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Biomedical subjects

R C Hickey

Publications and source records attributed to R C Hickey.

At least 55 records · Page 3Linked to original sources
PubMed1984

Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients.

The natural history and prognostic factors of medullary carcinoma of the thyroid (MCT) were studied in 161 patients seen at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1944 and 1983. One hundred twenty-five patients (77.6%) had the sporadic variety of MCT, 31 patients (19.3%) had multiple endocrine neoplasm (MEN) type IIa and 5 patients (3.1%) had MEN-IIb. The disease occurred equally in both sexes (M:F ratio 1:1.05). Thyroid nodules were the most common presenting feature especially in patients with the sporadic disease and MEN-IIb. Fifteen patients with MEN-IIa had occult MCT; the diagnosis was made through screening of family members with calcitonin measurement before and after stimulation with calcium or pentagastrin. Sixteen patients with MEN-II had pheochromocytoma and 7 had hyperparathyroidism. Total thyroidectomy was the most commonly performed operation. The lowest incidence of recurrence occurred in patients who underwent total thyroidectomy and modified neck dissection. Radioactive 131I was used as adjunct to surgery in 19 patients but it did not improve the survival or lower the incidence of recurrence. Patients who received postoperative radiotherapy had significantly lower adjusted survival rates than those treated by surgery alone, but we tended to irradiate patients with more advanced disease. Chemotherapy was administered to 11 patients with disseminated metastases but the response was poor. The 5- and 10-year adjusted survival rates of all the patients with MCT were 78.2% and 61.4%, respectively. Patients with MEN-IIa had much better rates than patients with sporadic disease (p = 0.0005), who were 7.74 times more likely to die of MCT. The stage of the disease at presentation was a major prognostic factor. Patients with stages III or IV disease were 7.31 times more likely to die of MCT than those with stages I or II. There was no significant difference in survival between patients with stages I and II or III and IV. The presence of cervical lymph node metastases did not affect the survival adversely. Direct extension with involvement of tissue was a bad prognostic sign. Patients younger than 40 years old at the time of diagnosis of MCT had a significantly better adjusted survival rate than those who were older. Women had a better prognosis than men, who were 1.89 times more likely to die of MCT. Diarrhea was a bad prognostic sign. However, it occurred more frequently in patients with advanced stages of the disease and larger tumor mass.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Adrenal cortical carcinoma. A study of 77 cases.

Seventy-seven patients with histologically proven adrenal cortical carcinoma seen at the University of Texas M. D. Anderson Hospital (1950-1981) were studied. Thirty-nine were women (mean age at diagnosis, 36.6 years), and 38 were men (mean age at diagnosis, 48.3 years). On presentation, 41 of 74 had abdominal symptoms (55.4%) and 25 of 74 had an abdominal mass (33.8%). Twenty-six patients (33.8%) were found to have clinically functional disease (18 women, 8 men). At diagnosis, 26 (33.8%) had clinical or radiologic signs of distant metastases. Preoperative radiologic studies yielded an abnormal intravenous pyelogram in 42 of 51 (82%), an abnormal abdominal ultrasound in eight of nine (88.9%), abnormal computerized tomography in 10 of 10 (100%), and abnormal arteriogram in 18 of 19 (94.7%). Surgery for localized or regional disease was associated with a disease-free interval of at least 2 years in 16 of 34 patients (47%). The use of op'DDD, abdominal radiotherapy, and systemic chemotherapy produced demonstrable effects in nine of 47 (19.1%), two of nine (22.2%), and three of 26 (11.5%), respectively. Distant metastases occurred in 60 patients, commonly in lung, liver, peritoneal and pleural surfaces, lymph nodes, and bone. Analysis of survival data showed a 5-year survival of approximately 30%. The authors concluded that early diagnosis and radical surgery offer the only prospects of long-term survival and the possibility of cure.

Adrenal Cortex Neoplasms↗
PubMed1983

Intrapericardial pheochromocytoma.

A patient with intrapericardial pheochromocytoma is described, and the literature on this subject is reviewed. Iodine 131-labeled metaiodobenzylguanidine scintigraphy was superior to computed tomography in localizing the tumor. This newly introduced method is safe, specific, noninvasive, and may prove to be the method of choice for localizing pheochromocytomas. The patient was prepared for surgery with alpha- and beta-adrenoceptor blocking agents. The tumor was markedly adherent to the posterior wall of the left and right atria. Cardiopulmonary bypass was used to allow excision of the tumor. Hemostasis was attained with difficulty due to marked vascularity of the tumor.

3-Iodobenzylguanidine↗
PubMed1983

Immunoperoxidase study of uncommon parathyroid tumors. Report of two cases of nonfunctioning parathyroid carcinoma and one intrathyroid parathyroid tumor-producing amyloid.

Nonfunctioning carcinomas of the parathyroid gland are rare and difficult to diagnose. They are often confused with thyroid tumors or with metastasis from other sites. We report two cases of nonfunctioning parathyroid carcinomas; one was originally diagnosed as follicular carcinoma of the thyroid gland. The immunohistochemical demonstration of parathormone in the tumor cells established the parathyroid origin of these neoplasms. An intrathyroid parathyroid tumor, associated with large amounts of interstitial amyloid, mimicking medullary carcinoma of the thyroid, in a patient with primary hyperparathyroidism is also reported. Positive immunoreaction in the tumor cells for parathormone, negative staining for calcitonin, and the return of patients' serum calcium levels to normal after tumor resection, confirmed the parathyroid nature of this neoplasm. Immunohistochemistry studies proved to be extremely helpful in establishing the diagnoses of these unusual parathyroid tumors.

Adult↗
PubMed1983

Impact of therapy for differentiated carcinoma of the thyroid: an analysis of 706 cases.

A retrospective analysis of clinical and pathological data was conducted on 706 patients (514 females and 192 males) treated for differentiated thyroid carcinoma at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1951 to 1975 and followed to 1981. The histological diagnoses were mixed papillary/follicular carcinoma (66.7%), papillary carcinoma (14.6%), follicular carcinoma (15.3%), or Hurthle cell carcinoma (3.4%). Patients diagnosed before the age of 40 yr lived significantly longer than those diagnosed over the age of 40 yr, and females lived longer than males. According to survival analyses and disease-free intervals, the order of increasing aggressiveness of the tumors was papillary, mixed, follicular, and Hurthle cell. Total thyroidectomy was associated with longer disease-free intervals and fewer recurrences. The 136 patients who received ablative 131I after surgery had fewer recurrences than a matched group who did not, but the disease-free interval and survival rate showed no significant difference. Further classification showed that patients with follicular and mixed tumors, and those who underwent total thyroidectomy benefited from 131I. There were 78 deaths attributed to thyroid cancer in the whole group. Approximately two thirds occurred in the first 10 yr after diagnosis. In conclusion, total thyroidectomy is recommended, when feasible, for differentiated thyroid cancer, followed by ablative 131I therapy, at least for follicular and mixed varieties.

Adenocarcinoma↗
PubMed1983

Parathyroid carcinoma: features and difficulties in diagnosis and management.

The objective of this review was to study the clinical course and the applicable diagnostic criteria in 12 patients with functioning parathyroid carcinoma, two patients with nonfunctioning parathyroid carcinoma, and a fifteenth patient who had an atypical intrathyroid tumor. The biologic patterns fell into four groups. The patients with functioning parathyroid carcinoma had either a prolonged tumor existence punctuated by hypercalcemic episodes ameliorated by operation to remove the tumor or an aggressive course with widespread metastases. The nonfunctioning cancers were aggressive cancers. The fourth group had one patient (others could have been considered) in whom a definitive diagnosis could not be made. The initial recognition of this cancer is sometimes difficult because consistent diagnostic features, either clinically or pathologically, are lacking. Enbloc resection at the first operation remains the best chance for cure. Surgical resection of recurrent disease appears to be the most effective palliative approach. Death results from hypercalcemia rather than from organ replacement by tumor.

Adult↗
PubMed1982

Parathyroid carcinoma: a clinical study of seven cases of functioning and two cases of nonfunctioning parathyroid cancer.

Seven cases of functioning and two cases of nonfunctioning parathyroid carcinoma are presented together with a general discussion of this disease. Functioning parathyroid carcinoma may be associated with prolonged survival. The morbidity and mortality from this disease are generally related to the prolonged hypercalcemia that occurs. The hypercalcemia is best treated with excision of local recurrences; however, this surgery is most often palliative and seldom curative. The best operative results were obtained when the disease could be localized preoperatively. Neck and mediastinal exploration in the absence of physical or radiographic evidence of recurrence failed to affect serum calcium levels. Two patients with nonfunctioning parathyroid cancer did poorly compared with those with functioning parathyroid carcinoma. The few cases reported in the literature are also suggestive of a more aggressive disease. The failure of this tumor to produce parathyroid hormone may allow it to escape clinical attention until it has achieved an advanced state.

Adenoma↗
PubMed1982

Cytogenetic abnormalities in a patient with hypercalcemia and papillary thyroid carcinoma.

Cytogenetic examinations on multiple peripheral blood cultures of a patient with papillary thyroid carcinoma and hypercalcemia revealed with following features: (1) The average frequency of cells with aberrations was 11.6%, considerably higher than in controls. Among metaphases with chromosomal abnormalities, 4.5% has chromosome-type aberrations. (2) One homolog of chromosome 11 showed a fragile site in the proximal end of the long arm, and in three metaphases the segment distal to the fragile site showed "branched morphology." (3) The rate of sister chromatid exchanges was within normal limits (8.78/metaphase). (4) The patient's two sons showed 7.0% and 5.0% abnormal metaphases, in the high normal range.

Carcinoma, Papillary↗
PubMed1982

Functioning oxyphil cell adenomas of parathyroid gland: immunoperoxidase evidence of hormonal activity in oxyphil cells.

Functional oxyphil adenomas of parathyroid gland are rare. Several studies have suggested that these tumors consist of a mixed cell population and that the transitional oxyphil cells and/or chief cells are the main source of parathormone, while the fully developed oxyphil cells have minimal or no hormonal activity. This report describes light, ultrastructural, and immunocytochemical features of six parathyroid adenomas, and confirms that these neoplasms are composed of a mixed cell population. It also demonstrates that the oxyphil cells have strong hormonal activity and therefore can play a significant role in the pathogenesis of hyperparathyroidism.

Adenoma↗
PubMed1982

Metastasis from squamous cell skin cancer of the extremities.

In a series of patients with localized squamous cell skin cancer treated at a cancer center, the incidence of metastasis was 1.4%. A premalignant condition, including thermal burns and irradiation dermatitis, was found in 30% of those patients, and 28% had multiple primary skin cancers. Forty-two of the 106 patients with metastasis had experienced local treatment failures, suggesting that such patients may be at greater risk of metastasis. In all but one instance of metastasis occurring from squamous cell skin cancer of the extremities, the regional lymph nodes were involved. Despite aggressive therapy, the five-year survival of patients with nodal metastasis was only 39%. Extracapsular spread of nodal disease was of grave significance. Based on the experience with metastatic squamous cell skin cancer of the head and neck, it is proposed to evaluate the adjunctive use of preoperative or postoperative irradiation and surgery in the treatment of metastatic squamous cell cancer of the skin of the extremities. Careful follow-up of patients with squamous cell skin cancer is necessary, and the lethal potential for recurrence and regional metastasis must be recognized.

Adolescent↗
PubMed1981

131I therapy in differentiated thyroid carcinoma: M. D. Anderson Hospital experience.

The therapeutic response and survival rates of 352 patients with differentiated thyroid carcinoma who had received radioactive iodine therapy since 1951 were studied. Of these patients, 72% had metastases to the cervical lymph nodes, lungs, bone, or other viscera. Of all patients, 70% showed complete remission, and 30% showed partial response or recurrence of disease or both. Patients with metastases before therapy had a higher incidence of recurrence than those who had localized thyroid disease (32.4% vs. 15.1%). Of these, 97 patients had recurrent disease. In 24 of these patients, the recurrent tumor failed to take iodine, indicating change in its iodine-concentrating characteristics. Of the 352 patients, 44 (12.5%) died of progressive thyroid carcinoma, and all were over 40 years of age at the time of initial diagnosis. Mean survival of patients with metastatic disease who were over 40 years of age at initial diagnosis was significantly lower than that of patients under 40 years of age (6.2 years vs. 11.5 years). Patients with recurrent metastases unresponsive to surgery or radioactive iodine therapy were treated with palliative radiotherapy or chemotherapy or both. They respond poorly and died within a few months.

Adenocarcinoma↗
PubMed1981

Hypercalcemia in patients with breast cancer. Osseous metastases, hyperplastic parathyroid tissue, or pseudohyperparathyroidism?

Breast cancer is the malignant neoplasm most commonly associated with hypercalcemia. At the University of Texas M. D. Anderson Hospital, Houston, during the fiscal year 1977 to 1978, of 16,887 patients having calcium determinations, 7.8% had hypercalcemia. From 1969 to 1979, 13 patients had proved and three had presumed primary hyperparathyroidism associated with breast cancer. Two other patients had pseudohyperparathyroidism. Selective neck vein catheterization was used in 17 of the 18 patients and helped localize and confirm the diagnosis of primary hyperparathyroidism. Chloride-phosphate ratios were elevated in 13 of the 14 patients with proved or presumed primary hyperparathyroidism. This condition may mimic osseous metastases by producing brown tumors or compression fractures. In patients with breast cancer and hypercalcemia, particularly without osseous metastases, a careful diagnostic evaluation is warranted to rule out primary hyperparathyroidism.

Adenoma↗
PubMed1980

Autografts of normal and hyperplastic human parathyroid: experience in eleven patients with immunoassay monitoring of function in seven.

Parathyroid autografts were implanted in 11 patients at this institution. Four patients had total or subtotal parathyroidectomy and implantation for parathyroid hyperplasia or adenoma, while 7 had one or more parathyroids removed and implanted during total thyroidectomy for carcinoma of the thyroid. Hyperplastic parathyroid was implanted in 4 instances and normal parathyroid in 7. Recurrent hyperparathyroidism occurred in 1 patient with an implanted adenoma who was returned to a normocalcemic state by partial reexcision ("titration") of the implanted tissue. All implants were placed in muscle pockets, a single site being used for patients receiving normal parathyroid tissue, and multiple sites for patients receiving hyperplastic glands. Those patients receiving forearm implants were followed up by serial parathyroid hormone determinations in venous blood drawn from both arms. In all cases, elevated levels were found on the implanted side, as compared to the contralateral control side.

Adenoma↗
PubMed1980

CT of pheochromocytoma.

The computed tomographic (CT) findings in 10 patients with pheochromocytoma are presented. Three of 10 patients had multiple endocrine adenomatosis, all with bilateral adrenal masses. One other patient had bilateral adrenal masses, four had right, and one had left sided adrenal masses. One tumor was extraadrenal. CT, when used as the initial imaging study, correctly identified nine of nine pheochromocytomas in six patients. In another four patients, recurrent or metastatic disease was identified. CT findings of use in diagnosis were mass lesions, some with areas of decreased attenuation indicating hemorrhage, and metastases identified in liver, mediastinum, lung, and spine. CT differentiation of benign from malignant lesions is facilitated by demonstration of local invasion or metastasis. CT is recommended as the initial radiographic procedure in the evaluation of patients with clinical or biochemical suspicion of pheochromocytoma, and for follow-up examination in patients with evidence of recurrent disease.

Adolescent↗
PubMed1980

Squamous cell carcinoma of the skin of the extremities.

Nonmelanomatous skin cancer usually occurs in fair-skinned persons on sites chronically exposed to sunlight. In a series of 35,000 patients with skin cancer seen at M. D. Anderson Hospital and Tumor Institute, 1,208 patients (13%) had squamous cell skin cancer of the extremities. Forty-one of these patients had a clear history of a preexisting thermal burn or irradiation dermatitis (Marjolin's ulcer). The average lesion was over 2 cm in diameter, and the average Marjolin's ulcer was over 5 cm. The treatment of choice in this series of relatively large lesions was surgical excision with or without skin grafting and with histologic evaluation of the surgical margins. The local recurrence rate was less than 10%. Regional metastasis developed in 1.4% of the patients and in 44% of those with Marjolin's ulcer. Even with prompt nodal dissection, the five-year survival rate for patients with nodal metastasis was only 35%. The presence of extracapsular spread of nodal disease is of grave significance, and adjunctive radiation therapy should be considered. Careful follow-up of all patients with squamous cell skin cancer is important.

Adult↗