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Immunhistochemical and electron microscope analysis of adenomas of the thyroid gland. I. A comparative investigation of hot and cold nodules.

Histologic, immunhistochemical and electron microscopic changes in 8 cases of scintigraphically proven autonomous thyroid adenomas are described and compared with non-functioning adenomas. Adenomas with a light microscopic appearance suggesting autonomy show follicles which are mainly small or normal sized and lined by columnar thyroid cells with a partly vacuolated and eosinophilic cytoplasm. Immunhistochemically a high content of thyroglobulin corresponds to the amount of rough endoplasmatic reticulum. Typical ultrastructural criteria are a well developed cytocavitary network, numerous mainly apically localized lysosomes, prominent Golgi fields with sprouting vesicles and autophagic vacuoles. The cell surface is, when compared to non-functioning adenomas, enlared apically by numerous long microvilli and basally by deep infoldings. On contrast to experimentally TSH-stimulated animal thyroids, colloid droplets and pseudopodia are rare. The morphological findings are compared with recent biochemical results and the diagnostic value of electron microscopy is discussed.

Adenoma

C cell adenoma of the human thyroid gland.

A case of C cell thyroid adenoma in a 47-year-old female patient is described. The nodule showed progression over 34 years. The adenoma cells showed histochemical and ultrastructural properties characteristic for C cells. Histologic examination revealed no atypical features of nodule cells nor infiltration of capsule by neoplastic cells. In the period of 8 years following the excision there was neither recurrence nor metastases.

Adenoma

Coexistent parathyroid adenomas and thyroid carcinoma. Can radiation be blamed?

The coexistence of parathyroid adenomas and thyroid cancer in a substantial number of patients with primary hyperparathyroidism has led to speculation implicating ionizing radiation as a possible cause. Experience with a group of 40 individuals harboring both tumors was reviewed and evidence of roentgen ray exposure to the head and neck was found in only one of these patients. Association of parathyroid adenomas and thyroid carcinoma cannot be explained on the basis of prior irradiation to the neck.

Adenocarcinoma

The coexistence of parathyroid adenoma and thyroid carcinoma.

Not well-known and inadequately understood is the high incidence of conexistent parathyroid adenoma and nonmedullary thyroid carcinoma. In a series of 144 patients with parathyroid adenoma, 11 (8%) were found to have concurrent thyroid carcinoma. Although similar to other multiple endocrine tumor syndromes, these two tumors have no common embryologic cell origin. The most likely explanation for this apparent relationship is the specific oncogenic effect of hypercalcemia on the thyroid gland.

Adenocarcinoma

Induction of thyroid follicular adenomas and carcinomas by N-nitrosobis(2-oxopropyl)amine.

Subcutaneous injection of N-nitrosobis(2-oxypropyl)amine (BOP) induced thyroid follicular adenomas and carcinomas in MRC rats. The tumor yield was 50% following a single dose and 60% after weekly treatment for life. In males the tumor incidence was slightly higher and the latency period shorter, while in females, the tumors were larger. Sites of origin, size, multiplicity and morphologic patterns of tumors were analyzed in relation to dose and sex. The possible mechanisms involved in tumorigenesis are discussed.

Adenocarcinoma

Thyrotrophin-responsive adenylate cyclase activity in thyroid toxic adenoma.

The adenylate cyclase system was studied in hyperfunctioning autonomous nodules in comparison with normal thyroid tissue. The basal, TSH- and NaF-stimulated adenylate cyclase activities were tested in purified plasma membrane preparations. Basal enzyme activity in membranes from hyperfunctioning nodules was variable and the response to TSH was either normal, low or absent. The present study demonstrates that an intact adenylate cyclase activity, hyporesponsive to TSH, may exist in the cell membrane of the adenoma.

Adenoma

Carcinoma of the thyroid gland, adenoma of the adrenal cortex and peptic ulcer: an unreported association.

A 39-year-old man, operated on for duodenal ulcer, was found to have a papillary carcinoma of the thyroid, an aldosterone-producing adenoma of the adrenal cortex, and a recurrence of a peptic ulcer. The probable coincidental occurrence of these diseases in this patient is suggested. Nevertheless, careful investigation of the other endocrine glands in patients with endocrine tumors is recommended.

Adenoma

Atrial myxoma associated with multiple hamartomas.

A case of cardiac myxoma associated with renal angiofibrolipomas, renal medullary fibromas, thyroid adenoma and jejunal polyp was presented. So far as we know, the combined form of cardiac myxoma and renal hamartoma has not been hitherto reported. The combination of these various complications may suggest the relationships of tuberous sclerosis, Cowden disease, lymphangiomatosis among others. Besides it is noteworthy that the three of them, i.e. cardiac myxoma, renal angiofibrolipomas and thyroid adenoma, presented considerable atypism at the same time. As to the histogenesis of cardiac myxoma, this case may be in accord with the hamartoma theory.

Autopsy

Solitary toxic adenoma of the thyroid gland.

The incidence of solitary toxic adenoma of the thyroid in a general surgical unit with an interest in thyroid disease has been reviewed over a 15-year period. Six hundred and thirty thyrotoxic cases were treated surgically, 35 (5.6 per cent) having a solitary toxic adenoma. Thyroid enlargement or toxicity had been present for more than 5 years in 7 patients (20.0 per cent). Cardiovascular complications were present in 6 cases (17.1 per cent). Thyroid lobectomy resulted in 30 (85.7 per cent) euthyroid and 5 (143.3 per cent) hypothyroid patients. One toxic adenoma contained a focus of carcinoma. The clinical features, diagnosis and management of solitary toxic adenoma, and the management of symptomatic nodules which are 'hot' but not biochemically toxic, are discussed.

Adenoma

Surgical significance of capsule invasion of adenoma of the thyroid.

Capsule invasion observed in instances of adenomas of the thyroid was studied in correlation with the clinical course of the patients. The invasion, as defined in the cut-off and turn-out of the collagen fibers in the capsule, occurred in eight of 611 adenomas. The clinical course of the eight patients revealed no recurrence of an adenoma, even though there was no antitumor drug therapy. On the other hand, recurrences of adenomas were found in five of the 603 patients with noninvasive adenoma, of the 603 patients with noninvasive adenoma. Capsule invasion, therefore, is not a cause for the recurrence of an adenoma. The recurrence may result from the leaving of microadenoma in the thyroid when the first operation took place. Capsule invasion cannot be considered as a histologic sign of malignant tumor of the thyroid.

Adenoma