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A method is described of high voltage electrophoretic separation of iodoamino acids from thin-needle biopsy of the thyroid gland and from resected tissue of thyroid neoplasms. Different patterns of iodoamino acids in malignant and non-malignant diseases of the thyroid gland were found.
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The classification of thyroid tumors, based on morphological and clinical aspects, makes it possible to compare the experience of several centers. The histology of the tumor and the age of the patient are the main criteria of prognosis. A differentiated tumor may become anaplastic. The therapeutic approach, which is primarily surgical, is therefore different for differentiated, medullary and anaplastic carcinomas. In the field of differentiated tumors, there are still some differences of opinion regarding the radicality of thyroidectomy and node dissection. In planning surgery, the incidence of bilateral tumor according to histological type, the pattern of primary lymphatic drainage and the risk of parathyroid insufficiency should be taken into account. The collaboration of the pathologist is essential. The results should be appreciated after a follow-up of at least 10 years.
The cytologic findings on aspirated material in a rare giant-cell, "osteoclastoma-like," malignant neoplasm of the thyroid are reported.
There is a potential hazard of thyroid cancer after exposure to external irradiation for the treatment of adolescent acne vulgaris. We noted a 60% incidence of thyroid carcinoma among 20 patients with such a history, who were operated on for thyroid nodules during a five-year period. Eighty-three percent of the patients with carcinoma had either a follicular or a mixed papillary-follicular carcinoma; 17% had a papillary carcinoma; 33% had regional node metastases; none had evidence of distant metastases. The interval between radiation exposure and thyroidectomy ranged from nine to 41 years. This association of thyroid neoplasms and a prior history of radiation for acne vulgaris may be coincidental and therefore remains to be proved by retrospective surveys of large numbers of treated patients with appropriate controls.
The differential diagnosis of thyroid neoplasms by routine cytology presents major difficulties. We therefore looked for measurable nuclear parameters that could be generated from Feulgen-stained smears obtained by fine needle aspiration biopsy (FNAB). These parameters would then be used to differentiate between benign and malignant lesions. Seventy-six patients whose cold thyroid nodule was surgically excised after FNAB and examined by a pathologist were used in this study: 56 benign, 18 malignant and 2 atypical adenomas. A set of 3,662 cells from the 33 benign cases was compared with the set of 1,712 cells from the 11 malignant nodules. Discrimination between the two populations was based on four nuclear features ranked according to their discriminating power. The first ranked was a textural parameter, followed by a densitometric and finally two other textural parameters. The rate of nuclei that could be regarded as benign was computed for each case using the ranked parameters. The average rate for the 33 benign cases was 85% (50.2 = 100%, set at the 95% confidence interval). In a prospective study of the 32 remaining patients, sensitivity and specificity were, respectively, 92% and 88%, which were higher than those obtained by conventional cytology.
The histopathologic and genomic landscape of thyroid tumors is well characterized, although new genetic alterations and tumor types are being described. We present 2 cases of thyroid tumors originating from follicular cells that had highly unusual and distinct morphologic features and carried an OCLN::PRKCI gene fusion. These tumors were well circumscribed, encapsulated, and composed of irregularly shaped tubular and follicular structures surrounded by layers of distinct fibrocollagenous basement membrane material positive for type IV collagen and laminin; they showed no definitive nuclear features of papillary carcinoma. Importantly, whereas one of the tumors had no invasive growth, the other demonstrated tumor capsule invasion, compatible with the adenoma-carcinoma spectrum seen in thyroid follicular and oncocytic tumors. Gene expression profiles of these tumors differed from those of common types of papillary thyroid carcinoma. The unusual and reproducible histopathologic characteristics and unique molecular profiles of these tumors support their designation as a distinct type of thyroid neoplasm that exists in noninvasive and invasive forms and, therefore, can be designated as fibrotubular adenoma and carcinoma. Recognition of this distinct entity is important for improving diagnostic accuracy and avoiding overtreatment of this likely indolent type of thyroid neoplasia.
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256 patients were referred to the endocrinic clinic because of enlarged thyroid gland. All of them except one were subjected to thyroid scintigraphy (TS). The scintiscans were cold in 123 patients. The cold scintiscans were distributed evenly on the various referral diagnoses with half the patients of each group having cold TS. A total of 216 of the referred patients underwent surgery, among them the 123 with cold TS. If the solitary adenomas are left out of account, there was poor agreement between referral diagnosis, primary tentative hospital diagnosis, and surgical findings. Five patients were found to have thyroid cancer (TC), none of whom had been referred with this diagnosis. For the entire material the incidence of TC was 2.3% (95% confidence limits: 0.8--5.7%). Calculated on the basis of those patients who had cold TS, the incidence was 2.4% (95% confidence limits: 0.8--7.1%). It is concluded that the diagnosis of TC is difficult to establish preoperatively, and that TS is of no greater diagnostic value in this connection.
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A retrospective study of medical records from twelve veterinary university hospitals-clinics yielded 144 dogs with a confirmed diagnosis of a thyroid neoplasm (25 adenomas and 119 carcinomas). Forty-five of these dogs had additional primary neoplasms. As in man, associated tumors suggested the inherited multiple endocrine adenomatosis, type 1, and a possible syndrome of thyroid and chemoreceptor lesions. Although the female preponderance of human thyroid cancer was not seen in dogs, females showed a much sharper increase in risk with advancing age than did males. Three breeds (beagle, boxer, and golden retriever) had a significantly greater risk for thyroid carcinoma than did all dogs combined, whereas miniature and toy poodles had a low risk. The function of thyroiditis in the origin of thyroid cancer, as suggested by reports of thyroid carcinoma in people with Hashimoto's disease, may be clarified by follow-up studies of beagles which are prone to Hashimoto-type thyroiditis.
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Thirty-seven patients with thyroid cancer were treated at 1a Clinica Chirurgica of Parma between 1962 and 1970. Fourty-five per cent of tumors were papillary, 24 per cent follicular, 2 per cent medullary, 9 per cent anaplastic. Surgery combined with ormonal therapy formed the commonest treatment. Eighty-five per cent of the patients with papillary carcinoma 70 per cent with follicular and 33,3 per cent with anaplastic carcinoma survived for 10 years. This present series indicates that total thiroidectomy combined with ormonal therapy influences the survival time, confirms the prognostic value of histology and shows that papillary node metastases do not prejudice survival.
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The nature of the TSH receptor in adenoma and carcinoma of the thyroid gland was studied using a radioreceptor assay technique. A membrane fraction of tissue homogenate was obtained by discontinuous sucrose gradient ultracentrifugation, and 125I-TSH, labelled by a lactoperoxidase method, was purified with a receptor adsorption method. Both the capacities and the association constants of high affinity receptors (4 x 10(9) M-1) and of low affinity receptors (0.073 x 10(9) M-1) observed in the normal thyroid were almost identical to those of the thyroid of Graves' disease and those of thyroid adenoma. Although the two papillary carcinomas examined were found to have two kinds of TSH receptors, one of the carcinomas showed decreased association constants for both high affinity and low affinity receptors.