1
|
Onaran Y, Tezelman S, Gürel N, Terzioğlu T, Oğuz H, Tanakol R, Kapran Y. The Value of DNA Content in Predicting the Prognosis of Thyroid Carcinoma in an Endemic Iodine Deficiency Region. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1999.12098437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Y. Onaran
- Departments of General Surgery, Istanbul Medical Faculty, Turkey
| | - S. Tezelman
- Departments of General Surgery, Istanbul Medical Faculty, Turkey
| | - N. Gürel
- Departments of Microbiology, Istanbul Medical Faculty, Turkey
| | - T. Terzioğlu
- Departments of General Surgery, Istanbul Medical Faculty, Turkey
| | - H. Oğuz
- Departments of Endocrinology, Istanbul Medical Faculty, Turkey
| | - R. Tanakol
- Departments of Endocrinology, Istanbul Medical Faculty, Turkey
| | - Y. Kapran
- Departments of Pathology, Istanbul Medical Faculty, Turkey
| |
Collapse
|
2
|
Abstract
OBJECTIVE To establish the long term outcomes of risk stratified management of differentiated thyroid cancer (DTC). BACKGROUND Guidelines for management of DTC lack a strong evidence base and expose patients to overtreatment. This prospective study of patients diagnosed with DTC between 1977 and 2012 describes the long term outcomes of a conservative risk stratified (AMES) management policy. METHODS Outcomes were analysed around patient and tumour characteristics, primary intervention (surgery ± radioiodine (RAI)), in terms of mortality, recurrence and reintervention. RESULTS Median follow-up in 348 patients was 14 years: mean age 48 (range 10-91) years, 257 (73.9%) female, 222 (68.3%) papillary cancer, tumour size 3.4 ± 2.0 cm (mean ± SD). 89 (25.6%) AMES high risk, 116 (33.3%) TNM stage III/IV and 16 (4.6%) had distant metastases. Primary surgery comprised lobectomy in 189 (54.3%): 11 (5.8%) patients had subsequent completion total thyroidectomy with cancer present in five. Primary nodal surgery was performed in 142 (40.8%) patients. 35 (13.5%) low and 43 (48.3%) high risk patients received RAI following initial surgery. Overall disease specific survival (DSS) was 92.1% at 10 years and 90.7% at 20 years. DSS at 20 years was 99.2% in low risk cases. AMES risk scoring predicted both survival and recurrence. Patients receiving RAI and AMES high risk were significantly associated with increased risk of death and recurrence. CONCLUSIONS Routine total thyroidectomy and RAI are not justifiable for low risk DTC. Treatment should be tailored to risk and AMES risk stratification remains a simple reliable clinical tool.
Collapse
|
3
|
Acquaviva G, Visani M, Repaci A, Rhoden KJ, de Biase D, Pession A, Giovanni T. Molecular pathology of thyroid tumours of follicular cells: a review of genetic alterations and their clinicopathological relevance. Histopathology 2018; 72:6-31. [PMID: 29239040 DOI: 10.1111/his.13380] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 02/05/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy. Knowledge of the molecular pathology of thyroid tumours originating from follicular cells has greatly advanced in the past several years. Common molecular alterations, such as BRAF p.V600E, RAS point mutations, and fusion oncogenes (RET-PTC being the prototypical example), have been, respectively, associated with conventional papillary carcinoma, follicular-patterned tumours (follicular adenoma, follicular carcinoma, and the follicular variant of papillary carcinoma/non-invasive follicular thyroid neoplasm with papillary-like nuclear features), and with papillary carcinomas from young patients and arising after exposure to ionising radiation, respectively. The remarkable correlation between genotype and phenotype shows how specific, mutually exclusive molecular changes can promote tumour development and initiate a multistep tumorigenic process that is characterised by aberrant activation of mitogen-activated protein kinase and phosphoinositide 3-kinase-PTEN-AKT signalling. Molecular alterations are becoming useful biomarkers for diagnosis and risk stratification, and as potential treatment targets for aggressive forms of thyroid carcinoma. What follows is a review of the principal genetic alterations of thyroid tumours originating from follicular cells and of their clinicopathological relevance.
Collapse
Affiliation(s)
- Giorgia Acquaviva
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Azienda USL di Bologna, Bologna, Italy
| | - Michela Visani
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Azienda USL di Bologna, Bologna, Italy
| | - Andrea Repaci
- Endocrinology Unit, University of Bologna School of Medicine, Bologna, Italy
| | - Kerry J Rhoden
- Medical Genetics Unit, University of Bologna School of Medicine, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Annalisa Pession
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Tallini Giovanni
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Azienda USL di Bologna, Bologna, Italy
| |
Collapse
|
4
|
Al-Sobhi S, Shira H, Al-Dayel F, Ahmed M, Ingemansson S. Parathyroid carcinoma: A report of two cases. Ann Saudi Med 1999; 19:431-3. [PMID: 17277512 DOI: 10.5144/0256-4947.1999.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Al-Sobhi
- Departments of Surgery, Medicine and Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | | | | |
Collapse
|
5
|
Stern Y, Segal K, Medalia O, Feinmesser R. DNA ploidy in papillary carcinoma of the thyroid gland in children and adolescents. Int J Pediatr Otorhinolaryngol 1998; 46:67-70. [PMID: 10190706 DOI: 10.1016/s0165-5876(98)00122-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate DNA ploidy in papillary thyroid carcinoma in children in correlation to the clinical course of the disease. METHODS Flow cytometric DNA ploidy measurements were performed on formalin-fixed, paraffin-embedded tumor specimens from 14 children and 14 adult patients with papillary carcinoma of the thyroid gland. Analysis of DNA content was performed blind to patient's age and clinical presentation. RESULTS Seven patients presented with cervical metastasis, one patient had distal metastasis and four patients had local invasion. All patients underwent total thyroidectomy. Seven children underwent bilateral modified neck dissection. Twenty-five tumors expressed diploid DNA content. No statistically significant difference in DNA content was observed between the tumors from child and adult patients. No correlation was found between DNA content and aggressive presentation in the pediatric group. CONCLUSION Our primary results indicate that diploid DNA content is common in papillary thyroid carcinoma in children and aggressive clinical presentation is not associated with DNA aneuploidy. Larger prospective studies and long-term clinical follow-up is warranted to document the clinical significance of these observations.
Collapse
Affiliation(s)
- Y Stern
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tiqva, Israel
| | | | | | | |
Collapse
|
6
|
Kashima K, Yokoyama S, Noguchi S, Murakami N, Yamashita H, Watanabe S, Uchino S, Toda M, Sasaki A, Daa T, Nakayama I. Chronic thyroiditis as a favorable prognostic factor in papillary thyroid carcinoma. Thyroid 1998; 8:197-202. [PMID: 9545105 DOI: 10.1089/thy.1998.8.197] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A subgroup of patients with papillary thyroid carcinoma (PTC) also has chronic thyroiditis (CT) as an associated disease of the thyroid. To assess the prognostic value of CT in patients with PTC, we reviewed the histological slides of 2225 patients with PTC who had undergone surgery between 1971 and 1992. Of the 2225 patients, 692 were excluded from the analysis because regional lymph nodes and/or nonneoplastic thyroid tissues were unavailable for histological assessment. The series included 281 patients with CT in nonneoplastic thyroid tissue and 1252 without CT. We performed statistical analyzes by the log-rank test and Cox's proportional-hazard method. Sixty-two (5.0%) of the 1252 patients without CT died of metastatic disease during the follow-up period and the relapse-free 10-year survival rate was 85%. By contrast, only 2 (<1.0%) of the 281 patients with CT died, and their relapse-free 10-year survival rate was 95%. The difference between patients with CT and those without CT in terms of relapse-free and overall survival was statistically significant (p < 0.0001). Risk factors for unfavorable outcome were age 45 years or more, absence of psammoma bodies, and absence of CT (p < 0.0001), followed by vascular invasion (p = 0.0007), male sex (p = 0.0013), and metastasis to regional lymph nodes (p = 0.047). Multivariate analysis indicated that all of these factors with the exception of gender were independent factors in the final model for overall survival. Chronic thyroiditis in the nonneoplastic thyroid of patients with PTC is a powerful prognostic factor for both relapse-free and overall survival.
Collapse
Affiliation(s)
- K Kashima
- Department of Pathology, Oita Medical University, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Stern Y, Lisnyansky I, Shpitzer T, Nativ O, Medalia O, Feinmesser R, Aronson M. Comparison of Nuclear DNA Content in Locally Invasive and Noninvasive Papillary Carcinoma of the Thyroid Gland. Otolaryngol Head Neck Surg 1997. [DOI: 10.1016/s0194-59989770021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Extrathyroidal invasion of papillary carcinoma of the thyroid gland has a very bad prognosis. A retrospective study was performed on 40 specimens from patients with papillary carcinoma of the thyroid gland to find out whether DNA ploidy correlated with aggressive tumor behavior. The nuclear DNA content of 20 locally aggressive papillary thyroid carcinomas was studied by flow cytometry. The results were compared with those of a matched control group of 20 patients with noninvasive papillary tumors. Forty percent of the tumors with spread to extrathyroid tissue were aneuploid, whereas all the tumors without such extension were diploid. This difference was statistically significant ( p < 0.003). The data suggest that the differentiation of locally noninvasive and invasive papillary thyroid carcinomas may be potentially possible by nuclear DNA determination.
Collapse
Affiliation(s)
- Yoram Stern
- Petan Tiqva and Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center
| | - Ilya Lisnyansky
- Petan Tiqva and Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center
| | - Thomas Shpitzer
- Petan Tiqva and Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center
| | - Ofer Nativ
- Petan Tiqva and Tel Aviv, Israel
- Department of Cell Biology and Histology, Sackler Faculty of Medicine, Tel Aviv University
| | - Ora Medalia
- Petan Tiqva and Tel Aviv, Israel
- Department of Cell Biology and Histology, Sackler Faculty of Medicine, Tel Aviv University
| | - Raphael Feinmesser
- Petan Tiqva and Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Beilinson Medical Center
| | - Moshe Aronson
- Petan Tiqva and Tel Aviv, Israel
- Department of Cell Biology and Histology, Sackler Faculty of Medicine, Tel Aviv University
| |
Collapse
|
8
|
Shaha AR, Shah JP, Loree TR. Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol 1996; 3:534-8. [PMID: 8915484 DOI: 10.1007/bf02306085] [Citation(s) in RCA: 160] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Our understanding of the natural history of differentiated thyroid carcinoma has improved with the definition of prognostic factors. These prognostic factors have helped us identify patients in various risk groups. METHODS A retrospective review of a consecutive series of 810 previously untreated patients with papillary carcinoma of the thyroid was undertaken to analyze the prognostic factors and risk groups. There were 403 patients in the low-risk group, 313 in the intermediate group, and 94 classified in the high-risk group. RESULTS With a median follow-up of 20 years, 99% survival was achieved in the low-risk group, whereas only 43% survived in the high-risk group. The intermediate-risk group had a 20-year survival of 83%. The favorable prognostic factors included female sex, young age, absence of distant metastases and extrathyroidal extension of the disease, size < 4 cm, and low-grade histology. Focality, presence of lymph node metastasis, and pure papillary or mixed variant had no statistical significance on prognosis. CONCLUSIONS Based on various prognostic factors, low-, intermediate-, and high-risk groups are identified. Patients in the low-risk group have excellent survival (99%). Appropriate selection of surgical and adjuvant treatment should therefore be used based on prognostic factors and risk group stratification.
Collapse
Affiliation(s)
- A R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | |
Collapse
|
9
|
Stern Y, Medelia O, Feinmesser M, Shpitzer T, Feinmesser R, Segal K. Nuclear DNA content of the tall cell variant of papillary carcinoma of the thyroid gland. Ann Otol Rhinol Laryngol 1996; 105:713-5. [PMID: 8800058 DOI: 10.1177/000348949610500908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tall cell carcinoma of the thyroid gland is an aggressive variant of papillary carcinoma. A high nuclear DNA content has been associated with aggressive clinical behavior and an unfavorable prognosis in several malignant human tumors. It was also described in differentiated thyroid carcinoma. Therefore, analysis of the nuclear DNA content may yield information predictive of aggressive behavior. Accordingly, the DNA content of the tall cell variant was measured and compared with that of the usual form of papillary carcinoma by flow cytometry. Although all the aneuploid tumors were in the tall cell variant group, the difference in nuclear content was not statistically significant. We conclude that differences in the clinical behavior of these neoplasms are not related to alterations in DNA ploidy.
Collapse
Affiliation(s)
- Y Stern
- Department's of Otolaryngology, Head and Neck Surgery, Beilinson Medical Center, Petah Tiqva, Israel
| | | | | | | | | | | |
Collapse
|
10
|
Balázs G, Lukács G, Juhász F, Györy F, Oláh E, Balogh E. Special features of childhood and juvenile thyroid carcinomas. Surg Today 1996; 26:536-40. [PMID: 8840438 DOI: 10.1007/bf00311563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A retrospective analysis was conducted on 36 patients who underwent surgery for childhood or juvenile thyroid cancers and who were regularly followed up during the course of 30 years. The biological properties and late prognosis of these patients were assessed, and the clinical and morphological characteristics of the tumors were examined. The distribution of the DNA content in the tumor cells was compared with that in adult tumor cells, and the results of cytogenetic tests performed on mothers operated on for thyroid tumors and their children are also discussed.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/mortality
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Carcinoma, Medullary/mortality
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/surgery
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Child
- Child, Preschool
- DNA, Neoplasm/analysis
- Female
- Follow-Up Studies
- Humans
- Infant
- Prognosis
- Retrospective Studies
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
Collapse
Affiliation(s)
- G Balázs
- First Department of Surgery, University Medical School, Debrecen, Hungary
| | | | | | | | | | | |
Collapse
|
11
|
Akslen LA, Varhaug JE. Oncoproteins and tumor progression in papillary thyroid carcinoma: presence of epidermal growth factor receptor, c-erbB-2 protein, estrogen receptor related protein, p21-ras protein, and proliferation indicators in relation to tumor recurrences and patient survival. Cancer 1995; 76:1643-54. [PMID: 8635070 DOI: 10.1002/1097-0142(19951101)76:9<1643::aid-cncr2820760922>3.0.co;2-#] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prognostic relevance of activated oncogenes and oncoproteins has not been well studied in papillary thyroid cancer, which is slow-growing, with only regional spread in most cases. Therefore, the influence of some protein markers and tumor cell proliferation on disease progress in a series of patients with surgically treated papillary thyroid carcinoma was studied. METHODS One hundred twenty-seven patients with papillary thyroid carcinoma larger than 10 mm in greatest dimension were studied retrospectively, and the majority were treated with total or near-total thyroidectomy. Immunohistochemical and flow cytometric analyses of paraffin embedded tumor material were performed and the results were related to time to recurrence and thyroid cancer deaths using the univariate product-limit survival analysis and the multivariate Cox' regression method. RESULTS Immunohistochemical expression of c-erbB-2 protein, estrogen receptor-related protein (p29), which may be regarded as an indicator of hormone-dependent growth, S-phase, G2M-phase, sex, age, histologic grade, and primary tumor extent were all of significant prognostic importance in univariate analyses of patient survival. In the final Cox' model, however, only male sex (P = 0.017), older age, (P < 0.00005) and high grade histologic features (P = 0.006) were associated independently with decreased survival. Among females, decreased expression of c-erbB-2 protein was independently related to decreased patient survival (P = 0.019). In multivariate analysis of time to recurrence, lymph node status (P = 0.0001), epidermal growth factor (EGF) receptor expression (P = 0.013) and estrogen receptor-related protein (P = 0.007) were independent risk indicators, and S-phase fraction (P = 0.074) showed a borderline significance. CONCLUSION In this study, sex, age, and histologic grade were independent indicators of deaths from thyroid cancer. Lymph node metastases, EGF-receptor expression, and decreased estrogen receptor-related protein staining persisted as prognostic variables in the final multivariate analysis of recurrence free survival. Alterations in these oncogenes thus seem to play some role in disease progression in papillary thyroid carcinoma, although conventional variables are still important as prognostic indicators.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Carcinoma, Papillary/metabolism
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Child
- Child, Preschool
- DNA, Neoplasm/analysis
- ErbB Receptors/metabolism
- Female
- Flow Cytometry
- Follow-Up Studies
- Heat-Shock Proteins/metabolism
- Humans
- Immunohistochemistry
- Infant
- Lymphatic Metastasis
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Oncogene Proteins/metabolism
- Ploidies
- Prognosis
- Proto-Oncogene Proteins p21(ras)/metabolism
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Regression Analysis
- Retrospective Studies
- Survival Rate
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
Collapse
Affiliation(s)
- L A Akslen
- Department of Pathology, Gade Institute, Haukeland Hospital, Bergen, Norway
| | | |
Collapse
|
12
|
Affiliation(s)
- G H Jossart
- Deparment of Surgery, UCSF/Mount Zion Medical Center
| | | |
Collapse
|
13
|
Abstract
BACKGROUND Controversy still exists about the influence of DNA content on the prognosis for patients with esophageal squamous cell carcinoma. METHODS DNA ploidy was determined by microspectrophotometric (MSPM) analysis of paraffin embedded malignant tissue from 78 patients with squamous cell carcinoma of the esophagus. The DNA distribution pattern was classified as diploid, low grade aneuploid (LGA), and high grade aneuploid (HGA) pattern. The relationships among DNA distribution patterns, pathologic features, clinical findings, and prognoses were investigated. Twenty-seven of 78 patients were also selected for analyses of the DNA ploidy pattern of lymph node metastases. RESULTS Of 78 cancers, 20 (26%) were diploid, 15 (19%) LGA, and 43 (55%) HGA. The advanced carcinomas had the higher distribution of HGA pattern (55%), whereas the diploid pattern was more frequent in early stage (70%) or superficial (65%) esophageal cancer. In patients with the HGA pattern, there was a significantly higher frequency of lymph node metastases (79%) and marked lymphatic (74.4%) and vascular (69.8%) invasion compared with those exhibiting the LGA (33.3%) or diploid (25%) pattern. Five-year survival rates for patients with diploid carcinoma (57%) was significantly better than for those with the HGA pattern (14%). The distribution of nuclear DNA content was much narrower in the metastatic lymph node than in the corresponding primary cases. CONCLUSIONS The HGA of DNA pattern based on spectrophotometry closely correlated with the factors generally indicative of the aggressive behavior of malignant tumors. Therefore, the role of the DNA ploidy pattern as a prognostic factor was emphasized.
Collapse
Affiliation(s)
- A R Minu
- First Department of Surgery, Tokyo Medical and Dental University, School of Medicine, Japan
| | | | | |
Collapse
|
14
|
Oyama T, Ishida T, Ishii K, Sakurai S, Joshita T, Sakamoto A, Nakajima T. Encapsulated papillary carcinoma of the thyroid gland: clinicopathological and cytofluorometric study in comparison with non-encapsulated papillary carcinoma. ACTA PATHOLOGICA JAPONICA 1993; 43:516-21. [PMID: 8237371 DOI: 10.1111/j.1440-1827.1993.tb01165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinicopathological and cytofluorometric studies were performed on nine encapsulated (EPC) and 23 non-encapsulated (non-EPC) carcinomas of the thyroid gland. The average age of the patients with EPC was 33 years, which was significantly younger than that of those with non-EPC. The average tumor size of EPC was twice as large as that of intraglandular non-encapsulated carcinoma. All patients with EPC were alive without disease, but three out of 23 patients with non-EPC had a recurrence of the disease or died. Cytofluorometric studies showed that the mean nuclear DNA content and percentage of tumor cells in the S-G2M phase of EPC were lower than that of non-EPC. According to the DNA histogram pattern, all EPC showed distinct modal DNA values in the diploid or near diploid region of normal cells. However non-EPC, especially extra-glandular non-encapsulated papillary carcinoma, showed a wide variety of DNA histogram patterns. The present study suggested that EPC is a distinct subtype of papillary carcinoma of the thyroid gland clinicopathologically and that cytofluorometrically it is different from non-EPC.
Collapse
Affiliation(s)
- T Oyama
- Second Department of Pathology, Gunma University School of Medicine, Maebashi, Japan
| | | | | | | | | | | | | |
Collapse
|
15
|
Salmon I, Gasperin P, Remmelink M, Rahier I, Rocmans P, Pasteels JL, Heimann R, Kiss R. Ploidy level and proliferative activity measurements in a series of 407 thyroid tumors or other pathologic conditions. Hum Pathol 1993; 24:912-20. [PMID: 8375861 DOI: 10.1016/0046-8177(93)90143-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study describes the ploidy level and proliferation rate in a series of 74 multinodular goiters (MNGs), 17 cases of Hashimoto's disease, 33 cases of Basedow's disease, 113 adenomas, 139 primary carcinomas, and 31 cervical lymph node metastases from 376 patients. Both ploidy level and proliferation rate were assessed by digital cell image analyses of Feulgen-stained nuclei from formalin-fixed, paraffin-embedded tissues. The ploidy level of each sample was assessed using both its DNA index and its DNA histogram type. The proliferation index assessments corresponded to the determination of the proportion of cells in the S-phase fraction. The data reveal that the proportion of aneuploid cases increases according to the following sequence: simple MNGs and normomacrovesicular adenomas-->MNGs with adenomatous hyperplasia and microvesicular adenomas and Hürthle cell adenomas-->papillary and Hürthle cell carcinomas-->follicular and medullary carcinomas-->anaplastic carcinomas. This suggests the preneoplastic nature of the microvesicular adenomas and even of MNGs with adenomatous hyperplasia. The ploidy levels of 99% of the 407 cases of the thyroid tumor series could be described using six DNA histogram types: diploid, hyperdiploid, triploid, hypertriploid, tetraploid, and polymorphic. It was possible to assess the proliferation rate of 279 samples. The results show that a significantly higher proportion of malignant compared with benign thyroid tumors (35.5% v 10.5%, respectively) exhibited a proliferation index higher than 5%, and that, whether benign or malignant, the hypertriploid thyroid tumors proliferated significantly less than the nonhypertriploid thyroid tumors.
Collapse
Affiliation(s)
- I Salmon
- Department of Pathology, Hospital Erasme, Brussels, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Monasebian DM, Ruskin JD, Pirruccello SJ. Flow cytometric analysis of posterior oropharyngeal tumors. J Oral Maxillofac Surg 1993; 51:292-7. [PMID: 8445471 DOI: 10.1016/s0278-2391(10)80178-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To date, few studies have evaluated the diagnostic and prognostic potential of flow cytometry in oropharyngeal tumors. The purpose of this study was to evaluate the interrelationship of anatomic location with the cytogenetic and cytokinetic characteristics of squamous cell carcinomas of the posterior oropharynx. Forty-eight paraffin-embedded squamous cell carcinoma specimens from the posterior oropharynx in clinical stages I to IV were analyzed with an Epics-C flow cytometer (Coulter Diagnostics, Hialeah, FL). Histopathologic grading was performed by the same pathologist, based on tumor differentiation. Of the 38 specimens suitable for analysis, several correlations were noted. First, as the %S-phase increased, the clinical stage increased. Second, as the histologic grade increased, the aneuploid frequency increased. Finally, as the tumor size increased, the histologic grade increased. From the results of this study, it was concluded that %S-phase may be useful in assessing the prognosis of squamous cell carcinomas of the posterior oropharynx. DNA index or aneuploid frequency, also may have value as a prognostic indicator. Finally, the lack of correlation between TNM staging and histologic grading stems not from tumor size but from nodal and metastatic involvement. Further studies are warranted to better define the usefulness of flow cytometric analysis in squamous cell carcinomas of the oropharyngeal region.
Collapse
Affiliation(s)
- D M Monasebian
- Department of Oral and Maxillofacial Surgery, University of Nebraska Medical Center, Omaha 68198-3010
| | | | | |
Collapse
|
17
|
Yamashita H, Noguchi S, Murakami N, Tsuji K, Yamaoka N, Sakamoto A. DNA ploidy and stromal bone formation as prognostic indicators of thyroid papillary carcinoma in aged patients: a retrospective study. ACTA PATHOLOGICA JAPONICA 1993; 43:22-7. [PMID: 8465653 DOI: 10.1111/j.1440-1827.1993.tb02910.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The prognostic value of flow cytometry for thyroid papillary carcinoma in aged patients was studied and compared with that of tumor histology. Seventy-five surgically removed primary papillary thyroid carcinomas larger than 30 mm in diameter were obtained from patients over 60 years of age. A subtotal thyroidectomy with modified radical neck dissection was performed in all patients. Sixteen female patients died of the carcinoma (non-survivors) and 18 survived longer than 12 years without recurrence (survivors). Histologically, papillary carcinoma was subclassified into poorly and well differentiated types, and the presence of stromal bone formation was noted. Flow cytometry was performed using paraffin-embedded materials. The incidence of the poorly differentiated type was 2/18 among the tumors of survivors and 6/16 among the tumors of non-survivors (P = 0.08). Stromal bone formation was only found in the tumors of the survivors (6/18 and 0/16; P = 0.014). In flow cytometry, tumors of the survivors showed a DNA diploid pattern (14/14), whereas half of the tumors of non-survivors (6/12) showed an aneuploid pattern (P = 0.004). Moreover, in the remaining six tumors of the non-survivors, two showed a third peak at 6C and one showed a higher S fraction. Therefore, only three showed a DNA diploid pattern that was indistinguishable from that of the survivors. These results suggest that flow cytometry is useful for estimating the prognosis of thyroid papillary carcinoma.
Collapse
Affiliation(s)
- H Yamashita
- Department of Pathology, Oita Medical University, Japan
| | | | | | | | | | | |
Collapse
|
18
|
Akslen LA, Myking AO, Salvesen H, Varhaug JE. Prognostic importance of various clinicopathological features in papillary thyroid carcinoma. Eur J Cancer 1993; 29A:44-51. [PMID: 1445745 DOI: 10.1016/0959-8049(93)90574-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The influence of various pathological features on tumour recurrences and cancer deaths has been studied in 173 consecutive cases of surgically treated papillary thyroid carcinoma recorded in 1971-1985. During the follow-up (median 7.3 years), 18.6% of the 161 radically treated patients had recurrent disease, and 8.7% died of thyroid cancer. In the univariate life-table analysis, recurrence-free survival was significantly related to age, pTNM category, tumour size, presence of certain growth patterns, tumour necrosis, tumour infiltration in surrounding thyroid tissue and thyroid gland capsule, lymph node metastases, presence of extra-nodal tumour growth and number of positive lymph nodes, whereas only tumour diameter, thyroid gland capsular infiltration and presence of extra-nodal tumour growth remained as significant prognostic factors in the multivariate analysis. Regarding thyroid cancer deaths, sex, age, pTNM category, radicality of surgical treatment, tumour diameter, macroscopic appearance, cellular atypia, tumour necrosis, thyroid gland capsular infiltration, vascular invasion, extra-thyroidal extension and lymph node metastases were all significant variables in the univariate analysis. However, only sex, age, radicality of surgical treatment and vascular invasion were found to be significant predictors of thyroid cancer deaths in the final multivariate Cox model, whereas cellular atypia and necrosis showed a borderline significance. Our study thus documents the independent importance of certain histological features for morbidity and mortality in surgically treated cases of papillary thyroid cancer.
Collapse
Affiliation(s)
- L A Akslen
- Department of Pathology, Gade Institute, Haukeland Hospital, Bergen, Norway
| | | | | | | |
Collapse
|
19
|
Herrera MF, Hay ID, Wu PS, Goellner JR, Ryan JJ, Ebersold JR, Bergstralh EJ, Grant CS. Hürthle cell (oxyphilic) papillary thyroid carcinoma: a variant with more aggressive biologic behavior. World J Surg 1992; 16:669-74; discussion 774-5. [PMID: 1413835 DOI: 10.1007/bf02067351] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The latest World Health Organization International Classification defines papillary thyroid carcinoma by its "follicular cell differentiation...as well as characteristic nuclear changes". However the oxyphilic (Hürthle cell) papillary carcinoma have nuclei which generally resemble the nuclei seen in oxyphilic follicular carcinomas, and such oxyphilic papillary tumors may behave more aggressively than typical papillary cancers. To further characterize these rare tumors, we identified during a 32-year period 22 patients with oxyphilic papillary cancer and compared them with 1,084 patients with typical papillary cancers and 57 patients with oxyphilic follicular cancers treated by the Mayo surgical group during the same time period. Although typical papillary and oxyphilic papillary cancers were comparable with regards to patient age, tumor size and extent, TNM stage, and prognostic score (AGES), there were significant differences. Compared to typical papillary tumors, oxyphilic papillary cancers had fewer neck nodal metastases at primary diagnosis (5% vs 40%, p less than 0.0001), were more often DNA non-diploid (71% vs 21%, p less than 0.001), and after 10 postoperative years had higher rates of both tumor recurrence (28% vs 11%, p less than 0.0001) and cause-specific mortality (1.7% vs 4%, p less than 0.0005). In these four important respects the oxyphilic papillary cancers more resembled the oxyphilic follicular cancers. For oxyphilic follicular cancers, the frequency of initial neck nodal metastases was 7% (cf 5%); 83% of the oxyphilic follicular tumors were non-diploid (cf 71%), and at 10 years postoperatively the tumor recurrence and cause-specific mortality rates were 28% and 18%, insignificantly different from 28% and 17% seen with the oxyphilic papillary cancers.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- M F Herrera
- Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Both DNA flow and image cytometry are methods that can be used for the quantitative determination of cellular DNA content. Objective, quantitative analysis of cellular morphology can also be obtained using image cytometry. Data thus generated have been shown to be of diagnostic and prognostic use in the study of many solid tumors and would be of particular value in the evaluation of endocrine tumors that show a poor correlation between their histology and biological behavior. The main application of these techniques to endocrine tumors has been in the analysis of thyroid nodules, although a limited number of studies of parathyroid, pituitary, adrenal, and pancreatic neuroendocrine tumors and tumors of the dispersed neuroendocrine system have been reported. Review of these studies shows that in the endocrine organs DNA and morphometric measurements have a very limited role in the diagnosis of individual cases, but are important as prognostic variables. The high incidence of abnormal DNA content in histologically benign lesions of the endocrine glands has important biological implications. Further investigation of this phenomenon may help to elucidate the process of endocrine tumorigenesis.
Collapse
Affiliation(s)
- Ingrid Zbieranowski
- Department of Pathology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - David Murray
- Department of Pathology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Abstract
The prognostic significance of ploidy level was studied in prostatic carcinoma and compared with the prognostic significance of morphologic grade and clinical stage. A nonselected group of 145 patients was studied in whom prostatic carcinoma was diagnosed by fine-needle aspiration biopsy at the Karolinska Hospital in 1966. All patients had endocrine therapy and were observed for 23 years or until death. Ploidy level was determined from cytophotometric measurements of Feulgen-stained tumor cell nuclei. The original May-Grünwald-Giemsa-stained cytologic slides, on which the cancer diagnoses were based in 1966, were destained and subsequently Feulgen stained for cytophotometric analysis. From the Feulgen-DNA data, the tumors were classified as near-diploid, near-tetraploid, and highly aneuploid, variants D-type, T-type, and A-type, respectively. The A-type tumors progressed rapidly, and 96% of the patients with this type died of the tumor within 5 years and all patients with this type died within 7 years. D-type and T-type tumors progressed much more slowly. None of the patients with these types of tumors died of the tumor disease within the first 5 years after diagnosis. As many as 12% of the patients (crude survival rate; corresponding to a relative survival rate of 43%) were still alive 15 years after diagnosis. According to multivariate Cox regression analysis, ploidy compared with grade and tumor stage was the strongest predictor of survival.
Collapse
Affiliation(s)
- G Forsslund
- Department of Pathology, Karolinska Hospital, Stockholm, Sweden
| | | | | | | |
Collapse
|
22
|
Mizukami Y, Michigishi T, Nonomura A, Hashimoto T, Noguchi M, Matsubara F, Watanabe K. Carcinoma of the thyroid at a young age--a review of 23 patients. Histopathology 1992; 20:63-6. [PMID: 1737627 DOI: 10.1111/j.1365-2559.1992.tb00918.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-three children and adolescents with thyroid carcinoma who were 20 years old or younger at the time of initial treatment were followed for a mean time of 9.5 years. Of the tumours, 21 were papillary and two follicular carcinomas. The majority (91%) of the 23 cases showed extra-thyroidal extension of the tumour. An association with chronic thyroiditis was observed in 30% of the cases. There was no history of irradiation of the head and neck in any patients. Relapse occurred in eight patients, lung metastases in two and local recurrences in six; one patient died from lung metastases 3 months after initial treatment. Male patients, advanced stage of tumour, less differentiated histological features and DNA aneuploidy were associated with a higher frequency of relapse. The prognosis of thyroid carcinomas in children and adolescents is not so good as is generally believed.
Collapse
Affiliation(s)
- Y Mizukami
- Department of Nuclear Medicine, Kanazawa University Hospital, Japan
| | | | | | | | | | | | | |
Collapse
|
23
|
Böttger T, Gabbert H, Stöckle M, Schernos B, Junginger T. [Initial results of image cytometric DNA analysis in the evaluation of prognosis in papillary thyroid cancer]. LANGENBECKS ARCHIV FUR CHIRURGIE 1991; 376:158-62. [PMID: 1870365 DOI: 10.1007/bf00250341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this study we analysed DNA-ploidy as a potential prognostic parameter in papillary thyroid carcinoma. Paraffin embedded histological material, obtained by resection from 19 patients with a papillary thyroid carcinoma, was selected for analysis. Tumor areas within the paraffin-embedded material were identified by HE-stained reference sections. One 50 microns section was dewaxed, rehydrated and mechanically and enzymatically prepared to form a suspension of 10,000 cells/ml. 1 ml of the suspension, which contained bare nuclei with small rests of cytoplasma, was centrifuged on glass slides. The fixed nuclei were air-dried and stained by Feulgen SITS technique, which allows for the quantitative measurement of DNA. The DNA analysis was carried out with a computer-controlled single-cell cytophotometry. In contrast to using flow cytometry, only the tumor cells were measured by image-cytometry. Overlapping nuclei, dirt and other artifacts as well as inflammatory cells were efficiently eliminated. With DNA image-cytometry, we could differentiate between diploid (n = 13) and aneuploid (n = 6) tumors. Best prognosis with a survival rate of 92% after 103 months had patients with diploid tumors in contrast to patients with aneuploid tumors who did not survive more than 72 months.
Collapse
Affiliation(s)
- T Böttger
- Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität, Mainz, Bundesrepublik Deutschland
| | | | | | | | | |
Collapse
|
24
|
Cusick EL, Ewen SW, Krukowski ZH, Matheson NA. DNA aneuploidy in follicular thyroid neoplasia. Br J Surg 1991; 78:94-6. [PMID: 1998875 DOI: 10.1002/bjs.1800780129] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The potential value of DNA aneuploidy, in distinguishing benign from malignant follicular thyroid neoplasms, was studied. The nuclear DNA content of 65 follicular thyroid neoplasms (52 adenomas and 13 carcinomas) was determined by flow cytometric analysis of paraffin embedded material; in 58 cases preparations were technically satisfactory. In 22 follicular neoplasms DNA analysis was also performed on fresh material obtained by fine needle aspiration of surgical specimens. Cell cycle analysis was performed on both fresh and fixed specimens. An aneuploid DNA profile was found on analysis of fixed tissue in eight of 45 (18 per cent) follicular adenomas and four of 13 (31 per cent) follicular carcinomas. DNA aneuploidy was also found in six of the 22 (27 per cent) fresh preparations from follicular adenomas. The frequency of DNA aneuploidy in apparently benign and malignant follicular neoplasms was similar. Follicular thyroid neoplasia are best regarded as a single entity with a low incidence of local and distant spread. All follicular neoplasia are therefore best excised.
Collapse
Affiliation(s)
- E L Cusick
- Department of Surgery, University of Aberdeen, UK
| | | | | | | |
Collapse
|
25
|
Abstract
There have been important recent advances in our understanding of the biologic nature of thyroid cancer and in the early diagnosis of the disease. Despite these advances, there is still considerable controversy over the management of thyroid cancer, including the extent of surgery, the indications for the use of iodine-131, the effectiveness of thyroid-stimulating hormone suppression, and the prediction of outcome. In this review, the current status of the diagnosis and management of the various types of thyroid cancer are carefully reviewed and extensively documented.
Collapse
Affiliation(s)
- O H Clark
- University of California, San Francisco
| | | |
Collapse
|
26
|
Balázs G, Lukács G, Csáky G, Boros P, Ilyés I. Late prognosis of childhood and juvenile thyroid carcinomas. PROGRESS IN PEDIATRIC SURGERY 1991; 26:41-7. [PMID: 1904597 DOI: 10.1007/978-3-642-88324-8_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The authors report on the biological properties and late prognosis of 16 children and juvenile patients operated on during the past 24 years for thyroid tumour who underwent regular followup. The clinical and morphological characteristics of the carcinomas are described, together with the late immune response of the patients undergoing complex treatment. The study is also concerned with the characteristics of the DNA content of the tumorous cell nuclei, the pregnancy success rate of the operated patients and the thyroid function of the children born.
Collapse
Affiliation(s)
- G Balázs
- First Department of Surgery, University Medical School of Debrecen, Hungary
| | | | | | | | | |
Collapse
|
27
|
Padberg BC, Garbe E, Achilles E, Dralle H, Bressel M, Schröder S. Adrenomedullary hyperplasia and phaeochromocytoma. DNA cytophotometric findings in 47 cases. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1990; 416:443-6. [PMID: 2107632 DOI: 10.1007/bf01605151] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fifty adrenalectomy specimens containing normal (n = 3), hyperplastic (n = 4) or neoplastic (n = 43) medullary tissue were subjected to quantitative cytophotometric measurements of DNA content. Differing evaluation schemes were applied for interpretation of DNA distribution patterns. Of the 43 phaeochromocytomas (PCC), 16 were inherited as part of the syndrome of multiple endocrine neoplasia type 2a (MEN 2a). Five of 27 sporadic PCCs followed a malignant course. Three benign and three malignant PCCs lacked endocrine activity. In normal medulla and in adrenomedullary hyperplasia, diploid or euploid DNA distributions were found. In contrast, 87% (33/38) of the benign and all 5 malignant PCCs exhibited non-diploid or aneuploid DNA histograms. No differences in DNA content existed between functioning and non-functioning PCCs or between sporadic and hereditary tumours. In this study, in contrast to earlier communications, DNA cytophotometry did not discriminate between benign and malignant adrenomedullary tumours. In addition, as opposed to the findings in a variety of other endocrine tumours, DNA measurements did not appear to be a useful tool to assess the prognosis of an individual malignant PCC.
Collapse
Affiliation(s)
- B C Padberg
- Institute of Pathology, University of Hamburg, Federal Republic of Germany
| | | | | | | | | | | |
Collapse
|
28
|
Tsuchiya A, Sekikawa K, Ando Y, Suzuki S, Kimijima I, Abe R. Flow cytometric DNA analysis of thyroid carcinoma. THE JAPANESE JOURNAL OF SURGERY 1990; 20:510-4. [PMID: 2243443 DOI: 10.1007/bf02471006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abnormal DNA content has been considered as an additional criterion for determining the biological behavior of a tumor. Flowcytometric DNA analysis was done on 121 patients with thyroid carcinoma encountered during the period between 1975 and 1987. Tumor tissues were sampled from paraffin-embedded blocks and the histology of thyroid carcinoma found to consist of 91 papillary, 23 follicular, 2 medullary, 1 squamous cell and 4 anaplastic carcinomas. The incidence of aneuploidy in thyroid carcinoma was 7.4 per cent (9 patients) while that of diploidy was 92.6 per cent (112 patients). The aneuploid specimens consisted of 6 papillary, 1 follicular, 1 medullary and 1 anaplastic carcinomas and, of 4 anaplastic carcinoma patients with subsequent death within 6 months, only 1 was aneuploid. As an indicator of proliferative potential, S-phase fraction (SPF) was also determined by flow cytometry, but this could not be used as an independent prognostic factor. The aneuploid patients showed a significantly decreased survival rate (p less than 0.01). Thus, although DNA measurement proved useful for predicting the survival of aneuploid patients, there is some discrepancy between DNA content and the biological behavior of the tumor.
Collapse
Affiliation(s)
- A Tsuchiya
- Second Department of Surgery, Fukushima Medical College, Japan
| | | | | | | | | | | |
Collapse
|
29
|
Cusick EL, MacIntosh CA, Krukowski ZH, Ewen SW, Matheson NA. Comparison of flow cytometry with static densitometry in papillary thyroid carcinoma. Br J Surg 1990; 77:913-6. [PMID: 2393818 DOI: 10.1002/bjs.1800770824] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prognostic accuracy of flow cytometric and static densitometric DNA analysis was compared in 31 patients who had undergone surgery for papillary thyroid carcinoma between 1959 and 1978 (median follow-up 18 years). There were five deaths from papillary thyroid carcinoma. Three of six patients with DNA aneuploid tumours on flow cytometry died (P greater than 0.05, Fisher's exact test) compared with four of eight patients whose tumours were found to be aneuploid by static densitometry (P less than 0.02). When quantitative analysis was applied to the static densitometry data, all five patients who died from papillary carcinoma were distinguished, with no false positives (P less than 0.002). The prognostic accuracy of flow cytometric DNA analysis is less than that of static densitometry in which morphological selection of malignant cells permits quantitative measurements. DNA analysis may add refinement to existing scoring systems in predicting the risk of death from papillary thyroid carcinoma. Such information could provide the basis for controlled prospective evaluation of bilateral resection as opposed to lobectomy in defined high risk patients. At present there is insufficient evidence upon which aneuploidy should be used as a determinant of the extent of operation for papillary thyroid carcinoma.
Collapse
Affiliation(s)
- E L Cusick
- Department of Surgery, University of Aberdeen, UK
| | | | | | | | | |
Collapse
|
30
|
Abstract
A number of evaluating techniques have moved from the research laboratory into the purview of the diagnostic pathologist and have been applied to the analysis of thyroid lesions. Some of these have already proved diagnostically and prognostically useful, whereas some have produced insights into pathogenesis of specific thyroid lesions and disorders. Rapid proliferation and application of these techniques should allow for increased understanding of human thyroid disease in the near future.
Collapse
Affiliation(s)
- Virginia A LiVoisi
- Surgical Pathology, Founders 6042, Hospital of the University of Pennsylvania, 3400 Spruce Street, 19104, Philadelphia, PA
| |
Collapse
|
31
|
Grant CS, Hay ID, Ryan JJ, Bergstralh EJ, Rainwater LM, Goellner JR. Diagnostic and prognostic utility of flow cytometric DNA measurements in follicular thyroid tumors. World J Surg 1990; 14:283-9; discussion 289-90. [PMID: 2368430 DOI: 10.1007/bf01658504] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Distinguishing cellular follicular adenomas (FA) from minimally invasive follicular carcinomas (FC) continues to plague even experienced thyroid pathologists. DNA ploidy analysis has been promoted as a means of making this differentiation; however, the finding of DNA aneuploidy in FA has caused concern that they may demonstrate potential for malignant behavior or should even be reclassified as low-grade noninvasive cancers. In histologically-proven FC, nuclear DNA content has been claimed to have predictive power equivalent to that of all other prognostic factors combined. The aims of the present study, therefore, were to define the DNA ploidy characteristics of FA and FC, to assess the diagnostic potential of cell-cycle parameters, and, in FC, to investigate the prognostic role of such measurements. We measured DNA content of 124 tumors (60 FA, 64 FC). DNA pattern was normal (diploid) in 75% of FA and 45% of FC, tetraploid/polyploid (T/P) in 13% of FA and 25% of FC, and aneuploid in 12% of FA and 30% of FC. FC was histologically verified in 39% of DNA normal, 67% of T/P, and 73% of aneuploid tumors. DNA index, S-phase, G2M, and S-phase plus G2M were analyzed and were not helpful in differentiating between FA and FC. No patient with FA developed tumor recurrence. In FC (excluding the Hürthle cell variant), no significant differences were found among the 3 DNA ploidy groups with respect to either cancer death or tumor recurrence; however, combining the Hürthle cell variant of follicular carcinomas with pure follicular carcinomas, the presence of distant metastases, DNA aneuploidy, and patient age were the only independently significant prognostic variables.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- C S Grant
- Department of Surgery, Mayo Clinic and Medical Center, Rochester, Minnesota 55905
| | | | | | | | | | | |
Collapse
|
32
|
McLeod MK. The Measurement of DNA Content and Ploidy Analysis in Thyroid Neoplasms. Otolaryngol Clin North Am 1990. [DOI: 10.1016/s0030-6665(20)31291-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Ekman ET, Bergholm U, Bäckdahl M, Adami HO, Bergström R, Grimelius L, Auer G. Nuclear DNA content and survival in medullary thyroid carcinoma. Swedish Medullary Thyroid Cancer Study Group. Cancer 1990; 65:511-7. [PMID: 2297642 DOI: 10.1002/1097-0142(19900201)65:3<511::aid-cncr2820650323>3.0.co;2-b] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In a nationwide study of medullary thyroid carcinoma, the relation between nuclear DNA content and survival was studied in 211 patients with complete follow-up of up to 27 years. Morphologically identified tumor cells were analyzed by an image cytometric method. The DNA histograms were classified (1) by an objective method in which the degree of aneuploidy was defined as the percentage number of tumor cells with DNA values exceeding the 90th percentile of diploid control cells (P90), and (2) according to a subjective evaluation of whether the DNA profiles represented a euploid or an aneuploid DNA pattern. Both classifications separated groups with marked differences (P less than 0.001) in survival. A multivariate proportional hazards analysis indicated that each method provided additional information when the other one was taken into account. In patients whose tumors were classified according to the objective P90 method 1, the relative hazards (with 95% confidence interval) in the groups with P90 values of 36% to 69% and greater than or equal to 70% were 1.6 (0.9-2.8) and 2.1 (1.1-4.0) respectively, compared with the reference group. With the subjective method 2 the corresponding figure for the group with aneuploid tumors was 1.7 (1.0-2.0) compared with the group with euploid tumors.
Collapse
Affiliation(s)
- E T Ekman
- Department of General Oncology, Radiumhemmet, Karolinska Hospital and Institute, Stockholm, Sweden
| | | | | | | | | | | | | |
Collapse
|
34
|
Schelfhout LJ, Cornelisse CJ, Goslings BM, Hamming JF, Kuipers-Dijkshoorn NJ, van de Velde CJ, Fleuren GJ. Frequency and degree of aneuploidy in benign and malignant thyroid neoplasms. Int J Cancer 1990; 45:16-20. [PMID: 2298499 DOI: 10.1002/ijc.2910450105] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The frequency and degree of aneuploidy in 44 benign and 124 malignant thyroid neoplasms were analyzed by DNA flow cytometry. Single aneuploid cell populations were found in 72% of the undifferentiated carcinomas, 64% of the follicular carcinomas, 24% of the papillary carcinomas and in 24% of the follicular adenomas. Multiple aneuploid cell populations were detected in 4% of the papillary and in 36% of the follicular carcinomas but not in undifferentiated carcinomas. A low degree of aneuploidy was found in well differentiated papillary carcinomas (mean DNA index of aneuploid populations: DI = 1.17; SD +/- 0.09). Significantly higher values were found for aneuploid moderately differentiated papillary carcinomas (DI = 1.46; SD +/- 0.29), well and moderately differentiated follicular carcinomas (DI = 1.61; SD +/- 0.33 and DI = 1.60; SD +/- 0.30, respectively) and undifferentiated carcinomas (DI = 1.72; SD +/- 0.19). High DNA indices were also found in several follicular adenomas (DI = 1.49; SD +/- 0.22). Comparison of the 10-year survival rates of patients with moderately versus well differentiated papillary carcinoma (79 vs. 98 months, respectively) indicates that loss of differentiation and progression of aneuploidy in this tumour type is associated with more aggressive clinical behaviour. Similarly, the high frequency and degree of aneuploidy in undifferentiated carcinomas is in agreement with the very poor survival rate (0% at 10 years) in this group of patients. However, the occurrence of highly aneuploid adenomas and (near)-diploid undifferentiated carcinomas does not point to a direct causal relationship between DNA-ploidy changes and clinical behaviour of these thyroid tumours.
Collapse
Affiliation(s)
- L J Schelfhout
- Department of Pathology, State University Hospital, Leiden, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
35
|
Ferrer-Roca O, Ballester-Guardia E, Martin J. Nuclear chromatin texture to differentiate follicular and papillary carcinoma of the thyroid. Pathol Res Pract 1989; 185:561-6. [PMID: 2626365 DOI: 10.1016/s0344-0338(89)80194-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study presents the results of an automatic classification of six purely papillary, five purely follicular and five mixed papillary-follicular carcinomas of the thyroid. All cases were correctly classified with only two chromatin textural parameters obtained in the Olga's scan software package developed in our laboratory. Chromatin texture lines were generated by a unidirectional grey level gradient, obtained as a natural logarithmic function of the integrated optical density of each nucleus; this increased the difference between clear papillary and granular follicular nuclei. The accuracy of the method allowed a follicular carcinoma to be correctly classified as a mixed follicular-papillary. Finally a columnar-cell carcinoma of the thyroid was detected by means of its atypical DNA histogram.
Collapse
Affiliation(s)
- O Ferrer-Roca
- Texcan Group of Development, Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | | | | |
Collapse
|
36
|
Payne CM, Graham AR, Bjore CG, Cromey DW, Rybski JA, Palmer T, Weber JE. Ultrastructural morphometric analysis of papillary neoplasms: biological and diagnostic relevance. Hum Pathol 1989; 20:864-70. [PMID: 2777243 DOI: 10.1016/0046-8177(89)90098-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ten papillary adenocarcinomas of thyroid origin (P-Thy), ten papillary adenocarcinomas of ovarian origin (P-Ov), and eight papillary neoplasms of non-thyroid/non-ovarian origin (P-Other) were morphometrically compared using 19 distinct quantitative nuclear and nucleolar parameters as a database for diagnosis. The selected cases consisted of 16 primary and 12 metastatic neoplasms. It was determined that the P-Thy group had a significantly smaller nucleolar area (NuA) and nucleolar perimeter (NuP), and smaller SDs of nuclear area (NA), NuA, and NuP compared with the P-Ov and P-Other groups (P less than .05). The P-Ov group had a significantly smaller SD of NA compared with the P-Other group (P less than .05). The P-Ov group exhibited the greatest variability among the papillary neoplasms. Linear regression analysis indicated that in the P-Thy group alone there was a significant correlation between mean nuclear form factor (4 pi A/P2) and mean NuA (r = -.82; P less than .01), and mean NP and mean NuA (r = +.77; P less than .01). Linear regression analysis also indicated that in the P-Ov group alone, there was a significant correlation between mean NA and mean NuA (r = +.75; P less than .02). Morphometric domains were established using statistically significant sets of variables that distinguished between the groups. The application of three-dimensional computerized cluster analysis techniques indicated that the P-Thy group consistently had the smallest morphometric domains. It was concluded that ultrastructural morphometric analysis of papillary neoplasms has diagnostic potential and reveals interesting biological relationships among distinct nuclear features in the different groups of neoplasms.
Collapse
Affiliation(s)
- C M Payne
- Department of Pathology, College of Medicine, University of Arizona, Tucson 85724
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Cytogenetic studies in thyroid neoplasia were performed by G-banding of chromosome preparations obtained from the in vitro cultures of nine adenomas, one follicular carcinoma, five papillary carcinomas, and two medullary carcinomas. Complex structural chromosome aberrations were found in one adenoma. Two more adenomas, both composed of Hürthle cells, showed multiple numerical chromosome deviations with trisomy 4 and tetrasomy 7 in common. Six metastasizing carcinomas were characterized by normal stemlines, which indicates that malignancy in thyroid neoplasia cannot be excluded by cytogenetic techniques used currently. Comparisons between cytogenetic findings and cytophotometric DNA measurements in the material studied illustrate that euploid tumors represent a heterogenous group including cases with various gross structural chromosome aberrations of yet unknown clinical significance. Further studies of additional material with long-term follow-up are called for by our findings of structural and numerical chromosome aberrations in follicular neoplasms that are benign according to histologic criteria.
Collapse
Affiliation(s)
- L Bondeson
- Laboratory of Cytology, Central Hospital, Skövde, Sweden
| | | | | | | | | | | | | |
Collapse
|
38
|
Bergholm U, Adami HO, Auer G, Bergström R, Bäckdahl M, Grimelius L, Hansson G, Ljungberg O, Wilander E. Histopathologic characteristics and nuclear DNA content as prognostic factors in medullary thyroid carcinoma. A nationwide study in Sweden. The Swedish MTC Study Group. Cancer 1989; 64:135-42. [PMID: 2731109 DOI: 10.1002/1097-0142(19890701)64:1<135::aid-cncr2820640123>3.0.co;2-g] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Complete follow-up for 4 to 27 years was achieved for virtually all 249 patients with medullary thyroid carcinoma (MTC) diagnosed in Sweden in a 23-year period. Tumor specimens from 241 patients were re-examined with regard to calcitonin immunoreactivity, amyloid content, argyrophil reaction, tumor capsule condition, and nuclear DNA content. In univariate analyses, these factors, with the exception of the argyrophil reaction, were strong predictors of survival. There were twofold-to-threefold differences in hazard rate between patients with a high (greater than 50%) and low (less than 10%) frequency of calcitonin-immunoreactive tumor cells, between those with amyloid-containing and amyloid-free tumors, and between those with an intact and a nonintact tumor capsule. Calcitonin immunoreactivity and the amyloid content also provided prognostic information in multivariate analyses that adjusted for all the other factors mentioned above and in the full multivariate model, which in addition considered age, sex, heredity, stage of the disease, tumor size, and treatment. The strong prognostic capacity of the nuclear DNA content found in univariate analyses became considerably weaker when other morphologic characteristics were considered.
Collapse
Affiliation(s)
- U Bergholm
- Department of Surgery, University Hospital, Uppsala, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Basic differences and similarities of flow and static cytophotometric instruments are viewed with regard to technical peculiarities and applicability in the fields of biology and tumor pathology. In flow systems, precision of the information concerning quantities of constituents is high, whereas precision of information concerning morphologic parameters is low. In static systems, morphologic identification by a trained operator can be used advantageously to classify any given cell interactively, thus replacing a large number of flow parameters. This is why the vast majority of automated static machines used in pathology are still more or less semiautomatic or interactive. Carefully performed specimen-adapted cell preparation procedures in which each step is strictly supervised, highly standardized staining methods, and internal controls are prerequisites in order to obtain reliable cytochemical results. In a number of human tumors with well-controlled cytopathologic and/or histopathologic and clinical data, quantitative cytochemical analysis has been demonstrated to provide diagnostic and prognostic information complementary to that obtained by conventional clinical and morphologic methods.
Collapse
Affiliation(s)
- G Auer
- Department of Tumor Pathology, Karolinska Institute and Hospital, Stockholm, Sweden
| | | | | |
Collapse
|
40
|
Lamberg BA, Karkinen-Jääskeläinen M, Franssila KO. Differentiated follicle-derived thyroid carcinoma in children. ACTA PAEDIATRICA SCANDINAVICA 1989; 78:419-25. [PMID: 2741684 DOI: 10.1111/j.1651-2227.1989.tb11102.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fifteen patients, 11 females and 4 males, aged 4-16 years with follicle-derived differentiated thyroid carcinoma treated at the Helsinki University Central Hospital during 1953 through 1984 are reported. Histologically 13 carcinomata were papillary, 1 follicular and 1 was suspected to be follicular carcinoma (atypic adenoma). Eleven (73%) had cervical lymphnode metastases and 4 (25%) pulmonary metastases as well. All patients were initially operated on; total thyroidectomy was performed in 11 and subtotal in 4 patients. In 5 patients there was invasion into the thyroid capsule, perithyroid tissues and blood vessels; 4 patients with pulmonary metastases belonged to this group. Postoperatively 5 patients received radioactive iodine, 4 patients external irradiation to the neck and 6 were given both types of radiation. Pulmonary metastases were treated with radioactive iodine. The patients have been given suppressive doses of thyroxine. The follow-up ranged from 3.5 to 33 years. One patient with extensive pulmonary metastases died 6 years after the initial treatment, all others are still alive. Twelve patients have been followed for 9 to 33 years, in 10 serum thyroglobulin was determined. Tg was undetectable in 9 patients when measured during thyroxin therapy; in 1 patient followed for 33 years, the dose was not suppressive, and there were no signs of disease and Tg in the normal range. In 2 patients Tg could not be determined but they had no signs of disease 18 and 22 years after initial treatment. It is, therefore, presumed that these patients, forming 80% of the material, are cured. Two patients followed for 3.5 years are still under treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- B A Lamberg
- Third Department of Medicine, University of Helsinki, Finland
| | | | | |
Collapse
|
41
|
van Thiel TP, van der Linden JC, Baak JP, van de Sandt MM, van Galen C, Bezemer PD. Reproducibility of flow cytometric assessment of follicular tumours of the thyroid. J Clin Pathol 1989; 42:260-3. [PMID: 2703542 PMCID: PMC1141865 DOI: 10.1136/jcp.42.3.260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The reproducibility of the DNA index of paraffin wax sections from 44 follicular tumours of the thyroid (18 follicular adenomas and 26 follicular carcinomas), which had been assessed by flow cytometry was analysed in two laboratories, using consecutive sections of the same specimens and two different commercially available flow cytometers. Two slightly different cell preparation and staining techniques were used in the two laboratories. Using strictly defined criteria the histograms were classified blind as diploid, peritetraploid, aneuploid, or inadequate and insufficient by two independent investigators. Both the concordance between the two different flow cytometers and the agreement of duplicate assessments within the same flow cytometers were assessed. The mean coefficient of variation of the G0/G1 peak of the diploid tumours in the PARTEC flow cytometer was 5.5 (range 2.3-9.8) and in the FACS flow cytometer 5.2 (range 3.7-8.3); this difference was not significant. There was concordance of classification between the two laboratories in 35 of 36 cases. In 25 cases (18 diploid, seven aneuploid) the intralaboratory variation showed a 100% concordance in histogram classification. It is concluded that flow cytometer DNA index assessment of follicular tumours of the thyroid is reproducible and can be used to evaluate the discriminating and prognostic value of this feature.
Collapse
Affiliation(s)
- T P van Thiel
- Institute of Pathology, Free University Hospital, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
42
|
Granberg PO, Bäckdahl M, Cedermark B, Hamberger B, Lundell G, Löwhagen T, Wallin G. Thyroid and Parathyroid Carcinoma. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
43
|
Ekman ET, Bäckdahl M, Löwhagen T, Auer G. Nuclear DNA measurements on thyroid carcinoma in young patients. Acta Oncol 1989; 28:475-9. [PMID: 2789823 DOI: 10.3109/02841868909092253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Nuclear DNA measurements were performed on thyroid carcinomas from 36 patients aged 20 years or less. Histologic material from the tumors were stained according to the Feulgen technique and measured with slide cytophotometry. Thirty-two of the 36 tumors were of papillary type, 3 were medullary carcinoma and 1 was a follicular carcinoma. Of the 32 papillary carcinomas, 6 tumors (19%) were aneuploid and 26 (81%) were diploid, including 2 cases with lung metastases at diagnosis. Of the 3 medullary carcinomas, 2 were diploid and 1 aneuploid. The only follicular carcinoma was aneuploid. The patients were followed between 10 and 35 years, and 34 were alive at the end of the study. Two patients died, both had medullary carcinomas. One patient, with a diploid tumor, died during surgery. The other patient, with an aneuploid tumor, died 5 years after diagnosis of metastatic disease. Six patients had recurrences, all within 7 years. All the primary tumors and the corresponding recurrences showed a diploid DNA content. The results show that the majority of thyroid carcinomas in young patients exhibit diploid DNA profiles which is in agreement with the overall good prognosis in this patient category. However, since also patients with aneuploid tumors exhibited a similar good prognosis it seems that DNA measurements do not contribute additional prognostic information in young patients.
Collapse
Affiliation(s)
- E T Ekman
- Department of General Oncology, Karolinska Hospital and Institute, Stockholm, Sweden
| | | | | | | |
Collapse
|
44
|
Chang TC, Kuo SH, Liaw KY, Chang CC, Chen FW. Cell kinetics, DNA content and TSH receptor-adenylate cyclase system in differentiated thyroid cancer. Clin Endocrinol (Oxf) 1988; 29:477-84. [PMID: 3253029 DOI: 10.1111/j.1365-2265.1988.tb03696.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to elucidate the changes of the TSH receptor-adenylate cyclase system in differentiated thyroid carcinomas, and their relationships with nuclear DNA content, cell kinetics and clinical stage. The results showed that the papillary carcinomas had an impaired TSH receptor-adenylate cyclase system. The production of cAMP stimulated by TSH was decreased when compared with non-cancerous tissue and high-affinity TSH receptors were reduced in number or even completely lost (nine in 24 cases). Follicular carcinomas also showed a reduction in, or even complete loss, of high-affinity TSH receptor (one in five cases). However, the responses to the stimulation of TSH, Gpp (NH)p and forskolin were not different from those in non-cancerous tissue. Papillary and follicular cancer cells showed more proliferative activity than those in non-cancerous tissue. Follicular carcinomas contained more hyperploid cells (DNA content greater than 2.5 C) than papillary carcinomas. There were no differences in cell kinetics, DNA content or the effects of Gpp (NH)p or forskolin on adenylate cyclase activity between those papillary carcinomas with high-affinity TSH receptor and those without. However, the presence of high-affinity TSH receptors had higher cAMP generation stimulated by TSH. The patients having papillary carcinomas in the absence of high-affinity TSH receptors were all in clinical stage III. These studies suggest that TSH receptors are the major sites influenced in the TSH receptor-adenylate cyclase system in papillary carcinomas. The TSH receptor-adenylate cyclase system of papillary carcinomas differs more from normal than does that of follicular carcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- T C Chang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Republic of China
| | | | | | | | | |
Collapse
|
45
|
Abstract
To document the presentation, findings, therapy, and postoperative course of lethal papillary thyroid carcinoma (PTC), 56 fatal cases were studied in a retrospective case-matched control fashion. These patients and their controls were taken from a larger series receiving their primary treatment at one institution (Mayo Clinic; 1946-1970). Mean follow-up for the lethal cohort was 8.5 years and 16.6 years for controls. Age, sex, tumor size, histologic grade, extent of disease at presentation, European Organization for Research on Treatment of Cancer (EORTC) and AGES scores (patient's age, tumor grade, tumor extent, and tumor size), and DNA ploidy pattern were found to be significant prognostic factors. The immediate causes of death were most frequently either local airway obstruction or respiratory insufficiency from pulmonary metastases. The results suggest that it is possible, at the time of initial treatment, to assess an individual patient's risk of dying from PTC. Aggressive postoperative adjunctive therapy should be restricted to that minority of patients who are at highest risk of death from PTC.
Collapse
Affiliation(s)
- S A Smith
- Department of Internal Medicine, Mayo Clinic and Medical Center, Rochester, MN 55905
| | | | | | | | | |
Collapse
|
46
|
Kokal WA, Gardine RL, Sheibani K, Zak IW, Beatty JD, Riihimaki DU, Wagman LD, Terz JJ. Tumor DNA content as a prognostic indicator in squamous cell carcinoma of the head and neck region. Am J Surg 1988; 156:276-80. [PMID: 3177750 DOI: 10.1016/s0002-9610(88)80291-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Our purpose in this study was to determine whether tumor DNA content is a prognostic factor independent of other standard clinical and histologic parameters in squamous cell carcinoma (SCC) of the head and neck region. Tumor DNA content was determined in 76 patients with primary resectable SCC of the oral cavity, larynx, or pharynx who were treated from 1978 to 1984 at the City of Hope. In addition, we measured various clinical and pathologic parameters in all patients. In comparison to patients with diploid SCC, those with aneuploid SCC had significantly decreased relapse-free and overall survival rates (p less than 0.001 for both). A Cox regression analysis demonstrated that tumor DNA content was a prognostic factor independent of all clinicopathologic features examined. By regression analysis, it was the single most important prognostic factor in determining relapse and death from SCC (p less than 0.001 for both).
Collapse
Affiliation(s)
- W A Kokal
- Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California 91010
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Hamming JF, Schelfhout LJ, Cornelisse CJ, van de Velde CJ, Goslings BM, Hermans J, Fleuren GJ. Prognostic value of nuclear DNA content in papillary and follicular thyroid cancer. World J Surg 1988; 12:503-8. [PMID: 3420932 DOI: 10.1007/bf01655433] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
48
|
Invited commentary. World J Surg 1988. [DOI: 10.1007/bf01655442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
49
|
Abstract
Four hundred nine consecutive breast cancer patients were studied retrospectively. Microspectrophotometric DNA measurements were performed using archival, fine-needle slide preparations upon which the primary diagnoses had been based 8 to 13 years earlier. The DNA distribution patterns of the tumor cell populations were analyzed according to various criteria and the cytochemical data were correlated to the clinical course, defined as distant recurrence-free survival. The results demonstrated a strong relationship between nuclear DNA content of the breast cancer cells and prognosis. Tumors exhibiting DNA values within the limits of normal tissues (DNA euploidy) were found to be correlated with a favorable prognosis. In contrast, tumors with increased and scattered DNA values (DNA aneuploidy) were found indicative of poor prognosis. This was found to be the case regardless whether the percentage of cells above 2.5c or 5c, DNA index/modal value, or the histogram typing according to Auer et al were utilized to discriminate low-grade from high-grade malignant cases. All of these DNA variables were also shown to be significantly correlated. With the aid of the Cox regression method, the additional prognostic value of any given variable was tested against the others. The statistical analyses showed that the histogram typing gives significant prognostic information in addition to that provided by any other variable. In conclusion, the current study demonstrates that tumor nuclear DNA content is a strong indicator of prognosis in patients suffering from invasive breast adenocarcinoma. However, the results also show that simple determination of the stemline position is not the optimal DNA measure of intrinsic tumor malignancy potential. The fraction of cells scattered outside the modal peaks of the histograms are of utmost importance for adequate cytochemical malignancy grading in breast carcinomas.
Collapse
Affiliation(s)
- A G Fallenius
- Department of Tumor Pathology, Karolinska Institute and Hospital, Stockholm, Sweden
| | | | | |
Collapse
|
50
|
Clark OH, Levin K, Zeng QH, Greenspan FS, Siperstein A. Thyroid cancer: the case for total thyroidectomy. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1988; 24:305-13. [PMID: 3281846 DOI: 10.1016/0277-5379(88)90273-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Since there are no prospective studies concerning the treatment of thyroid cancer, there continues to be a considerable disagreement about the 'best' or most appropriate form of surgical treatment for patients with papillary or follicular thyroid cancer. Some surgeons recommend selective treatment depending upon the type of thyroid tumor and stage of the disease. Some advocate thyroid lobectomy and isthmusectomy, some near total thyroidectomy, and some total thyroidectomy for patients with papillary and follicular thyroid cancer. Total thyroidectomy for thyroid cancer would be the treatment of choice for virtually all patients with thyroid cancers if it could be done without complications. We therefore reviewed 160 consecutive patients who had total thyroidectomy for suspected or proven thyroid cancer to determine the complication rate of total thyroidectomy. One hundred and three patients had primary operations, 57 had reoperations with completion of total thyroidectomy and 124 had thyroid cancer. Serious complications (i.e. vocal cord paralysis or hypoparathyroidism) included two cases of transient bilateral recurrent nerve palsy, two patients with presumed transient unilateral vocal cord paralysis, three recurrent laryngeal nerves that were purposely sacrificed because of invasion of the nerve, and one case of permanent hypoparathyroidism. Two other patients developed postoperative wound infections. Only one of the permanent complications, the case of permanent hypoparathyroidism, could have been avoided by a lesser procedure. The experienced surgeon can perform a total thyroidectomy with minimal morbidity, and this procedure has certain theoretical and practical advantages. It should not be done, however, if it will result in a significant complication rate and, in selected patients, it may be preferable to leave a small amount of thyroid tissue to protect the blood supply to the parathyroid glands or recurrent laryngeal nerve.
Collapse
Affiliation(s)
- O H Clark
- Veterans Administration Medical Center, San Francisco, California
| | | | | | | | | |
Collapse
|