Biomedical subjects
Publications and source records attributed to K Shimaoka.
Two patients with anaplastic carcinoma of the thyroid following irradiation for Hodgkin's disease are presented, and the previously reported cases briefly reviewed. The risk of late development of thyroid carcinoma is life-long and high-dose irradiation in patients with prolonged life expectancy may result in anaplastic carcinoma as well as less malignant histological forms.
Post-irradiation carcinoma of the thyroid is usually histologically well-differentiated. In general, those subjects who developed carcinoma had been exposed to low-to-moderate doses of irradiation for benign conditions. We reviewed the charts of 520 patients with Hodgkin's disease seen at Roswell Park Memorial Institute, and found 2 cases of anaplastic carcinoma amongst other thyroidal abnormalities. The existing reports of post-irradiation carcinoma are reviewed and suggestions are made for the management of heavily irradiated, potentially cured patients with Hodgkin's disease.
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A rare case of hamartomatous adiposity of the thyroid gland was found incidentally in a 73 year old white female with adenocarcinoma of the rectum. Pressure symptoms related to the goiter (120 gms) were the only manifestations noted. Extensive laboratory investigations failed to reveal any demonstrable functional abnormality of the thyroid gland.
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Involvement of the thyroid gland by plasma cell neoplasms is very rare. On review of 248 cases, we found 4 cases in which pathological evidence of plasma cell neoplasm in the thyroid was verified. This was a heterogeneous group of patients; the thyroid involvement was clinically recognized as a site of extramedullary plasma cell neoplasm in one patient and as a part of generalized disease in two patients. In another patient with generalized disease, the thyroid involvement was discovered at autopsy.
Prognosis of well-differentiated carcinoma of the thyroid gland is generally favorable, while that of anaplastic carcinoma, extremely poor. Well-differentiated carcinoma may sometimes be fatal; the most common underlying cause is considered to be due to anaplastic transformation of the original well-differentiated carcinoma to a less differentiated form. We studied 27 consecutive autopsy cases of fatal thyroid cancer treated at the Ito Hospital, Tokyo, during a five-year period, 1969-1973. We found uniform histological features of anaplastic carcinoma in 10 cases and of well differentiated carcinoma in four cases. In addition, co-existence of well-differentiated and anaplastic carcinomas was observed in nine cases and well differentiated and squamous cell carcinomas in four. Circumstantial evidence strongly suggests that malignant transformation is a part of the natural history of thyroid carcinoma, from well-differentiated carcinoma to less differentiated forms, either squamous cell or anaplastic carcinoma.
Patients with thyroid cyst (TC), non-toxic nodular goiter (NNG), follicular adenoma (FA) and papillary carcinoma (PC) were given a tracer dose of 125I 40h prior to surgery. Tissue specimens were hydrolysed with Pronase and their labeled iodocompound distribution determined by paper or thin layer chromatography; they were then derivatized and their stable iodoamino acids (IAA) determined by gas liquid chromatography (GLC). Specific activity (SA) of MIT, DIT and T4 was within the same range in TC, FA and grossly normal part of a PC, and was markedly lower in two NNG. SA of T3 was very high in a TC, and higher than that of other IAA, in one NNG, indicating preferential synthesis. SA of MIT and DIT was very high in grossly normal part of a second PC but stable iodothyronines were undetectable. Specimen therefore was biochemically abnormal though grossly normal. In the two abnormal specimens of PC stable IAA were undetectable, even though type of distribution of labeled IAA in one specimen closely approximated that found in TC, FA and NNG. In a second abnormal PC specimen RAI uptake was too low for analysis to be carried out. By combining labeled and stable IAA measurements new parameters for studying human thyroids have been obtained.
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A patient with malignant lymphoma developed goiter and thyrotoxicosis during the course of her disease. A thyroid biopsy revealed involvement of the thyroid gland with a malignant lymphoma. This was associated with the high levels of circulating thyroglobulin and thyroid hormones. The patient was treated with propylthiouracil, local radiotherapy, and nitrogen mustard and prednisone. The patient became euthyroid with the disappearance of goiter. Circulating levels of thyroglobulin and thyroid hormones returned to the normal range.
Clinical and laboratory evaluations are reported on two patients with congenital goiter and hypothyroidism due to iodide organification defect. In one patient, a 31-year-old white male with severe mental retardation, administration of perchlorate caused discharge of 69% of the radioiodine accumulated in the thyroid gland. Thyroid tissue had negligible peroxidase activity in the tyrosine-iodinase, triliodide, and guaiacol assays. Preincubation of subcellular fractions with hematin restored activity. The restored enzyme was labile to high concentrations of H2O2 (5.6times 10-4 h2o2 produced inhibition in the triiodide assay). Heating of the enzyme for 5 min at 46 degrees C produced 50% inactivation, while higher temperatures were required to half-inactivate normal peroxidases. This case represents a second example of the "peroxidase apoenzyme-prosthetic group defect" causing congenital goiter. The second patient, an example of the "deficient peroxidase defect," was a 10-yr-old girl with 35% discharge of thyroidal radioiodine by perchlorate. Peroxidase activity in the goiter tissue was quantitatively decreased (10%-20% of normal values) but kinetically normal with respect to apparent Km for H2O2. Hematin had little effect on the enzyme. Peroxidase activity had abnormal subcellular distribution, since pellets sedimenting between 39,000 and 105,000 g contained most of the activity. Normal thyroglobulin was observed in the thyroid gland of the patient. Two distinct defects of the peroxidase system can produce congenital goiter by limiting organification of iodide.
Needle aspirations of benign and malignant epithelial lesions of the thyroid were investigated in 265 patients. An 18-gauge needle connected to a 20-cc glass syringe was used to puncture each tumoral mass. Smears were stained by the Wright-Giemsa method. The material obtained consisted of 180 nontoxic goiters, 18 toxic goiters, 15 cases of thyroiditis and 52 malignant lesions. Aspirations taken from 21 patients (8%) were either blank or contained only blood and insufficient material for diagnosis. Results were correlated with clinical findings and laboratory tests. Biopsies were obtained only in selected patients to establish the final diagnosis. One false positive and one false negative were recorded. Although well-preserved follicular patterns can be seen on the cytologic specimens, the differentiation of thyroid adenoma from early follicular carcinoma based on cytologic criteria only if fraught with many difficulties. Cell density, nuclear structure and presence of nucleoli are sometimes helpful in making the cytologic diagnosis of thyroid carcinoma.