1/120. Use of immunohistochemistry in fine needle aspiration of thyroid nodules in patients with a history of malignancy. A report of two cases.BACKGROUND: A history of a nonthyroid malignancy may present a diagnostic dilemma in the assessment of fine needle aspiration (FNA) of thyroid nodules. One reported series, on patients with prior malignancies and a thyroid nodule, indicated that in 17% of patients, the thyroid nodule represented metastatic malignancy, 6% were classified as primary thyroid cancers, and the remainder were benign or inconclusive lesions. The resolution of this problem is essential to patient management. CASES: We report two cases in which patients with a history of renal cell carcinoma presented with a thyroid nodule. The first patient was an 80-year-old female whose Papanicolaou-stained FNA demonstrated clusters of round to polygonal cells with round to ovoid, hyperchromatic nuclei and abundant, wispy cytoplasm. The second patient was a 55-year-old female with clusters and single cells with round to oval, eccentric nuclei and copious, granular, gray cytoplasm noted on Papanicolaou-stained material. In each case, the diagnosis was inconclusive on initial review of Papanicolaou-stained slides, and immunohistochemical staining was ordered to better characterize the lesions. Tumor cells from case 1 were positive for cytokeratin cocktail and vimentin and negative for thyroglobulin, epithelial membrane antigen and calcitonin, suggestive of metastatic renal cell carcinoma. In contrast, the tumor cells from case 2 expressed cytokeratin, thyroglobulin and vimentin, consistent with a primary thyroid neoplasm. In each case, the cytologic diagnoses were confirmed in the resected specimens. CONCLUSION: immunohistochemistry is a helpful adjunct in the evaluation of thyroid nodules in patients with a past history of malignancy.- - - - - - - - - - ranking = 1keywords = thyroid nodule, thyroid, nodule (Clic here for more details about this article) |
2/120. Thyroglossal duct carcinoma.Primary carcinoma of the thyroglossal duct is rare. This discussion reports two cases and reviews the 50 previously reported in the literature. The criteria for diagnosis include evidence of a thyroglossal duct remnant and a normal thyroid gland. The differentiation from cystic metastases to lymph nodes is pointed out. The histologic types parallel those of carcinoma of the thyroid gland, papillary carcinoma being the most common and having a generally favorable prognosis. The clinical presentation of these tumors is similar to that with benign cysts and thus is of limited value in the diagnosis.- - - - - - - - - - ranking = 0.056029519343keywords = thyroid (Clic here for more details about this article) |
3/120. Papillary adenocarcinoma of the thyroid in a thyroglossal duct cyst.A case report is presented of an 8-year-old boy who underwent resection of a thyroglossal duct cyst to illustrate a rare, but significant, complication of a common clinical problem. Pathological examination revealed that it contained a papillary adenocarcinoma of the thyroid, presumably arising from ectopic glandular tissue in the cyst. Thyroglossal duct cysts are a common cause of midline neck masses in children. Occult thyroid carcinoma is a rare co-morbid finding. It infrequently leads to death, but thyroglossal duct cysts may also contain the only functioning, albeit ectopic, thyroid tissue. patients with clinical thyroglossal duct cysts should be carefully evaluated preoperatively for the presence of tumor and other functioning thyroid tissue prior to excision of the cyst.- - - - - - - - - - ranking = 0.224118077372keywords = thyroid (Clic here for more details about this article) |
4/120. Neutrophilia associated with anaplastic carcinoma of the thyroid: production of macrophage colony-stimulating factor (M-CSF) and interleukin-6.Cancers associated with marked neutrophilia are relatively rare. We report here two cases of anaplastic thyroid carcinoma associated with neutrophilia. We measured the concentrations of granulocyte colony-stimulating factor (G-CSF), macrophage CSF (M-CSF), granulocyte-macrophage CSF (GM-CSF), interleukin-1alpha (IL-1alpha), IL-1beta, IL-6, and tumor necrosis factor-alpha (TNF-alpha) in sera, pleural effusion, cyst fluid of the thyroid carcinoma region, or culture supernatants of carcinoma cells. Maximum levels of elevated white blood cell counts reached 106.1 x 10(9)/L (neutrophils 103.0 x 10(9)/L) in case 1 and 62.3 x 10(9)/L (neutrophils 57.9 x 10(9)/L) in case 2. Acute-phase reactants were elevated to various degrees, and hypercalcemia was found in both cases. IL-6, G-CSF, and M-CSF seemed to play the principal roles in neutrophilia in case 1, and the elevated levels of IL-6 and M-CSF seemed to mainly contribute to neutrophilia in case 2. Immunohistochemical staining revealed that carcinoma cells themselves produce IL-6 regardless of the types of carcinoma cells. To our knowledge, this is the first report describing the contribution of M-CSF to neutrophilia in patients with thyroid carcinoma.- - - - - - - - - - ranking = 0.1961033177005keywords = thyroid (Clic here for more details about this article) |
5/120. hyperthyroidism in a patient with TSH-producing pituitary adenoma coexisting with thyroid papillary adenocarcinoma.A 27-year-old woman who presented with a left thyroid nodule was found to have hyperthyroidism caused by a syndrome of inappropriate secretion of TSH. The levels of free T3, free T4 and TSH were 9.50 pg/mL, 4.05 ng/dL and 2.16 microU/mL, respectively. magnetic resonance imaging of the head revealed a pituitary macroadenoma. The TSH response to TRH stimulation was normal and responses of other anterior pituitary hormones to stimulation tests were also normally preserved. Administration of octreotide with iodine successfully reversed hyperthyroidism prior to total resection of pituitary adenoma, which was followed by hemithyroidectomy of the left thyroid five months later. Histologically, the resected pituitary adenoma was a TSH-producing adenoma (TSH-oma) and the thyroid nodule was a papillary adenocarcinoma. serum TSH diminished to undetectable levels immediately following pituitary adenomectomy but gradually normalized over nine months. Coexistence of a TSH-oma with thyroid cancer is very rare and only two similar cases have previously been documented. This combination raises the possibility that TSH may be involved in tumorigenesis in the thyroid gland.- - - - - - - - - - ranking = 0.59575235117555keywords = thyroid nodule, thyroid, nodule (Clic here for more details about this article) |
6/120. Cribriform variant papillary thyroid cancer: a characteristic of familial adenomatous polyposis.Inherited cancer syndromes may predispose to more than one type of cancer, and these characteristically develop at an earlier age than their sporadic counterparts. The occurrence in a single individual of multiple, early onset primary cancers may indicate an inherited cancer susceptibility. Familial adenomatous polyposis (FAP), an autosomal, dominantly inherited susceptibility to colorectal adenomas and cancer also predisposes to childhood medulloblastomas and to a specific rare histologic type (cribriform variant) of papillary thyroid cancer. We describe a patient who developed a childhood medulloblastoma of the cerebellum, and subsequently a cribriform papillary thyroid cancer. These cancers predated the diagnosis of FAP in this patient, who was later found to have several relatives with FAP. The adenomatous polyposis coli (APC) mutation delineated in this family was in the region associated with those causing an increased risk of thyroid cancer. We submit that the diagnosis of the cribriform variant of papillary thyroid cancer in a young individual, especially after a previous cancer diagnosis, should alert the physician to the possibility of a diagnosis of FAP.- - - - - - - - - - ranking = 0.224118077372keywords = thyroid (Clic here for more details about this article) |
7/120. Spontaneous necrosis of gallbladder carcinoma in patient with pancreaticobiliary maljunction.While gallbladder carcinoma is occasionally associated with pancreaticobiliary maljunction, spontaneous necrosis of carcinoma is extremely rare. We herein present a case of spontaneous necrosis of gallbladder carcinoma associated with direct invasion of viable cancer cell nests to the muscularis propria and subserosal layer located beneath the primary nodules. A 65-year-old Japanese man was admitted to a local hospital, complaining of repeated discomfort in the right hypochondrium. ultrasonography and computed tomography scanning revealed cholecystitis associated with gallstones. cholecystectomy was performed, and operative cholangiography demonstrated pancreaticobiliary maljunction. The resected gallbladder showed multiple mixed stones filled with necrotic debris and bile sludge. Scrutiny of the mucosal surface revealed multiple small necrotic nodules in the fundus, which were histologically confirmed to be necrotic remnants of a cancerous glandular structure. Small nests of papillary adenocarcinoma were found beneath the nodules in the muscularis propria and in the venous structure located in the connective tissues next to the divided margin of the gallbladder bed. Resection of S4a and S5 of the liver and resection of the extrahepatic bile duct was then performed to remove the remaining cancerous tissues and/or micrometastasis in the liver and bile duct. The biliary tree was reconstructed with a hepaticoduodenostomy. No cancer nests or any precancerous lesions were found in the additionally resected specimens. This case indicates a unique morphological feature of gallbladder carcinoma associated with pancreaticobiliary maljunction, which provides some insight into the pathogenesis of spontaneous necrosis of gallbladder carcinoma.- - - - - - - - - - ranking = 0.001794020598287keywords = nodule (Clic here for more details about this article) |
8/120. Pulmonary epithelioid hemangioendothelioma coexistent with pulmonary metastasis of thyroid cancer.We report a 45-year-old man with epithelioid hemangioendothelioma (EH) and simultaneous pulmonary metastasis of thyroid cancer in his lung. Thyroid cancer, and multiple small nodules in both lungs were noted. He underwent total thyroidectomy followed by radiotherapy with 131I. However, 131I scintigraphy showed poor uptake of radionuclide in the nodules, and the size of the nodules remained unchanged. The diagnostic thoracoscopic biopsy showed two types of nodules, some were positive for thyroglobulin and cytokeratin, and others were reactive for factor viii. The former nodules were diagnosed as pulmonary metastases of thyroid cancer, and the latter EH.- - - - - - - - - - ranking = 0.19909335203098keywords = thyroid, nodule (Clic here for more details about this article) |
9/120. Malignant struma ovarii with thyrotoxicosis.BACKGROUND: Malignant struma ovarii is seldom diagnosed preoperatively due to the rarity of the disease itself and the even rarer complications of thyrotoxicosis. CASE: A 48-year-old woman presented with symptoms of hyperthyroidism and a pelvic tumor raising the possibility of ovarian malignancy. Hormonal findings revealed increased thyroid function, but the thyroid gland was normal in size and texture. Thus, she was diagnosed preoperatively as having a hormone-producing malignant struma ovarii. At surgery, a FIGO stage Ia ovarian papillary adenocarcinoma of the thyroid was found. An immunohistochemical tumor stain for thyroglobulin was positive and the ovarian venous thyroglobulin level was extremely high. Findings of hyperthyroidism disappeared over several weeks. CONCLUSION: Malignant struma ovarii can be diagnosed preoperatively. Complications of thyrotoxicosis should be kept in mind when evaluating an ovarian tumor.- - - - - - - - - - ranking = 0.1400737983575keywords = thyroid (Clic here for more details about this article) |
10/120. Implantation metastasis of head and neck cancer after fine needle aspiration biopsy.One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.- - - - - - - - - - ranking = 0.0280147596715keywords = thyroid (Clic here for more details about this article) |
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