Intense and prolonged Tl-201 accumulation in a slow growing bronchioloalveolar carcinoma

Thallium-201 SPECT was performed to evaluate a pulmonary lesion in a 73-year-old male which had been considered to be an inflammatory lesion for two years. The lesion has slowly increased in size on x-CT. Tl-201 was intensely taken up and retained in the lesion, suggesting a malignant lesion. Histological examination revealed that the lesion was bronchioloalveolar carcinoma. This case suggested that Tl-201 uptake of pulmonary carcinoma would not be necessarily related to cell growth rate.

Pseudolymphoma of the thyroid gland. A case report

An unusual case of pseudolymphoma of the thyroid gland is presented. A well-demarcated whitish mass measuring 1.0 cm in diameter was found in the upper center of the right lobe of the thyroid gland. Microscopically, the lesion was composed of hyperplastic lymphoid tissues with many follicular centers and mixed infiltration of plasma cells and macrophages. The immunostain revealed a similar distribution of T-and B-lymphocytes to reactive lymph node and a polyclonal nature of the plasma cell infiltrates. No lymphoepithelial lesion was associated. The adjacent thyroid tissues showed chronic lymphocytic thyroiditis. This finding suggests that the lesion is a pseudolymphoma of the thyroid gland. This condition is rare, but it should be considered during the differential diagnosis of lymphoproliferative lesions occurring in the thyroid gland, especially with low-grade malignant lymphoma of the thyroid gland.

201Tl and 99Tcm-human serum albumin for assessment of the effect of hypertensive treatment with angiotensin II infusion on tumour circulation

The biodistribution of 201Tl and of 99Tcm-human serum albumin (99Tcm-HSA) was observed in tumour-bearing mice to investigate if tissue blood circulation could be evaluated in groups of mice infused with angiotensin II at a rate of 0.5 micrograms kg-1 min-1 (L) or 1 microgram kg-1 min-1 (H). Ten minutes after tracer injection, tumour uptake of 201Tl in the angiotensin II infused group showed a 2.20- and a 3.18-fold increase in the L and H groups, respectively, when compared to a group of mice infused with saline (P = 0.0478 and 0.0029, respectively). The effect of angiotensin II infusion on 201Tl uptake was minimal in normal organs. Decreased normal organ uptake of simultaneously injected 99Tcm-HSA in the L and H groups indicated the contraction of normal organ vessels, while increased tumour uptake of the tracer indicated mechanical dilatation of tumour vessels. We conclude that the effect of angiotensin II or other vasoactive agents can be non-invasively assessed by 201Tl and 99Tcm-HSA scintigraphy.

Encapsulated follicular thyroid carcinoma exhibiting glandular and spindle cell components. A case report

We describe an unusual case of a thyroid carcinoma exhibiting glandular and sarcomatous features. The tumor occurred in a 16-year-old girl. Histologic study of the resected thyroid gland revealed an encapsulated tumor composed predominantly of glandular structures and some solid areas. In the glandular areas, the tumor cells showed a cribriform growth pattern, and neither colloid secretion into the lumen nor clear-cut cytologic features suggestive of papillary or follicular thyroid carcinoma were observed. In the solid areas, tumor cells became spindled and showed a sarcomatous arrangement with occasional whorl formation. A transition from the glandular areas to the solid ones was observed. Immunohistochemical study revealed that tumor cells were positive focally for epithelial membrane antigen, cytokeratin and secretory component. Thyroglobulin was positive only in a few and limited areas of the glandular component. Calcitonin was negative throughout the tumor. The histologic and immunohistochemical evidence indicates that this tumor is of thyroid origin and is probably derived from thyroid follicular cells. The histology of this tumor is unique, so we report this case briefly.

Medullary thyroid carcinoma experienced at Kanazawa University Hospital

Eleven cases of medullary thyroid carcinoma (MTC), which were experienced at Kanazawa University Hospital between 1975 and 1993, were examined to correlate the clinical, histologic, and immunohistochemical findings. Seven patients were women and four men, and the mean age was 46.6 years. The mean follow-up was 88.3 months. Three patients had familial non-multiple endocrine neoplasia (MEN) MTC (familial MTC unassociated with other endocrinopathies) and the remaining eight had sporadic disease. At the end of the observation period, six patients were alive without disease and four were alive with metastatic disease. One patient died of MTC 8.3 years after surgery. Thus, the 10-year survival and disease-free survival rates were 67% and 53%, respectively. Histologically MTCs from the 10 surviving patients showed a classic type, while the one patient who died had a tubular variant MTC. Immunohistochemically, there were no significant correlations between the outcome of the patients and the expression of calcitonin (CT), carcinoembryonic antigen (CEA), calcitonin gene-related peptide (CGRP), or chromogranin A (CgA) in the primary tumors, and there were no differences in expression of these antigens between the primary and the recurrent tumors. Although only a small number of patients with MTC were studied here, it was suggested that the prognosis of MTC is worse than that of papillary and follicular thyroid carcinoma. The patients with lymph node involvement at the time of primary surgery showed a high risk of persistent or recurrent disease. The expressional level for the antigens did not influence the prognosis of MTC.

N-myc protein expression in human breast carcinoma: prognostic implications

The overexpression of N-myc gene and its protein products has been thought to be limited to cases of neuroblastoma, retinoblastoma and small cell lung carcinoma, but there is increasing evidence of its wider distribution in human tumors. This study showed that the protein of N-myc gene is associated in normal, benign and malignant human breast tissues. We found that N-myc oncoprotein is overexpressed in most breast carcinomas and that N-myc overexpression is significantly correlated with clinical stage, and histological grading of the tumors, and, more importantly with the clinical outcome of the patients. Analysis of DNA, mRNA and protein levels suggested that the high N-myc expression in breast cancer occurs without concomitant gene amplification. The finding of a direct inverse correlation between N-myc overexpression and the prognosis of patients with breast carcinoma suggests that N-myc expression may be useful as a prognostic factor in human breast cancer.

Poorly differentiated ('insular') carcinoma of the thyroid

Three cases of unusual poorly differentiated ('insular') carcinoma of the thyroid gland are presented. These three thyroid carcinomas were large; the tumors from patients 1 and 3 were encapsulated, and that from patient 2 showed invasive growth. Microscopically the tumors were characterized by well-defined solid nests (insulae), which were composed of rather small and uniform tumor cells with round to oval nuclei. Formation of small and colloid-containing follicles was associated with these nests to varying degrees. The tumors of patients 1 and 3 were composed entirely of insular components, but that of patient 2 was associated with small areas of well-differentiated follicular carcinoma. The metastatic tumors of patients 1 and 2 were essentially similar to the primary with small foci of follicular carcinoma. Patient 1 is alive with local and mediastinal node recurrences, but patient 2 died of the disease with local recurrences and metastases to lungs, bones and skin. Patient 3 had no recurrences and died of unrelated disease 5 years after surgery. The present study indicates that insular carcinomas have characteristic histologic features and a less favorable prognosis, confirming the findings of previous studies.

Histological features of the thyroid gland in a patient with lithium induced thyrotoxicosis

A 26 year old woman with lithium induced thyrotoxicosis is reported. The thyrotoxicosis was associated with a non-tender diffuse goitre and a low radioiodine uptake by the gland. The thyrotoxicosis was reversible and remitted on withdrawal of the drug. The histopathological alterations of the thyroid glad were characterised by extensive follicular cell disruption with no lymphocytic infiltration. It is postulated that lithium might directly damage thyroid follicular cells and that subsequent release of thyroglobulin into the circulation might be a cause of transient thyrotoxicosis.

Papillary carcinoma of the thyroid gland with fibromatosis-like stroma: a case report and review of the literature

A new case of a rare variant of papillary carcinoma of the thyroid gland with fibromatosis-like stroma is reported. The patient was a 43-yr-old woman who had a well demarcated tumor that showed an expansive growth from the left thyroid lobe into perithyroidal soft tissues. Histologically, the tumor was composed predominantly of a fibromatosis-like stroma in which were diffusely dispersed small follicles of papillary carcinoma. At the advancing front of extrathyroidal extension of the tumor, fibromyxomatous changes of soft tissues were preceded by infiltration of the papillary carcinoma component. Immunohistochemistry and electron microscopy showed that the stromal cells had a myofibroblastic nature. One metastatically involved lymph node did not show fibromatosis-like stroma. The patient has remained well with no evidence of recurrence for 1 yr.

Differential (Ha-, K- and N-) ras p21 expression in benign and malignant human thyroid tumors: an immunohistochemical study

An immunohistochemical study of 24 thyroid carcinomas, 10 thyroid adenomas and 10 normal thyroids was performed using monoclonal antibodies directed against each of the three members of ras p21s; Ha-, K- and N-ras p21. Normal thyroids showed a negative staining for all of the three ras p21s. The expressional levels of the three ras p21s were various in each benign and malignant thyroid tumor, but a higher expression of Ha- and N-ras p21 and a lower or negative expression of K-ras p21 was a common finding in thyroid tumors of all histologic categories. There were no correlations between the expressional levels of ras p21s and the histologic subtypes, tumor size or lymph node status in the thyroid carcinomas.

Pathologic Assessment of Surgical Margins on Frozen and Permanent Sections in Breast Conserving Surgery

The diagnostic value of frozen section was evaluated in the histologic assessment of surgical margins obtained by wide excision of breast tumors. There were 87 patients with unilateral breast cancer, and 5 with bilateral breast cancers. The periphery of the excised breast tissue was peeled like an orange and histologically examined by frozen and permanent section. If either in situ or infiltrating microscopic tumor was found at the margin, it was considered positive. Using frozen sections, the margin was judged histologically positive or suspicious in 30 tumors (31%) and negative in 67(69%) tumors. Positive surgical margins were histologically confirmed by permanent section in 20(67%) of the 30 tumors diagnosed as positive or suspicious on frozen section. Another 10 tumors had negative margins. In 4 tumors, however, while the initial or re-excised margin was negative on frozen section, the margins were positive by permanent section. These surgical margins were positive due exclusively to the presence of ductal carcinoma in situ (DCIS). Evaluation of surgical margins in breast cancer by frozen section, thus exhibited a diagnostic accuracy of 86&prtcnt;, a sensitivity of 83%, and a specificity of 86%. It is concluded that frozen sections are useful in the determination of involvement of surgical margins after the wide excision of breast cancer. It must be pointed out that frozen sections will ofter overestimate involvement of the surgical margins.

Prominent uptake of Tl-201 by duodenal leiomyosarcoma after exercise myocardial perfusion study

Thallium-201 SPECT performed preoperatively for the evaluation of myocardial ischemia in a 72-year-old man with duodenal leiomyosarcoma demonstrated prominent focal uptake in the abdomen. Comparing a transaxial slice of SPECT through the abdominal uptake to the CT scan, the uptake was confirmed to be corresponding to the tumor. The tumor was delineated clearly, in good contrast to the surrounding normal intestine, which showed far less Tl-201 uptake than the tumor. In the delayed SPECT performed 3 hours after injection, although the intestinal activity became perceptible, the tumor still could be differentiated from the surrounding normal intestine. In this case, the exercise might be attributable to the initial low Tl-201 uptake by the normal intestine, which might otherwise have been an obstacle to Tl-201 scintigraphy for abdominal tumor detection. This case suggests the use of exercise for avoiding unfavorable intestinal activity, and the possibility of Tl-201 SPECT for abdominal tumor imaging.

Adenolipoma of the thyroid gland

A rare case of adenolipoma (thyrolipoma) of the thyroid gland is reported. Previously reported cases are reviewed and the pathogenesis of this unusual thyroid lesion is discussed.

Anaplastic thyroid carcinoma producing the granulocyte colony stimulating factor (G-CSF): report of a case

We report herein the unusual case of a 60-year-old woman with an anaplastic thyroid carcinoma which produced granulocyte colony stimulating factor (G-CSF). She presented with large neck masses, respiratory difficulty, and a high fever. Laboratory examinations revealed marked leukocytosis of 43,200/mm3 with 85% granulocytes and an elevated G-CSF level of 67 pg/dl. Total thyroidectomy with bilateral node dissection and tracheostomy was performed, and a histological diagnosis of large-cell anaplastic thyroid carcinoma was confirmed. Immunohistochemical examination with a polyclonal antibody against G-CSF stained the tumor cells. Although the respiratory difficulty, fever, and marked granulocytosis subsequently improved, she died 1 month after undergoing surgery due to metastatic mediastinal disease.

Variable portal circulation from inferior mesenteric vein assessed by per-rectal radionuclide administration

The intrahepatic distribution of radioactivity after the per-rectal administration of 201T-chloride and/or 99Tcm-pertechnetate was investigated in 177 studies in 149 patients with no liver disease or diffuse liver disease and compared with that of 99Tcm-stannous (99Tcm-Sn) colloid scintigrams. The patients were classified into two groups: distribution of intrahepatic radioactivity of 201Tl and/or 99Tcm-pertechnetate scintigrams similar to (homogeneous) or different from (heterogeneous) that of 99Tcm-Sn-colloid scintigrams. The heterogeneous group was divided into three subgroups: increased radioactivity of the right lobe (right dominant pattern), increased radioactivity of the left lobe (left dominant pattern) and uneven distribution of radioactivity in both lobes (uneven pattern). Of the 80 patients in whom the studies were performed in the supine position at rest, 14 (17.5%) showed a heterogeneous pattern (8 right dominant, 4 left dominant, 2 uneven) and 66 (82.5%) a homogeneous pattern. In the 97 patients allowed free body movement, 6 (6.2%) showed a heterogeneous (1 right dominant, 5 left dominant) and 91 (93.8%) a homogeneous pattern. A significant difference in the incidence of heterogeneous distribution between the resting and free body movement groups was found (P < 0.05). One patient with a left dominant pattern after free body movement with 201Tl showed a right dominant pattern at rest in the 99Tcm-pertechnetate study. It is concluded that a heterogeneous intrahepatic distribution of inferior mesenteric vein blood is sometimes observed and that the distribution of portal vein blood flow seems to be affected by the patient's positioning and free body movement.

Sarcoidosis of the thyroid gland manifested initially as thyroid tumor

A rare case of a patients with sarcoidosis of the thyroid gland, who was preoperatively diagnosed as having thyroid carcinoma and who had no other clinical features of sarcoidosis, is reported. Thyroidectomy specimen revealed numerous noncaseating, epithelioid granulomas in the thyroid tissue. Mycobacteria, fungi and foreign body material were not identified. Similar granulomas were also found in the lymph nodes and muscular tissue adjacent to the thyroid gland and parathyroid gland After the diagnosis of sarcoidosis of the thyroid, systemic examination failed to reveal any involvement in other sites, including lung, eye and skin. This case demonstrated that sarcoidosis can manifest initially as a thyroid tumor with no other evidence of disease.

Columnar cell carcinoma of the thyroid gland: a case report and review of the literature

A rare case of columnar cell carcinoma of the thyroid gland is reported. The tumor was characterized by a predominantly papillary proliferation of tall columnar cells with marked nuclear stratification with associated focal areas showing solid or microfollicular growth. The nuclei of the tumor cells did not have the ground-glass appearance that characterizes papillary thyroid carcinoma; rather their nuclear features resembled follicular carcinoma. The tumor was found in an advanced stage and the patient died of lung metastases 2.5 years after surgery. The unique histopathological features and highly aggressive nature of columnar cell carcinoma require that this variant be differentiated from common papillary carcinoma of the thyroid. We also reviewed the literature emphasizing the lethal biological nature of this variant.

Immunohistochemical demonstration of thyrotropin (TSH)-receptor in normal and diseased human thyroid tissues using monoclonal antibody against recombinant human TSH-receptor protein

We performed an immunohistochemical analysis of TSH-receptor in normal and diseased human thyroid tissues using a monoclonal antibody (T3-356) against the C terminal region of human TSH receptor. In normal human thyroid tissues, a positive staining was observed exclusively along the basal cell surface of the flattened follicular cells. In the tissues from adenomatous nodules, adenomas, and papillary carcinomas, a positive staining was also found along the basal cell surface of the follicular cells. In addition, a considerable cytoplasmic staining was observed. The apical and lateral cell surfaces of the follicular cells showed no staining. The foci of squamous cell metaplasia of papillary carcinomas, anaplastic carcinoma, and medullary carcinoma did not show a positive staining. In Graves' thyroids, the positive staining was also observed along the basal cell surface of the follicular cells. The staining was obviously intense in the Graves' thyroids, and the most intense staining was noted in the foci of papillary projection of the columnar follicular cells. These findings indicate that TSH receptor is preserved essentially in the basal cell surface of the thyroid follicular cells in neoplastic conditions and that the amount of TSH receptor protein is increased in Graves' thyroid.

The relationship of p53 protein and lymph node metastases in invasive breast cancer

The p53 expression in invasive breast cancers from 106 patients was correlated with clinicopathological variables to ascertain its usefulness for estimating prognosis. The p53 expression was significantly associated with the number of axillary lymph node metastases and the presence of internal mammary lymph node metastases; however, it was not associated with age, menopausal status, histologic type, or tumor size. Although p53 expression was a significant prognostic factor according to univariate analysis, it did not appear to be an independent prognostic factor according to multivariate analysis. Thus, the prognostic power of p53 expression is likely to be weak and therefore probably of limited clinical value. Nevertheless, the number of patients in our study was small, and we believe that an investigation of a larger series of patients is indicated.

Immunohistochemical demonstration of thyroid peroxidase (TPO) in human thyroid tissues from various thyroid diseases

Human thyroid peroxidase (hTPO) was detected immunohistochemically in 61 normal, benign and malignant thyroid tissues with a monoclonal antibody (38E) against hTPO using paraffin-embedded sections. Thyroid peroxidase was expressed intensely not only in tissues from Graves disease and hyperfunctioning adenomas, but also in those from carcinomas, adenomas and Hashimoto's thyroiditis. The staining pattern of TPO in the follicular cells was a diffuse and fine granular one in the normal thyroids, Graves' thyroids and adenomas, but abnormal coarse granular deposits of TPO were characteristically identified in most of the papillary carcinomas and Hashimoto's thyroiditis. These coarse granular deposits of TPO suggested that qualitative or structural changes in the TPO molecule are present in carcinomas and Hashimoto's thyroiditis. Consequently, these qualitative changes in TPO may be responsible for the lack of biochemically measured TPO activity in these diseases. This finding may also be useful in distinguishing between benign and malignant thyroid tumors.

Solid cell nests of the thyroid. A histologic and immunohistochemical study

A histologic and immunohistochemical study was performed to identify the histogenesis of solid cell nests (SCN), which were found incidentally in 11 thyroid glands obtained by surgery. Histologically, SCN consisted of small nests showing solid and cystic structures. Cystic features of SCN were found in 3 of the 11 cases (27%), with mucinous materials in their lumens. Some goblet cells were also present in three cases (27%). In one case, SCN were associated with lymphocyte aggregation. Immunohistochemical analysis using serial sections of the SCN showed that the cells comprising SCN were positive for calcitonin in 5 cases (45%), for carcinoembryonic antigen (CEA) detected using polyclonal antibody in 11 (100%), for CEA detected using monoclonal antibody in 3 (27%), for calcitonin gene related peptide in 2 (18%), for chromogranin A in 5 (45%), and for keratin in 11 (100%). These antigens were expressed concomitantly in the same SCN, but the number and distribution of the positive cells for the antigens were different for each antigen in the same SCN in each case. These findings strongly support the view that SCN are derived from the ultimobranchial body. In addition, the biologic function to produce the antigens may vary greatly in individual cells comprising SCN.

Autonomously functioning (hot) nodule of the thyroid gland. A clinical and histopathologic study of 17 cases

The authors present the clinical and pathologic findings of 17 patients with autonomously functioning (hot) nodule of the thyroid (AFNT). The patients were 13 to 68 years of age, and 12 were female. Five had obvious laboratory findings of hyperthyroidism, but the other 12 were euthyroid. Fifteen patients had solitary or multiple benign nodules. The remaining two had autonomously functioning carcinomas; one of these patients had a papillary carcinoma with no distant metastases, and the other had a follicular carcinoma with widespread metastases. Total thyroidectomy was performed in one patient, subtotal thyroidectomy was performed in four, and hemithyroidectomy in eight. Diagnostic large needle biopsy was performed in only four patients. Of the 13 patients undergoing thyroidectomy, 3 had multiple hot nodules, and 10 had a solitary hot nodule. The size of the nodules ranged from very small to 6 cm, with no definite correlation found between the size of the nodule and thyroid function. Pathologically, cystic change and hemorrhage to various degrees were common features of AFNT. On histologic examination of the nodules, 13 were diagnosed as follicular adenoma (6 predominantly macrofollicular; 4 mixed micro-, normo-, and macrofollicular; and 3 predominantly papillary) and 2 as adenomatous goiter (1 predominantly papillary and 1 predominantly macrofollicular). The remaining two were diagnosed as carcinoma (1 follicular variant of papillary carcinoma and 1 follicular carcinoma). Two children had benign nodules showing a predominantly papillary architecture. Microcarcinoma outside the nodules was found in two patients, and both microcarcinomas were a papillary type. The AFNTs showed characteristic pathologic findings, and the pathologic differentiation of AFNTs from usually observed nonfunctioning (cold) nodules was not difficult. Pathologists should pay particular attention to AFNTs showing a papillary architecture, because these papillary lesions are sometimes mistaken for papillary thyroid carcinoma.

99mTc colloid and 99mTc IDA imagings in diffuse hepatic disease

Ninety-six patients with various diffuse hepatic diseases were observed using both 99mTc colloid and 99mTc iminodiacetic acid (IDA), focusing on the potential etiologies of the disease process as well as its chronicity and severity. The presence of acute hepatic disease was more sensitively depicted with 99mTc IDA than with 99mTc colloid. In chronic hepatic disease, on the other hand, 99mTc colloid and 99mTc IDA demonstrated a similar sensitivity. The potential etiology of the disease process (differential diagnosis) and the chronicity of the disease could be evaluated better with 99mTc colloid. Among the patients with different stages of liver cirrhosis, however, 99mTc IDA significantly discriminated the severity of the hepatic disease. These results suggest that 99mTc IDA may be used to determine the degree of functional disorder in acute hepatic disease and evaluate the severity of diffuse hepatic disease, whereas 99mTc colloid can effectively evaluate the potential etiology and chronicity of the disease.