish thyroid cancer from invasive thymoma. Received: December 17, 1997 / Accepted: October 15, 1998     

The encapsulated papillary carcinoma of the thyroid. A morphologic subtype of the papillary thyroid carcinoma

Of a total of 182 papillary neoplasms, 25 lesions (average size, 3.1 cm) were classified on cytologic and histologic grounds as being encapsulated carcinomas. In eight of these tumors (32.2%) cervical lymph node metastasis and/or intraglandular lymphatic spread was observed. It was not possible to separate on histologic grounds those that did metastasize from those that did not. The excellent prognosis for the encapsulated variant of papillary thyroid carcinoma was confirmed by a long follow-up period in which no evidence of recurrences or further metastasis was registered as compared with the time of initial diagnosis, whatever the mode of therapy. On the basis of these findings, the encapsulated papillary carcinoma can be regarded as an early or slowly growing form of the papillary thyroid carcinoma.     

甲状腺乳头状癌与乳头状增生的病理研究

  目的 探讨Galectin3，CK19及Ki-67在甲状腺乳头状癌与乳头状增生中的表达，寻找有助于两者鉴别诊断的标志物。方法 运用免疫组化方法检测100例甲状腺乳头状癌、100例良性乳头状增生中Galectin3，CK19及Ki-67的表达。结果 Galectin3，CK19及Ki-67在甲状腺乳头状癌阳性表达率分别为100 %，97 %及93 %，而在乳头状增生中表达率分别为13 %，30 %及1 %，3种蛋白在乳头状癌与良性乳头状增生间差异有统计学意义（P＜0.05）。在乳头状癌中2种或3种蛋白同时阳性表达为94.3 %，而乳头状增生为0。结论 Galectin3，CK19及Ki-67是鉴别诊断甲状腺乳头状癌与乳头状增生的有用标志物，尤其联合使用更有价值。     

体质量指数与甲状腺乳头状癌临床病理特征的相关性分析

目的:分析体质量指数（body mass index,BMI）与甲状腺乳头状癌（papillary thyroid carcinoma,PTC）临床病理特征的相关性。方法:回顾性分析2017年1月至2018年6月于西京医院甲乳血管外科行手术的829例PTC患者临床资料,并将入组患者根据BMI的不同分为四组:较轻组（BMI＜18.5 kg/m2）、正常组（18.5≤BMI＜25 kg/m2）、超重组（25≤BMI＜30 kg/m2）及肥胖组（BMI≥30 kg/m2）。通过单因素分析及多元逻辑回归分析BMI与PTC临床病理特征相关性。结果:不同BMI组PTC患者的年龄、性别以及高血压病史之间具有统计学差异（P<0.001）。超重组患者与其他组相比平均年龄较大,肥胖组患者男性居多。单因素分析显示,BMI与肿瘤多灶性、BRAF V600E基因突变以及TNM分期显著相关（P<0.05）,而与病灶大小、病灶分布、是否侵犯包膜以及淋巴结转移数目和位置无关（P>0.05）。BMI正常组患者的肿瘤发生灶多为单灶（60.3%）,而非正常组患者多灶的发生率显著增加（P=0.040）。随着BMI的增长,BRAF V600E基因突变率显著提高（P=0.001）。经多元逻辑回归分析的校正,PTC患者的TNM分期与BMI无统计学差异（P>0.05）,肿瘤多灶性以及BRAF V600E基因突变仍与BMI显著相关。结论:在PTC患者中,非正常BMI组患者肿瘤多灶的发生率较正常BMI组显著增加,且BRAF V600E基因突变率与BMI呈正比,而除多灶性以外的侵袭性病理特征与BMI之间未发现相关性。     

甲状腺乳头状癌的变异型

甲状腺乳头状癌(PTC)组织学变异型众多,大部分变异型与典型乳头状癌有相似的临床行为,但有少数变异型预后较差,如高细胞变异型、柱状细胞变异型、实体/梁状变异型等;且有一些变异型在诊断上有争议,如滤泡变异型易误诊为滤泡腺瘤、透明细胞变异型可能与肾细胞癌混淆、诊断高细胞变异型所需的高细胞的比例和细胞高度有分歧意见等.     

Simultaneous occurrence of medullary carcinoma and papillary carcinoma and papillary carcinoma of the thyroid

We report a case of simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in the same thyroid gland. Immunoreactivity of calcitonin, carcinoembryonic antigen, neuron specific enolase and thyroglobulin made a sharp distinction between both neoplasms of the thyroid. It appears reasonable to consider that simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in this case does not have embryological or genetical significance. © 1995 Wiley-Liss, Inc.     

Carcinoma of possible thymic origin presenting as a thyroid mass: a new subgroup of squamous cell carcinoma of the thyroid

Intrathyroidal thymoma is a rare tumor that occurs in the thyroid gland and has been reported as a low-grade malignant tumor. The present report describes a 59-year-old male patient with this tumor, who was treated with subtotal thyroidectomy followed by radiation and chemotherapy. The tumor was located in the lower pole of the left lobe and the isthmus of the thyroid, and it had invaded the thyroid parenchyma, thyroid capsule, adjacent connective tissue, and neck muscles. Continuity between the cervical thymus and the tumor was noted. Subsequently, the patient developed widespread metastases in the liver, lungs, bones, and lymph nodes without local recurrence. Histologic examination disclosed a solid growth of epithelial cells with squamous cell differentiation and keratinization. The tumor cells had an ill-defined cell border and large nuclei with large nucleoli. Moderate mitoses and slight necrosis of the tumor were seen. Immunohistochemical examination showed that the tumor cells were stained positively for keratin but not for calcitonin or thyroglobulin. There were infiltrations of lymphocytes in the tumor and fibrous stroma, and most of them proved to be T cells.     

Pericardial tamponade as initial presentation of papillary thyroid carcinoma.

We herein describe a 19-year-old woman who presented with pericardial effusion that resulted in heart tamponade. The clinicopathological study revealed papillary carcinoma of the thyroid metastasized to the heart. Although malignant pericardial effusion is a known complication of thyroid cancer, it is rarely the first manifestation and shows a relatively favourable prognosis despite widespread metastases if adequate treatment is given.     

Renal cell carcinoma presenting as skeletal muscle mass

Solitary muscle tumor, representing the first manifestation of metastatic renal cell carcinoma, is rare. A case report of a tumor mass in the left posteromedial arm, which proved to be metastatic from the right kidney, is presented. The incidence of this condition among patients presenting as a soft tissue sarcoma may be about 1%.     

甲状腺乳头状癌声像图特征探讨

目的：评价甲状腺乳头状癌（papillary thyroid carcinoma,PTC）的声像图特点。方法：回顾性分析34例经手术和病理证实的PTC彩色多普勒超声图像特点。结果：32例（94.1%）低回声,30例（88.2%）结节纵/横≥1,26例（76.5%）伴细微钙化,23例（67.6%）毛剌边缘,29例（85.3%）结节单发,20例（58.8%）边界不清晰,14例（41.2%）侧后方声影,6例（17.6%）检出血流信号,8例（23.5%）颈淋巴结肿大。出现上述异常声像图特征2项以上者占73.5%（25/34）。结论：低回声、微钙化、纵/横≥1、边界、毛剌是PTC具有特征性的超声表现。     

Surgical treatment of papillary thyroid carcinoma

Four hundred and thirty-seven patients with papillary thyroid carcinoma were treated from April 1963 to December 1989. The main treatment was surgery which was divided into 4 types: lobectomy combined with neck dissection (RND or MND); total thyroidectomy; isthmusectomy plus lobectomy; lobectomy combined with RND and then followed by contralateral MND. The 10-year survival rates of these four groups were 88.6%, 89.5% 80% and 80%, respectively. The overall 5, 10 and 15-year survival rates were 92.7%, 87.9%, 79.4%. Lymph node metastasis was present in 80%. The authors believe that functional neck dissection is indicated if the number of lymph node is limited and the size is small.     

Familial occurrence of papillary thyroid carcinoma

The occurrence of familial medullary carcinoma in the thyroid is a well-known entity, but cases of familial papillary carcinoma have been rarely reported. A case of thyroid papillary carcinoma which occurred almost synchronously in a mother and her two daughters is presented. No significant difference between familial and nonfamilial papillary carcinoma was noted in clinical, histopathological and chemical findings. The pedigree of our case is considered to show autosomal dominant inheritance.     

甲状腺乳头状癌声像图特征探讨

目的:评价甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的声像图特点。方法:回顾性分析34例经手术和病理证实的PTC彩色多普勒超声图像特点。结果:32例(94.1%)低回声,30例(88.2%)结节纵/横≥1,26例(76.5%)伴细微钙化,23例(67.6%)毛剌边缘,29例(85.3%)结节单发,20例(58.8%)边界不清晰,14例(41.2%)侧后方声影,6例(17.6%)检出血流信号,8例(23.5%)颈淋巴结肿大。出现上述异常声像图特征2项以上者占73.5%(25/34)。结论:低回声、微钙化、纵/横≥1、边界、毛剌是PTC具有特征性的超声表现。     

Inherited aspects of papillary thyroid carcinoma

The presence of papillary carcinoma of the thyroid in multiple generations of one kindred is a statistical impossibility as an occurrence of chance. However, traditional and molecular genetic analyses to date have failed to support the notion of a single gene mutation or identify one, in distinct contrast to medullary carcinoma of the thyroid. Findings to date, outside of distinct multicancer syndromes, suggest the interplay of inherited susceptibility and other factors, such as environmental exposures. It is possible that the main identifiable genetic risk factors at this time are the presence of multinodular goiter or Hashimoto's thyroiditis within the family.     

Treatment of intrathyroidal papillary carcinoma of the thyroid

Among 237 patients with grossly noninvasive (intrathyroidal) papillary carcinoma of the thyroid treated by surgery at the Massachusetts General Hospital and followed for a median of 14 years, no patient had tumor recurrence either in the thyroid bed or opposite lobe. There were 12 metastatic recurrences with risks of recurrence 4.0% and 6.9% at 10 years and 20 years respectively. Eight of these recurrences were restricted to cervical lymph nodes and did not herald the development of more serious recurrent disease. The remaining recurrences were lung metastases in four patients, two of whom died, accounting for the only deaths from thyroid carcinoma in this series. Factors that influenced the risk of recurrence included lymph node metastases at initial surgery, large tumor size, and to a lesser extent, male sex. The majority of patients (176) had subtotal thyroidectomies, mostly lobectomy (131 patients). There was no evidence that the 61 patients who underwent total thyroidectomy fared better than those with similar patient and tumor characteristics on whom subtotal procedures were performed. The overall findings of this study strongly support the concept that intrathyroidal thyroid carcinoma can be successfully treated by conservative surgery.     

Prognostic factors in papillary carcinoma of the thyroid

In a retrospective study of 119 patients, followed for 1 to 30 years after treatment of a papillary carcinoma of the thyroid, the authors searched for possible prognostic factors of the risk of recurrence. Microcarcinomas, anaplastic tumors and Hürthle cell carcinomas were excluded from the study. In a univariate analysis, age (greater than 45 years), sex (male), loss of histologic differentiation, size (greater than 3 cm), presence of carcinomatous lymphangitis, extrathyroid extension, and presence of metastasis at diagnosis were associated with a higher recurrence rate; type of growth and multifocality were not significant. In a multivariate analysis (logistic regression), age, size, and carcinomatous lymphangitis were significant predictors for women, whereas metastasis at diagnosis and cystic growth were significant for men.     

BRAF mutation in papillary thyroid carcinoma

The BRAF gene has been found to be activated by mutation in human cancers, predominantly in malignant melanoma. We tested 476 primary tumors, including 214 lung, 126 head and neck, 54 thyroid, 27 bladder, 38 cervical, and 17 prostate cancers, for the BRAF T1796A mutation by polymerase chain reaction (PCR)-restriction enzyme analysis of BRAF exon 15. In 24 (69%) of the 35 papillary thyroid carcinomas examined, we found a missense thymine (T)-->adenine (A) transversion at nucleotide 1796 in the BRAF gene (T1796A). The T1796A mutation was detected in four lung cancers and in six head and neck cancers but not in bladder, cervical, or prostate cancers. Our data suggest that activating BRAF mutations may be an important event in the development of papillary thyroid cancer.     

单纯乳头状甲状腺癌与合并桥本甲状腺炎的乳头状甲状腺癌的临床特点及分析

目的 分析单纯乳头状甲状腺癌(PTC)与PTC合并桥本甲状腺炎(HT)患者的临床特点.方法 将149例PTC患者,按是否合并HT分为PTC组(n=120)与HT-PTC组(n=29).对比两组患者的性别、年龄、术前促甲状腺激素(TSH)水平、甲状腺微小乳头状癌(PTMC)发生率、术后左旋甲状腺激素剂量以及术后TSH抑制...