1/38. Sclerosing papillary carcinoma of the thyroid with tubular features.A case of papillary thyroid carcinoma (PTC) in a twenty-seven year old female is reported. The patient presented with complaints of a goiter and associated dysphagia. Histologically, the tumor was characterized by diffuse growth of branching tubules lined by a single layer of the tumor cells and surrounded by circularly arranged fibrous tissue of variable thickness. Focally, micropapillary projections of the epithelium budding into the lumen of tubules were visible. The cells showed features of PTC (overlapping ground glass nuclei, multiple grooves and pseudoinclusions). Nevertheless, no areas of "classical" PTC were identified. A striking feature was the presence of a severe lymphoplasmocytic infiltrate and the presence of plentiful S-100 protein positive dendritic/langerhans cells. The tumor shares several features with diffuse sclerosing PTC, namely the age and sex of the patient, the infiltrative growth pattern and the presence of severe chronic thyroiditis that is associated with a large number of dendritic/langerhans cells in the background. There are, however, several distinct differences - particularly the absence of massive squamous metaplasia, psammoma bodies, areas of classical PTC, and also lack of invasion of lymphatic vessels. We believe that this tumor represents an unusual example of diffuse sclerosing PTC with special tubular features.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/38. Anaplastic thyroid carcinoma in a 49 year-old woman with a long-standing goiter. A case report.A 49 year-old woman with anaplastic thyroid carcinoma came, for the first time, to our clinic with an enlarged supraclavicular lymph node. Ten years earlier she received a diagnosis of benign nodular goiter and has been followed up with ultrasonography, which never demonstrated any enlargement of her thyroid nodule and with fine needle aspiration biopsies (FNAB), that always proved normal. An ultrasonographic control, performed 10 months before diagnosis, showed the onset of a shell calcification all around the thyroid nodule that forbade the performance of FNAB. At initial examination in our endocrinology centre she was found to have an enlarged thyroid nodule (changing from 3.5 cm to 4.5 cm) and a supraclavicular lymph node 3 cm wide. The patient was therefore sent to the surgeon who performed a total thyroidectomy and a lymph node exenteration. The histological examination reported a thyroid anaplastic carcinoma, composed of osteoclast-like cells and large calcifications, which showed signs of local invasion and vessel infiltration; the supraclavicular lymph node proved to be a large metastasis of anaplastic thyroid cancer. Total body CT scan, bone scintigraphy and brain CT scan showed, respectively, lung, bone and brain metastasis. Postoperative chemotherapy was rapidly interrupted for acute toxicity. The patient died for lung, bone and brain metastasis, 2 months after initial examination.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/38. Thymic carcinoma with tumor thrombus into the superior vena cava.Tumor thrombus into the vena cava have been reported in cases with renal cell carcinoma, thyroid tumor and in those with thymoma. These tumors are frequently invasive and continuous from the main tumor that shows direct vessel wall invasion. Here, we report a case of thymic carcinoma with superior vena cava syndrome, which was caused by a tumor thrombus in the superior vena cava without vessel wall invasion. The main mediastinal tumor did not show innominate vein invasion, and the superior vena cava syndrome was a result of separate tumor thrombus that was free of vessel wall invasion. The tumor thrombus could be removed through a simple venotomy. To prevent stenosis in the superior vena cava and the left innominate vein, we used a pericardial patch to close the venotomy site.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/38. Capsular intravascular endothelial hyperplasia: a peculiar form of vasoproliferative lesion associated with thyroid carcinoma.AIMS: Florid vasoproliferative processes are uncommon in the thyroid gland. We report three cases of an unusual vasoproliferation involving the capsular blood vessels of thyroid carcinoma. methods AND RESULTS: The histological diagnoses of the three cases were made on conventional histological sections. Two cases were minimally invasive follicular carcinomas and one case was an encapsulated variant of papillary carcinoma. Some blood vessels in the tumour fibrous capsule were filled with spindly cellular proliferations forming irregular vascular clefts and papillae. Immunohistochemical studies for CD31, CD34 and muscle-specific actin confirmed that the spindly cells were mostly endothelial cells variably supported by pericytes. CONCLUSION: This peculiar intravascular endothelial hyperplasia by itself should not be mistaken for vascular invasion by tumour, but evidence of malignancy must be diligently sought by extensive sampling because the lesion has thus far been consistently associated with malignant thyroid neoplasms.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/38. Histological study of papillary thyroid carcinoma treated with percutaneous ethanol injection therapy.An 86-year-old male patient was treated by percutaneous ethanol injection therapy (PEIT), following tumorectomy of a papillary thyroid carcinoma and a modified radical neck dissection for its metastasis. After seven treatments with PEIT, the patient was admitted to hospital for a tracheotomy to treat progressive severe dyspnea. Seven days later the patient died from acute renal failure caused by diabetic ketoacidosis. At autopsy, tumor masses were found to comprise mostly scar tissue, and the remaining neoplastic cells often showed anaplastic changes. Fresh coagulation necrosis and hemorrhages were scattered throughout the tumor lesions and their microvessels were occasionally occluded by thrombus. These changes were seen prominently, especially at the central areas of PEIT treatment. Given these findings, we believe that PEIT may be useful in providing local control for the progression of thyroid cancer, especially in cases of unresectable malignant thyroid tumors.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/38. Incidental metastatic papillary thyroid carcinoma in microvascular reconstruction.OBJECTIVES/HYPOTHESIS: Occult papillary thyroid carcinoma has a reported prevalence of 1% to 35% based on autopsy studies. Cervical lymphatic metastases from papillary thyroid carcinoma have been associated with a higher likelihood of recurrence with a questionable impact on survival. Without clinically evident disease in the thyroid or cervical nodes, management of these patients presents a treatment dilemma. We propose an individualized treatment plan for patients in whom metastatic papillary thyroid carcinoma is incidentally detected during neck exploration for other purposes. STUDY DESIGN: Retrospective review and discussion of the literature. methods: The clinical course of two patients with incidentally discovered metastatic papillary thyroid carcinoma to the cervical lymph nodes is described. Both patients had previously received head and neck irradiation in childhood and required free flap reconstruction of extensive skull base defects following extirpation of meningiomas. RESULTS: neck dissection specimens from levels I and II obtained during exposure of recipient vessels for microvascular tissue transfer revealed papillary thyroid carcinoma in both cases. The patients subsequently underwent total thyroidectomy, neck dissection, and postoperative radioactive iodine ablation of residual thyroid tissue. After 1 year of follow-up, both patients were without evidence of recurrent disease. CONCLUSIONS: An individualized approach is justified to treat metastatic papillary thyroid carcinoma incidentally discovered during other procedures. The case reports underscore the importance of pathological analysis of surgical specimens obtained during head and neck reconstruction.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/38. Malignant thyroid lymphoma presenting as acute airway obstruction.Malignant thyroid lymphoma is an uncommon form of thyroid cancer which most commonly presents in elderly women. Most patients demonstrate a rapidly enlarging mass and may show tracheal deviation on chest roentgenogram. Radioisotopic scanning of the thyroid often demonstrates a "cold" or "cool" process of decreased uptake in the affected area. There is often an underlying lymphocytic thyroiditis process noted. Unfavorable prognosis is related to extracapsular extension, blood vessel wall infiltration, diffuse architectural pattern, and cervical lymph node involvement. We present two unusual cases of thyroid lymphoma presenting with acute airway obstruction and review the literature concerning this subject. One case presented a clinical and radiographic appearance similar to a prevertebral space abscess.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/38. myofibromatosis-like hemangiopericytoma metastasizing as differentiated vascular smooth-muscle and myosarcoma. Myopericytes as a subset of "myofibroblasts".A thyroid hemangiopericytoma that was resected in a 5-year-old boy recurred insidiously in the larynx 8 years later. Marked cicatricial mucosal inflammation prevented a definitive pathologic diagnosis of recurrence until a nodule grew to obstruct the airway 15 years after initial surgery. After excision of the nodule, a larger sarcomatous metastasis was discovered in the upper esophagus and resected, but the patient eventually succumbed to widespread disease at the age of 20 years. The original tumor contained atypical pericytes and bundles of hyalinizing smooth muscle abutting on "staghorn vessels," a pattern similar to infantile myofibromatosis. desmin immunostaining was negative in the pericytes but positive in smooth-muscle cells dispersed singly as well as in bundles. Both elements reacted strongly for vimentin and the alpha-isoform of actin (alpha-SMA) found in normal smooth muscle and pericytes. A third cell type showing dendritic processes and immunoreactivity for all three antigens was interpreted as a myopericyte. Spindled cells in multiple subsequent mucosal biopsy specimens stained retrospectively also positive for these antigens. Large bundles of vascular smooth muscle surrounded by radiating myocytes characterized the occluding laryngeal nodule. In the esophageal metastasis, which showed no histologic features typical of hemangiopericytoma, numerous mitotically active, small, vimentin , desmin , alpha-SMA cells often maintained shortened processes and tended to form nodular aggregates about capillaries. Single rows of pericytes accreted to endothelial tubes. Ultrastructurally, some cells contained myofilaments and irregular dense material or showed rare cell junctions and variable investment by a basal lamina.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/38. Macrofollicular variant of papillary carcinoma of the thyroid: a histologic, cytologic, and immunohistochemical study of 3 cases and review of the literature.CONTEXT: The macrofollicular variant of papillary carcinoma of the thyroid is a rare entity described by J. Albores-Saavedra and colleagues in 1991. It is characterized histologically by a predominance of macrofollicles and clinically by a low incidence of metastasis. This entity may represent a source of diagnostic error, since it can be easily misinterpreted as a macrofollicular adenoma or nodular goiter. DESIGN: In this study, we describe 3 cases of papillary carcinoma of the thyroid with a macrofollicular growth pattern and review the literature. RESULTS: The fine-needle aspiration biopsies in 2 cases showed large cells with optically clear nuclei and nuclear grooves, suggestive of papillary carcinoma of the thyroid. In one case, the cytology showed no signs of malignancy. In all cases, the tumors showed a combination of the conventional follicular variant of papillary carcinoma of the thyroid and macrofollicles (diameter, >250 microm) occupying more than 50% of the cross-sectional area. Cytologic features were large, cuboidal cells with optically clear, ground-glass nuclei with smooth outlines, a fine chromatin pattern, nuclear grooves, and pseudoinclusions. The colloid was dense and more eosinophilic than in adjacent normal follicles. In 2 cases, there was capsular or blood vessel infiltration, and one tumor had metastasized to a cervical lymph node. One tumor recurred 1 year later as an anaplastic carcinoma. Immunohistochemical staining showed a positivity of the tumor cells for cytokeratins 7, 17, and 19, thyroid transcription factor-1, and galectin-3 and a negativity for cytokeratin 20 and p53. CONCLUSIONS: Although it has been suggested that this tumor is a highly differentiated variant with a favorable prognosis, our study shows that its biologic behavior is not conclusive because metastases and recurrences with dedifferentiation may occur.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/38. Extensive vascular invasion is a marker of risk of relapse in encapsulated non-Hurthle cell follicular carcinoma of the thyroid gland: a clinicopathological study of 18 consecutive cases from a single institution with a 11-year median follow-up.AIMS: To determine the prognostic value of certain clinicopathological features in a series of 18 consecutive cases of encapsulated follicular carcinoma (EFC) of the thyroid gland with long follow-up. methods AND RESULTS: Eighteen consecutive cases of EFC were retrieved from 1975 to 1993. Gender, age at onset, type of surgery, presence of capsular and/or vascular invasion, number of involved vessels, tumour size, and TNM/pTNM classification were evaluated and correlated with disease outcome. None of the cases presented with distant metastases. Extensive vascular invasion (defined as more than four capsular vessels involved) was present in two cases. After a median follow-up of 133 months, all patients were alive. Three cases had relapsed in lung and bone. In two out of these three cases, extensive vascular invasion was present. Radioiodine therapy was curative in two of three of the relapsed cases. CONCLUSIONS: EFC is a low-risk carcinoma, with no patients' deaths after a median follow-up of 11 years. Extensive vascular invasion should be considered as a risk factor for relapse. A conservative surgical approach is recommended. Since relapses may occur up to 14 years after the initial surgery, life-long follow-up is advisable.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
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