Histopathological findings of human thyroid tumors and dynamic MRI

Objective: Time intensity curves for gadolinium-diethylenetriaminepentaceticacid (Gd-DTPA) enhanced magnetic resonance imaging (MRI), namely dynamic MRI, were determined for thyroid diseases, and compared with findings of histopathologic examination. Methods: Time intensity curves for the thyroid tumors were determined. Three different patterns of time intensity curves were observed: a rapid washout pattern, a delayed washout pattern and no change. Cell proliferating activities of thyroid tumors were estimated immunohistochemically by proliferating cell nuclear antigen (PCNA). Results: In most of malignant diseases and a few benign diseases that had marked cell proliferative activity with showing more than 20% on labeling indexes of PCNA, the time intensity curve displayed the delayed washout pattern, in which intensity was above half-maximal value within 10 min after injection Gd-DTPA. Almost all benign diseases and a few well differentiated carcinomas displayed the rapid washout pattern, in which intensity was decreased to lower than half of peak grade within 10 min following injection and showed from 10 to 20% on labeling indexes of PCNA. Benign diseases that displayed no change of time intensity curve did not show PCNA positive cells. Conclusion: These findings suggested that the time intensity curve obtained from dynamic MRI might indicate cell proliferating activity of thyroid tumors.     

Role of dynamic MRI in differentiating benign from malignant follicular thyroid nodule

Objectives

Thyroid nodular swellings are very common, consisting of both benign and malignant ones. Fine needle aspiration cytology is an excellent diagnostic modality for papillary cancers, medullary cancers, colloid goiter and lymphoma but fails in differentiating follicular adenomas from carcinomas. The purpose of this study was to evaluate role of Dynamic MRI with signal intensity time curve evaluation in differentiating benign from malignant follicular nodules.

Materials and methods

This study was carried out in Department of Surgery in collaboration with department of Radiodiagnosis, Maulana Azad Medical College, Delhi. 28 patients with solitary thyroid nodule (STN) having follicular etiologies were included in the study. Dynamic MRI with signal intensity time curve analysis was carried out in all the cases and findings were compared with the final diagnosis based on histopathological examination of surgical specimen.

Results

In the present study, rapid enhancement was seen in 87.5% of malignant cases and washout pattern was seen in 87.5% of malignant STN (p = 0.019). Only 20% of the benign lesions showed washout pattern (p = 0.0034). Benign cases demonstrated gradual enhancement in 85% cases as compared to 12.5% in malignant STN (p = 0.0098).

Conclusion

This study suggests that signal intensity time curve may help in differentiating benign from malignant follicular thyroid nodules.     

豚鼠内耳钆喷酸葡胺MRI显像的初步探讨

目的 通过MRI观察豚鼠鼓膜穿刺听泡内注射钆喷酸葡胺后内耳增强显影的特征,观察不同时间点造影剂在内耳的分布,找出内耳增强显影的最佳时间,同时了解钆喷酸葡胺在内耳的药代动力学特点,探讨在现有实验条件下内、外淋巴区分显影的可行性.方法 65只豚鼠随机数字表法分为13组,每组5只.豚鼠鼓膜穿刺听泡内注射生理盐水稀释8倍的钆喷酸葡胺,分别在注射前、注射后0.5、1、2、4、6、8、10、12、24、48、72及96 h行内耳MRI扫描(3D-T1 FSE序列).使用e-Film软件对内耳各部位MRI图像灰度值进行提取,应用体外试验获得的灰度值-造影剂浓度关系将灰度值转化成浓度.分别测量注射前、注射后1 d及7 d豚鼠左耳(生理盐水)和右耳(稀释造影剂)的听性脑干反应(ABR)阈值并进行对比.结果 注射后6 h为造影剂扩散至全内耳并达到较好显影条件的时间点,也即造影剂在内耳各部分达到较高浓度的时间,此时造影剂在前庭、底转鼓阶、底转前庭阶、第二转、第三转、顶转的浓度分别为589.29、552.54、570.17、255.08、107.09、139.18 μmol/L;造影剂选择性进入外淋巴,未见内淋巴增强显影.造影剂注射后1 d及7 d豚鼠左、右耳ABR阈值相比,差异无统计学意义(P值均＞0.05).结论 豚鼠听泡内注射钆喷酸葡胺后6 h为MRI内耳增强显影的最佳观察时间.造影剂可选择性显影外淋巴,对豚鼠ABR阈值无明显影响.通过MRI可以间接研究钆喷酸葡胺在内耳的代谢特点.     

Dexamethasone does not affect endolymphatic hydrops (EH) in patients with Meniere's disease within 24 h,and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

BackgroundIntratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.Materials and methodsIn an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere's disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hT₂FLAIR-MZFI) sequence.ResultsThe retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman's Rho), between diagnosis and vestibular EH (p < 0.01, Spearman's Rho), and between cochlear and vestibular EH (p < 0.01, Spearman's Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.ConclusionsIntratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.Level of evidence3.     

Dexamethasone does not affect endolymphatic hydrops (EH) in patients with Meniere's disease within 24 h,and intratympanic administration of gadolinium plus dexamethasone simplifies high-quality imaging of EH using a novel protocol of 7 min

BackgroundIntratympanic administration of gadolinium chelate allows for a better visualization of endolymphatic hydrops (EH) using MRI than intravenous injection and was recently further improved to facilitate high-quality imaging of EH in 7 min. The aim of the present study was to simplify the intratympanic administration protocol by mixing gadolinium chelate with therapeutic dexamethasone and to evaluate the effects of this mixture on the visualization of EH in MRI.Materials and methodsIn an in vitro study, the potential impact of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) on the stability of dexamethasone was evaluated by analyzing dynamic changes in dexamethasone with high-performance liquid chromatography (HPLC) after mixing with Gd-DTPA. Ten patients with definite Meniere''s disease (MD) were recruited to study the potential interference of dexamethasone on MRI visualization of EH, and 49 patients with MD were recruited to evaluate the effect of intratympanic injection of Gd-DTPA mixed with dexamethasone on MRI of EH using a 3T MR machine and a novel heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed using a magnitude plus zero-filled interpolation (hT₂FLAIR-MZFI) sequence.ResultsThe retention times and peak area of dexamethasone in HPLC were not modified by the addition of Gd-DTPA. EH grading in the cochlea and vestibule was not influenced in any ear by intratympanic injection of dexamethasone. Excellent inner ear images were obtained from all patients, and EHs with various grades were displayed. There were significant correlations between diagnosis and cochlear EH (p < 0.01, Spearman''s Rho), between diagnosis and vestibular EH (p < 0.01, Spearman''s Rho), and between cochlear and vestibular EH (p < 0.01, Spearman''s Rho). The distribution of Gd-DTPA plus dexamethasone negatively correlated with the grade of vestibular EH. Injury of the endolymph-perilymph barrier was detected in one cochlea and three vestibules of 59 inner ears with MD.ConclusionsIntratympanic administration of Gd-DTPA plus dexamethasone yielded high-quality MRI images of EH in patients with MD using a novel 7-min protocol and simplified the clinical application. Intratympanic administration of Gd-DTPA plus dexamethasone might be used to test its therapeutic effect in future work.Level of evidence3.     

Hurthle cell tumors of the thyroid gland.

Hurthle cell lesions of the thyroid gland, which are derived from follicular cells, occur in a variety of thyroid diseases. Hurthle cell neoplasms are generally easy to differentiate from non-neoplastic lesions, but the separation of benign from malignant Hurthle cell tumors is difficult on a purely histologic basis unless capsular or vascular invasion or metastases are present. Since this distinction is so difficult to make, the authors recommend treating all Hurthle cell neoplasms as potentially malignant. Treatment includes total thyroidectomy, peritracheal node dissection and if palpable jugular nodes are present, a regional node dissection. A series of 11 patients with this disease and the literature are reviewed to document these recommendations.     

Significance of epidermal growth factor receptor and tumor associated tissue eosinophilia in the prognosis of patients with nasopharyngeal carcinoma

OBJECTIVE: The expression of epidermal growth factor receptor (EGFR) is one of the indicators, which can predict the malignant potential of squamous cell carcinoma of the head and neck (HNSCC). On the other hand, previous histological studies have proved tumor-associated tissue eosinophilia (TATE) to be a favorable prognostic indicator for HNSCC. We studied the prognostic significance of co-expression of EGFR and TATE. METHODS: We examined the expression of EGFR and TATE in 53 patients with nasopharyngeal carcinoma (NPC). Biopsy specimens were subjected to immunohistochemical-staining for EGFR expression and Luna-staining for TATE. EGFR staining was considered negative when immuno-stained cells were less than 25% in a field. TATE was divided into four grades as grade 0 for 0-2 eosinophils in a high power field, grade 1 for 3-9, grade 2 for 10-29, and grade 3 for 30 or more. RESULTS: In terms of TATE expression, 27 patients were classified as grade 0, 12 as grade 1, six as grade 2, and eight as grade 3. Forty-four patients were EGFR positive and nine were negative. We found no statistical significance in the distribution of EGFR positivity and TATE grades. Among EGFR-positive patients, 5 year survival rates were significantly better in TATE-positive (grades 1, 2, 3) patients than in TATE-negative (grade 0) patients (P=0.0139). CONCLUSION: Eosinophils may be activated in the tumor tissue, in which the expression of EGFR is up-regulated. This suggests that the activated eosinophils in EGFR-positive tumors resulted in better prognoses. TATE infiltration and EGFR expression may be closely related to the malignant potential of NPC, and co-expression of TATE and EGFR may be an important prognostic factor.     

7.0T磁共振成像观察耳后给药促进药物进入内耳的可行性

目的借助磁共振成像系统,观察新给药方式耳后给药,药物在内耳的吸收过程,探讨耳后给药治疗内耳疾病的可行性。方法 12只白色红目豚鼠随机分为2组,一组耳后注射造影剂,一组静脉注射造影剂。7.0T小动物专用磁共振成像系统,在给药前、给药后0.5h、1h、2h、3h、4h、6h、8h、12h、24h、48h,分别进行磁共振T1加权像成像。测量右侧耳蜗底转鼓阶的信号强度,描绘信号-时间曲线,计算曲线下面积,对比耳后组与静脉组之间的差异。结果耳后组与静脉组信号-时间曲线下面积分别为68.14×105及36.17×105,耳后组面积更大,差异有统计学意义(P<0.05)。结论耳后给药治疗内耳疾病是可行的,局部疗效好,全身并发症少,便于在临床推广应用。     

Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI – a preliminary report

Conclusion: At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (T_peak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe.

Objective: To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: T_peak and WR.

Methods: The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen.

Results: Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on T_peak and WR values, two distinct clusters of parotid malignancies were identified. The cut-off value for T_peak optimally differentiating between the clusters was 140?s; the cut-off value for WR could not be identified. The two clusters did not differ in terms of dynamic and diffusion-weighted MRI parameters, patient age, sex and prevalence of lymphadenopathy. Significant inter-cluster differences were found in the prevalence of deep parotid lobe involvement and presence of a single mass.     

术前伴喉返神经麻痹的甲状腺肿瘤的临床病理分析

目的　探讨术前伴喉返神经麻痹的甲状腺肿瘤的良恶性分布,喉返神经情况及组织病理学特征。方法  2007年1月～2014年12月本院共12 488例甲状腺肿瘤患者,其中80例为初治术前伴喉返神经麻痹,分析其临床及病理资料。结果　16例（20.00%）为良性,64例（80.00%）为恶性。良、恶性肿瘤患者性伴喉返神经麻痹率分别为0.30%和0.90%。低-未分化癌患者麻痹率25.93%,显著高于其他病理类型。良性肿瘤患者术中8例未粘连神经,6例粘连,锐性解剖后保留,2例神经变性,无法保留,切除率12.50%。恶性肿瘤患者术中3例神经无粘连,3例包绕,锐性解剖后保留,42例切除,切除率87.50%。低-未分化癌术中神经均切除。经保留神经的14例良性肿瘤患者及6例恶性肿瘤患者术后神经功能获改善或恢复。结论　恶性肿瘤患者术前麻痹率显著高于良性肿瘤患者,术中神经切除率高。如能解剖保留神经,术后功能可恢复。     

Horner's syndrome and thyroid neoplasms

Although thyroid goiter is a common condition, it rarely results in Horner's syndrome. We report a case of a patient with an intrathoracic multinodular goiter complicated by Horner's syndrome. Benign thyroid disease was confirmed pathologically, and the patient's symptoms improved after surgery. In the literature, the major cause of Horner's syndrome is neoplasia, with malignant lesions being twice as frequent as benign tumors. An extensive review of the literature demonstrates a different repartition for thyroid neoplasia: including our case, 38 cases of Horner's syndrome secondary to a benign thyroid tumor are described, against only 8 cases caused by a thyroid carcinoma. We conclude that contrary to the commonly held opinion, Horner's syndrome is more often due to benign thyroid diseases than to thyroid malignancies.     

鼻咽泡状核细胞癌和低分化鳞癌的临床生物学行为的对比研究

目的：探讨鼻咽泡状核细胞癌（ＶＮＣＣ）和低分化鳞癌（ＰＤＳＣＣ）的临床生物学行为的差异性。方法：用原位杂交和免疫组化染色（ＳＰ法）技术,检测ＶＮＣＣ和ＰＤＳＣＣ癌组织中ＣｅｒｂＢ２、表皮生长因子受体（ＥＧＦＲ）和增殖细胞核抗原（ＰＣＮＡ）表达,用原位末端标记（ＩＳＬＥ）方法检测癌细胞凋亡,并对其预后和临床特征进行对比分析。结果：①ＶＮＣＣ的ＩＳＥＬ和ＰＣＮＡ染色强度指数（ＳＩ）明显高于ＰＤＳＣＣ;②ＶＮＣＣ的ＣｅｒｂＢ２、ＥＧＦＲｍＲＮＡ和ＣｅｒｂＢ２蛋白表达与ＰＤＳＣＣ无明显差别;③ＶＮＣＣ的５年生存率比ＰＤＳＣＣ高。结论：与ＰＤＳＣＣ比较,ＶＮＣＣ是一种生长增殖活跃、分化程度更低,但有较好预后趋向的一种癌型。     

Toluidine blue. An aid in the microlaryngoscopic diagnosis of glottic lesions?

The value of toluidine blue staining in vivo in the diagnosis of glottic lesions was examined by comparing the results obtained in a series with the histological findings. This material included 272 biopsy specimens from the vocal cords (202 microlaryngoscopic examinations). In 148 of these, the changes were classified as "malignant" (moderate and severe dysplasia and carcinoma) and in 124 as "benign." The sensitivity of the staining test in detection of malignant lesions was 91%. Among 13 false-negative results (9% of the malignant group), there was keratosis in 11. The overall specificity of the staining tests was 52%. The false-positive lesions displayed "benign" pathological alterations, such as inflammation and ulceration. False-positive findings were more common after radiotherapy. A correct diagnosis of malignancy on the basis of positive staining was more frequent the greater the intensity of staining.     

Positive predictive values of MRI and ultrasound-guided fine-needle aspiration biopsy for isolated parotid swelling in adults: A STARD comparative analysis

ObjectivesTo evaluate positive predictive values (PPVs) of magnetic resonance imaging (MRI) and ultrasound-guided fine-needle aspiration biopsy (UFNAB) in patients with isolated parotid swelling.Material and methodsObservational study following the STARD guideline, based on a cohort of 212 patients from 18 to 93 years of age, with isolated parotid swelling (malignant: 16.9%; benign: 83.1%), consecutively operated on between 2015 and 2020, after work-up including MRI and UFNAB in an otorhinolaryngology department of a university hospital. The main endpoint was PPV for diagnosis of benign tumor, malignant tumor and the most frequent etiology. Secondary endpoints were correlations between PPVs and clinical factors for malignancy, and the impact on PPV of various situations: dynamic analysis on MRI; diagnostic disagreement between MRI and UFNAB; and UFNAB PPV according to MRI diagnosis.ResultsPPVs for MRI and UFNAB were respectively 45.4% and 88.8% for malignant tumor, 89.6% and 46.9% for benign tumor, and 88.1% and 85.2% for pleomorphic adenoma (the most frequent etiology). Tumor fixation and history of head and neck radiation therapy PPVs were the only one higher than the MRI one for malignant tumor. MRI PPV did not differ between groups with or without dynamic analysis. PPV for malignant tumor, benign tumor and pleomorphic adenoma on MRI and UFNAB was respectively 42.8% and 33.3%, 42.8% and 100%, and 36.3% and 50% in case of diagnostic discordance. When MRI suggested malignant tumor, UFNAB PPV was 51.8% for malignant tumor, 67.7% for benign tumor, and 37.5% for pleomorphic adenoma; when MRI suggested benign tumor, it was 32.2% for malignant tumor, 91.5% for benign tumor, and 88.5% for pleomorphic adenoma; and, when MRI suggested pleomorphic adenoma, it was 23.5% for malignant tumor, 93.9% for benign tumor, and 92% for pleomorphic adenoma.ConclusionSystematic association of UFNAB to MRI did not fundamentally improve diagnostic accuracy. UFNAB appeared most valuable in case of history of radiation therapy, in case of tumor fixation, and when MRI diagnosis was uncertain and/or suggested malignant tumor and/or the apparent diffusion coefficient (ADC) was low. The contribution of UFNAB when MRI suggested benign tumor or especially pleomorphic adenoma was more limited.     

蝶窦炎性病变和肿瘤的诊断与治疗

分析２７例蝶窦炎性病变和肿瘤的临床资料，其中炎症１２例，良性肿瘤１０例，恶性肿瘤５例。比较了蝶窦炎性病变与肿瘤的ＣＴ扫描与ＭＲＩ检查的表现，发现炎性病变骨质侵蚀较肿瘤者少，Ｔ＿２信号强度增强较明显，讨论了各种蝶窦手术进路的适应症，提出经鼻外筛窦进路是治疗蝶窦病变的优选术式。     

副腮腺肿瘤临床分析

目的　探讨副腮腺肿瘤的临床、影像、病理特点及治疗效果。方法　收集并分析我院经治的8例副腮腺肿瘤病例资料。结果　多形性腺瘤5例,基底细胞腺瘤、多 形性腺瘤恶变（高分化非特异性腺癌）、高分化鳞状细胞癌各1例。良性肿瘤病例的CT表现为肿块呈椭圆形、边界清楚、密度均匀;恶性肿瘤病例的CT表现为肿块形状不规则、境界不清、密度欠均匀。8例患者均行手术治疗,入路分别选择：1例面颊部直接切口,2例口内入路,5例标准腮腺肿瘤切除入路,鳞状细胞癌病例同时行选择性颈清扫术。2例恶性肿瘤患者术后辅以放疗。所有患者治疗后随访1～5年,无复发及转移。结论　副腮腺肿瘤CT表现具有一定的特征性,彻底切除是首选治疗,入路宜选用标准腮腺切除切口,恶性肿瘤术后辅以放疗,短期疗效较好。     

9666例鼻咽喉部肿瘤病理分析

目的 了解鼻、咽、喉肿瘤发病的年龄、性别、部位及与病理类型的关系。方法 对华西医院病理科在1984～1999年间全部经病理诊断的9666例鼻、咽、喉肿瘤组织学类型的构成进行分析。结果 ①良、恶性肿瘤之比为1：8．6，在鼻咽部为1：62．0；②良性肿瘤21种，以乳头状瘤、血管纤维瘤和血管瘤多见；③恶性肿瘤25种，癌和肉瘤之比为11．98：1，以分化型非角化鳞状细胞癌最多见；④恶性肿瘤患者的发病年龄较良性肿瘤者约长10岁，且男性患者多于女性；⑤良性肿瘤以口咽鳞状上皮乳头状瘤最常见；恶性肿瘤以鼻咽癌为主，肉瘤以鼻腔淋巴瘤最常见。结论 鼻、咽、喉肿瘤的发病年龄、性别和部位与肿瘤的组织病理类型有一定关系。     

2017年新版WHO甲状腺交界性肿瘤解读

2017年第4版WHO内分泌肿瘤分册对甲状腺肿瘤的分类进行了全面更新,提出了甲状腺交界性肿瘤的概念,进一步完善了甲状腺疾病谱。甲状腺交界性肿瘤包括原透明变梁状肿瘤、形态和生物学行为界于滤泡腺瘤和滤泡癌/滤泡型乳头状癌之间的其他包裹性滤泡性肿瘤。后者根据有可疑包膜和/或脉管浸润或无浸润分成恶性潜能未定的肿瘤和具有乳头状核特点的非浸润性甲状腺滤泡性肿瘤两大类。而恶性潜能未定的肿瘤,进一步根据无/有甲状腺乳头状癌细胞核特点分为恶性潜能未定的高分化肿瘤和恶性潜能未定的滤泡性肿瘤。     

Expression of epidermal growth factor receptor in laryngeal dysplasia and carcinoma

The immunoreactivity of epidermal growth factor receptor (EGFR) was studied in laryngeal biopsy specimens from 24 patients. The study comprised 5 cases of normal laryngeal mucosa, 5 cases of dysplasia, 7 cases of well differentiated squamous cell carcinoma, and 7 cases of poorly to moderately differentiated squamous cell carcinoma. EGFR was in general not expressed in normal and dysplastic epithelia, whilst all carcinomas showed a rather strong positive immunoreactivity. There was no significant difference in staining patterns between the well and poorly to moderately differentiated carcinomas. The results suggest that EGFR constitutes a component of neoplastic, but probably not preneoplastic, laryngeal disease. The study failed to reveal any difference in staining pattern between different types of laryngeal squamous cell carcinoma.     

Submandibular gland myoepithelioma

Benign myoepithelioma is a very rare form of salivary gland tumor, composed entirely of myoepithelial cells. It accounts for approximately 1% of all salivary gland tumors and is most frequently located in the parotid gland and in the minor salivary glands of the hard palate. We describe herein the ninth reported case of myoepithelioma of the submandibular gland. Benign myoepithelioma must be differentiated from several benign and malignant epithelial and mesenchymal tumors. Immunohistochemical staining can help differentiate between these conditions, but histopathology remains the gold standard for diagnosing this neoplastic process.