Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept.

BACKGROUND
The criteria for minimally invasive (low grade) follicular carcinoma of the thyroid (MI) remain controversial, often resulting in unnecessary treatment.

METHODS
The records of 130 patients with minimally invasive (MI) follicular thyroid carcinoma were retrieved from the files of the Endocrine Tumor Registry of the Armed Forces Institute of Pathology.

RESULTS
Ninety-five patients were confirmed to have MI based on the authors' criteria of small-to-medium vessel invasion, capsular invasion of up to full thickness, no parenchymal tumor extension, and no tumor necrosis (patients with oxyphilic tumors were excluded). The remaining 35 patients had tumors that were reclassified as “not low grade” based on large vessel invasion, extension into parenchyma, and tumor necrosis (oxyphilic cases excluded). The MI patients included 67 women and 28 men, ages 20–95 years (average, 42.0 years). Nearly all patients presented with a thyroid mass (n = 90 patients). The mean tumor size was 2.8 cm. Histologic features examined for tumor classification included cellularity, capsule nature, capsular invasion, vascular invasion, extension into parenchyma, cytoplasmic oxyphilia, mitotic activity, and necrosis. All patients were treated with surgical excision. Adjuvant radioactive iodine therapy was performed in 24 patients. Five patients developed recurrent disease: four were alive or had died without evidence of disease after additional treatment (mean, 18.1 years), and one patient died with disease (MI tumor) at 15.1 years. All of the remaining patients were disease free (mean follow-up, 16.5 years).

CONCLUSIONS
There are reproducible histologic criteria to diagnose patients with MI follicular carcinoma. The overall excellent long term prognosis and a good patient outcome suggests that no additional surgery is necessary. Cancer 2001;91:505–24. © 2001 American Cancer Society.

A clinicopathologic study of minimally invasive follicular carcinoma of the thyroid gland with a review of the English literature.

BACKGROUND. The criteria for minimally invasive (low grade) follicular carcinoma of the thyroid (Ml) remain controversial, often resulting in unnecessary treatment. METHODS. The records of 130 patients with minimally invasive (MI) follicular thyroid carcinoma were retrieved from the files of the Endocrine Tumor Registry of the Armed Forces Institute of Pathology. RESULTS. Ninety-five patients were confirmed to have MI based on the authors' criteria of small-to-medium vessel invasion, capsular invasion of up to full thickness, no parenchymal tumor extension, and no tumor necrosis (patients with oxyphilic tumors were excluded). The remaining 35 patients had tumors that were reclassified as not low grade based on large vessel invasion, extension into parenchyma, and tumor necrosis (oxyphilic cases excluded). The MI patients included 67 women and 28 men, ages 20-95 years (average, 42.0 years). Nearly all patients presented with a thyroid mass (n = 90 patients). The mean tumor size was 2.8 cm. Histologic features examined for tumor classification included cellularity, capsule nature, capsular invasion, vascular invasion, extension into parenchyma, cytoplasmic oxyphilia, mitotic activity, and necrosis. All patients were treated with surgical excision. Adjuvant radioactive iodine therapy was performed in 24 patients. Five patients developed recurrent disease: four were alive or had died without evidence of disease after additional treatment (mean, 18.1 years), and one patient died with disease (MI tumor) at 15.1 years. All of the remaining patients were disease free (mean follow-up, 16.5 years). CONCLUSIONS. There are reproducible histologic criteria to diagnose patients with MI follicular carcinoma. The overall excellent long term prognosis and a good patient outcome suggests that no additional surgery is necessary.

A clinicopathologic study of minimally invasive follicular carcinoma of the thyroid gland with a review of the English literature

Current treatment strategies for pediatric patients with nonmedullary, well-differentiated thyroid carcinoma (WDTC) are derived from single-institution clinical cohorts, reports of extensive person...

Current Controversies in the Management of Pediatric Patients with Well-Differentiated Nonmedullary Thyroid Cancer: A Review

Background: Fine Needle Aspiration Cytology (FNAC) is a simple and rapid diagnostic technique. Because of early availability of results, simplicity, minimal trauma and complications, the aspiration cytology is now considered a valuable diagnostic aid and is part and parcel of a pathologist's repertoire. Objectives: The aim of the study was to evaluate the results of fine needle aspiration cytology (FNAC) of lymph nodes in our institution in comparison to result of histopathology. Materials and methods: The present study on 130 patients of lymphadenopathy was conducted in the Department of Pathology Kathmandu Medical College Teaching hospital, Kathmandu from June 2006 to May 2008 (2 years). Results: In this series of FNAC cervical lymph nodes were 66 (50.76%), and axillary lymph nodes were 20 (15.38%). Male to female ratio of the patients was 1: 0.9. Th age of patients ranged from 3 to 85 years. FNAC diagnosis was found to be as follows : reactive hyperplasia 54( 41.55%), tubercular lymphadenitis 36 (28 %), metastatic carcinoma 16 (12.3%), granulomatous lymphadenitis 12 ( 9.2 % ), lymphoma 8 (6%) and suppurative lymphadenitis 4(3%). Out of 28 cases of FNAC 26 (92.85%) were consistent with histopathological diagnosis of tubercular lymphadenitis. In metastatic carcinoma to lymph nodes sensitivity and specificity of FNAC were 100% each. Conclusion: FNAC is useful and reliable in diagnosing neoplastic and non- neoplastic lesions of lymph nodes. It helps in planning surgery for malignant cases, where definitive operative intervention can be performed in one session. Key words: FNAC; lymphadenopathy. DOI: 10.3126/kumj.v7i2.2707 Kathmandu University Medical Journal (2009) Vol.7, No.2 Issue 26,139-142

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Evaluation of fine needle aspiration cytology of lymph nodes in Kathmandu Medical College, Teaching hospital.

Eight cases of squamous cell carcinoma of the thyroid are reviewed. The clinical features and natural history of our cases are presented. All tumours showed an aggressive biological behaviour. Two patients showed association with well-differentiated thyroid cancer. It is difficult to conclude whether these tumours are de novo occurrences or were a result of a complete replacement of a previously existing condition after a change in histologic character.

Squamous cell carcinoma of the thyroid

Fine needle aspiration cytology (FNAC) was used as a preliminary diagnostic procedure in evaluating discrete, asymptomatic cervical lymphadenopathy of more than four weeks duration. Benign pathologies were encountered in 294/359 patients (82%); of these 86% had tuberculosis. Even in the elderly, a large number of patients (25/78) harboured tubercular lymph glands. FNAC obtained adequate material for cytologic diagnosis in 97.5% and had an overall accuracy rate of 97%. Malignancy was correctly diagnosed in 100%; in tuberculosis the accuracy rate of 96% with a 3.5% false negative results. FNAC is reliable as the initial evaluating procedure even in benign disorders; it is also cheap, speedy and easy to perform, with no complications, making it suitable for wider application in developing countries with scant resources.

Fine needle aspiration cytology as a preliminary diagnostic procedure for asymptomatic cervical lymphadenopathy.

A retrospective analysis of 23 cases of amoebic liver abscess with intraperitoneal rupture is presented. Group I consisted of 16 patients with clinical features of generalized peritonitis. Eight of these patients were treated surgically, and four died. Group II consisted of seven patients with features of localized peritonitis and all were treated conservatively. In all cases the diagnosis of liver abscess was established by liver scan or ultrasound examination; peritonitis was established either at operation or, in the conservatively managed group, by aspiration of pus from the peritoneal cavity. Amoebiasis was diagnosed by serology. Eight group I and all group II patients were managed conservatively by aspiration of the liver abscess, antibiotics and amoebicides. There were no deaths in this group. It is suggested that, if the diagnosis can be made early, conservative treatment offers the best chance of cure for patients of amoebic liver abscess with intraperitoneal rupture.

Intraperitoneal rupture of amoebic liver abscess.

A case of primary hyperparathyroidism associated with osteitis fibrosa cystica presenting as paraplegia is described herein. The symptom complex of normocalcemic hyperparathyroidism with osteitis fibrosa cystica is a distinctly rare entity and to the best of our knowledge, this is the first case report of the normocalcemic variant of primary hyperparathyroidism presenting with paraplegia as a complication.

Paraplegia due to osteitis fibrosa secondary to primary hyperparathyroidism: report of a case.

Although serum thyroglobulin (STg) is a useful tumour marker to detect the recurrence of tumour in well differentiated thyroid carcinoma, it has as yet not been reported to be of value in predicting the behaviour of thyroid cancer. In the present study of 20 patients, the measurement of preoperative Stg/thyroid mass has been utilised to find out Tg synthesizing capacity of the tumour. This ratio was significantly higher in the patients with follicular variety than in papillary thyroid carcinoma. It was significantly higher in the metastasis group than in the group of patients without metastasis. The patients with functioning metastasis had a higher than average value of this 'ratio' than those with non functioning metastasis, though the difference was not statistically significant. Despite the limitation of a small number of patients included in this study, it is possible to highlight the possible utility of preoperative Stg estimation as a tumour marker in categorization of the patients of carcinoma of the thyroid gland.

The role of estimation of the ratio of preoperative serum thyroglobulin to the thyroid mass in predicting the behaviour of well differentiated thyroid cancers.

A. K. Sarda

Papers

Squamous cell carcinoma of the thyroid

Fine needle aspiration cytology as a preliminary diagnostic procedure for asymptomatic cervical lymphadenopathy.

Intraperitoneal rupture of amoebic liver abscess.

Paraplegia due to osteitis fibrosa secondary to primary hyperparathyroidism: report of a case.

The role of estimation of the ratio of preoperative serum thyroglobulin to the thyroid mass in predicting the behaviour of well differentiated thyroid cancers.