[Hyperfunctioning parathyroid carcinoma combined with papillary carcinoma of the thyroid gland--report of a case (author's transl)].
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The RET proto-oncogene encodes a transmembrane receptor of the tyrosine kinase family and has frequently been found activated in human thyroid carcinomas of the papillary subtype. In most cases the activation consisted of the fusion of its tyrosine-kinase domain with the 5'-terminal region of a gene designated H4 or D10S170. We have named the resulting H4/RET chimeric oncogene RET/PTC. Another activated form of the RET oncogene has subsequently been found in a thyroid carcinoma and is now referred to as RET/PTC2. Here we report the identification and cloning of a novel rearranged version of the RET oncogene in a human thyroid papillary carcinoma. In this case the tyrosine-kinase domain of RET was fused to a sequence 790 bp long belonging to a new gene that we have named RFG (RET Fused Gene). This novel chimeric oncogene has been designated RET/PTC3. In order to have more insights into the function of RFG we have completely cloned and sequenced its cDNA. RFG predicted amino-acid sequence does not have any significant homology to any already known genes and is ubiquitously expressed in human and mouse tissues. Finally we provide evidence indicating that the rearrangement leading to the generation of RET/PTC3 occurred in vivo in the original tumor DNA.
Prophylactic total THIO-TEPA treatment was employed in 44 cases over a period of five years, following radical surgery (including reoperations) for recurrent vesical papillomatosis or carcinoma, and numerous subsequent transurethral coagulations or resections owing to multiple recurrences. Three patients have been now free from recurrences for five years, 13 patients for four years, 11 patients for three years and 9 patients for two years. Eight patients proved unresponsive, the recurrence rate having remained unaffected. No toxic effects requiring any special measures were encountered.
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The clear ("Orphan Annie Eye") nucleus has been accepted as one of the important microscopic features of papillary carcinoma of the thyroid. This study undertook an examination of 100 consecutive thyroid lesions exclusive of papillary, mixed, and follicular carcinomas for the presence of these nuclei. Only two lesions (2%), a follicular adenoma and diffuse hyperplasia, had such nuclear morphology but as focal changes. Thirty-seven cases of papillary, mixed, and follicular carcinoma were also studied. Clear or empty nuclei were present in 83% of papillary carcinomas. One carcinoma of follicular type had clear nuclei in a diffuse distribution. "Pseudoclear" nuclei were noted in a variety of situations ranging from normal thyroids to diffuse hyperplasia, where they were present in 65% of cases. We conclude that clear nuclei when present as a diffuse changes in a thyroid tumor are a reliable sign of papillary carcinoma but are not pathognomonic. If the character of the clear nuclei is questionable, other histologic features of papillary carcinoma should be looked for, such as papillae with overlapping nuclei, psammoma bodies and multicocality. It was also fould that frozen sections and imprints do not demonstrate the nuclei; they appear only in fixed tissues.
We recently detected a novel activated oncogene by transfection analysis on NIH 3T3 cells in five out of 20 primary human thyroid papillary carcinomas and in the available lymph node metastases. We designated this transforming gene PTC (for papillary thyroid carcinoma). Here we describe the molecular cloning and sequencing of the gene. The new oncogene resulted from the rearrangement of an unknown amino-terminal sequence to the tyrosine kinase domain of the ret proto-oncogene. This gene rearrangement was detected in all of the transfectants and in all of the original tumor DNAs, but not in normal DNA of the same patients, thus indicating that this genetic lesion occurred in vivo and is specific to somatic tumors. Moreover, the transcript coded for by the fused gene was detected in an additional PTC-positive human papillary carcinoma for which mRNA was available.
A case of papillary carcinoma of the thyroid gland identified by needle aspiration cytology is presented, and correlation between the ultrastructure of the cytologic material and the neoplastic tissue is emphasized. Needle aspiration is recommended for diagnosis of thyroid gland lesions and may allow, without significant risk to the patient, establishment of a specific preoperative diagnosis.
We present a case of papillary carcinoma of the thyroid gland with pulmonary metastases in a 5 year old boy. The child also suffered from atresia of the gallbladder and the common bile ducts with biliary cirrhosis of the liver and died from hepatic insufficiency. Possible correlations between childhood thyroid carcinoma and congenital malformations are discussed.
The coexistence of organ-specific and nonorgan-specific autoimmune diseases is an interesting phenomenon. A 52-year-old woman was admitted with fever, general discomfort, polyarthritis, and Raynaud's phenomenon. Physical examination revealed a goiter of stony consistency, hardening, paleness, and atrophy of the skin on the face and upper limbs, and blood hypertension (180/110 mmHg). The biological data included leukopenia, moderate anemia, and a very high sedimentation rate. The latex test was positive (+++); LE cells positive (+); hypergammaglobulinemia (3.5 g); antinuclear antibodies, 1/1280 with an immunofluorescence granular pattern; antithyroid antibodies, 1/160. There was pulmonary, renal, and gastrointestinal involvement compatible with scleroderma, which was confirmed by skin biopsy. A thyroidectomy revealed the existence of a papillary carcinoma with thyroiditis. Responde to treatment with immunosuppressive agents, hypotensive drugs, and thyroid substitution therapy was initially good. The patient was readmitted 8 months later with general discomfort and a severe hyperproteinemia (10 g/100 ml), including 65 percent gammaglobulin and requiring various sessions of plasmapheresis. The patient was discharged, but died suddenly 4 months later. The association of lupus and scleroderma in this patient is discussed and the possibility of its being a mixed connective tissue disease is discarded. The association of this condition with Hashimoto's thyroiditis, and the latter with papillary carcinoma of the thyroid are analyzed. The peculiar features of this case are pointed out. The authors postulate that the cause of the sudden death was a vascular cerebral complication induced by the extreme hyperproteinemia.
The clinicopathologic features of six cases of a peculiar variant of differentiated carcinoma of the thyroid composed of follicles with or without solid areas and having a characteristics ground-glass appearance of the nuclei were studied and compared with those of conventional papillary and follicular carcinomas. This variant resembled papillary carcinoma in its biologic behavior and all morphologic features with the exception that papillae were not present. The term "papillary carcinoma, follicular variant" is proposed for this tumor type in order to emphasize its close biologic relationship with the conventional papillary carcinoma.
During a five-year period, 1958--62, 97 cases of papillary thyroid carcinoma had been diagnosed in Finland. Twenty two of these patients died from this cancer during a follow-up of 13--18 years. Five of them had initially had distant metastases. Of the remainder seven had had no thyroid operation or only a biopsy, nine an operable tumour that invaded through the thyroid capsule (extrathyroid) and only one a primary tumour confined to the thyroid (intrathyroid). The mortality rates were: 83% for patients with distant metastases, 47% for patients with no thyroid operation, 28% for patients with extrathyroid tumours, and 4% for patients with intrathyroid tumours. Death from an intrathyroid or occult papillary carcinoma that does not show initial distant metastases seems to be exceptional, also if the thyroid operation has been unilateral.
The otorhinolaryngologist often encounters patients with pathological findings in the thyroid gland which may be overlooked if he is not aware. Alarming symptoms are rarely present in a goiter which is undergoing malignant change. Papillary and follicular carcinomas can exist over long periods of time as nodular goiters with globus symptoms or are discovered after cervical lymph nodes have appeared. The discovery of a goiter is thus of clinical importance regardless of the patient's age. Diagnostic iodine isotope scanning and cytological analysis is to be recommended as a matter of general policy. Excellent results in the treatment of papillary carcinoma can be obtained by subtotal thyroidectomy with modified neck dissection, followed by isotope elimination of remaining thyroid tissue.
An unusual type of prostatic carcinoma is described. Histopathologic examination showed a papillary and acinar appearance. Aspiration cytology showed papillary fragments and sheets of malignant cells. The ultrastructural features of this tumor were similar to those reported for prostatic carcinoma rather than endometrial carcinoma supporting a prostatic orgin for this tumor.
Two cases of carcinoma in situ of the bladder treated with radical cystoprostatourethrectomy were evaluted by histologic study of the totally embedded epithelium. Clinical symptomatology consisted of urinary frequency with diminished bladder capacity and pain on voiding. Urinary cytology and multiple biopsies were essential for diagnosis of this lesion. The resected specimens of both cases were fixed in formalin and totally embedded for step sections that were mapped after histopathologic study. In both cases atypical epithelium and carcinoma in situ with foci of microinvasion affected the bladder mucosa and extended continuously to the distal ureters as well as the prostatic urethra. Since the lesion subsequently may result in invasive bladder cancer and often involves the prostatic urethra and distal ureter as in our cases the radical cystoprostatourethrectomy is recommended.
BACKGROUND: Papillary thyroid carcinoma (PTC) usually has a favorable prognosis, yet a subset of patients develops persistent, recurrent, or biologically aggressive disease. The clinical relevance of lysine β-hydroxybutyrylation (Kbhb)-related transcriptional programs in PTC remains unclear. Accordingly, this study aimed to characterize Kbhb-related molecular heterogeneity in PTC, construct a prognostic signature, and explore its association with the tumor microenvironment (TME). METHODS: Transcriptomic and clinical data from PTC samples within The Cancer Genome Atlas Thyroid Carcinoma (TCGA-THCA) cohort were analyzed to identify Kbhb-related differentially expressed genes (DEGs), define molecular subtypes, construct a prognostic signature, and characterize tumor microenvironmental features. Single-cell RNA-sequencing data from PTC were further used to explore the cellular distribution of representative genes. RESULTS: We identified 51 Kbhb-related DEGs in PTC and defined two Kbhb molecular subtypes. The Kbhb_C2 subtype showed shorter progression-free interval (PFI) and a more immune- and stroma-enriched microenvironment. A six-gene prognostic signature comprising TARID, CDSN, PIMREG, KLRC1, SYT13, and NPR3 was then established. High-risk patients had significantly worse PFI in the full, training, and testing cohorts, with 1-, 3-, and 5-year areas under the curve (AUCs) of 0.715, 0.793, and 0.771, respectively, in the full cohort. High-risk tumors also exhibited higher stromal, immune, and ESTIMATE scores, altered immune infiltration, and increased expression of multiple immune checkpoint molecules. Single-cell analysis confirmed distinct cell-type-specific expression patterns of representative genes. CONCLUSIONS: Kbhb-related transcriptional programs define clinically relevant molecular heterogeneity in PTC and are closely associated with prognosis and TME remodeling. The identified six-gene signature provides a biologically interpretable framework for risk stratification in PTC.